I’m going to kick off this Doc Gumshoe missive with a little bit of undoubtedly excellent news, albeit information that isn’t prone to have an effect on many voters of Gumshoe Nation. In a nutshell, it’s this: on September twenty sixth, the FDA authorized the primary new drug to deal with schizophrenia in additional than 30 years. The drug is Cobenfy (xanomeline/trospium chloride, a fixed-dose mixture medicine. It was initially developed by Lilly (LLY), which bought the license to Karuna Therapeutics. Karuna has since been acquired by Bristol Myers Squibb (BMY).
Dr Tiffany Farchione, director of the FDA’s Division of Psychiatry, mentioned “This drug takes the primary new strategy to schizophrenia remedy in many years. This approval presents a brand new various to the antipsychotic drugs folks with schizophrenia have beforehand been prescribed. Schizophrenia is a number one reason for incapacity worldwide. It’s a extreme, persistent psychological sickness that’s typically damaging to an individual’s high quality of life.”
For a lot of many years, remedy of schizophrenia relied on blocking dopamine receptors. Frequent dopamine receptor blockers embody Thorazine (chlorpromazine), Prolixin (fluphenazine), and Haldol (haloperidol). These have been round a very long time. For instance, Thorazine bought its FDA approval in 1954.
Blocking dopamine receptors has advantages in addition to drawbacks. It reduces signs like hallucinations and paranoia to a stage that sufferers discover livable. However dopamine receptor blockers regularly end in vital weight achieve, such that sufferers taking these medication are inclined to have larger charges of cardiac illnesses, leading to decreased life expectancy. And plenty of sufferers have discontinued taking these just because these medication made them really feel sluggish and unmotivated.
Cobenfy has an impact on dopamine ranges, however its principal goal is one other neurotransmitter, acetylcholine.
About 25 years in the past, the muscarinic acetylcholine receptor agonist xanomeline (which is among the two compounds in Cobenfy) was reported to cut back psychotic signs and enhance cognition in sufferers with Alzheimer’s illness. The antipsychotic and procognitive properties of xanomeline had been subsequently confirmed in a small research of acutely psychotic sufferers with persistent schizophrenia.
The origins of the phrase “schizophrenia” recommend that the important dysfunction is a mind whose totally different capabilities are basically disjointed – basically a “break up thoughts.”
In response to the Nationwide Institute of Psychological Well being, schizophrenia is a psychological dysfunction characterised by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Though the course of schizophrenia varies amongst people, schizophrenia is often persistent and will be each extreme and disabling.
Schizophrenia is comparatively unusual. Within the US, it impacts between 0.25 and 0.75% of the inhabitants. Nonetheless, it’s a disproportionately costly situation. The monetary burden of schizophrenia contains the direct value of healthcare, which frequently entails life-long institutionalization, but additionally prices akin to misplaced productiveness, involvement with the legal justice system, and social providers.
Signs of schizophrenia embody psychotic signs akin to hallucinations, delusions, and thought dysfunction (uncommon methods of pondering), in addition to decreased expression of feelings, decreased motivation to perform targets, problem in social relationships, motor impairment, and cognitive impairment.
The proof supporting Cobenfy as a remedy for schizophrenia is, to this point, slightly sparse. There have been solely three managed trials of the drug, and every trial lasted solely 5 weeks. In these trials, Cobenfy decreased the signs of schizophrenia to a manageable stage, with out producing the unwanted side effects linked with dopamine receptor blockers akin to cardiac illness or weight achieve. BMY launched outcomes of long-term observational research of Cobenfy, during which sufferers didn’t expertise metabolic adjustments or motion problems akin to affected sufferers taking different medication to manage schizophrenia.
Pharmaceutical corporations are enthusiastic in regards to the Cobenfy outcomes, and are engaged on related drugs which might be efficient in treating such circumstances as bipolar dysfunction, autism, and Alzheimer’s illness.
BMY has set the wholesale value of Cobenfy at about $22,500 per 12 months. It’s anticipated to generate revenues between $3 billion and $5 billion per 12 months.
Eisai and Eli Lilly conceal instances of mind accidents linked to their Alzheimer’s medication
Clearly, these are genuinely dreadful information objects. The medication in query are Eisai’s Leqembi (lecanemab) and Eli Lilly’s Kisunia (donanemab). The NY Occasions just lately devoted greater than a full web page to this case, describing a number of instances during which sufferers taking these medication skilled mind accidents, which might have been anticipated primarily based on their genetic profiles.
