Issue 106

Precision genetic medicine: The fourth wave of drug development

Hello friend! Welcome to Scrap Facts.

I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each issue, I'll bring you some of my favorite facts that I picked up on the job or while out living life.

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May 9, 2021

The complete guide to the fourth wave of pharmaceuticals, and my swan song for Quartz.

Reader, a lot has happened since my last issue.

For one thing, I resigned from my role at Quartz last month. I’m incredibly grateful for each and every story that publication gave me to write, and for all the talented colleagues I got to work with along the way.

For another, it means that I had to decide what I wanted my final piece of work to be after nearly six years (five years, 11 months, and three days to be exact, since I started as an intern). I chose a massive overview of a topic that had been in the back of my mind for years, that only recently gained mainstream notoriety because of Covid-19.

Illustration credit: Beatrice Liu

Precision genetic medicine doesn’t sound sexy, but it’s the era of medicine that could cure whatever ails us in our lifetimes—20 years, by some estimates. This kind of medicine is modeled after our cellular biology, and how our bodies use and interpret our DNA into proteins and ultimately keep us strong and functioning.

If it sounds far out, keep in mind that the Pfizer-BioNTech and Moderna Covid-19 vaccines are a prime example of this kind of medicine. By introducing mRNA to our muscle cells, our muscle cells get the set of instructions to make the SARS-CoV-2 virus, which is enough to spook our immune systems into making antibodies.

But there’s all kinds of RNA you can introduce into your cells to make all kinds of proteins. Sometimes, you’d want to get the body to produce the proteins found on the outside cancer cells, to get your immune system to kill off those cells instead. Other times, you may want to get the body to stop producing deformed proteins from a mutation that makes us sick.

It’s easy breezy in theory, but in practice it’s been some 70 years in the making. Biologists and chemists have worked tirelessly together to make it happen. But now, it’s there time to shine: There were less than 10 approved therapies using these techniques before the Covid-19 pandemic; now that precision vaccines have proven themselves, it won’t be long before that number increases exponentially.

Some scrap facts on the topic to get you started:

  • DNA may be our master genetic code, but all life stems from RNA—which is why it’s a tool we use in at least three forms in our cells.

  • Alec Bangham, a biophysicist and clinician University College London, invented the first iteration of lipid nanoparticles to carry medicine in 1965. He called them “multilamellar smectic mesophases,” but for obvious reasons, “banghasomes” is the name that took off

  • Most cancer hides tells your immune system to ignore it. Cancer vaccines are actually just reintroducing the proteins on cancer cells to our immune systems to they can attack it.

  • “Blockbuster” drugs is a technical term that means a product pulls in more than $1 billion in revenue. Because drug companies love to pursue these products, rare diseases have often been ignored—or treatments have cost upwards of hundreds of thousands of dollars to make up for the small patient base.

  • Each of our cells have combinations of some 4,000 receptor proteins on their outside. Getting drugs to target cells requires figuring out the right combination of these receptors to match your therapy.

You can read my feature here: Huge thanks to Alex Ossola, a friend and the editor who made it all happen in my last weeks at Quartz.

As for me, I’m headed to Politico! I’ll be covering the US Food and Drug Administration—and hopefully lots of genetic medicine in that context.

Before I can continue Scrap Facts and Age, I’ll need to clear it with my new editors—but I’m optimistic we can work something out. I should be back in your inbox with new links to new stories in a jiffy.

That’s all for now—stay curious, friend ❤️

If you love Scrap Facts, consider hitting the “like” button at the bottom of this page, or sending it to a friend. You can also send your own scrap facts to scrapfacts@gmail.com to be featured in future editions. Wanna keep in touch outside of this newsletter? Follow me on Twitter and Instagram.

Top image by E. Y. Smith; headshot by Matt Anzur.

Issue 105

Racism stalling pandemic science, external advisory boards, and broadband as a social determinant of health

Hello friend! Welcome to Scrap Facts.

I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each issue, I'll bring you some of my favorite facts that I picked up on the job or while out living life.

Love Scrap Facts? Consider hitting the “like” button, or tell your friends to sign up!

March 28, 2021

Racism is getting in the way of answering questions critical for preventing future pandemics.

Found while reporting: Where Covid-19 came from is as much a political question as a scientific one.

At the beginning of the pandemic, scientists were more preoccupied with the explosive spread of Covid-19 than they were with the origin of the SARS-CoV-2 virus. Four out of the last five respiratory pandemics were viruses that evolved from infecting animals to infecting people—that was likely the story for this virus, too.

