Doctor Docs: Incorporating Climate Change into Physician Training
A growing number of medical professionals across the U.S. have realized that climate change plays a large role in medical issues and will continue to do so, so they’re working to incorporate climate change into medical professional training and are striving to prepare the healthcare system for the inevitable increased role it will have on public health. Cecilia Sorensen, MD, Director of the Global Consortium on Climate and Health Education and Professor of courses on climate and health impacts at Columbia University’s School of Public Health, explains that the oversight in medical students’ training is glaring. Climate change consequences have direct impacts on myriad health issues, from skin cancer, respiratory diseases, and cardiac stress, to changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, all of which are interwoven with social determinants of health and equitable healthcare access across communities.
As a medical resident at Denver Health in Colorado, Dr. Sorensen learned that summer was known as “trauma season” and it was all related to climate changes. “How did I hear nothing, nothing, about this during my entire medical training?” Sorensen found herself wondering. She and students and faculty across the nation are taking up the arduous task of incorporating even more material into the already packed medical school curriculum.
Some have already begun to do so. Nursing students and faculty, who have a holistic approach to health, are also including “planetary health” in their curriculum. In January, Harvard University’s medical school committed to embedding climate and health in its curriculum. George Washington University has adopted a “climate theme” that will weave learning objectives into all four years of medical school. For others, a group of medical students and faculty from various universities started the Climate Resources for Health Education (CRHE) to crowdsource and vet an evidence-based and open-source repository of climate- and health-related learning objectives, slides, and case studies aiming to offer faculty members an easy way to incorporate the resources into their courses.
The Global Consortium, comprised of over 300 institutions, provides resources and online classes that also aid in incorporating climate change health impacts into curriculums as well as preparing current medical professionals in the field. As Dr. Sorenson explains, the body of research and evidence about the health impacts of climate continues to grow. The real challenge in the years ahead will be how to respond.
Discoveries & Innovations: Bear Studies Unveil Blood Clotting Mysteries
Blood clotting, including deep vein thrombosis, poses about as much risk to relatively healthy individuals who are stagnant for a short period of time as to those who are chronically immobilized. The causes and mechanisms behind venous thromboembolism (VTE) continue to stump researchers. But now, answers to the many questions surrounding the nature of blood clots can be found in studies of bears—creatures that hibernate for months without experiencing clotting.
Researchers from Denmark’s Aarhus University and Aarhus University Hospital developed a study to compare the blood of bears, humans with chronic immobility, and healthy humans to find that the body’s methods of increasing and decreasing levels of heat shock protein 47, or HSP47, is what prevents blood clots in veins. “This protein is the key to a natural mechanism to protect the body against blood clots when it cannot move,” stated Ole Frøbert, MD, PhD, study co-lead, in a press release. “This finding is very exciting as it has the potential to be of great importance for people at risk of developing blood clots due to inactivity.”
HSP47 is important to collagen folding and inflammatory processes, and appears on the surface of platelets to facilitate connections between clotting proteins and immune cells called neutrophils. This is the first study showing that reduced levels of HSP47 are directly linked to the reduced risk of blood clots in immobile animals, including humans.
The study began when the researchers found that bears were prone to blood clots when awake, but didn’t develop them while hibernating. They found that HSP47 was the one protein with drastically decreased levels in winter compared to summer in bears. The researchers showed that HSP47 played multiple roles in platelet aggregation, most notably when HSP47 is presented on platelets, it helps them bind to the blood enzyme thrombin. Thrombin triggers platelet aggregation, ultimately leading to blood clots.
When the research team moved on to testing HSP47’s role in clotting in humans, they took blood from eight individuals who were immobilized due to chronic spinal cord injuries and compared them with samples from eight non-disabled individuals. They saw a pattern similar to the one they had seen in bears—immobilized participants had lower levels of HSP47 compared to controls. The healthy, non-disabled volunteers were then placed on bed rest for 27 days, with blood samples taken before and after. HSP47 expression dropped dramatically over the period, just as it did in the bears during and post-hibernation.
While more studies need to be conducted, the HSP47 discoveries greatly illuminate the mechanisms behind blood clotting and thrombosis, opening pathways for new antithrombotic drug development as well as new guidelines for treating VTE.
FDA Update
Drug Approvals
The FDA approved Qalsody (tofersen) to treat patients with ALS that is associated with a mutation in the superoxide dismutase 1 (SOD1) gene. Biogen’s Qalsody is an antisense oligonucleotide that targets the SOD1 mRNA to reduce the synthesis of SOD1 protein via monthly spinal injections. SOD1-ALS is a progressive neurodegenerative disease that attacks and kills the nerve cells that control voluntary muscles that control actions such as breathing or talking. Currently, between 16,000 and 32,000 Americans are living with ALS with approximately 2% associated with mutations in the SOD1 gene.
The FDA expanded approval of AbbVie’s Qulipta (atogepant) to include the preventive treatment of chronic migraine in adults. The drug was previously approved for episodic migraine. The oral drug is the first CGRP receptor antagonist authorized to prevent both episodic and chronic migraine.
Pfizer has received expanded use authorization from the FDA for its Prevnar 20 vaccine, a pneumococcal conjugate vaccine, to include infants and children. It is now approved to prevent invasive pneumococcal disease caused by 20 different Streptococcus pneumoniae serotypes in infants and children six weeks through 17 years of age, as well as to prevent otitis media, an infection of the middle ear, in infants six weeks through five years of age caused by the original seven serotypes contained in Prevnar. Prevnar 20 was cleared for adults in 2021.
Med Device Approvals
Inspire Medical Systems received approval to market the Inspire Upper Airway Stimulation (UAS) system, an implantable nerve stimulator used to treat sleep apnea in young people with Down Syndrome. The Inspire UAS system includes an implantable pulse generator that detects the patient’s breathing pattern and maintains an open airway by stimulating nerves using small electrical impulses. Physicians implant and program the system while patients use an external remote to turn the device on before sleep.