In 2021, Eisai put out a name for volunteers to take part in a scientific trial of their experimental drug lecanemab (then referred to as BAN2401) for the remedy of Alzheimer’s illness. Practically 2,000 individuals answered the decision. Eisai sought particularly to incorporate people whose genetic profiles made them particularly prone to develop Alzheimer’s. However these similar people had been extra prone to mind bleeding or swelling in the event that they acquired the drug.
Eisai made a public assertion that every one volunteers could be given a genetic take a look at to determine the precise people who had been at explicit threat for mind accidents. Nonetheless, Eisai didn’t inform these trial volunteers that they had been at particularly excessive threat of experiencing these mind accidents. It has been revealed {that a} whole of 274 volunteers joined the trial unaware that they had been at elevated threat. Two of those volunteers died of their mind accidents, and greater than 100 others skilled mind bleeding or swelling.
On July 6, 2023, the FDA granted accelerated approval to Leqembi/lecanemab for the remedy of Alzheimer’s, noting that its modest profit outweighed its dangers. The advantages of Leqembi/lecanemab for the remedy of Alzheimer’s are certainly modest. Remedy with the drug slows cognitive decline for a couple of months solely.
The same scenario has emerged with regard to Eli Lilly’s anti-Alzheimer’s drug Kisunia (donanemab). Lilly selected to not inform 289 volunteers in a scientific trial of donanemab that their genetic profiles made them particularly weak to mind accidents. A couple of quarter of volunteers within the Kisunia trials skilled mind swelling or bleeding.
The FDA granted approval to Kisunia virtually precisely a 12 months after Leqembi’s FDA blessing – July 2, 2024.
In each the Leqembi and Kisunia trials, volunteers first needed to signal consent kinds that mentioned that individuals with sure genetic traits confronted larger dangers of mind accidents from receiving the medication, and that individuals within the trial could be given genetic checks for these traits. However they had been informed that they’d not be told as to the outcomes.
Basically, the volunteers in these trials had been anticipated to go forward and take part within the trials with out realizing whether or not they had been at elevated threat for mind harm. The folks conducting the trial would know, however the trial topics wouldn’t know.
Each Leqembi/lecanemab and Kisunia/donanemab are BACE inhibitors (beta-site amyloid precursor protein cleaving enzyme inhibitors), that means that they aim amyloid beta, a type of plaque that clogs mind connections. The unlucky Aduhelm/aducanumab (from Biogen), which was taken off the market as a result of its poor efficiency in addition to the tendency to end in mind bleeds, can also be a BACE inhibitor.
Mind bleeding and mind swelling is particularly prevalent in individuals with the APOE4 gene. About 40% of people with two copies of the gene skilled mind bleeding, and about 35% skilled mind swelling. This gene is extremely correlated with Alzheimer’s illness. Individuals with one copy of APOE4 have double or triple the chance of growing Alzheimer’s illness, whereas folks with two copies have an eight- to twelvefold enhance in threat.
It ought to be identified that the profit these BACE inhibitors ship is minimal. It slows the onset of dementia in sure Alzheimer’s sufferers for lower than a 12 months earlier than the illness resumes its harmful course.
The annual value of Leqembi/lecanemab is $26,500. For Kisunia/donanemab it’s $32,000. Evidently, neither Eisai nor Lilly need to allow unlucky particulars, such because the frequency of mind bleeds, to intervene with their gross sales prospects.
A drug-free nasal spray could protect in opposition to respiratory infections
The nasal spray we’re discussing is a gel-like spray formulated with out energetic pharmaceutical substances. It has but to be examined in people, however the researchers say it created a protecting coating that lasted for as much as eight hours within the nasal cavities of mice. If the spray’s security and efficacy are confirmed in people, the analysis crew mentioned the strategy might play an necessary function in lowering respiratory illnesses and safeguarding public well being in opposition to new threats.
The nostril is a standard passage into the physique for a lot of viruses and micro organism. Most respiratory infections, akin to flu and COVID, are transmitted when an individual inhales tiny droplets of fluid that carry the pathogen. As soon as they get contained in the nostril, the viral or bacterial particles contained in the droplets infect the cells that line the nasal cavity. These pathogens replicate and journey additional down the respiratory tract of the contaminated particular person, generally reaching the lungs, the place they will trigger bronchitis and pneumonia. Pathogens may also be launched again into the air when an contaminated particular person sneezes, coughs, laughs, sings, talks, and even simply breathes out and in.
