In 1981, the CDC first reported on a rare lung infection that would eventually be called Acquired Immune Deficiency Syndrome. The subsequent discovery of HIV in 1984 paved the way for effective treatment of HIV through antiretroviral therapy (ART). Additionally, prevention strategies such as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are helping prevent people from getting HIV.
The knowledge that a higher viral load indicated higher transmissibility of HIV was apparent to researchers prior to 1996 (Murphy, 2023). While the Swiss Federal AIDS Commission announced in 2008 that a person who is seropositive, but has had an undetectable viral load for at least six months, does not risk transmitting HIV to a seronegative partner.
Today, the majority of research on U=U is conducted in the public health sector, to examine how – and how accurately – knowledge of U=U is disseminated across the world. In a November 2024 Personal View published in The Lancet. HIV, an international team of authors surveyed evidence relating to viral load suppression and the U=U message – which has been translated to different wordings across cultures and languages – with a view towards ending HIV as a public health crisis by 2030 (Okamoto et al., 2024). Among the chief aims of U=U is enabling people with HIV to thrive, and addressing barriers to thriving – namely, stigma, discrimination, and criminalization. There are 80 countries that have HIV-specific criminal laws, and sexual transmission of HIV is prosecuted – even where no actual transmission has taken place (Okamoto et al. 2024).
From: Okamoto, E. E., Anam, F. R., Batiste, S., Dukashe, M., Castellanos, E., Poonkasetwattana, M., & Richman, B. (2024). Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk. The Lancet. HIV, 11(11), e783–e790. https://doi.org/10.1016/S2352-3018(24)00241-8
Making evidence-based education a priority is a key to the success of U=U. Yet awareness of U=U remains critically low among individuals, healthcare providers, and communities. Another challenge to U=U arises in barriers to viral load-testing access. Without access to such testing, individuals are unable to confirm their virus status. When regular adherence to ART is a challenge, this can lead back to stigmatization in individuals who are HIV positive.
Despite U=U having been understood for decades, there remain challenges – systemic, legislative, and cultural – to it being widely accepted and adopted by the public. But it is a key to ending HIV as a public health crisis, so we will likely continue to see evidence being generated on public awareness and implementation of U=U.
Okamoto, E. E., Anam, F. R., Batiste, S., Dukashe, M., Castellanos, E., Poonkasetwattana, M., & Richman, B. (2024). Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk. The Lancet. HIV, 11(11), e783–e790. https://doi.org/10.1016/S2352-3018(24)00241-8
Today is World Diabetes Day, a day meant to support and raise awareness for the 537 million diabetics around the world. This year, the theme set by the International Diabetes Foundation is “Diabetes and wellness.” Healthy eating and exercise can make a profound impact on preventing and controlling diabetes. While many factors influence diabetes, their hope is to empower people to take agency over the disease or to encourage others to do the same.
infographic from the Lexington-Fayette County Health Department
As the Mayo Clinic points out, the benefits of exercise extend to holistic improvement of health, both physically and mentally. For adults, they recommend “150 minutes a week of heart-pumping aerobic activity.” This might sound like a lot, but 2 and a half hours divided over seven days is about 21 minutes of activity a day. In other words, a total investment in health could be accomplished with a few jogs, walking to the metro, biking around, or – as the signs all around Ross Hall remind us – taking the stairs when possible.
Personally, I am always an advocate for running, as it’s (nearly) free and can improve sleep, cardiovascular health, and mental health. And although research is still nascent, a connection between exercise and increased insulin sensitivity is beginning to emerge. Moreover, the amount of running necessary to improve health (20 minutes a day) is possible to fit into many different schedules, unlike other cardio exercises like swimming or kayaking.
Of course, for diabetics, especially those suffering from hypoglycemia, extra precaution is necessary. The Mayo Clinic recommends checking blood sugar before exercise and gives guidance on when to avoid exercise. They recommend consulting with a doctor about activities before engaging with them.
The PA program, ranked in the top five in the US, lasts 24 months, the PA/MPH program is 36 months. The Washington, DC location of the program makes the PA program an excellent place for PAs in training to take part in an annual leadership and advocacy summit sponsored by the AAPA, and to avail themselves of other opportunities to visit Capitol Hill to advocate on health policy.
