S8 E3: What's New with WHO? Updates in Epidemiology

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The Missing Magnolia's podcast tells the stories
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these kids went to Saint Hussy and
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Hello, and welcome to Cause of Death

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one hundred seconds to midnight. I'm
your host, Jackie Morante. I wanted

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to take a moment to discuss some
recent happenings in the world of epidemiology.

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I'm going to talk about some diseases
that I've addressed in previous episodes and some

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that I haven't touched on yet,
but all of them have been in the

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news recently. I won't be getting
into the ideology and pathology of these diseases

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in this episode. If I haven't
talked about some of these yet, they're

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on the list, so I'll address
that when the full episode drops. There

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have been recent updates on the mystery
disease that's affecting dogs in nineteen states,

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confirmed cases have been reported in California, Colorado, Florida, Georgia, Idaho,

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Illinois, Indiana, Maryland, Massachusetts, New Hampshire, Nevada, Oregon,

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Pennsylvania, Rhode Island, Maine,
Texas, North Dakota, Vermont,

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and Washington State. The cause of
a typical canine infectious respiratory disease complex is

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still unknown and researchers are still trying
to find the cause through DNA testing.

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In November of twenty twenty three,
two hundred cases were reported in Oregon,

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and most of these were in the
Portland area. Veterinarians are urging people to

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limit their dogs social lives, including
doggy daycares, boarding facilities, dog parks,

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and even dog shows. Several shows
have been canceled to prevent the spread

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of the disease. The symptoms of
the disease mirror kennel cough and include cough,

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fever, and lethargy. The animals
may also exhibit sneezing and watery eyes.

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The main concern with this disease is
that it often leads to pneumonia,

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and there have been fatalities. According
to doctor William Hagen's, a veterinarian at

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the Town and Country Animal Clinic in
Hazard, Kentucky. Quote, this new

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respiratory disease is starting to present with
more symptoms, more severe and they meaning

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the dogs decline more rapidly than your
typical kennelcloth patients would end quote. Vets

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are still recommending that dogs are updated
on all vaccinations and they urge puppy parents

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to take an extra measure with a
booster of bordtele vaccine and canine influenza.

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While the true causative agent is still
unknown, the University of New Hampshire's Veterinary

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Diagnostic Laboratory has said that it may
have identified a bacterium that is responsible for

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the illness, based on genetic SCIS
sequencing of samples taken from thirty dogs who

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had presented with the illness in twenty
twenty two and forty more from Rhode Island

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and Massachusetts in twenty twenty three.
David Needle, chief pathologist at the diagnostics

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lab, has described the bacterium as
lacking a cell wall and being smaller in

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size than a normal bacterium. He
believes that it may be a member of

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the normal flora that grows in the
respiratory tract, but it has developed a

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virulence associated gene trait. There is
some good news for dog owners, though

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in many states the incident's rate is
declining. Colorado, which had one of

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the highest rates of illness in the
country, has reported fewer cases of the

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disease, according to a representative at
the Colorado State University School of Veterinary Medicine.

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Veterinarians at Coloratto State aren't sure whether
this is because the disease is running

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its course or it's because people are
keeping their dogs home and limiting their social

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interactions. Another bright spot in this
is that the disease is showing no sign

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of zoonotic potential. It hasn't jumped
to humans. Speaking of zoonotic potential,

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avian flu H five and one has
made its way to dairy, cows and

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cats. I talked a lot about
av and flu in season two, episode

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six. That episode was called playing
Chicken with a train. If you want

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to know the ins and outs of
avian flu, it's all right there.

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Eight herds in Texas, three in
Kansas, two in New Mexico, and

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one herd each from Idahom, Michigan, and Ohio have been confirmed as infected

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with avian influenza It's unclear how the
herds were infected. The cows may be

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passing it from cows cow, or
it could be related to insufficient cleaning of

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milking equipment during milking. There may
also be risk associated with the transportation of

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cattle from winter grazing grounds to summer
grounds. It is suspected that the birds

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infected the cattle when they left droppings
in the feed or water. Bird flu

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has also been known to travel in
the wind from chicken farm to chicken farm.

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The infected felines were found in Texas. When veterinarians came to the farm

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to treat the cattle, they noticed
that cats were also sick and took samples

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from them. Infections and cats have
been previously reported in the US, Poland,

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and South Korea. Cats and pigs
are among the few species of mammals

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known to contract H five N one. The CDC announced that the first human

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infection linked to dairy cow exposure was
confirmed. The patient was a worker on

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one of the dairy farms, so
had constant contact with the sick cattle.

