The 2 Minute Medicine Podcast Episode 37

We begin with a discussion about our article of the week entitled “Electronic nicotine delivery systems for smoking cessation. In the second half of the episode, we discuss Kate Middleton’s recent cancer diagnosis and have a conversation about cancer trends that have recently made the news. Next, we follow with a discussion about the first person to undergo kidney transplantation from a genetically altered pig, take a closer look at the solar eclipse and its impact on eye health, and conclude with a conversation about lab-grown meat and what the research has shown so far.

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Transcript

[Deepti] Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians. For our full suite of daily medical study summaries and updates written by practicing doctors, please visit our website at 2minutemedicine.com to start reading new daily content right now, for free. On this podcast, twice a month, we cover the latest in health care news and research evidence. We are your hosts Deepti and Andrew. On today’s episode, we’ll start off by discussing our two articles of the week. In the second half of the episode, we will look at health issues that have arisen in popular media. 

[Andrew] Our article of the week comes from the New England Journal of Medicine and is entitled “Electronic nicotine delivery systems for smoking cessation.” E-cigarettes allow users to inhale nicotine while avoiding many of the toxic combustion products of tobacco cigarettes. However, e-cigarette aerosols are also hypothesized to contribute to adverse biological effects, and literature discussing the safety and efficacy of e-cigarette use for tobacco cessation is scarce. This multicenter, open-label, randomized controlled trial was conducted in Switzerland and involved 1,246 adults with a smoking history of at least five cigarettes per day for at least 12 months as well as a desire to quit smoking within three months of enrollment. Participants were randomized in a 1:1 ratio to receive either standard-of-care counseling or standard counseling plus two e-cigarette starter kits with up to 10 e-liquid bottles. Those who were assigned standard counseling alone also received a voucher valued at $50, which they could use for any purpose. Abstinence from smoking was biochemically validated by an anabasine level of less than 3ng per milliliter in a urine sample or an exhaled carbon monoxide level of 9 ppm or lower. Continuous abstinence from smoking at six months occurred in 28.9% (180 of 622) of the participants in the intervention group and 16.3% (102 of 624) in the control group (crude relative risk, 1.77; 95% Confidence Interval [CI], 1.43 to 2.20). A total of 59.6% of the participants in the intervention group and 38.5% in the control group reported abstinence from tobacco in the seven days before the six-month visit. However, only 20.1% of the intervention group and 33.7% of the control group reported abstinence from nicotine completely in that same period. During the follow-up period, 25 participants in the intervention group and 31 participants in the control group had a serious adverse event (p=0.49). However, of the participants in the intervention group, 272 (43.7%) reported 425 adverse events; of the participants in the control group, 229 (36.7%) reported 366 adverse events (relative risk, 1.19; 95% CI, 1.04 to 1.37; unadjusted p = 0.01). In summary, this trial found that those who received e-cigarettes in addition to standard counseling were significantly more likely to have biochemically validated, continuous abstinence from tobacco smoking at six months versus those who received standard counseling alone. However, those in the intervention group had a lower rate of nicotine abstinence compared to the control group, largely due to the continued use of e-cigarettes. Those in the intervention group also had more adverse events overall compared to those in the control group, but the frequency of serious adverse events was similar between groups. This study had several limitations, including transparency of group assignment, a short follow-up period, and a single-country setting. Overall, these findings reinforce that e-cigarettes may be a valuable addition to standard care in reducing tobacco use in the short term.

[Andrew] Now for The Scan.

The story: Kate Middleton’s disappearance in the past few months gave rise to many speculations, however, on March 22, she released a videoto update the public about her health status. The Princess of Cambridge underwent a successful abdominal surgery in January and shared that she was diagnosed with cancer post-operation. At the age of 42, Kate has now begun her preventative course of chemotherapy. You may be thinking, Is cancer on the rise among young people?

[Deepti] We have heard about many celebrities who have been diagnosed with cancer before the age of 40, for example, Park So-dam, the Korean star from the movie “Parasite” or  Michael C. Hall, the actor playing the popular serial killer “Dexter”. Both Michael C. Hall and Park So-dam survived their cancer, however, the “Black Panther” movie star, Chadwick Boseman who was diagnosed with colon cancer at age 40, passed away in 2020, when he was only 43 years old. New studies are showing a concerning trend. One study showed that Between 2010-2019, there was a significant increase in the incidence rates of early-onset malignancies among people younger than 50 years in the United States. Of note, the greatest increases occurred in the gastrointestinal system, breast, and endocrine system with gastrointestinal cancers showing the fastest-growing incident rates (14.80%; from 6431 cases to 7383 cases). Those between the ages of 30 and 39 saw the biggest increases in the incidence rates of early-onset gastrointestinal malignancies.    