Present nasal sprays provide restricted safety in opposition to respiratory pathogens as a result of they’ve a single mechanism of safety. They both neutralize pathogens or block their entry into the cells lining the nostril, they usually carry out each duties with restricted efficacy.
The projected new drug-free nasal spray was developed to dam germs in 3 ways — the spray kinds a gel-like matrix that enhances the seize of respiratory droplets, immobilizes the germs, blocking their transport into the nasal lining, and successfully neutralizes the germs, stopping an infection. The nasal spray, referred to as Pathogen Seize and Neutralizing Spray (PCANS), was developed with nonpharmaceutical substances already utilized in authorized nasal sprays or listed within the FDA’s Typically Acknowledged as Secure (GRAS) listing.
The researchers designed the formulation and studied its means to seize respiratory droplets in a 3D-printed duplicate of the human nasal passages. The experiments confirmed that when administered into the nasal cavity mannequin, the spray captured twice as many droplets as naturally occurring mucus produced as a part of the physique’s innate protection system.
The researchers examined the spray’s protecting results in opposition to a pressure of influenza in mice. The spray was quickly activated following administration into the nostril and lasted as much as eight hours. A single dose might successfully block an infection from an influenza virus at 25 occasions the deadly dose of the virus. Which means that the spray was able to keeping off an infection even when animals had been uncovered to a heavy load of the virus. In response to the investigators, virus ranges within the lungs of pretreated animals had been decreased by almost 100% p.c, in contrast with virus ranges within the lungs of nontreated animals.
The nasal spray was developed by Harvard Medical Faculty researchers working with Brigham and Girls’s Hospital. The knowledge above got here from a Harvard Medical Faculty launch.
It could be anticipated that the builders of the nasal spray could be extremely smitten by its advantages. Doc Gumshoe’s skeptical flip of thoughts poses a query: even when this superb drug-free nasal spray achieved in human topics outcomes akin to these in mice, would extraordinary people be prone to routinely spray a gel coating into their nasal passages to guard themselves in opposition to pathogens? People who had regularly skilled higher respiratory illnesses, or who had been warned that they had been at elevated threat for higher respiratory illnesses would possibly use this system. Such individuals would possibly take up the behavior of a every day dose of this nostril spray, roughly as a routine observe, like brushing their tooth. I emphasize the phrase “would possibly” in that sentence. It could rely, to a substantial diploma, on what the nostril spray felt like once you press the button or squeeze the tube. Extra considerably, it might rely upon whether or not these people perceived precise enchancment: did spraying gel of their noses truly end in fewer instances of colds or the flu?
At this second, the protecting nasal spray is a great distance from the scientific trials that may be essential to fulfill the FDA and get the nasal spray authorized as a medical system. Designing scientific trials themselves could be a problem. The trial would wish to enlist voluntary topics, a few of whom could be spraying a placebo of their noses. Then, to be able to confirm the efficacy of the nasal spray in stopping an infection, the themes – together with these within the placebo arm – must be uncovered to pathogens, to be able to confirm that the nasal spray decreased an infection. Subsequently, some trial topics would undoubtedly expertise precise infections. Primarily based on the experimental proof that the gel captured twice as many respiratory droplets as naturally occurring mucus, those that bought the true nasal spray would presumably expertise infections at half the speed, however they’d be uncovered to infectious viruses and micro organism, and if the an infection charge matched that within the mice, maybe half of the themes would truly get sick. And the an infection charge within the placebo group could be twice as excessive.
There could also be methods round this, but it surely strikes this observer as a protracted, lengthy shot.
Attempting to make sense of lengthy COVID
Sure, COVID 19 remains to be with us, though a lot much less of a menace. The newest figures for deaths, hospitalizations, emergency division visits, and optimistic checks are approach, approach down. There have been 444 deaths within the US as a result of COVID in the course of the week ending November 3. This was about 1.0% of all of the deaths within the US at that time. And solely 0.5% of the emergency division visits had been as a result of COVID. Listed below are some mortality figures going again to the beginning of the epidemic to supply some perspective in regards to the present state.
Week ending 09/14/2024 – 563 deaths as a result of COVIDWeek ending 08/31/2024 – 663 deaths as a result of COVIDWeek ending 05/18/2024 – 336 deaths as a result of COVIDWeek ending 01/27/2024 – 2,131 deaths as a result of COVIDWeek ending 01/17/2023 – 3,870 deaths as a result of COVIDWeek ending 01/15/2022 – 19,078 deaths as a result of COVIDWeek ending 01/19/2021 – 25,974 deaths as a result of COVID
The parade of variants continues. Presently, the dominant variant nationwide is KP.3.1.1, which accounts for 52% of instances, adopted by XEC, with 28% of instances, and MC.1, with 6% of instances. The unique Omicron variant has been changed by subvariants, together with LB.1, KP.2, and KP.3. As I’ve tediously famous, because the virus mutates, essentially the most “profitable” variants – profitable when it comes to their very own survival as a viral species – are the variants that let the human illness sufferer to outlive and move the virus on to different. A virus that kills its victims shortly is doomed to extinction.
All in all, COVID as an acute an infection is receding. However what continues to have an effect on a number of folks, and trigger an excessive amount of concern to the healthcare group, is lengthy COVID, which continues to be a puzzle. Lengthy COVID signs are just like the signs of an acute COVID an infection. Generally reported lengthy COVID signs included fatigue, mind fog, muscle ache, joint ache, again ache, headache, sleep disturbance, lack of scent or style, and gastrointestinal signs.
The CDC’s criterion for lengthy COVID is that the virus that causes COVID-19 is “current for at the very least three months as a steady, relapsing and remitting, or progressive illness state that impacts a number of organ methods.”
In response to the CDC, estimates of the prevalence of lengthy COVID range as a result of totally different research standards, signs investigated, affected person populations, and timing of when signs are assessed. In 2022, 6.9% of adults and 1.3% of youngsters (roughly 17 million and 1 million, respectively) in the USA reported ever experiencing lengthy COVID. The newest figures I might discover, dated February fifteenth of this 12 months, ranged from 1.9% within the US Virgin Islands to 10.6% in West Virginia. These are clearly outliers; general, the prevalence remained on the similar stage because it had been in 2022.
I ought to add right here that an AI-enabled strategy, developed by Mass Normal Brigham, means that lengthy COVID prevalence is far larger – about 22%. The algorithm used was developed by drawing nameless affected person knowledge from the scientific data of almost 300,000 sufferers throughout 14 hospitals and 20 group well being facilities within the Mass Normal Brigham system. That algorithm might determine extra individuals who ought to be receiving look after this debilitating situation.
Whereas lengthy COVID can happen in anybody who will get the coronavirus an infection, some folks or teams of persons are at larger threat of growing lengthy COVID. These embody girls, folks with underlying circumstances, individuals who skilled extra extreme outcomes of COVID-19, and folks of Hispanic ethnicity. Roughly 1 in 4 adults with lengthy COVID reported experiencing vital limitations of their every day exercise.
A research performed by a crew of researchers at Brigham and Girls’s Hospital centered particularly on lengthy COVID. Researchers discovered folks with wide-ranging lengthy COVID signs had been twice as prone to have SARS-CoV-2 proteins of their blood, in comparison with these with out lengthy COVID signs.
The crew discovered that 43% of these with lengthy COVID signs affecting three main methods within the physique – the cardiovascular, digestive, and respiratory methods – examined optimistic for COVID viral proteins inside 1 to 14 months of their preliminary optimistic COVID take a look at. However solely 21% of those that didn’t report any lengthy COVID signs examined optimistic for the COVID virus on this similar interval.The hope expressed by the researchers is that by figuring out a subset of people that have a reservoir of the coronavirus of their our bodies, it might be attainable to deal with these individuals with efficient antivirals to alleviate their signs.
The research analyzed 1,569 blood samples collected from 706 people, together with 392 individuals from the Nationwide Institutes of Well being-supported Researching COVID to Improve Restoration (RECOVER) Initiative, who had beforehand examined optimistic for a COVID an infection. Utilizing SIMOA, an ultrasensitive take a look at for detecting single molecules, researchers appeared for entire and partial proteins from the SARS-CoV-2 virus. In addition they analyzed knowledge from the individuals’ lengthy COVID signs, utilizing digital medical chart data or surveys that had been gathered similtaneously the blood samples had been taken.
Researchers identified that it’s attainable {that a} persistent an infection explains some however not all the lengthy COVID signs. If so, testing and remedy might help in figuring out sufferers who could profit from various remedies.