When asked about three things that people might not know about the PA profession, Bart Gillum shared the following thoughts:
"We are now "Physician Associates." In 2021 the American Academy of PAs voted to change the name from physician assistant to physician associate. While some states and institutions have already adopted the name, the new title is still in progress. Adopting the new name has been slow due to the requirement of state laws and healthcare institutions to be updated. In the meantime, you might continue to hear physician assistant and physician associate or even just PA interchangeably."
"Unlike physicians who undergo residency training for a specific specialty, PAs have the unique ability to move between medical specialties without additional formal training. A PA can work in areas such as cardiology, emergency medicine, or dermatology and switch to another field. This provides more flexibility for those who want to work in a variety of settings throughout their career."
"While PAs are most prevalent in the US. PAs or PA-like professionals are present in about 15-20 other countries, including Canada, the UK, Australia, The Netherlands, Germany, South Africa, and New Zealand. Other countries are currently exploring incorporating PAs in their healthcare systems."
Don't forget to thank a physician assistant this week -- their important work expands patient access to healthcare. Tune in to both Good Morning America and the TODAY show on Friday morning, October 11, for a chance to see PAs representing their profession!
Himmelfarb Library provides clinical, evidence-based medicine resources including DynaMed and epocrates+ which provide information to support cancer care. DynaMed is a point-of-care tool designed to facilitate efficient and evidence-based patient care information including drug and disease information. DynaMed provides information including background, history and physical, diagnosis, disease management, prognosis, prevention, and screening information on medical conditions. DynaMed’s easy-to-read topic pages cover a wide range of conditions and diseases, including cancers such as acute lymphoblastic leukemia/lymphoblastic lymphoma in children as seen in the screenshot below.
epocrates+ is Himmelfarb’s other evidence-based point-of-care database that provides disease and drug information. epocrates+ provides a step-by-step approach, covering prevention, risk factors, history and exam, diagnosis, treatment, and prognosis. Like DynaMed, epocrates+ covers coverage of a wide range of medical conditions, including cancers. Epcorates also offers a quick reference area that covers the basics of a condition, as seen in the cervical cancer quick reference screenshot below.
If you’re looking for the latest in cancer research, Himmelfarb provides access to many cancer journals! The following list is just a sample of the cancer-related titles you can access through Himmelfarb’s journal collection:
Cancer: An American Cancer Society journal that started publication in 1948, Cancer is one of the oldest peer-reviewed oncology journals. This journal focuses on highly relevant, timely information on the etiology, course, and treatment of human cancer.
JAMA Oncology: This definitive oncology journal publishes important clinical research, major cancer breakthroughs, actionable discoveries, and innovative cancer treatments.
Cancer Cell: This journal provides access to major advances in cancer research including clinical investigations that establish new paradigms in treatment, diagnosis, or prevention of cancers.
Gynecologic Oncology: This journal publishes clinical and investigative articles about tumors of the female reproductive tract and the etiology, diagnosis, and treatment of female cancers.
Journal of the National Cancer Institute: This journal publishes significant cancer research findings focused on clinical, epidemiologic, behavioral, and health outcomes studies.
Journal of the National Comprehensive Cancer Network: JNCCN publishes the latest information on clinical practices, oncology health services research, and translational medicine, as well as updates to the NCCN Clinical Practice Guidelines in Oncology.
If you’re interested in finding health statistics about cancer, we have information on that too! Check out our Health Statistics: Cancer Guide. This guide provides links to resources to find general cancer statistics, as well as breast cancer, prostate cancer, and colon cancer. Resources to find cancer mortality maps and graphs are also included.
September is Suicide Prevention Month - making it a good opportunity to raise awareness about suicide and suicidal ideation. If you or someone you know has thoughts of suicide, immediate help is available. Call, text, or chat 988 to speak to a trained crisis counselor.
Just like other mental health conditions, suicidal thoughts can impact anyone. According to the Centers for Disease Control (CDC), over 49,000 people died by suicide in 2022, equating to one death every eleven minutes (CDC, 2024a). Between 2000 and 2018, suicide rates increased by 37%, and returned to their peak in 2022 following a brief decline between 2018 to 2020 (CDC, 2024a).