Except the evidence confirming it never emerged. It still hasn’t, which is why the World Health Organization sent over a delegation of 10 scientists to Wuhan, China, earlier this year. They were looking for evidence that the virus either came from an animal, or that it may have escaped from a lab, like the Wuhan Institute of Virology, while it was being studied.

Most of the evidence points to the fact that it was zoonotic (science speak for “from animals”)—but it’s suspicious that scientists haven’t been able to find actual animals hosting the virus nearby. If that were the case, we’d want to double down on finding and studying viruses that could evolve to infect humans, which scientists have already been doing. But if it did escape from a lab—even if it were originally a zoonotic virus that had been brought back to be studied—scientists would want to know, because it’d have huge implications for how they’d approach security in these spaces. The WHO delegation’s final report is expected any day this week.

But scientists haven’t been enable to properly conduct this work. Part of it is because the Chinese government hasn’t been particularly forthcoming with information about the virus in the early days of the pandemic. But a much larger part has to do with politics.

When former US president Trump started blaming Chinese scientists for the pandemic (a flimsy accusation; there are so many other reasons this virus has killed nearly 3 million people, including a general lack of pandemic preparedness overall), he immediately associated anyone exploring the lab-release theory with his anti-Asian racism. As a result, scientists didn’t want to even explore the question, for fear of perpetuating hate. Arguably, the murder of eight women, six of whom were Asian, two weeks ago, were motivated by this racist sentiment.

I’ve donated to the Asian American Journalists Association in the wake of the horrific rise in racist violence. If you can, consider doing the same to support Asian voices in the media.

The US Food and Drug Administration has dozens of external advisory panels to keep them in check.

Found while reporting: AstraZeneca’s data missteps shows that drug regulation actually works.

The bad news is that the US Food and Drug Administration is understaffed. They’ve got way too many medical products and therapies to clear and authorize or approve than they’ve got people power.

But fortunately, they’ve got a workaround to make sure they’re holding drug companies accountable—external advisory boards.

If you’ve been hearing talk about the safety and efficacy of AstraZeneca’s Covid-19 vaccine this week, it’s because an external data and safety monitoring board flagged some discrepancies in the data AstraZeneca submitted. It could have been an honest mistake, and the Anglo-Swedish drug company has since rectified the error to show that their vaccine is actually around 69 to 75 percent effective.

While it’s been an unfortunate PR moment for AstraZeneca, the fact that this external board acted so promptly showed that the FDA’s current system works, even in a dire situation like a pandemicwhich is a great thing!

Although I’d argue that ideally the US government would fund the FDA enough to have all of these boards internally reviewing data, Jordan Paradise, a professor of law at Loyola University in Chicago, pointed out that really, you probably don’t want the same group of people making the final decision to authorize drugs to do all the data review. There’s can be a surprising (or, maybe not so surprising, depending on how cyclical you are) amount of funding from pharma companies to the FDA per the 1992 US Prescription Drug User Fee act, which can allow drug companies to finance the FDA to expedite its review of the product in question.

Groups of physicians are banding together to argue that access to broadband gets the status of a “social determinant of health.”

Found while reporting: Access to broadband could affect your healthcare.

There are a lot of factors medical professionals wish they could control for their patients. Racism is one of the biggest, but there’s also socioeconomic status, geographic location, and many more. They label these factors “social determinants of health.”

Now that we’ve seen how telehealth can be a complement in-person health care, we’ve also seen where it doesn’t work—which includes people with inadequate internet access. Those individuals are disproportionately likely to fall though the cracks of regular, in-person health care, too.

Independent physicians, as well as professional groups like the American Medical Informatics Association have noticed this, and are petitioning to get broadband access labeled as another social determinant of health, which could allow it additional funding from groups like the Department of Health and Human Services. Right now, independent groups and the Federal Communication Commission are trying their best to rectify these discrepancies, but they could use the extra help.

Other stuff you may have missed:

The speed with which Covid-19 vaccines came to market is the speed of science—sans red-tape/cost prohibitions. I spoke with Panagis Galiatsatos, a pulmonologist at Johns Hopkins University, for a Quartz event answering EVEN MORE of your. Covid-19 vaccine questions. You can watch the recap here.

Bonus shot: My face when Galiarsatos said an exceedingly rare side effect of Tylenol is your skin melting off. (He said you should still take Tylenol if you need it—its effects are exceedingly more beneficial than it is risky.)