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The infected animals all seem to be
recovering well with the help of anti viral

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medication and the human patient is also
recovering. Epidemiologists have found no evidence of

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human to human transmission from the infected
worker. Now, let's talk about what

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this means for milk production and the
food chain. Milk infected with H five

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one has been found post production.
As far as I can tell, this

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milk was tested prepasteurization, but the
producers destroyed the milk so that it wouldn't

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get into the food chain. The
threat to humans remains low, largely due

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to the pasturization of milk. This
virus is heat sensitive and pasteurization will kill

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it. If the virus should make
its way into beef cattle, cooking will

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kill it. It's the same thing
that I always say, cook your meat

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well and make sure that any dairy
products that you ingest have been pasteurized.

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The CDC is keeping an eye on
the gene sequence of the current H five

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N one strain, which has mutated
a bit, but not enough to be

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considered concerning. The various strains of
avian influenza have been put into a database

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called next Strain, which allows researchers
to map the family tree of virus sequences.

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This tool will be invaluable as time
goes on and the virus mutates further.

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Okay, so now that I've ruined
your dog's social life and you're going

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to be asking about pasteurization at your
favorite ice cream shop, let me ruin

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your sex life as well. Syphilis
is skyrocketing in the US. The numbers

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haven't been this high since nineteen teen
fifty. I'm planning a whole season on

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sexually transmitted infections, and syphilis will
be among those. For now go with

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you really don't want this disease.
While overall STIs declined one percent between twenty

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twenty one and twenty twenty two,
the infection rate of syphlis rose seventeen percent

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and congenital syphlis rose thirty percent over
that period. Numbers for twenty twenty three

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have not been released yet, but
it would be prudent to surmise that the

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numbers haven't gone down much, if
at all. Reports of syphilis in twenty

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twenty two reached epidemic proportions with two
hundred and three thousand, five hundred cases.

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Rates of congenital syphlis resulted in two
hundred and thirty one still births and

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fifty one infant deaths. The uptick
in the infection rates have been to substance

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use, which is tied to risky
sexual behavior, and better prevention of HIV,

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which has led to fewer people using
condoms. The main reason for the

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rise in the disease is the lack
of sexual health care clinics in the US.

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Doctor J. Varma, chief medical
officer at Psyga Technologies and former Deputy

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Commissioner of Health in New York City, told The New York Times quote,

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when you miss one case, then
you end up with two more cases.

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And if you miss two cases,
then you end up with four. That's

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how epidemics grow. End quote.
South Dakota has the highest infection rate,

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followed by New Mexico, Arkansas,
Oklahoma, and Mississippi. Gonorrhea and Syphlis

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are often asymptomatic, so there are
cases that have gone undetected since the carriers

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haven't been screened for the disease.
About eighty six percent of Syphlis cases were

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diagnosed outside of sexual health clinics in
twenty twenty two. This suggests that primary

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care physicians, emergency departments, community
health centers, and correctional and drug treatment

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programs need to screen for the disease. If left untreated, syphlis can cause

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severe damage to the heart and brain. It can lead to blindness, deafness,

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and paralysis. Congenital syphlis leads to
miscarriage and stillbirth. Infants who survive

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are often blind, deaf, or
have severe developmental delays. Of course,

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I can't talk about epidemics without the
honorable mention of COVID nineteen. There isn't

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much out there on COVID nineteen anymore, but who is currently working to downgrade

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COVID nineteen from immer urgency management to
longer term disease management. Overall, in

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the past month, seventy six countries
reported new COVID nineteen cases and forty six

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reported deaths from the disease. Between
the fifth of February and the third of

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March, reported cases and deaths have
decreased by forty four percent and fifty one

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percent, respectively. It's not time
to kiss COVID goodbye yet, though,

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since many countries have changed the way
they report the disease, it's come to

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light that COVID nineteen cases are under
reported. I feel like this is the

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trend with any infectious disease. It
certainly happened back in twenty twenty when we

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were under quarantine. Many cases went
unreported then and that trend will continue.