Knowing the risk factors of suicidal ideation and behavior is important for everyone. According to a 2016 review published in The Lancet, “approximately 45% of individuals who die by suicide consult a primary care physician within one month of death, yet there is rarely documentation of physician inquiry or patient disclosure” of suicidal ideation or behavior (Turecki, & Brent, 2016).
While many individuals with suicidal ideation do not attempt suicide (Dlonsky, et al., 2016), recognizing the risk factors can help you identify someone in need of help and help you find the help they need. According to the CDC, factors that contribute to suicide risk range from individual, relationship, community, and societal factors and can include, but are not limited to the following:
Individual Risk Factors:
Previous suicide attempt
History of depression and other mental illness
Serious illness
Job or financial problems
Impulsive or aggressive tendencies
Sense of hopelessness
Relationship Risk Factors:
Bullying
Family or loved one’s history of suicide
Loss of relationships
Social isolation
High-conflict or violent relationships
Community Risk Factors:
Lack of access to healthcare
Community violence
Historical trauma
Discrimination
Societal Risk Factors:
Stigma associated with seeking help and mental illness
Easy access to lethal means of suicide
Unsafe media portrayals of suicide
(CDC, 2024b)
Some factors can protect people from experiencing suicidal ideation and behavior. These include, but are not limited to the following:
Effective coping and problem-solving skills
Strong sense of cultural identity
Support from loved ones
Feeling connected to others
Feeling connected to school, community, and social institutions
Availability of high-quality physical and behavioral healthcare
If you are interested in learning more about suicide prevention, Himmelfarb Library has a Suicide and Suicidology Collection that includes numerous books on this topic. Notable books from this collection include:
Tribute in Light, photographed by Jack Cohen, licensed for free on Unsplash
The terrorist attacks of September 11, 2001, are now 23 years behind us. In a general sense, they have receded from our collective memory. However, the human health effects of the events of that day linger, and continue to be the subject of research across a variety of disciplines. A MeSH search of the PubMed database between 2022 and 2024 produces 93 results, with publications focusing on a variety of topics, including PTSD, specific health outcomes, and racial and ethnic mortality disparities. In this post, we will focus on a 2024 publication focused on the longitudinal effects and treatment of PTSD on those most affected by this event.
In selecting the two interventions to test, the authors found that while trauma-focused cognitive behavioral therapy (CBT) is one of the most effective and empirically-supported treatments for PTSD, it has a number of limitations, including geographic constraints, stigma, and the limited number of expert practitioners of this type of therapy. Another type of therapy, integrative testimonial therapy (ITT), which presents none of the challenges of trauma-focused CBT, is an Internet-based form of CBT which is conducted via asynchronous patient-therapist written communications. ITT involves patients constructing a chronological narrative of their lives. Prior RCTs found that ITT yielded significant reductions in PTSD among trauma survivors of other historical events.
For the purposes of this study, ITT was compared to therapist-assisted Internet-based modified present-centered therapy (I-MPCT). I-MPCT is a modification of present-centered therapy (PCT), which has been found to be modestly less or as effective as trauma-focused PTSD therapies, with lower dropout rates. The authors hypothesized that ITT would have a greater impact on the reduction of PTSD symptoms of those affected by the events of September 11, 2001. Participants in the trial came from several categories, including both traditional responders (e.g. police officers and firefighters), non-traditional responders (e.g. construction workers and volunteers), and survivors.
Both therapies included three modules of guided writing exercises (or “narratives”) which were interspersed with written feedback from the therapist. Both types of therapy had patients write eleven narratives in total, each taking 45 minutes to complete. For each therapy modality, patients contributed biographical information, wrote about their current life circumstances, and/or discussed problems. The effectiveness of each therapy modality was assessed through a self-reported scale.
Both therapy modalities showed significant reduction in chronic PTSD symptoms and depressive symptoms, and improved quality of life across the board. In post-treatment, both therapies showed significant impact on PTSD, and represent promising treatment options for this particular population.
References
Feder, A., Kowalchyk, M. L., Brinkman, H. R., Cahn, L., Aaronson, C. J., Böttche, M., Presseau, C., Fred-Torres, S., Markowitz, J. C., Litz, B. T., Yehuda, R., Knaevelsrud, C., & Pietrzak, R. H. (2024). Randomized controlled trial of two internet-based written therapies for World Trade Center workers and survivors with persistent PTSD symptoms. Psychiatry Research, 336, 115885–115885. https://doi.org/10.1016/j.psychres.2024.115885
Within the graphic novel sector is a subgenre known as Graphic Medicine, a term coined in 2007 by Dr. Ian Williams, a cartoonist and the founder of a website of the same name. Graphic Medicine provides comprehensive information about the genre, including reviews of new publications and podcasts. Since 2010, they have also sponsored an annual conference – the 2024 conference just wrapped in Athlone, Ireland.
Graphic medicine is also a subset of the field of narrative medicine, which centers patient narratives in clinical practice, research, and medical education. One practitioner within this field is Dr. Benjamin Schwartz, who completed his medical training, but is now a cartoonist for the New Yorker, and a professor of narrative medicine at Columbia University. You can read an interview with him at the website, Doctors Who Create. You can view some of Schwartz’s work for the New Yorker here.
Himmelfarb’s Reference and Instruction Librarian Rebecca Kyser, herself a cartoonist, suggests the following titles to help you delve into the world of graphic medicine:
Kid Gloves: Nine Months of Careful Chaos, by Lucy Knisley (available to borrow through our local consortium) follows the cartoonist as she goes through the process of trying to become pregnant, being pregnant, and her birth experience. As she chronicles her own experiences with miscarriage, morning sickness, and preeclampsia, Knisley also explores the history of pregnancy, women’s health, myths and superstitions around miscarriage and pregnancy, and the decisions that factor into the choice to have kids in the first place. Entertaining, emotional, and well-researched, this is a great book for anyone, regardless if they plan to have kids, have kids, or never intend to have kids at all.
The Nib (website): The Nib used to be a magazine publisher of anthology comics, usually all revolving around a specific issue, as well as daily comics. While the magazine stopped publishing last year, the entire site is still live for those who wish to buy back issues or view any of the older strips, which sometimes feature medical themes. There’s plenty to check out such as a comic regarding the Covid-19 pandemic’s impact on the Navajo Nation, living with OCD during Covid-19, and the high maternal mortality Black women face.
Comics for Choice, Second Edition (anthology, currently on New Books Shelf) Published after 2021, this anthology takes a look at the history of abortion in the United States from a range of perspectives. From personal stories about their own abortions to narratives about those who sought to provide access even when the procedure was entirely illegal, this collection showcases the multiple ways reproductive choice and access impact everyone.
Memento Mori by Tiitu Takalo (coming soon to DC Public Library). Takalo, a cartoonist from Finland, tackles her own experience dealing with a cerebral hemorrhage with honesty and a dynamic drawing style. Using color to reflect her own emotions, Takalo takes us through her frightening medical emergency, the monotony of the hospital, and her struggle to access proper health care upon her release. It’s an engaging story bringing to light the reality of an experience most people rarely face themselves
Lighter Than My Shadow by Katie Green (available at DC Public Library). Mental health conditions can be hard to understand, especially given that the symptoms are often internal. By using comics as her medium of choice, Green gives physicality to her own battle with an eating disorder in her teens and college years. Black scribbles follow her from page to page, growing more busy and large as her anorexia worsens. Later, a mouth on her stomach grows and grows as she struggles against the urge to binge food. It’s a difficult read at times – as it should be given what Green was facing – but it explores her own battle with empathy and thoughtfulness.
For a break from studying, or for a way to see the health professions from a different perspective, dive into some graphic medicine!
In summer, the sun is a near-constant companion in many parts of the world. But we know that the sun can be our adversary – particularly the ultraviolet radiation emanating from it. Ultraviolet light is used as phototherapy, in the treatment of conditions including jaundice, psoriasis, and cutaneous T-cell lymphoma. But in honor of UV Safety Awareness Month, we focus here on UV exposure that is environmental and not therapeutic in nature, and how best to achieve protection from harmful UV rays. Use of tanning beds is one dangerous source of ultraviolet radiation, but exposure to them is avoidable via behavioral and lifestyle changes. For other types of exposure, there are fortunately a multitude of products available for protection.
