Show Me the Science

In this episode, Washington University researchers discuss the Food and Drug Administration's recent full approval of the drug Leqembi (lecanemab) and what it could mean to the future of Alzheimer's disease treatments. The drug is approved for use in people with mild dementia from Alzheimer's disease, but researchers at Washington University's Charles F. and Joanne Knight Alzheimer Disease Research Center (ADRC), believe the drug, along with other medications in clinical trials, one day may help prevent the development of memory loss and problems with thinking in people who have Alzheimer's pathology in the brain but who have not yet developed clinical symptoms of the disease. Barbara Joy Snider, MD, PhD, a professor of neurology and director of clinical trials at the Knight ADRC, says that although Leqembi doesn't cure Alzheimer's disease, it slows the decline in memory and thinking, and it also slows the progression of the disorder by removing some amyloid plaques from the brain. John Morris, MD, director of the Knight ADRC, says with amyloid PET brain scans, blood tests and cerebrospinal fluid tests to detect problems before clinical symptoms of Alzheimer's appear, it soon may be possible to delay or even prevent the development of Alzheimer's dementia in some people at high risk. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

In this episode, we discuss new research into psychedelic drugs as potential therapies for psychiatric illness. Several studies have suggested that drugs, such as psilocybin, may be useful in treating problems such as post-traumatic stress disorder, addiction and depression. Psychiatry researchers at Washington University School of Medicine in St. Louis have been using a brain-imaging technique called precision functional mapping to learn how psilocybin affects certain networks in the brain. Principal investigator Ginger Nicol, MD, an associate professor of child psychiatry, says scientists have suspected since the 1950s that there may be benefits from some psychedelic drugs, but because the drugs were classified as schedule one substances, researchers weren't allowed to study them. Recently, that has changed and Nicol, with fellow psychiatry researcher Josh Siegel, MD, PhD, gave a lecture sponsored by Washington University's Taylor Family Institute for Innovative Psychiatric Research, outlining some potential benefits of psychedelics in addressing hard-to-treat psychiatric problems. Using high-tech brain scans, they have been able to see what happens in the brain when a person takes psychedelic drugs, and they've found that the drugs cause more rapid changes than other medications used in psychiatry. What they want to learn next is whether the responses they've observed in brain scans translate into similar responses in the clinic, which could lead to improved mental health. They are planning to participate in a phase 3 clinical trial using psilocybin to treat people with treatment-resistant depression. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

In this episode, we hear from two physician-scientists who have been leaders in the U.S. effort to deal with two medical crises that emerged almost 40 years apart: HIV/AIDS and COVID-19. Anthony S. Fauci, MD, the recently retired director of the National Institute for Allergy and Infectious Diseases at the National Institutes of Health (NIH), spoke to Washington University School of Medicine's 2023 graduating class. His role at NIH made him a leader in the worldwide effort to understand and develop treatments for HIV/AIDS, beginning shortly after the virus first was recognized. Also, in those early days of HIV/AIDS, William G. Powderly, MD, tested emerging therapies at the School of Medicine's AIDS Clinical Trials Unit, which he oversaw. Powderly, now the Larry J. Shapiro Director of the Institute for Public Health, co-director of the Division of Infectious Diseases, and the J. William Campbell Professor of Medicine and director of the Institute of Clinical and Translational Sciences at the School of Medicine, points to key similarities and differences between the nation's response to HIV/AIDS and to COVID-19. In both cases, he says, the key to a successful response involved embracing science and battling against theories that are untrue. In his Commencement speech, Fauci told the 110 newly minted physicians who graduated this spring that they must push back on destructive forces that dispute science. He advised the new doctors to push back with civility, but also with all of the strength they can muster. While he was at Washington University, Fauci also spoke to the St. Louis press corps about the end of the COVID-19 emergency and where we go from here. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

