The year in medical research

Previously, we mentioned the fascination that the human microbiome holds over medical researchers. In sum, it is the genome of the microorganisms that inhabit the human body, which includes bacteria, fungi, and viruses.

Most of us are perhaps more familiar with bacteria, especially those present in the gut. Researchers have linked gut bacteria to a wide array of health phenomena, including, most recently, weight loss, heart disease, and inflammation.

Our body’s most surprising permanent lodgers are viruses, which we tend to associate with infections and ill health. However, not all viruses are the same, and scientists believe that many might even play a positive role in health,

Back in February 2021, scientists from the Wellcome Sanger Institute and the European Bioinformatics Institute in Hinxton, United Kingdom, reported that they had established a comprehensive “atlas” of bacteria-eating viruses that inhabit the human gut. These viruses are called bacteriophages or phages for short.

This new database indicates that the human gut contains over 140,000 different phages. While most of these viruses can only infect and attack a single bacterial species, around 36{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of phages may have the capability to infect several types of bacteria.

Researchers identify previously unknown phages regularly. One study from October 2021 reported on a newly identified phage that occurs in the human gut. The scientists dubbed it LoVEphage, which stands for “lots of viral elements.”

Currently, it is unclear what role or roles this and other bacteriophages might play in human health. Yet, it is becoming increasingly apparent that they could provide the key to some unanswered questions.

“Everyone knows that gut bacteria are important,” said our Senior News Editor, Tim Newman. “That’s something that has become common knowledge over the last 20-30 years. But these bacteriophages kill bacteria. So if gut bacteria are really important to health, then these phages will be as well.”

One way bacteriophages interest scientists is through their potential for offering an alternative to antibiotics in an era when antibiotic resistance is becoming a widespread problem. Indeed, one study published this autumn suggests that a naturally occurring phage can successfully reduce the spread of the bacterium that causes dysentery.

It is no secret that, like many other fields, medical research and healthcare are gravely affected by structural racism and other forms of discrimination. This impacts who receives healthcare and whether they feel able and confident to seek medical assistance in the first place.

There are many expressions of structural racism in medicine, and one of these is through the visual representation of skin conditions. For years, visual reference material about skin conditions has taken white skin as the standard.

Yet, it stands to reason that signs of dermatological issues will present differently on skins of different tones and colors. So, not including accurate visual representations for the full spectrum of skin colors results in untreated conditions, often leading to fatalities.

For example, around one-quarter of African American people with skin cancer only receive a diagnosis once the cancer has already spread to the lymph nodes. And while white adults in the United States who have received a diagnosis of melanoma have a 5-year survival rate of 92{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, African American people with skin cancer have a 5-year survival rate of 67{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

One global initiative — called Project IMPACT, built on the clinical decision support system software VisualDx — is now working to level these disparities by creating and sharing a catalog of images that show how different skin conditions appear on darker skins.

Earlier this year, Ana Sandoiu, News Editor II at MNT, interviewed Dr. Nada Elbuluk about systemic discrimination in healthcare and the development of Project IMPACT, which she helped launch. Dr. Elbuluk is a skin of color expert, practicing dermatologist, and dermatology professor at the Keck School of Medicine at the University of Southern California in Los Angeles.

“[I]n our interview, it quickly became clear that basically worse disease outcomes [for] morbidity and mortality that result from these inequities are the main reason why resources, such as the one that VisualDx created, are so important,” said Ana.

She called the statistics showing the lower survival rates for African Americans with skin cancer “chilling numbers,” pointing out that they mean one thing: Black Americans do not receive timely care for this condition.

“[W]hen Black Americans do reach the doctor’s office, and they get a diagnosis, it’s either already at a late stage, or as Dr. Elbuluk pointed out in her interview with me, these biases in dermatology and medical practice that favor white skin could mean that a lot of these conditions may be missed altogether or misdiagnosed,” Ana noted.

Dr. Elbuluk and her colleagues also found a shockingly low number of published research articles looking at how skin discoloration, acne, and eczema affect People of Color.

According to her, such articles are “in the single digits,” and this situation will likely impact outcomes for People of Color who, as the expert’s research shows, often seek dermatological care for these same conditions.

“Having that cultural competence, or cultural humility, which is a more recent term, is really important. When patients feel that they’re seen and they’re heard and they’re acknowledged, it makes a difference,” Dr. Elbuluk told Ana.

“[T]hose things carry a lot of weight for patients, and if I’m a patient of color and my physician understands what’s pertinent to me, to my background, [and] to how I take care of my hair or my skin, all of that is so important in making a connection with the patient.”

– Dr. Nada Elbuluk

Racism is not the only issue that medical research and healthcare have had to face in 2021. They have also had to contend with the gender data gap, as evidenced by reports that some people who menstruate experienced unusual periods following a COVID-19 vaccine.

The gender data gap refers to the phenomenon that, historically, researchers have taken men’s lives and the male body as the standard of health and well-being and then applied them to female bodies.

However, it has become increasingly evident that females experience many conditions, such as coronary heart disease and ADHD, differently. The gender data gap means that many females with these conditions do not receive an accurate diagnosis.

