The Scan by 2 Minute Medicine®: Triple Attack Against Endometriosis, Vaccines and Autism, Revisited, The Final Frontier of Human Health, and Eating Well to Live Better:

The Scan by 2 Minute Medicine® is a pop-culture medical newsletter and exclusive benefit for 2 Minute Medicine Plus subscribers.

We begin with a discussion about a new, three-in-one therapy for endometriosis. Then we take a closer look at a planned Centers for Disease Control and Prevention study for connections between vaccines and autism. After that, we examine the effects of extended durations of space flight on human health. Finally, we discuss the relationship between eating well and healthy aging.

Triple Attack Against Endometriosis:

The Story: Relugolix combination therapy, marked under the brand name Ryeqo, is the first daily pill for treating endometriosis and has been approved by the National Health Service (NHS) for use in England and Wales.

So, what is endometriosis?

Endometriosis is a chronic gynecologic disease in which tissue similar to the inner lining of the uterus grows outside of the uterine cavity. It affects approximately 10-15% of women of reproductive age and diagnosis is often delayed, leading to avoidable suffering. Endometrial tissue, like normal uterine tissue, reacts to a woman’s natural hormonal cycle and proliferates under the influence of estrogen. However, its presence in unnatural locations leads to chronic pelvic pain, pain with menstruation or vaginal intercourse, excessive vaginal bleeding, recurrent urinary tract infections, and even infertility.

How is endometriosis currently treated?

There is unfortunately no cure for endometriosis and treatment targets symptom management. Nonsteroidal anti-inflammatory agents are cheap but weak and carry the risk of kidney disease and stomach and small intestine ulcers. Combined hormonal contraceptives are commonly prescribed for endometriosis although their effectiveness is equivocal. 

Surgery is reserved for patients who fail to respond to drugs and consists of removing endometrial lesions or removing the uterus and/or ovary and fallopian tubes in patients with no desire for future pregnancy. This may temporarily reduce pain but symptoms often return and patients require further operations.

How does Relugolix combination therapy, or Ryeqo work?

Relugolix blocks the estrogen “control hormone”, thereby decreasing estrogen levels, the hormone responsible for endometrial tissue proliferation. However, low estrogen can lead to menopause-like symptoms such as hot flashes, weak bones, vaginal dryness, and irritability. Ryeqo solves this issue by combining relugolix with two other hormones, estradiol and norethisterone acetate, to optimize the body’s estrogen levels. This three-in-one tablet provides patients suffering from endometriosis with convenience, more choices, and even hope for those who have seemingly exhausted all options.

Vaccines and Autism, Revisited:

On February 28, 1998, Andrew Wakefield, a former British doctor, infamously published an article in The Lancet, a prestigious medical journal, linking the measles, mumps, and rubella vaccine to autism. The paper has since been retracted by its co-authors and the journal, numerous studies have refuted its findings, and Andrew Wakefield was de-licensed and found guilty of deliberate fraud. However, it took nearly two decades for the United Kingdom’s (UK) immunization rates to recover, and measles outbreaks in the UK in 2008 and 2009 and the current outbreak in the United States (US) have been attributed to low vaccination rates.

Nearly 30 years later, the belief that vaccines cause autism remains strong. Earlier this month, The US Department of Health and Human Services (HHS) asked the Centers for Disease Control and Prevention (CDC) to study potential connections between vaccines and autism. HHS spokesman Andrew Nixon said, “As President Trump said in his Joint Address to Congress, the rate of autism in American children has skyrocketed. CDC will leave no stone unturned in its mission to figure out what exactly is happening.” President Trump and Robert F. Kennedy, Secretary of HHS, have both linked autism to vaccines. However, advocates for people with autism are pushing against this announcement. Alison Singer, president of the Autism Science Foundation, said, “Even just the notion that the government needs to study this is harmful. It will plant seeds of fear, […] parents will withhold vaccines, and children will die.”

The Final Frontier of Human Health:

On June 5, 2024, American astronauts Sunita Williams and Butch Wilmore launched into space for an eight-day mission. Over nine months later, they finally returned to Earth after mechanical issues with their Boeing Starliner spacecraft unexpectedly extended their stay. At 286 consecutive days, well over the average six-month duration of International Space Station (ISS) missions, Ms. Williams and Mr. Wilmore’s prolonged stay is the sixth-longest in National Aeronautics and Space Administration (NASA) history.

While many of us dream of traveling to space, recovering from “the most extreme environment that humans have ever encountered” can take years. NASA uses the acronym “RIDGE” to summarize spaceflight hazards: Space Radiation, Isolation and Confinement, Distance from Earth, Gravity fields, and Hostile/Closed Environments. As the body shifts from gravity to weightlessness, its muscles, heart, and blood vessels no longer have to fight against gravity and weaken, with weight-bearing bones losing an average of 1%-1.5% of their density every month. Fluids within the body are also not pulled down by gravity and drift upwards, potentially leading to brain swelling and changes in the eye. Even things we can’t see, such as radiation and microbes, are more dangerous in space. Despite these risks (and no overtime pay!), Ms. Williams had no regrets, telling reporters, “I love being up here in space. It’s just fun, you know?”

Eating Well to Live Better Later:

A recent study found specific diets during midlife can increase the chances of “healthy aging”. The study, published Monday in Nature Medicine, a prestigious medical journal, followed over 100,000 individuals from 1986 to 2016. Participants were assessed for their diet and for “healthy aging”, which the study defined as “surviving to the age of 70 years without the presence of 11 major chronic diseases (e.g. cancer, diabetes, kidney failure, etc.) and with no impairment in cognitive function, physical function or mental health”.

The study examined the association between healthy aging and long-term adherence to eight healthy dietary patterns. While it is widely known that healthy eating correlates with healthy aging, the study identified specific relationships. For example, the Alternative Health Eating Index was most strongly associated with maintaining physical function, mental health, and healthy aging overall. The Planetary Health Diet Index was most strongly associated with maintaining cognitive health and surviving to 70 years old. Indeed, Blue Zones, geographical areas with exceptionally high life expectancies and low rates of chronic disease, have dietary patterns similar to those identified in this study. As Dr. Marta Guasch-Ferré, the principal investigator, said, “It’s not just about living longer but also maintaining good health in the later stages of life.”