Ken Covinsky's guest appearances

Ken Covinsky

GeriPal

OwlTail

Jason Karlawish

We’ve talked at length on prior podcasts about the failures of aducnumab, Biogen, and the FDA’s decision to approve it.   But wait, there’s a shiny new anti-amyloid drug, lecanemab!  (No it’s not just the French version of Aducanumab).   In an article in the NEJM (a published article this time, wonder of wonders!) lecanemab was shown to slow the rate of cognitive decline by 0.45 points on an 18 point cognitive scale compared to placebo.  Wow!  Wow?  Wait,  what?   On today’s podcast we talk with Jason Karlawish, who we’ve had on  previously talking about his book The Problem of Alzheimer’s and with Aaron Kesselhim, to discuss  FDA approval of Aducanumab, as well as frequent guest and host Ken Covinsky.   They debate today’s central question: is it time for geriatricians to get on board with lecanemab?  Along the way we address:  Is this degree of slowed cognitive decline meaningful to patients or care partners? What about the burdens, risks, and harms? Every 2 week visits for infusions, regular monitoring for brain swelling and bleeding,  case report level risk of death? Did the study do enough to address issues of  inclusion and diversity by age, race and ethnicity, and multimorbidity? What does this study say about the amyloid hypothesis? Should the FDA approve, and under what conditions?  Their answers may surprise you.   As a preview of final thoughts at the end of the episode, Ken and Jason agree that the FDA should approve lecanemab conditional on a post-approval monitoring system and public access to study data, geriatricians should be prepared to have thoughtful conversations with patients about the risks and benefits of lecanemab in view of their values and priorities, and ultimately, that geriatricians should be open to prescribing it.  Wow! The times, they are a changin. -@AlexSmithMD 

We’ve talked at length on prior podcasts about the failures of aducnumab, Biogen, and the FDA’s decision to approve it.   But wait, there’s a shiny new anti-amyloid drug, lecanemab!  (No it’s not just the French version of Aducanumab).   In an article in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2212948" rel="nofollow" target="_blank">NEJM</a> (a published article this time, wonder of wonders!) lecanemab was shown to slow the rate of cognitive decline by 0.45 points on an 18 point cognitive scale compared to placebo.  Wow!  Wow?  Wait, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02480-1/fulltext" rel="nofollow" target="_blank"> what</a>?   On today’s podcast we talk with Jason Karlawish, who we’ve had on <a href="https://geripal.org/the-problem-of-alzheimers-podcast-with/" rel="nofollow" target="_blank"> previously</a> talking about his book <a href="https://www.jasonkarlawish.com/" rel="nofollow" target="_blank">The Problem of Alzheimer’s</a> and with Aaron Kesselhim, to discuss <a href="https://geripal.org/aducanumab-aduhelm-for-the-treatment-of-alzheimers-a-podcast-with-aaron-kesselheim-and-jason-karlawish/" rel="nofollow" target="_blank"> FDA approval of Aducanumab</a>, as well as frequent guest and host <a href="https://www.mlb.com/cubs" rel="nofollow" target="_blank">Ken Covinsky</a>.   They debate today’s central question: is it time for geriatricians to get on board with lecanemab?  Along the way we address: <ul> <li>Is this degree of slowed cognitive decline meaningful to patients or care partners?</li> <li>What about the burdens, risks, and harms? Every 2 week visits for infusions, regular monitoring for brain swelling and bleeding, <a href="https://www.science.org/content/article/second-death-linked-potential-antibody-treatment-alzheimer-s-disease" rel="nofollow" target="_blank"> case report</a> level risk of death?</li> <li>Did the study do enough to address issues of <a href="https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18043" rel="nofollow" target="_blank"> inclusion and diversity</a> by age, race and ethnicity, and multimorbidity?</li> <li>What does this study say about the amyloid hypothesis?</li> <li>Should the FDA approve, and under what conditions?</li> </ul> Their answers may surprise you.   As a preview of final thoughts at the end of the episode, Ken and Jason agree that the FDA should approve lecanemab conditional on a post-approval monitoring system and public access to study data, geriatricians should be prepared to have thoughtful conversations with patients about the risks and benefits of lecanemab in view of their values and priorities, and ultimately, that geriatricians should be open to prescribing it.  Wow! The times, they are a changin. -@AlexSmithMD

Is it time for geriatricians to get on board with lecanemab? Jason Karlawish and Ken Covinsky

Sheryl Zimmerman

Kenny Lam

Assisted Living Communities (no longer preferable to call them Assisted Living Facilities, as we learned on the podcast) are…what, exactly?  That’s the central question on today’s podcast.  The problem is the tremendous heterogeneity in services offered and quality of care.  If you’ve seen one Assisted Living Community you’ve seen one Assisted Living Community.  To address this question, we talk with Sheryl Zimmerman, author of a recent  study in JAMA Network Open that used a Delphi process to ascertain what experts thought were the essential services an Assisted Living Community should offer to residents.  The experts settled on a range of key services, from more palliative care focused (e.g. end of life care and advance care planning) to more geriatrics focused (e.g. toenail trimming) to things in between (e.g. staff training in person centered care).  The problem, as Kenny Lam and Ken Covinsky, authors of an  accompanying editorial, state on the podcast: there is an inherent tension between the motives of the corporations that own most Assisted Living Facilities (profit) and the ideal services offered in Assisted Living Facilities.   We additionally firmly establish that the song How to Save a Life by the Fray was a product of the aughts (2005, to be exact), not the 90’s ): Enjoy! -@AlexSmithMD (still on Twitter at present)

Assisted Living Communities (no longer preferable to call them Assisted Living Facilities, as we learned on the podcast) are…what, exactly?  That’s the central question on today’s podcast.  The problem is the tremendous heterogeneity in services offered and quality of care.  If you’ve seen one Assisted Living Community you’ve seen one Assisted Living Community.  To address this question, we talk with Sheryl Zimmerman, author of a recent <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2796840" rel="nofollow" target="_blank"> study in JAMA Network Open</a> that used a Delphi process to ascertain what experts thought were the essential services an Assisted Living Community should offer to residents.  The experts settled on a range of key services, from more palliative care focused (e.g. end of life care and advance care planning) to more geriatrics focused (e.g. toenail trimming) to things in between (e.g. staff training in person centered care).  The problem, as Kenny Lam and Ken Covinsky, authors of an <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796836" rel="nofollow" target="_blank"> accompanying editorial</a>, state on the podcast: there is an inherent tension between the motives of the corporations that own most Assisted Living Facilities (profit) and the ideal services offered in Assisted Living Facilities.   We additionally firmly establish that the song How to Save a Life by the Fray was a product of the aughts (2005, to be exact), not the 90’s ): Enjoy! -@AlexSmithMD (still on Twitter at present)