Earlier this year, a study looking at sex bias in clinical trials concluded that females were most underrepresented in the area of oncology, which is the study of cancer. Other neglected areas include neurology, immunology, cardiology, and genitourinary disease.

Little wonder then that reports of the COVID-19 vaccines potentially disturbing menstrual cycles caused confusion: Do the vaccines really cause these disturbances, and if so, what might the mechanisms be, and who is most at risk of experiencing them?

There is currently only one study that gathered data about COVID-19 vaccines and menstrual changes. Dr. Katharine Lee, a postdoctoral research fellow in the Division of Public Health Sciences at the Washington University School of Medicine in St. Louis, MO, and Dr. Kathryn Clancy, an associate professor in the Department of Anthropology at the University of Illinois at Urbana-Champaign conducted the study. I interviewed them in July 2021.

They set up a survey — now closed, with data analysis pending — asking people who menstruate about their experiences back in spring, after Dr. Clancy and then Dr. Lee experienced changes to their periods following vaccination.

The study, however, only looks at the prevalence of such menstrual changes and not at the potential mechanisms, which, hopefully, future studies will cover.

Understanding how often such changes might occur post-vaccination is only the first step in a long process.

Researchers are yet to determine whether these disturbances to menstrual cycles are due to COVID-19 vaccines since many independent factors can affect periods, including chronic stress — and an ongoing pandemic, as well as vaccine hesitancy, can be prominent stress factors.

Looking out for how new vaccines might impact menstrual cycles at the clinical trial stage could go a long way towards clarifying the presence — or absence — of causal links.

Yet when I interviewed Dr. Lee, she expressed some surprise and disappointment that the researchers behind COVID-19 vaccine development and testing do not seem to have given much thought to how these vaccines might affect periods.

“I think just remembering to ask about differences in the menstrual cycle as part of standard clinical testing of vaccines might be nice, given that we expect a huge immune response, and we know that huge immune response[s] can disrupt lots of other inflammatory pathways in people. Menstrual cycles tend to be something that people who have periods pay attention to, and [they] notice when things get a little bit wonky […].”

– Dr. Katharine Lee

In the meantime, an editorial that appeared in The BMJ also called for more investigation into the potential link between COVID-19 vaccines and changes to periods.

Data cited in the editorial at the time of publication indicate that over 30,000 people in the United Kingdom alone had reported disturbances to menstrual cycles following vaccination.

Our News Editor, Yasemin Nicola Sakay, was most struck by the debates around the so-called Freedom Day in the United Kindom, home to the MNT offices.

On July 19, 2021, British authorities announced Freedom Day when they lifted almost all previous pandemic restrictions — including requiring people to wear masks indoors and on most means of public transport.

While some members of the public, tired of the sense of isolation that obligatory mask-wearing and physical distancing can give, rejoiced at this decision, some public health experts criticized it as unwise, suggesting that it might lead to surges in SARS-CoV-2 infections.

At the time, a study conducted by Imperial College London found that new infections with the Delta variant were on the rise in unvaccinated 5-12-year-olds and in 18-24-year-olds who had only just become eligible to receive a COVID-19 vaccine.

In an open letter published in The Lancet at the end of July, several signatories warned about lifting the restrictions too soon.

“My epidemiology colleagues are concerned that this virus has a high propensity to mutate, and the ‘survival of the fittest’ principle will ensure that new variants are adapted to their environment better than the ones they replace,” one of the signatories, Prof. Trish Greenhalgh, told Yasemin.

In hindsight, her prediction appears to have come true. At present, the U.K. is facing an alarming rise in cases of COVID-19, mainly attributed to the spread of the new Omicron variant of SARS-CoV-2.

Keeping one key restriction in place could have made a significant difference, Yasemin explained: “[A]lmost all of the scientists [I interviewed] converged on one point, and that was that some restrictions, namely mask-wearing, should remain in place. And that decision was science-based because COVID-19, as we know, is an airborne disease and SARS-CoV-2 particles spread through the air.”

Yet there has been and continues to be widespread resistance to mask-wearing. The concept of psychological reactance, which refers to the phenomenon whereby people react adversely to messages concerning public health, may help explain it.

A study that appeared in PLOS ONE in February suggests that to address psychological reactance and improve adherence to mask-wearing, those generating the public health messages should focus more on highlighting personal choice and its impact on the individual and on those around them.

“[D]o it for yourself or someone you love,” said Yasemin when asked what she would tell people who are unsure about using face masks. She and our other editors encourage all of our readers to reflect on how small choices — such as wearing a mask or not — could alter the lives of those at high risk of developing severe COVID-19.

Looking to 2022, MNT‘s editors would like to see more exciting research on the intriguing, mysterious inhabitants of the human body, such as phages.

We also hope there will be an increased focus on health equity in research and healthcare and that health workers and public health experts will continue to empower those who seek medical advice by listening closely to all their concerns.

Finally, we hope to see more research into how emerging COVID-19 vaccines and therapies affect people who are immunocompromised and into ways of offering more protection to those at risk of becoming seriously ill.

In the meantime, may we all stay healthy and safe!