In this episode, we visit a recent event sponsored by the Becker Medical Library at the School of Medicine. Called "In Our Words: Connection," the storytelling event brought together 12 faculty members, medical students, residents and fellows who told stories about how their lives have been affected by medicine as caregivers, those receiving care or otherwise. The idea behind the evening was to share stories and assist physicians and trainees in better understanding that they face many of the same challenges that their patients and colleagues face. Knowing that can help prevent burnout among physicians and help them to provide better care for their patients. Emily Podany, MD, is a hematology/oncology fellow who works with cancer patients, many of whom know their time is short. Her story detailed a meeting several years ago with a patient whose only goal was to make it back home one more time to be with her children and her dogs. Podany made it her mission as a provider to help her patient do just that. We also hear from Amy Riek, MD, an associate professor of medicine in the Division of Endocrinology, Metabolism & Lipid Research. Riek was preparing to give birth to her second child when she discovered a lump in her breast. Her story dealt with how cancer can rob patients of the feeling that they have any control over their lives. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

In this episode, we report on the disturbing spike in maternal mortality rates in recent years. Although rates of maternal death have long been higher in the U.S. than in other wealthy countries, the rate recently reached its highest level since 1965. The number of deaths of mothers has risen from 17.4 deaths per 100,000 births in 2018 to 20.1 deaths in 2019 and 23.8 in 2020 — the first year of the pandemic. Then in 2021, the most recent year for which statistics are available, there were 32.9 deaths per 100,000 births. In all, about 1,200 people died during pregnancy, or within six weeks of giving birth, a 40% increase from the previous year. Ebony B. Carter, MD, an associate professor of obstetrics & gynecology at Washington University School of Medicine in St. Louis, says the groups most likely to be affected by these rising numbers are poor. Many tend to live far away from medical care, and many are members of minority groups. The maternal death rate among Black Americans was 69.9 per 100,000, 2.6 times higher than the rate for pregnant white Americans. Carter says physicians and scientists at Washington University and Barnes-Jewish Hospital are working hard to provide good prenatal care, but she explains that when people get pregnant, they often already have serious health issues that can contribute to maternal death, such as diabetes or hypertension, and put them and their babies at risk. She says the time to try to intervene is before chronic illnesses develop and make an eventual pregnancy risky. That, she says, will require an intentional focus from health-care professionals and systemic changes in how health care and other social services are provided in the United States. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

In this episode, we report on a major international study involving psychiatry researchers from the School of Medicine who are working to identify causes and effects of the early stages of schizophrenia in young people — an illness characterized by significant changes in thoughts, feelings and behavior that may include a loss of contact with reality. The goal is to improve early diagnosis and treatment to potentially prevent the most devastating effects of the disorder. The study's principal investigator is Daniel Mamah, MD, a professor of psychiatry. He has a clinic in St. Louis, where he works with young people to identify biomarkers in the blood and the brain that may help predict risk of debilitating psychiatric illness. He also studies potential drug targets for treating such conditions. In addition, Mamah and his colleagues have expanded their efforts to East Africa. Working with collaborators in Kenya, the researchers are launching a site in Africa to study young people at risk for schizophrenia in hopes of learning more about what causes the illness, as well as how to potentially prevent it. Mamah previously has collaborated with researchers at the Africa Mental Health Research and Training Foundation, and now the scientists are working to identify and compare risk factors for schizophrenia in patients from North America and from Africa. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

In this episode, we head to the emergency department. Doctors in most emergency departments around the country are dealing with fewer COVID-19-positive patients than before, but they continue to be faced with a different epidemic of sorts: the 20% to 30% of patients with dementia-related cognitive issues who seek emergency care. As the U.S. population ages, it's more common for emergency physicians to find themselves treating older people who are living with dementia. Further, during the thick of the COVID-19 pandemic, such patients were not allowed to have relatives stay with them to help navigate and better understand what is happening during their visits to the emergency department. While completing his medical training, Christopher Carpenter, MD, a professor of emergency medicine, had a bad emergency department experience involving his grandfather, who was suffering from dementia at the time. For more than two decades since then, Carpenter has looked for ways to make the emergency department experience easier for those who are living with dementia and their family members and caregivers. He is part of a national effort known as the GEAR Network, which stands for Geriatric Emergency Care Applied Research Network. The organization is studying ways to better identify and serve older patients with dementia. Carpenter says it's essential to improve emergency care for people living with dementia because as the U.S. population continues to age, the number of such people seeking treatment in emergency departments will continue to increase. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