There are some “low hangover” boozy drinks out there, but weirdly that’s not science’s top priority right now. We’re gonna have to wait for those clinical trials for a hot minute. Don’t hold your breath, though—booze still isn’t ever gonna be great for anyone.

Want to hang out with your vaccinated friends? According to the US Centers for Disease Control and Prevention, your household can—but it’s probably unwise to go beyond that for now, until more studies on whether vaccines can stop transmission have occurred…

But luckily, they’re already underway! The CDC is keeping track of several observational studies that should give public health experts information on how well vaccines stop against transmission.

The Biden administration has orchestrated cooperation in the drug industry. Even more former competitors are working together to make Covid-19 vaccines, thanks to to the Defense Production Act. His team’s got a lot of work ahead of it if they want us to be able to celebrate America’s birthday in July—but it’s doable.

Nine of the 10 happiest countries are in Europe. Even with those harsh winters. Woof. Europe is also home to some of the largest populations of vaccine hesitant people 🤔 despite their enormous trust in government. That’s a public health conundrum!

That’s all for now—stay curious, friend ❤️

If you love Scrap Facts, consider hitting the “like” button at the bottom of this page, or sending it to a friend. You can also send your own scrap facts to scrapfacts@gmail.com to be featured in future editions. Wanna keep in touch outside of this newsletter? Follow me on Twitter and Instagram.

Top image by E. Y. Smith; headshot by Matt Anzur.

Age: Issue 3

Bacteria: The origins of aging

March 21, 2021

Hello friend! Welcome to Age, a bi-weekly special edition of Scrap Facts.

Every issue, I’ll be exploring how different kinds of life experience time, based on an interview with a researcher in the field. Got a question about aging you’d like answered? Reply to this email and you may see it in a future edition.

Love Scrap Facts? Consider hitting the “like” button, or tell your friends to sign up!

Bacteria: The origins of aging

In conversation with Lin Chao, a computational geneticist at the University of California San Diego.

Lin Chao didn’t mean to study the origins of aging. Instead, he wanted to study evolution. It’s hard to do in species with long life cycles (such as humans) because it simply takes too long (literal decades). But for bacteria—specifically, a species called E. coli—a new generation buds in 30 minutes. Humans have been around for roughly 10,000 generations, says Chao. For E. Coli, that same number of generations are born in less than a year.

An electron microscope image of E. Coli, courtesy of the US National Institute of Allergy and Infectious Diseases

Chao planned to study the rate at which bacteria evolves. But instead, he discovered something else: Aging as we know it originated in bacteria—which means all the consequences of aging we see in multi-cellular creatures have an evolutionary basis in our single-celled friends.

To explain this a little more, we first have to actually define aging. Most scientists would agree that it’s the collection of damaged proteins and mutations our cells accumulate over time.

Because bacteria only have one cell, they don’t collect genetic mutations over time. (In fact, because they have less DNA than we have, bacteria actually mutate less generation-to-generation than humans do! Bacteria introduce random mutations roughly once every 100 offspring. Though human have a unique combination of their parents’ DNA, they usually have one completely random mutation per generation.)

But bacteria do accumulate damaged proteins the longer they’re around. And there’s where things get fascinating. When a mother bacterium replicates, it keeps all of its damaged proteins to itself. This way, the daughter bacterium it produces is as healthy as can be. (“Mother” is the terminology for any parent bacteria, and “daughters” are their offspring, even though bacteria is genderless. I like to think it’s a matriarchy, though.)

Chao and his team noticed that as bacteria replicate, they don’t simply clone themselves like scientists had thought for decades. Instead, they elongate their cylindrical bodies as they double their cytoplasm (the jelly inside cells), their organelles (like organs within a cell), and their genetic material. Then, as beings twice their normal size, they slice themselves down the middle. One bacterium becomes two.

The longer the mother bacteria is a live, however, the more damaged proteins it accumulates. These proteins are a result of exposure to oxygen, which is the catch-22 of life. On the one hand, most life needs oxygen to convert sugar into cellular fuel, but on the other, oxygen rips up proteins cells need to stay alive.

As they elongate, mother bacteria have these damaged proteins spread out through themselves. But before they break off their daughters, they shuffle all the damaged goods to one side. This way, the daughter bacterium is squeaky clean as it starts to bud off daughters of its own. Though it will accumulate damaged proteins over time, too, it’ll have started off as healthy as possible. Conversely, as mother bacteria hoard more and more damaged proteins over time, they start to slow down.