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Currently who is tracking five variants of
interest and three variants under monitoring. It's

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still to proceed with caution, but
it seems that as mutations become less virulent,

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severe cases and cases of long COVID
are decreasing. We're going to take

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a quick break to hear from our
sponsor, then we'll be back to talk

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00:15:16.200 --> 00:15:22.240
about Alzheimer's and some exciting news on
that disease. Spring is coming and I'm

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00:15:22.279 --> 00:15:26.919
preparing my garden beds and pots for
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and you know where I'll be headed
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I'm going to True Leaf Market.
I'm pretty new to growing, and this

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year True Leaf Market has added a
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grow like a pro. It's the
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It helped me choose the best varieties
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level of experience, and the characteristics
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all, I had chosen several varieties
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and peppers. I'm still building my
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get your grow on with true Leaf
market. Diseases like Alzheimer's and als aren't

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really in my wheelhouse, so I'm
not sure that I'll be addressing them in

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00:18:11.839 --> 00:18:18.480
future seasons. It's not that they're
not interesting or worthy of explanation. It's

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00:18:18.519 --> 00:18:22.160
more that I don't feel that I
know enough about them to give an honest

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00:18:22.200 --> 00:18:27.000
and clear report on them. In
this case, I felt that recent discoveries

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were worth mentioning since it's very exciting
news. There have been some breakthroughs on

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00:18:33.559 --> 00:18:38.559
the Alzheimer's front, and the news
is both good and bad. In the

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past few years, monoclonal antibodies have
shown promise as amyloid inhibitors. Amyloid plaques

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are the buildup of amyloid in the
brain, a hallmark of Alzheimer's disease.

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There are currently almost two hundred Alzheimer's
drugs in active clinical trials, but only

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three have gotten FDA approval in recent
years. The first was agucanu map registered

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00:19:07.880 --> 00:19:15.039
as Agihelm, approved in twenty twenty
one. This drug targets amyloid plaques that

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00:19:15.079 --> 00:19:19.720
build up in the brain. The
FDA approval of this drug came under the

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00:19:19.720 --> 00:19:26.279
scrutiny of a US oversight committee after
its approval. Several findings were made by

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00:19:26.279 --> 00:19:33.279
the committee. The committee found that
the FDA didn't document every meeting or exchange

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00:19:33.319 --> 00:19:41.319
that took place between FDA and Biogen
while the approval process was happening. This

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is a major breach of protocol for
any company or agency. If you didn't

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document it, it didn't happen.
Or if you didn't document it, what

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were you hiding. They also found
that the FDA collaborated with Biogen on a

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joint briefing document or the PCNs Advisory
Committee. At the time this briefing was

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prepared, the FDA had differing opinions
on the safety and efficacy of agiehelm,

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and a consensus was never given prior
to FDA and Biogen working on the document.

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The third thing they found was that
the FDA allowed Agehelm to be approved

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under an accelerated pathway, the traditional
approval pathway would have included review for nine

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months. The FDA approved the accelerated
pathway, which allows review of data for

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three weeks. This decision was made
after an expert council meeting resulted in an

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unfavorable feedback for the approval of the
drug. The next finding was that the

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FDA approved and Biogen accepted a broad
label indication for the drug, despite a

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lack of clinical data on all Alzheimer's
disease stages. What this means is that

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the FDA approved Agiehelm for treatment of
people with Alzheimer's disease. They didn't specify

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what stage of the disease. The
patients who participated in the clinical trials were

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only in the mild cognitive impairment or
mild dementia stage of the disease. Biogen

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did tell the FDA that they had
reservations about accepting the broad label, but

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it wasn't until patients and providers began
questioning the use of the drug and Biogen

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came under fire after the drug came
to market. The following three findings were

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all related to the cost of Agiehelm. Biogen set an unjustifiably high price for

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Agiehelm in order to make history for
the company. Despite the impact on patients

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and the Medicare program. Biogen expected
Agehelm to be a burden to Medicare and

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costly to patients, and finally,
Biogen planned to spend billions to market Agehelm

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despite the financial impact on patients and
the healthcare system. The initial price of

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Agiehelm was set at fifty six thousand
dollars a year. Despite the lack of

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demonstrated clinical benefit in a broad patient
population, Biogen was aware that the financial

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burden would fall primarily on Medicare.
Eighty five percent of the drug's target population

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would be covered by Medicare, and
by the end of the day, Biogen

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calculated that Agihelm would cost Medicare twelve
billion dollars in one year. Out of

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pocket costs for patients would be twenty
percent of their income. When it all

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shook out, the FDA came under
scrutiny, as did Biogen. Anjihelm will

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be discontinued in twenty twenty four,
and in the meantime, Biogen continues to

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work on other monoclonal antibodies that target
amyloid plaques. One of these is lacnamab,

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registered as Lakembi. This is the
latest medication granted full approval by the

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FDA. This drug was created as
a collaborative effort between Biogen and SSA,

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a Japanese pharmaceutical company. This drug
went through the traditional pathway for approval and

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indications and warnings are clearly spelled out
on the label. While still very expensive,

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Lekemby is half the price of agiehelm
Eli. Lilly is also seeking approval

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from the FDA for its drug,
the nanomab, for Alzheimer's patients, and

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as more drugs are approved, the
price tag will go down. I wanted

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to talk about this because I want
my listeners to know that there are failsafes

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in place when drugs are approved.
The FDA doesn't have the final say on

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approval. Drugs go through rigorous testing
before they even get to clinical trials.