One of many questions raised by the research is why greater than half of sufferers with wide-ranging lengthy COVID signs examined unfavorable for persistent viral proteins.
Dr David Walt, principal investigator on the research noticed that the discovering famous above suggests there’s probably a couple of reason for lengthy COVID. For instance, one other attainable reason for lengthy COVID signs might be that the virus harms the immune system, such that immune dysfunction continues after the virus is cleared.
Dr Walt and his crew are at the moment conducting follow-up research to higher perceive whether or not an ongoing an infection is behind some folks’s lengthy COVID signs. They’re analyzing blood samples and symptom knowledge in bigger teams of sufferers, together with folks of huge age ranges and people with compromised immune signs. It could be necessary to determine people who usually tend to have persistent virus of their our bodies, resulting in lengthy COVID.
The coronavirus inflicting COVID just isn’t distinctive in staying within the physique and inflicting ongoing signs months after the preliminary acute an infection. Animal research have discovered Ebola and Zika proteins in tissues post-infection and these viruses have additionally been related to post-infection sickness.
My tackle this matter is that, whereas acute COVID infections are a lot much less frequent and rarely trigger critical sickness or demise, they will and do result in lengthy COVID, which is an end result to be assiduously averted. Subsequently, cautious people (my spouse and myself) proceed to put on masks in some public locations, together with the road on the pharmacy to choose up our drugs and medical amenities.
Who is aware of when – if ever! – it’s going to actually and really be over.
A Division of Power regulation might drastically change our mild bulbs
That regulation might have a major adversarial impact on the well being of many individuals within the US, particularly epileptics and migraineurs.
The regulation is scheduled to take impact in July 2028, and it’s centered completely on vitality effectivity, as one would anticipate of a regulation coming from the Division of Power. The related assertion is as follows:
“The adopted requirements, that are expressed in minimal lumens (“lm”) output per watt (“W”) of a lamp or lamp efficacy (“lm/W”). These requirements apply to all merchandise manufactured in, or imported into, the USA beginning on July 25, 2028.”
At current, the one mild bulbs (“lamps,” within the official DOE parlance) that may meet these requirements are the LEDs that emit mild within the 460 – 495 nm (nanometer) vary. A nanometer, by the best way, is a billionth of a meter. Gentle in that vary is emphatically on the blue finish of the spectrum, ranging into the ultraviolet.
However mild at that frequency has clear and distinct points. Within the night, it messes up our circadian rhythms. Our mind thinks it’s nonetheless broad daylight, undoubtedly not time to fall asleep. Blue mild suppresses the manufacturing of melatonin, which helps us fall asleep and keep asleep. We’ve got all been informed that staring into our pc screens or watching tv within the half-hour or so earlier than bedtime is a really dangerous concept, as a result of the blue mild will make it tougher to get an excellent night time’s sleep.
Past the circadian rhythm problem that impacts us all, blue LED mild is a serious public well being problem for epileptics and migraineurs, lots of whom are extraordinarily delicate to the standard of sunshine and easily can’t tolerate blue LED mild. Yellow and white LEDs, though problematic, are extra acceptable, however the LEDs on the blue finish of the spectrum are past what these individuals can tolerate.
For these people, even temporary publicity to unnatural mild, significantly on the blue finish of the spectrum, can set off epileptic seizures and migraine complications. And a migraine is way more and far worse than a foul headache. Along with the pounding ache, a migraine can carry on different signs, akin to extreme nausea and vomiting, in addition to excessive sensitivity to any mild, such that the migraineur must shelter in a darkish room.
The prevalence of migraines within the US inhabitants is surprisingly excessive – virtually 10% of males and about 21% of ladies report migraines or exceptionally extreme complications throughout a three-month interval.
What we want is mild whose frequencies are extra evenly distributed over the seen spectrum, not concentrated on the blue finish. Sure, broader spectrum mild bulbs are much less vitality environment friendly, however they’re more healthy and far, way more nice.
It’s price mentioning that we people, together with all different creatures whether or not animal or vegetable, developed with incandescent mild, and I don’t imply Edison mild bulbs. The solar and all the celebs in our cosmos emit incandescent mild, as do candles and torches and cooking fires. Incandescence is mild produced by any sizzling or burning matter.