That ultraviolet radiation awareness has increased dramatically in recent years is generally a positive change, but where do consumers go to get informed about UV protection? One prominent result in Google searches is a resource from the Environmental Working Group. EWG is an activist nonprofit focused on chemicals used in agriculture and cosmetics, as well as pollutants in drinking water. The EWG has been compiling an annual review of sunscreens since 2008. Its methodology includes assigning numerical ratings to sunscreens based on their “safety.” The EcoWell, a website dedicated to combating misinformation in the cosmetics industry, has expressed some doubts about the EWG’s methodology, which is disclosed at length on their website, but is not easily evaluated by non-experts. EWG includes the following statement in their page on methodology: “Most people [believe] the government oversees the safety of their cosmetics and other personal care items. Not so.” (EWG, n.d.) Even a non-expert can understand that this position stakes a specific claim, and thus the information is not coming from an unbiased source. Additionally, EWG offers companies an opportunity to become “verified” on their website, which in part involves a financial transaction, and means that verified products appear before others in the database. This information is inconclusive, but doesn’t inspire confidence in a nonprofit that claims to be organized in the public interest.
While consumers might be grateful for a source that is easily accessible, it is very important to understand that the EWG’s findings are not evidence-based. According to Dr. Adewole Adamson, MD, MPP, speaking to Dermatology Times this month, “None of [the EWG’s] data is actually based on any information that involves actual clinical or actual patient use in the real world. I do not think that patients should change their behavior related to putting on whatever sunscreen it is that they use based on this data.” (Andrus, 2024)
Another important thing to understand about sunscreens on the market in the United States, as opposed to those sold in Europe or Asia, is that in the U.S. sunscreen is regulated as though it were a drug. In Europe and Asia, sunscreen is regulated as a cosmetic. Because drug regulation is a more rigorous process, the U.S. has seen fewer sunscreen filters approved for use than in other countries. As a result, Americans have fewer and more limited product choices for protection.
One recent evidence-based guide to sunscreens is this 2023 review on photoprotection, published in the Archives of Dermatological Research. Photoprotection is the practice of minimizing damage to skin and eyes from damage that ranges in severity from sunburn to photoaging to the development of malignant neoplasms. There are two types of ultraviolet radiation, UVA and UVB. UVB exposure is at its highest level in summer, while UVA exposure is more constant throughout the year and leads to carcinogenesis. Sunscreens which are labeled “broad spectrum” primarily protect from UVB, but also protect from UVA. In addition to UV, 50% of ultraviolet radiation comes from visible light, which causes other types of skin conditions, or else can trigger flares of chronic conditions. While UV radiation is absorbed or scattered, visible light is reflected.
The authors of the review state that people “should be encouraged to avoid outdoor activities during peak sun hours, seek shade, apply sunscreen, wear sun protective clothing, and sunglasses.” (McDonald et al, 2023) Avoiding exposure, then, is our first line of protection. But that isn’t practical for most people, especially those who want to participate in summer activities outdoors. It is important to learn more about the different types of sunscreen products and their pros and cons. Sun Protection Factor, or SPF, is a common measure of the effectiveness of sunscreens.
On an FDA website explaining SPF, we learn that the number associated with a sunscreen product’s SPF is commonly misconstrued as a measure of protection based on the amount of time one is exposed to the sun. This is incorrect because solar intensity differs by time of day. In fact, SPF denotes the amount of UV radiation required to produce sunburn on protected versus unprotected skin. (FDA, 2017) One study cited in the review from Archives of Dermatological Research found that SPF 85 provided significantly more protection against sunburn than did SPF 50. A product with a higher SPF may help compensate for an insufficient amount of sunscreen being applied. Frequency of reapplication of sunscreen is important, particularly when there is water exposure or perspiration.
The two main types of sunscreen are chemical, or organic sunscreens, which represent 75% of products currently on the market, and include chemical filters which absorb UVR. Physical, or inorganic sunscreens approved by the FDA include zinc oxide and titanium dioxide, which form a physical barrier to UV absorption. While chemical sunscreens are absorbed more readily on the skin, physical sunscreens are not. Tinted sunscreens contain iron oxides and synthetic mica for cosmetic purposes, in addition to other sunscreen ingredients. The authors of the review found limited evidence of the use of systemic agents protecting against UVR.