Mother bacteria could just pass along damaged proteins for their daughters. They’d have a much easier time in life if they did. But it’s a tradeoff they make for their offspring. “Aging is the price parents pay to have vigorous offspring,” Chao says.

If you think about it, we see the same pattern in most species: Parents don’t pass on any damage they acquire in life to their children. (Coral, of course, is the exception I wrote about last time.) Because single-cell organisms like bacteria were the first to evolve, we can say that aging and its inherent protection of offspring is as old as life itself.

But here’s the final twist to this odd tale: Whereas the accumulation of these damaged proteins in most life eventually results in death, it’s not fatal to bacteria—at least in a lab setting. Under ideal circumstances (right temperature, right food, no threats), bacteria are immortal. They reach a critical mass of damaged proteins and then they seem to stop. Chao and his colleagues aren’t sure how, but it seems like they’re able to pass on trace amounts of these damaged proteins to their daughter cells, but not enough to detect using their current electron microscopy. It’s a field of future study for this group.

Immortality doesn’t mean being able to survive anything. Antibiotics, Chao pointed out, can disfigure enough bacterial proteins to put them beyond that critical mass so that they do die. You can also starve them of resources, like agar (sugary microbe snacks), or burn them with UV light or heat.

In any case, bacteria’s immortality causes a heated debate among aging researchers. Can we really call the process of accumulating damaged proteins aging if it doesn’t lead to death? That is a question above my pay grade, I can tell you—but it does make me think that if it isn’t aging, then what is?

That’s all for now—stay curious, friend ❤️

If you love Scrap Facts, consider hitting the “like” button at the bottom of this page, or sending it to a friend. You can also send your own scrap facts to scrapfacts@gmail.com to be featured in future editions. Wanna keep in touch outside of this newsletter? Follow me on Twitter and Instagram.

Top image by Rachel Couch; headshot by Matt Anzur.

Issue 104

Immunity vigilantes, lagging vaccination rates, and an effective double-masking strategy

Hello friend! Welcome to Scrap Facts.

I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each issue, I'll bring you some of my favorite facts that I picked up on the job or while out living life.

Love Scrap Facts? Consider hitting the “like” button, or tell your friends to sign up!

B-cells break all the rules in biology.

Found while reporting this obsession email on the immune system.

Generally speaking, pathogens like viruses and bacteria can evolve a lot faster than we do. They’re constantly reproducing, which gives them a chance to introduce mutations which may make them better at infecting us.

We, of course, evolve very slowly. Ordinarily, this would mean that we wouldn’t have time to evolve new defenses against these pathogens. But, we’ve got a trick up our sleeves (er, in our bloodstreams): Vigilante adaptive immune cells.

B-cells, which produce antibodies that glob onto pathogens to prevent them from invading our cells, break all the rules of biology to keep pace with pathogens. Usually, the last thing you want to do as a cell is mutate or break your double-stranded DNA on purpose. That can cause cancer down the line.

But B-cells do just that to avoid an even more dangerous, imminent threat of an infectious disease. It’s “basically an accelerated evolutionary process, or like natural selection happening in miniature,” Kevin Bonham, a researcher with a doctorate in immunology, who studies microbiology at Wellesley College, told me. When threats are that big, there are no rules.

A breakdown of who’s getting vaccinated in the US by race/ethnicity.

Found while reporting: Why many US Latinos aren’t getting Covid-19 vaccines.

In the first month that Covid-19 vaccines were available in the US, it was mostly non-Hispanic White people getting the shots.

These data only represent about half of all vaccinations during that time period; healthcare providers didn’t always collect demographic information.

But it speaks to a much larger problem at hand: Minorities, who have been most harmed by the Covid-19 pandemic, are getting protection from it the slowest. It’s not only an issue of access—though that’s a clear part of it. And there’s not one solution to public health experts can point to.

It’s going to take a nuanced approach to reach minorities at the community level. The first step is understanding broadly why these disparities exist. I took a look into the historical and present circumstances that are affecting Latino populations in the US.

First, there’s a history of neglect by the US government, which often left some people out of benefits they were entitled to. Second, the Trump administration intimidated documented and undocumented immigrants to the point where they felt severe distrust of any governmental figures. And third, misinformation on encrypted social media like WhatsApp runs wild in limited-English proficiency circles.