The actual high quality of incandescent mild sources, which can’t be matched by LEDs, is that it emits mild all through your complete steady spectrum. LED producers could make mild bulbs that mimic your complete spectrum, mixing diodes that emit radiation at a variety of factors, from the ultraviolet to the infrared. However irrespective of what number of diodes the LED accommodates, it is not going to be a steady spectrum like incandescent mild. Components of the spectrum can be lacking, and what we’re in a position to see illuminated by LEDs is not going to cowl your complete seen spectrum.
In Rockland, Maine, there’s an artwork museum, the Farnsworth, which homes a wonderful assortment of the works of Andrew Wyeth. The Wyeth work are illuminated by LEDs – all aside from one portray which is adjoining to a big window that allows the portray to be lit by daylight. The distinction between the LED-lit work and the one portray close to the window is large. The LED-lit work look drab as compared.
It may be attainable to make LEDs which are superior to those within the Farnsworth, however absence of your complete seen spectrum can be a deficit. I wish to suppose that sooner or later the Authorities, whether or not the Division of Power or the Division of Well being and Human Companies, will come to comprehend that mild bulbs that span the seen spectrum are, at the very least in some instances, a necessity.
Power-efficient mild bulbs that emit a pleasing mild that may be tolerated by epileptics and migraineurs and are sympathetic to the wants of our circadian rhythms ought to, I deeply hope, turn into out there effectively earlier than that dire date in 2028.
Temporary remark: is Lesstranol the reply to elevated ldl cholesterol?
An everyday reader and web buddy despatched a chunk about this complement with the query “Is there something to this?”
My reply is a cautious “perhaps.”
The commercial selling Lesstranol just isn’t a wild overstatement. Right here is the principal assertion of Lesstranol’s worth:
“After many years of treating hundreds of sufferers with unhealthy levels of cholesterol, I got here to the conclusion that there needed to be a neater all-natural approach to assist my sufferers help their levels of cholesterol. After meticulous analysis, I recognized 1 all-natural key nutrient that helps preserve each regular ldl cholesterol and triglyceride ranges whereas selling optimum LDL/HDL stability and cardiovascular well being.
This key nutrient is Pink Yeast Rice. Historic Chinese language healers believed crimson yeast rice might promote good blood circulation. As we speak, fashionable scientists know that it accommodates monacolins, substances identified to advertise regular levels of cholesterol. These monacolins cease the motion of the HMG-CoA reductase, an enzyme that helps make ldl cholesterol.”
Certainly, crimson yeast rice can have a helpful impact on levels of cholesterol. Right here’s what the Mayo Clinic says about it:
“Analysis exhibits that crimson yeast rice containing appreciable quantities of monacolin Ok can decrease your whole blood ldl cholesterol stage, your low-density lipoprotein (LDL, or “dangerous”) ldl cholesterol stage and your triglyceride stage.
Whereas the complement is mostly thought of secure, it would carry the identical potential unwanted side effects as statin ldl cholesterol medication.
Pink yeast rice may cost lower than a statin. Nonetheless, with a complement, there’s much less assurance concerning high quality and the way a lot energetic ingredient is definitely within the product. Some crimson yeast merchandise would possibly include solely small quantities of monacolin Ok and doubtlessly have little impact on levels of cholesterol.”
And who is aware of how a lot of that monocolin Ok is within the Lesstranol complement. As has been regularly identified in these items, dietary supplements are completely unregulated. There is no such thing as a approach of realizing what is definitely within the Lesstranol tablets. Talking for myself, if I had elevated ldl cholesterol (which, fortunately, I don’t!), I might observe the recommendation of my doctor, which might probably level me to a statin.
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In previous Doc Gumshoe epistles, now we have mentioned elevated ldl cholesterol and methods of managing that situation, and in addition famous the introduction of latest statins. Is it maybe time to muster up an summary of that image? Please let me know!
I used to be solely in a position to cowl a couple of of the current developments on this installment, so within the subsequent one I’ll choose up the place I left off and convey you extra bits and items.
Within the meantime, thanks for all feedback and benefit from the holidays, in addition to the non-holidays. Michael Jorrin (aka Doc Gumshoe).
[ed note: Michael Jorrin, who I dubbed “Doc Gumshoe” many years ago, is a longtime medical writer (not a doctor) and shares his commentary with Gumshoe readers once or twice a month. He does not generally write about the investment prospects of topics he covers, but has agreed to our trading restrictions. Past Doc Gumshoe columns are available here.]