[Andrew] The reason behind this alarming trend is not well-known yet. However, several factors such as sedentary lifestyle, smoking, drinking, and obesity as well as environmental factors such as exposure to carcinogenic chemicals and pollutants are believed to play a role in early-onset cancers.   

Monitoring the age trends of cancer diagnosis has important implications for clinical guidelines and practice. In 2018, the American Cancer Society updated its guidelines and recommended colorectal screening at the age of 45 rather than 50 based on the more recent data. In 2023, the American College of Radiology advised all women to have risk assessments at age 25 to see if they would benefit from breast cancer screenings before the age of 40, especially Black and Ashkenazi Jewish women.

[Deepti] Next, let’s take a look at how on March 16, 2024, a man in the United States became the first person to undergo a kidney transplant from a genetically altered pig. Richard Slayman of Weymouth, Massachusetts is a 62-year-old man with end-stage renal disease who underwent the 4-hour-long operation and so far, has been recovering well. 

The kidney was taken from a miniature pig with 69 genomic edits to prevent organ rejection and reduce the risk of viral infection transmission from the organ donor to the recipient. Thousands of researchers and medical professionals have worked for decades to successfully perform this transplant.

Malorie Blackman is no medical scientist, but the British children’s author has been hopeful about xenotransplantation (the transplantation of organs from one species to another) for many years. In 1997, she published “The Pig Heart Boy”, a novel about a 13-year-old boy transplanted with a pig’s heart. In 2022, 25 years after Blackman’s novel, the first successful human heart transplant using a genetically modified pig heart happened in history, at the University of Maryland Medical Center. The second living person to receive a pig heart was transplanted on September 20, 2023.  While both patients passed away due to heart failure about 6-7 weeks post-operation, valuable lessons were learned from this ground-breaking procedure that hopefully can pave the path for further xenotransplantation attempts. Now, we will take a closer look at the the risks of viewing a solar eclipse unprotected.

[Andrew] On April 8th of this year, many North Americans will have the opportunity to see a total solar eclipse. Considering that the next coast-to-coast total solar eclipse will be in 2045, it is understandable that many people would not want to miss this event. However, what some people might not know is how the unsafe viewing of this celestial event can lead to permanent eye injuries. 

[Deepti] On March 20, the New York Times went over reports from ophthalmologists from the US and UK highlighting the vision complaints received after past solar eclipse events including the case of four Irish women who suffered from blind spots in their central vision 11 years after viewing the 2009 eclipse without protection. So, what is a safe way to enjoy this once-in-a-lifetime event?

According to NASA, a total solar eclipse permits spectators to remove their eclipse glasses for a brief period of time while the moon totally covers the sun. However, outside this narrow time window (not more than 4 ½ minutes on April 8th within the path of totality), viewers should always utilize their eclipse glasses or alternative viewing techniques, like a pinhole projector, until totality occurs. 

[Andrew] Lab-grown meat, also known as cultivated meat, is thought to reduce climate pollution and animal suffering. Bill Gates and Leonardo DiCaprio are among some of the celebrities who have been advocating for cultivated meat by investing in companies such as “Upsides Foods”, “Aleph Farms” and “Mosa Meat”. Even Saudi’s Prince Khaled bin Alaweed has invested in “BlueNalu” to support cultivated seafood.

 However, despite these advocacies, with the introduction of HB 1071 and SB 1084 bills, Florida legislators are pushing for the production and sale of lab-grown meat to be outlawed statewide. Aside from an attempt to protect the cattle industry, the Florida state representatives argue that long-term studies to prove the safety of cultivated meat are lacking.

[Deepti] What has research shown so far? The safety profile of cultivated meat is not well known yet. Considering the high-level cell multiplication involved in the production of cultivated meat, some dysregulation is likely as happens in cancer cells. In addition, currently, it is not clear how to control the nutritional makeup. In terms of environmental impact, there is a controversy over the cultivated meat industry being more advantageous than conventional meat, especially concerning greenhouse gas emissions. According to a new preprint paper by researchers at the University of California, Davis (UC Davis), the global warming potential (defined as the carbon dioxide equivalents emitted per kilogram of meat produced) of lab-based meat produced with the use of purified growth media is 4 to 25 times greater than the average for conventional retail beef. 

 It remains to be seen if advancement in the cultivated meat industry will be sufficient to make lab-grown meat compete with traditional meat and replace it on a large scale.

[Andrew] We’d like to acknowledge the following members of our team for their contributions to this week’s episode

• Marzyeh Azimi
• Thomas Su
• Keira Liblik

Thank you for joining us today for this episode of the 2 Minute Medicine Podcast. New episodes come out every other week and all of our content has been curated and written by practicing physicians.