One photoprotective measure whose availability has dramatically increased in recent years is sun protective clothing. When selecting UPF (ultraviolet protection factor) clothing for sun safety, the number associated has to do with how much UVR is able to penetrate through different fabrics. However, the authors note that “UPF does not account for body surface area covered.” (McDonald et al, 2023) In general, most natural fibers provide less protection from UVR than synthetic fabrics or wool, darker colors absorb more UVR, and looser clothing provides more protection from UVR. Clothing marked UPF50+ is considered an excellent source of protection.
Now that we’ve discussed protecting the body, what about our heads and eyes? Wearing sunglasses helps decrease UVR damage to the skin around the eyes, the lens, and the cornea. Wearing a hat protects our vulnerable scalps, with wider brimmed hats providing optimal protection for both head and neck.
The review goes on to discuss evidence on adverse effects from photoprotection, including a comparison of evidence on superficial cutaneous absorption versus systemic absorption, concluding that despite the presence of sunscreen compounds in plasma, there simply is no evidence to date that sunscreen ingredients cause any harm to humans – a conclusion in stark contrast to those drawn by the EWG.
We only have the one skin we’re born with, so learning how best to protect it from UVR is time well spent!
McDonald, K. A., Lytvyn, Y., Mufti, A., Chan, A. W., & Rosen, C. F. (2023). Review on photoprotection: a clinician's guide to the ingredients, characteristics, adverse effects, and disease-specific benefits of chemical and physical sunscreen compounds. Archives of dermatological research, 315(4), 735–749. https://doi.org/10.1007/s00403-022-02483-4
Dr. William Coley (center), public domain photo from https://commons.wikimedia.org/wiki/File:William_Coley_1892.jpg
May is Melanoma Awareness Month, which serves as an annual reminder to visit a dermatologist regularly for a skin check. Melanoma affects every skin tone. Visit Himmelfarb's collection, Diversity in Dermatology, to explore our library resources on this topic.
This year, let’s go back in time to learn about the origin of one tremendous contemporary advance in the treatment of malignant melanoma -- immunotherapy -- and learn about a new development coming for patients diagnosed with melanoma.
Dr. William Coley (1862-1936) was a bone surgeon and cancer researcher who spent his career at the New York Cancer Hospital. At the time, cancers were commonly treated with amputation. Coley’s young patient, 17 year old Elizabeth Dashiell, presented with an aggressive sarcoma in her hand. Despite an amputation, her cancer had metastasized and she died ten weeks later. Coley began to comb through hospital records, and found a patient who had had four recurrences of an inoperable sarcoma, whose disease had gone into remission when he developed a superficial streptococcal infection of the skin. Coley managed to locate the patient, who did not present with any clinical evidence of malignancy. He also found a number of observational publications connecting this particular skin infection with positive outcomes for sarcoma patients.
The Treatment of Malignant Inoperable Tumors, by William B. Coley, MD (1914)
Coley began intentionally inducing this skin infection in his cancer patients, despite the fact that antibiotics were not yet available to help control infections. His practice is of course shocking and unethical in the light of our contemporary understanding of medical ethics. Additionally, the specific infection, erysipelas, was difficult to induce in patients, some of whom never developed the infection, and some of whom were injected repeatedly in the attempt to induce it. Having achieved some results with his initial attempts, Coley began using a heat-killed version of the infection, combined with one other toxin (which is known to us today as Serratia marcescens) to increase the virulence, and in turn, patients’ immune responses. This combination came to be known as “Coley’s toxins.” A summary of the patients treated with Coley’s toxins prior to 1940 shows that 22 soft-tissue sarcoma patients and 8 lymphoma patients were found to be free of clinical evidence of disease for a period of at least 20 years. (Starnes, 1992). Results for other types of cancers varied, but were not nearly as dramatic. You can read Coley’s 1914 report on his treatment of patients with toxins in its entirety online.
