Health Wanted: Direct-to-Consumer Medicine

The Episode

We’ve all been there: You’re on your couch watching TV, when suddenly a celebrity appears to try to sell you Ozempic. How does pharmaceutical marketing influence patient behavior, doctor-patient relationships, and public policy? Learn all that and more this week on Health Wanted, when host Laurel Bristow dissects the uniquely American phenomenon that is direct-to-consumer prescription drug advertising. Then, she is joined by Steve Woloshin, MD, for a doctor’s perspective.

Listen to the episode now

The Listener Questions

What is going on with the rabbits with horns in Colorado?

These rabbits have Shope papilloma virus (SPV), a relative of human papilloma virus (HPV). SPV is harmless to humans but can be spread to rabbits via the bite of an infected insect. It can cause growths made of keratin, which look like horns coming out of the head or tentacles around the mouth.

SPV was instrumental in how we learned that viruses can cause tumor growth. The horns are papillomas, which is, essentially, a tumorous growth of the epithelial. 

In the 1930s, a researcher by the name of Richard Shope heard tales about these jackalope-like rabbits and asked a friend to catch one and send him the horn. He suspected that it might actually be a form of tumor, so he ground the horn up, mixed it with a liquid, and put it through a fine filter. He then rubbed the solution on the head of a rabbit and voila! Horns grew, showing that a virus can cause tumorous growths.

The rabbits are mostly fine. Sometimes the horns can get in the way of their eating, but they aren’t a threat to people.
People can also develop cutaneous horns from HPV infections or excessive sun damage. The horns can also be an indicator of cancer, so if you develop a horn, please see a doctor.

Are there forever chemicals in my contact lenses?

The only “evidence” of this is in a “study” from 2023 on a website that appears to be a chemophobia (fear of chemicals) site aimed at mothers. Everything on the site is about finding “toxic” products.

They list the reviewers they used, and pretty much all of them are professors of environmental health, which is fine, but it’s unclear if any of them have the laboratory expertise to validate if the methods used were appropriate. 

It seems like they were picked because they are on the side of being very against per- and polyfluoroalkyl substances (PFAS). That isn’t necessarily a bad thing, but it does mean that there was potential bias in their review.

The gist of the research is that multiple brands of contacts were sent for testing, and the testing involved checking for fluorine by oxygen flask combustion and ion-selective electrode. This basically means they combusted the contact to create fluorine ions, which they then measured.

They then determined the level of free fluorine ions and subtracted that from the total fluorine to estimate the amount of organic fluorine, which they use as evidence of PFAS.

But other things can create organic fluorine, including non-PFAS medications. Plus, even if there are PFAS in contacts (which there very well might be), detecting them by exploding a contact doesn’t really give you a sense of if those chemicals could leach out of the contact and into your eye.

The methods of the study are not available, there’s no information about sterile process to prevent cross contamination, and there’s no limitations discussion. This is not what I would consider a research paper.
It’s very possible that contacts have PFAS, but this study is a bit of a reach and doesn’t give any context for the risk that contacts pose to the person.

Can COVID activate cancer cells?

There was a study that investigated if infection with things like COVID or flu could cause dormant cancer cells, like the kind that might exist in someone who is in remission, to reactive, grow, and spread. The paper that presented the data had three parts: one was the actual mouse study, and two were data reviews that seemed to support their suspicions.

• The mouse model is straightforward: Mice infected with dormant breast cancer cells in the lungs started to have those cells grow and replicate when they were infected with flu or COVID, indicating that something about the immune response to these viruses reactivates cancerous cells.
• One of the data review studies looked at a cancer biobank and found that people who had cancer and a COVID infection were twice as likely to die of cancer.
• The other data review looked at women who had a breast cancer diagnosis to see if they had an increased risk of progressing to metastatic cancer if they had a COVID infection and found a slight increase.

This all seems like good evidence that viral infections can worsen cancer outcomes, but there are a few caveats to keep in mind: 

• Mice are not people. What happens with a mouse model is a good starting point to investigate something, but it’s not an ending point.
• The impact of COVID infections in people is limited by the availability of testing. It could be that the effects of COVID are overestimated if there are people who had an undiagnosed COVID infection but were marked as “negative."
• It could be that people with cancer are more susceptible to COVID infections and poor outcomes, rather than the other way around.

As we learn more about the long-term impacts that viral infections can have, I think we need to remain cautious about attributing everything to a viral cause. This is a good starting point, but we need much more data, particularly in people, before we can draw conclusions that two things are related.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
• Subscribing on Apple or Spotify
• Watching on WABE's YouTube channel