HUB's LIST of medical fun facts

Take Paxlovid or Not, if you’re not high risk?
A recent study of reasonably healthy (standard risk level) middle aged (42 yo.) patients symptomatic with COVID-19 who took 5 days of Paxlovid showed that the drug did NOT reduce the duration or severity of symptoms, reduce the incidence of hospitalization, or decrease the death rate (very low in both medication-takers and placebo groups). This was true of both vaccinated and unvaccinated people IF they were free of heart disease, diabetes, hypertension, and did not smoke. The evidence for rebound (a return of symptoms 2-8 days after taking Paxlovid) is still being collected, but so far the data suggests that treatment rebound may occur in 20% of cases,. The rebound symptoms are mild, and it is speculated that the treatment with Paxlovid blunts our initial immune response so that a portion of the virus resurges temporarily in our body. Extending the duration of Paxlovid treatment longer than 5 days does not seem to help. There is no definite evidence that Paxlovid treatment increases the risk for “long-haul COVID” (about 15% in both treated and placebo groups). Treatment with Paxlovoid is clearly beneficial for symptomatic high-risk patients (unvaccinated people, people over 65 yo. or patients with chronic diseases).

Wearable Digital Recorders
The types and brands of wearable digital recorders have become so numerous and varied that they have earned their own group label –  DHT (Digital Health Technologies).  A device that started out as a hip pocket pedometer and evolved into wrist band “fit bits” can now measure blood pressure, blood glucose, pulse rate, blood oxygen, heart arrhythmias, epilepsy, falls, and even incipient depression! How accurate are they?  Three governmental agencies and a professional electrical engineer society have developed standards, guidelines, or regulations for the accuracy and application of DHT devices, but manufacturers currently have pretty much free range of claims and marketing.  For example the number of false alerts with the devices (wrist bands or credit card sized in your wallet) that claim to detect atrial fibrillation ( a fairly common asymptomatic heart irregularity) can be quite high.. Who owns the data?  Great question! The potential use of de-identified data is heralded as a potential major leap in population-based health improvement, but whether individual health data can make it into your electronic medical record to aid your clinicians’ decision-making without exposing your private data to telemarketers or AI programs is an unresolved question. In the meantime, it is hoped that the data from your device will enhance your personal efforts to develop a healthier life style. These devices generate a huge amount of daily data that will require interpretation by multiple clinical providers,  may inundate EHRs, and generate anxiety and even unnecessary care by worried-well patients. Will the devices be reimbursed by insurance? Reimbursement codes have already been developed, BUT health insurance companies  are waiting to see if the use of DHT actually reduces cost (to them) of care or actually increases cost through exaggerated responses to digital alerts by patients or providers.

All Steps Are Not the Same
Speaking of step monitors, we have already written about the arbitrary goal of 10,000 daily steps to fitness being based on the Japanese symbol for 10,000 that looks like a runner. A recent study looked at why some people who walk 8300 average steps a day put on weight, while others don’t. The short answer, or at least one of them because food diaries were not kept by the study, is “who your parents are”. The genetic risk for obesity (measured by the Polygenic Risk  Score – a higher PRS indicates a higher risk of becoming obese) in 3100 non-obese people revealed that 13% adults with the lowest genetic-risk score (PRS) developed obesity while 43% with the highest PRS became obese over the 5 years of the study.  If your hoping that steps will avoid obesity and your PRS is low (   your parents are not obese) you can set your daily goal at 3660 less steps; those with a high PRS should increase their goal of total daily steps by 2280. The editorialist states that since your don’t know your PRS (not available outside a research study), and you gain weight while averaging 8000 -10,000 steps a day “you might need to increase activity by 3000 to 4000 steps a day.”  Obviously it is still important to pick your parents right, but if you can’t, just keep walking a bit further every day! .

Just in Time for August on Cape Cod
Tomatoes are GOOD for you, in at least one way. One tomato a day in about 6000 elderly people with low-level (Grade 1 of 4) high blood pressure lowered their high blood pressure by as much as 30% in three years. For the other 1000 people in the study who did not have high blood pressure, one large tomato a day reduced their risk of developing high blood pressure by 36%. Presumably the reason is lycopene, the chemical which gives the tomato its red color, which is a powerful antioxidant (and we ALL know how good antioxidants are in fighting inflammation and cleaning up damage our cells).  The tomato has apparently replaced the apple in “An apple a day keeps the doctor away”, though they are both red. On the other hand, Consumer Reports reports that 16 of 36 types of fruits and vegetables tested positive for low levels of pesticides. Tomatoes  were among them. The frequency of positive tests for pesticides was very low (3-4% of hundreds of samples), and both U.S. grown and imported tomatoes had low levels of pesticide (“don’t eat more than 3 a day”). Organic tomato samples were very low in risk (“more than 10 tomatoes a day is OK”), but the average price of organic tomatoes was $1.00 more a pound, one of the largest price differences between regular and organic vegetables studied.