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Preclinicals take years. It's expensive to
get a drug to market, and that

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expense is passed along to the consumer. But drugs also should be priced so

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00:24:33.720 --> 00:24:38.039
that people don't have to make the
choice between eating and getting the medicines they

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00:24:38.119 --> 00:24:44.920
need. Bi Agena is a reliable
company, but like many others, they

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00:24:44.960 --> 00:24:52.079
got overly ambitious Agiehelm was the first
Alzheimer's drug to be approved in the US,

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and this prompted FDA to push it
through. Agie Helm isn't a dangerous

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drug, but it was labeled improperly. None of the drugs currently in the

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00:25:02.359 --> 00:25:07.079
approval stages will cure Alzheimer's, and
none of them are approved for people in

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the later stages of the disease.
It's important to know that these drugs will

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prolong the quality of life by four
to six months, giving patients more time

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to spend doing the things that they
love to do and giving them more time

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with their families. Research is ongoing, and one day there may be a

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cure for Alzheimer's. These drugs are
only the beginning. There are a ton

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of updates out there, and there
just isn't time in the day to cover

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all of them. I chose these
because they give a deeper look into not

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00:25:45.440 --> 00:25:57.839
only infectious disease, but also into
cures and approvals. Often there is no

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clear path when it comes to disease
and it's spread. Several things factor in

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00:26:03.599 --> 00:26:10.039
when we talk about epidemiology. Do
we know what causes the disease? Can

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00:26:10.079 --> 00:26:15.200
we prevent or cure it? Has
the genome of the pathogen changed, Are

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there resources available to diagnose it?
Where did it start? And where is

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it going? How can we track
it? These questions can be rabbit holes

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that may lead researchers to incorrect conclusions. When that happens, it's back to

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the drawing board to figure out where
they went wrong. It takes time to

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00:26:37.440 --> 00:26:41.920
correct mistakes, and often those mistakes
become public before we know the information is

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incorrect. This causes confusion and mistrust
from the public. On the research side,

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we learned a lot from COVID nineteen. The next pandemic may see a

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much slower response. I'm not sure
that that's the right answer, but it

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may keep the insanity at bay.
Thank you all for listening to Cause of

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00:27:07.640 --> 00:27:11.880
Death one hundred seconds to midnight.
Check out the show notes for more information

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00:27:12.079 --> 00:27:15.599
on the topics that I talked about
today. You can also find the link

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00:27:15.640 --> 00:27:21.480
to my sponsor this month, True
Leaf Market. Go get your grow on

275
00:27:21.839 --> 00:27:29.680
with True Leaf Market. Please don't
forget to rate, review and subscribe to

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the show. If you'd like to
support the show monetarily, you can find

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00:27:33.440 --> 00:27:40.680
my Patreon page at patreon dot com
slash Jackie Morante. There are several levels

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00:27:40.680 --> 00:27:45.599
you can join there, and I'll
have different benefits. Everyone who subscribes on

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00:27:45.680 --> 00:27:51.720
Patreon gets AD free episodes. I'm
a little behind on sending merch out,

280
00:27:51.799 --> 00:27:55.160
so bear with me. There's been
quite a bit going on in my life

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00:27:55.200 --> 00:28:00.000
personally, and I just haven't made
it to the post office. Apple Subsist

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00:28:00.000 --> 00:28:03.440
Descriptions is also available for those who
would rather support the show that way.

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00:28:04.319 --> 00:28:11.359
There you can get AD free episodes
and bonus content. I'm playing catch up,

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00:28:11.519 --> 00:28:17.240
so there will be another episode coming
out next weekend on Toxoplasma GANDHII.

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00:28:18.039 --> 00:28:22.319
My third podversary is coming up this
month. Also. I'm working on that

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00:28:22.440 --> 00:28:27.759
episode now and it promises to be
super entertaining. I hope you'll listen in

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00:28:27.799 --> 00:28:33.680
on that one until next week.
Limit your dog's social lives, and make

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00:28:33.720 --> 00:28:34.440
sure your milk is pasteurized.