In this episode, we learn more about one of the leading problems associated with long COVID-19. Those who have been infected with the virus are at increased risk for a range of neurological conditions in the first year after an infection. Research conducted at the School of Medicine and the Veterans Affairs St. Louis Health Care System has found that strokes, cognitive and memory problems, depression, anxiety and migraine headaches are more common in people who have had COVID-19 than those who haven't. The most common neurological symptom, called brain fog, makes it more difficult for some people to remember things such as names, daily tasks or where they parked the car. Ziyad Al-Aly, MD, a clinical epidemiologist, says that since the pandemic began, COVID-19 has contributed to more than 40 million new cases of neurological disorders worldwide. Infections even have been associated with movement disorders — from tremors and involuntary muscle movements to epileptic seizures — hearing and vision problems, and issues with balance and coordination. We also speak with Robyn Klein, MD, PhD, director of the Center of Neuroimmunology & Neuroinfectious Diseases at Washington University School of Medicine in St. Louis. Her team studied the brains of hamsters and brain tissue from people who died of COVID-19 infections and found that although the virus doesn't seem to get into neurons directly, it does increase the numbers of immune cells, called microglia, in brain structures important to learning and memory, potentially explaining why some of those structures in the brain may not function as well during and after COVID-19 infections. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

In this episode, we visit the team at the Washington University Living Well Center. It was launched to improve outcomes for patients with orthopedic issues. For example, if someone needs hip-replacement surgery, that person also can receive help losing weight, stopping smoking and taking other actions to make it more likely the outcome from their surgery will be as good as possible. The center uses dietary counseling, physical therapy, massage, acupuncture and behavioral therapy to prepare some patients for surgery, while helping others improve without surgical intervention. In addition to orthopedic issues, health professionals at the center work with cancer patients, long COVID-19 patients and others. The idea, according to Devyani M. Hunt, MD, a professor of orthopedic surgery and the center's medical director, is to treat the whole patient and to do it all in one place. Specialists at the center work together to apply the "pillars of lifestyle medicine including using food as medicine, encouraging physical activity and exercise, addressing sleep issues, managing stress and addressing anxiety and depression, avoiding risky substances such as tobacco, and encouraging patients to make positive social connections. The center has had more than 200 patients come through its doors the last few years, and the outcomes for those patients suggest the approach is working. The podcast, "Show Me the Science," is produced by WashU Medicine Marketing & Communications at Washington University School of Medicine in St. Louis.

As we get deeper into autumn and winter approaches, we discuss COVID-19 vaccines. New boosters have been developed to rev up the immune system not only to fight the original strain of the virus but also to boost the immune system against more recent omicron strains of SARS-CoV-2. In this episode, we discuss the boosters — now approved for use in children as young as 5 — with infectious diseases specialist Rachel M. Presti, MD, PhD, an associate professor of medicine and medical director of Washington University's Infectious Diseases Clinical Research Unit. New vaccines may be on the horizon, too. A nasal vaccine developed by Washington University scientists recently was approved for emergency use in India, and that technology has been licensed to Ocugen, a U.S.-based biotechnology company focused on developing and commercializing novel gene and cell therapies and vaccines. Ocugen plans to seek approval for the nasal vaccine in the U.S., Europe and Japan. The nasal vaccine was developed by Washington University virologist and immunologist Michael S. Diamond, MD, PhD, the Herbert S. Gasser Professor of Medicine and a professor of molecular microbiology, and of pathology & immunology; and David T. Curiel, MD, PhD, the Distinguished Professor of Radiation Oncology. The hope is that the nasal vaccine will stoke the immune response in the nose and throat so that the virus never gets farther into the body. Current vaccines require a person to be infected before antibodies revved up by the vaccine can fight it. As a result, Diamond and Curiel say a nasal spray may be more effective at preventing infections and at keeping vaccinated people from spreading the virus to others. The podcast, "Show Me the Science," is produced by the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis.