Dr. Klotman’s Week 288 video address is available here. My notes from his address follow.

Leucovorin for Autism

  • Leucovorin is a brand of folinic acid that has been used since I was a medical student to treat cancer patients being given Methotrexate. The cancer drug Methotrexate thwarts the metabolism of folic acid in order to kill cancer cells; it also does that to healthy cells. So, after a dose of Methotrexate, we administer leucovorin to “recue” the healthy cells.
  • While there is some observational evidence that leucovorin can be beneficial in the management of cerebral folate deficiency, there are no trials that demonstrate a benefit (or lack thereof) in the management of autism.
  • FDA recommendations to administer leucovorin to children who have symptoms of autism is unwarranted at best and irresponsible at worst. Merde!

FDA on Acetaminophen in Pregnancy

  • The FDA’s warnings to physicians and the public regarding the use of acetaminophen during pregnancy are unsupported by the preponderance of clinical studies
  • Fever itself is a potential hazard to a healthy pregnancy
  • The use of other analgesics and anti-pyretics during pregnancy carries greater risk than acetaminophen

ACIP Recommendations

  • The newly constituted Advisory Committee on Immunization Practices has changed the recommendation for “universal” COVID vaccination to target only the high risk and elderly – based on ideology rather than science (IMHO).
  • The new ACIP advises “shared decision making” (aka, talk with your doctor) for other folks. They stopped short of requiring a prescription. Again, IMHO, this is ideology rather than science.
  • Health insurers have committed to paying for every COVID vaccine until the end of 2026
  • The m-RNA COVID vaccines target the JN.1 variant spike protein. The “NextVax” vaccine targets the particular receptor binding domain on the spike protein.

Hepatitis B (Hep-B) Vaccine

  • Hepatitis B vaccine has been recommended for infants for years. The reason for this is that infants born to Hep-B infected mothers develop an infection which leads to liver cirrhosis and liver cancer later in life
  • The new recommendation calls for testing expectant mothers for Hep-B, and for vaccination of the infant is the mother is positive

MMRV & MMR vaccines

  • MMR is the Mumps-Measles-Rubella vaccine. The ACIP now advises that MMRV (includes Varicella aka chicken pox) be separated into two vaccinations – MMR and Varicella in reduce the risk of post-vaccination febrile seizures

Texas Typhus

  • Typhus is a flea-born illness endemic in Texas caused by a Rickettsia borne by rodent fleas
  • Other animals that can be vectors are opossums and domestic cats. The possums eat fleas and ticks, of course. Cats, coming in proximity to possums, can pick up those fleas
  • Murine typhus looks like a viral illness (fever, aches, rash, feel-bads) but is not viral and needs to be treated with doxycycline

COVID

  • COVID cases in Texas are waning; we may have reached the summer peak
  • COVID wastewater levels are falling too

IMHO:

  • As relates to leucovorin, I say, “Shit or get off the pot.” If the FDA is going to recommend leucovorin for autism, it needs to pony up the dollars to fund a proper randomized, controlled, double-blind, trial to show that leucovorin has benefit.
  • As regards acetaminophen in pregnancy, I think that the entire RF (Lysenko) Kennedy contingent at HHS needs to be hoisted on its own petard and put at financial peril for bogus recommendations. As Warren Buffett has often observed, you get the best results when your players have “skin in the game”
  • Regarding ACIP recommendations for COVID vaccinations, I can tell you that I worked for United Healthcare and was a discussant in several coverage issues regarding therapies and vaccinations. Our decisions always came down to financial considerations. If it was cheaper to pay for a treatment or a vaccination that to pay for the healthcare costs of not providing that treatment or vaccination, we always chose the former. By doing what was best for our enrollees, we were doing what was best for our shareholders. [I only wish that it were always so.]
  • As regards Hep-B vaccine for infants; I’m agnostic on this except to say that to not vaccinate an infant without evidence that the mother does not carry Hep-B is medical malpractice, in my mind. It would be as not giving peri-natal anti-HIV drugs to an HIV positive mother.
  • MMRV and MMR – again, I’m agnostic except to say that our “Most Spectacularly Idiotic Presidential Simpleton’s” recommendation to give each vaccine component is profoundly ignorant because there are no separate vaccines for M, M, and R. But WTF, this is the same moron who suggested a strong and powerful butt light and IV Chlorox during the COVID apocalypse. Pendejo!
  • Finally, regarding Typhus, I can only say that my closest connection to this illness is my son treating a Nebraska resident for it. The patient was a homeless person. Typhus can be transmitted not only by fleas but by lice. The lice borne Typhus is not murine typhus but produces a similar set of symptoms. Sigh.
    • I recently read that Chagas disease has become endemic in the US southern states where the climate is receptive to triatomine bugs, commonly known as kissing bugs, a species that can transmit the infectious agent – Trypanosoma cruzi.
    • Years ago, I saw a patient who had been infected with this Trypanosome and had developed a left ventricular aneurysm. This parasite destroys heart muscle.
    • A public health colleague of Susan’s who had worked in Peru to eradicate Chagas disease observed that they eliminated it by replacing “dirt floors” with actual floors. This excluded the bugs that carried the disease.
    • So, I speculate that we will begin to see Chagas disease in our unhoused populations who must live on “dirt floors.”

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