Building trust in any community takes time, but public health officials have to start somewhere. It’s not just for the sake of this pandemic on our hands; it’s any future public health crisis that comes our way, too.

Bonus: Vaccines won’t eradicate the pandemic—and that’s okay. Science journalists (myself included) and healthcare providers have been writing all kinds of warnings about the dangers of assuming that vaccines will fix everything. It’s understandably made a lot of readers frustrated; this was the thing we were holding out

PSA: More masks isn’t always better.

Found while reporting: Why don’t we have an ideal mask yet?

As SARS-CoV-2 variants continue to spread, it’s not a bad idea to increase the filtration your mask provides. In fact, shortly after I wrote the above article, the US Centers for Disease Control and Prevention updated their guidelines to recommend wearing two masks.

There’s one catch, though: both your masks, whatever they’re made of, should still be breathable when over your nose and mouth.

If they aren’t, that means that air and water droplets aren’t actually being filtered through them, which is the whole purpose of wearing a mask in the first place. Instead, the air you’re taking in comes from gaps around the bridge of your nose or under your cheeks.

One quick way to check if your double masks are too thick is to go outside with glasses or sunglasses on. Some fogging from escaped air is inevitable, but your glasses shouldn’t steam up entirely. If they are, it’s a sign that a lot of air is coming out from gaps over your nose, which can be addressed with a mask that has a metal band on the top.

✨ Do you have Covid-19 vaccine questions that are still unanswered? I got ya—tune in at 11 am US eastern on Wednesday, March 3 to hear a conversation with me and Panagis Galiatsatos, a critical care pulmonologist at Johns Hopkins Bayview Medical Center. It’s free! Register here:

Other stuff you may have missed:

Pfizer took a big bet on their six-dose vaccine vials. Without the right syringes, though, most healthcare providers won’t be able to extract all the doses possible.

In addition to the above story, I talked about it with Arirang News in South Korea.

All you need to know about the SARS-CoV-2 variants. In case you weren’t sold on double masking before.

Johnson & Johnson’s Covid-19 vaccine prevents severe Covid-19 cases, even if it doesn’t block illness entirely—and that’s a key way to end the pandemic. This story was written before the single-dose jab got authorized on Saturday night, and carries even more relevance now.

The tech and ethics behind the fertility business: Watch the recap of the Kavli Conversation with MIT Tech Review’s Antonio Regalado and Dr. Norbert Gleicher.

I hope you enjoy these screenshots; I think they are very funny.

That’s all for now—stay curious, friend ❤️

If you love Scrap Facts, consider hitting the “like” button at the bottom of this page, or sending it to a friend. You can also send your own scrap facts to scrapfacts@gmail.com to be featured in future editions. Wanna keep in touch outside of this newsletter? Follow me on Twitter and Instagram.

Top image by Rachel Couch; headshot by Matt Anzur.

Kavli Conversation: Biotechnology, journalism, and the future of fertility

A FREE live (on the internet) event, Wednesday, Feb. 25 at 6:30 ET

Hello friend! Welcome to Scrap Facts.

I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each issue, I'll bring you some of my favorite facts that I picked up on the job or while out living life.

Love Scrap Facts? Consider hitting the “like” button, or tell your friends to sign up!

Let’s talk about talking about biotech businesses.

There are a lot of important questions for journalists to ask when writing about science—and even more when there’s major money to be made.

On Thursday, Feb. 25, at 6:30 pm ET, I’ll be moderating a conversation with Antonio Regalado, MIT Tech Review’s senior biomedicine editor, and Norbert Gleicher, a reproductive endocrinologist and pioneering scientist in fertility medicine. We’ll be looking at the fertility industry as a case study of when science and medicine meets business, and talking about how the media covers it.

This event is FREE, and open to anyone. Sign up here! I’ll be facilitating audience questions.

If you like this conversation, be sure to check out other Kavli Conversations, happening online later this spring, as well as an archive of previous conversations. These are all sponsored by Sponsored by the Kavli Foundation and the Science, Health and Environmental Reporting Program at New York University (my alma mater).

That’s all for now—stay curious, friend ❤️

If you love Scrap Facts, consider hitting the “like” button at the bottom of this page, or sending it to a friend. You can also send your own scrap facts to scrapfacts@gmail.com to be featured in future editions. Wanna keep in touch outside of this newsletter? Follow me on Twitter and Instagram.

Top image by E. Y. Smith; headshot by Matt Anzur.

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