The concept of inducing an immune response in patients to address malignancies also underlies the pioneering work done by contemporary researcher James Allison, for which he shared the 2018 Nobel prize with Tasuku Honjo, for their work on immunotherapy. Allison’s work is chronicled in the documentary Breakthrough, which is available to stream on a number of platforms. Immune checkpoint therapy stimulates the patient’s immune system by blocking inhibitory checkpoints, in order to enable T cells to attack the tumor. Currently, immune checkpoint inhibitors which target the molecules CTLA4, PD-1, and PD-L1 are approved. The very first immune checkpoint therapy, ipilimumab, was approved in 2011 for the treatment of melanoma; since then, seven additional immune checkpoint inhibitors have been approved for use in the treatment of an ever-increasing number of cancers.
Research is ongoing towards the development of melanoma vaccines, which also build on the basis of activating patients’ own immune systems. The April 2024 issue of Cancer Research contains a brief comment on the growing body of evidence for vaccines tailored to specific tumor mutations, noting that progress has accelerated and increased during the past five years. (Fritsch & Ott, 2024)
While the ultimate goal is to prevent patients from developing melanoma in the first place, the results of research are leading to exciting and unprecedented outcomes for patients who have the disease. Dr. Coley’s early work with the immune system of cancer patients reminds us that pioneering ideas may come before their time and before the technology exists to support them, but may nonetheless lead to unimaginable and positive outcomes centuries later.
References
Coley, W. B. The Treatment of Malignant Inoperable Tumors with the Mixed Toxins of Erysipelas and Bacillus Prodigiosus : With a Brief Report of 80 Cases Successfully Treated with the Toxins from 1893 to 1914 / by William B. Coley. M. Weissenbruch, 1914; 1914.
Fritsch, E. F., & Ott, P. A. (2024). Personalized Cancer Vaccines Directed against Tumor Mutations: Building Evidence from Mice to Humans. Cancer research, 84(7), 953–955. https://doi.org/10.1158/0008-5472.CAN-24-0565
Starnes C. O. (1992). Coley's toxins in perspective. Nature, 357(6373), 11–12. https://doi.org/10.1038/357011a0
National Nutrition Month, an annual event that takes place in March, is a time for people to learn more about nutrition, the role nutrition plays in health and how to meet their personal nutrition needs. The 2024 National Nutrition Month’s theme is “Beyond the Table” which looks at the role of food production and distribution, as well as the ways in which nutritional meals may be enjoyed outside of a traditional dining setting. Below are some ways in which you can speak with your patients about the importance of nutrition.
The Academy of Nutrition and Dietetics is a valuable resource to share with patients interested in making changes to their current diet or those interested in receiving help from a registered nutritionist. The Academy’s website features information about food groups, food safety, fitness tips and recipes. The Find a Nutrition Expert database contains contact information for credentialed nutrition and dietetics providers and includes in-person or telehealth providers. Last, 50 Ideas to Get Involved in National Nutrition Month will encourage your patients to think about nutrition in new ways, educate their local community and test weekly meals and food groups that they may be unfamiliar with.
Himmelfarb Library’s catalog has a wide range of educational materials related to nutrition and public health. The Nutrition Research Guide is a great resource for library books, journals and other professional information such as data and statistics. Library research guides are useful for quick reference or for locating a resource based on a specific subject. Our guides change over time as library staff locate new and relevant information, so be sure to check the guide’s homepage often for updated information.
The GW Culinary Medicine Program offers an elective for 3rd and 4th year medical students as well as free courses (both virtual and in-person) for the general public. During the classes “participants will learn to cook healthy, delicious recipes and learn basic nutrition concepts such as building a healthy meal, eating on a budget, meal planning, and how to use leftovers.” (MD Culinary Medicine Program, n.d.) The program’s Culinary Medicine elective is offered during fall and spring semesters to third and fourth year medical students. The purpose of the elective is to provide “students the skills to teach patients how to incorporate healthy eating for the prevention and treatment of diseases by altering their diets, meal preparation and food choices.” (MD Culinary Medicine Program, n.d.) If you are interested in a hands-on approach to learning about nutrition, visit the Culinary Medicine Program’s website.
National Nutrition Month is a great time to discuss nutrition in an inclusive and gentle way. For many people, nutrition is a difficult topic because of preconceived notions about healthy food, costs associated with a “healthy” lifestyle or anxiety surrounding food and food rules. By approaching these conversations with empathy and active listening, you can work alongside your patients to break down food stigma and slowly introduce healthy eating habits to meet nutritional needs.
