Here's the thing about preexisting immunity. Does it magically just avoid prisons? ~2100 inmates were infected at San Quentin (~ 2/3 the population). I guess they just let the people with prior immunity to COVID go early?
It is not a secret that roughly 4 years ago, I resigned my faculty position @UCSF and closed my lab to go to @ThirdRockV to work on a new company concept. This was not a spur of the moment or rash decision but it was made easier by the fact that the new idea was something motivated and inspired by my friend and mentor, Charles Homcy. The group at that time was small, but my partner in these early stages was @VyasRamanan who is pretty special if you don't know him. Oh and I would mention Jeff Tong too but I know he is not on social media but Hi Jeff!
Charles did not have a roadmap for what he envisioned but he did have two guiding principles:
1. Do something important. That is, work to develop new medicines that would address important areas of biology or medicine.
2. Do something different. Again, these cannot be exclusive. I.e., don't be different and not important. But Charles guided us to aspire to be creative in trying to find areas of biology and medicine that were not well-addressed or were not likely to be addressed soon.
So we set out to come up with ideas were we could satisfy this guidance. We quickly aligned that cardiovascular/cardiometabolic/cardioendocrine diseases were, even in the peak of COVID, still the number one killer of people in the world. But where could we also satisfy #2? Here we came to our focus on and ultimate foundation built on human genetics and the power of the large now mostly publicly available databases that existed. This was around the time that Vyas and I were joined by @beryl_bbc who brought the fuel we needed to ignite things with her energy, tremendous intellect, and her expertise in human genetics
A story for a Friday afternoon. Spoiler, I really don't know what to do with it.
So I have this patient. He is mid-50's & healthy aside from an ACS event a few years ago for which he was stented & is on all the right 2ndry prevention things. He is also very active
He wears an Apple Watch, & a couple of years ago the watch was telling him he had Afib. Given his CAD, this was important as it would mean adding a DOAC to his regimen which of course does not come without risk.
The watch continued to trigger frequent AF alerts and we did a Zio
He kept very careful notes and the Zio was on for a week. There was no AF at all. And the events the watch was calling fib were clearly not fib
I don’t understand why people are so bothered by the fact that metabolic disease can be treated by medicines. It’s not that lifestyle solutions can’t work; they can! It’s that they don’t work for a very large number of people…
We should celebrate that more people have solutions that can work for them. Not doing so is the height of arrogance
It also seems relatively uncontroversial to acknowledge that medicines are a life-saving solution for those with hypertension who cannot control their blood pressure with lifestyle alone
Here’s a question for @nicknorwitz & @realDaveFeldman: if I understand, your model hypothesizes that increased ApoB in lean/athletic people on low carbohydrate or ketogenic diets does not result from either 1) saturated fat or 2) genetic variation, but rather from CHO restriction
So in the spirit of n=1 case studies, I have one for you. 52 year old male cardiologist BMI 21, exercises 6 days a week, on low SFA ketogenic diet for 4+ years with ApoB ~80 mg/dl
So how do you explain this? Is it genetics? Is it environment? If so, what else besides carbs is it? Fiber?