Pranab Chatterjee MBBS MD DTM&H

I’m not sure if blogging is a thing anymore but I’ve decided to write more this year. And this is the account of how a random drive helped clear out the cobwebs in my mind. The Nocturnal Odyssey: Driving as a Pathway to Cognitive Restoration and Creative Insights: open.substack.com/pub/sceptice...

Meanwhile over on the other side of the spectrum, the resident AI has gone … umm … yeah. Not good.

Re-reading this classic book at a time when it’s important to re-reimagine global health. The dismantling of the US supported apparatus will be a shock, but it’s my hope that it’ll also push us to reach a more sustainable, locally-led future.

Bats are viral superheroes with fascinating immune systems.

Bats can host deadly viruses like Ebola, Nipah, and coronaviruses without getting sick. Their secret? A constantly “switched on” antiviral response and a finely tuned immune system that avoids the inflammation seen in other mammals.

Hanging out in style! These majestic fruit bats (also known as flying foxes) are enjoying a leafy snack while chilling upside down, because why not? Native to tropical regions, these gentle pollinators play a vital role in maintaining forest ecosystems by dispersing seeds and pollinating plants.

Meet the Northern Bald Ibis. Punk-rock plumage and a scimitar bill to match! Once widespread across Europe, North Africa & the Middle East, it’s now listed as endangered; breeding programs in Morocco, Turkey & Europe are driving a fragile comeback. Share, donate, advocate. Extinction isn’t an option

Yellow-bellied Slider (Trachemys scripta scripta) drifting under a mirrored water surface. 🌿🐢
Hear the soundtrack? Ripples tapping pads, cicadas buzzing, and a Red-eyed Vireo swapping its cheery “question-and-answer” phrases from the canopy! Wetland meditation in full surround-sound.
#nature #Turtle

So @bhavnaseth.bsky.social and I thought it was a hummingbird fluttering over the milkweed, until we looked closer. Meet the Hummingbird Clearwing Moth (Hemaris thysbe), a master mimic that hovers and feeds just like its avian namesake. It is a vital native pollinator, drawn to nectar-rich plants.

The world’s priciest pizzas just became a billionaire’s meal. @bitcoin.bsky.social #btc #crypto Today marks 15 years since Laszlo Hanyecz purchased two pizzas for 10,000 bitcoins. Worth $1.12 billion today. #PizzaDay

So… this just happened with @bitcoin.bsky.social Where is this headed? #btc #crypto

So… this just happened with @bitcoin.bsky.social Where is this headed? #btc #crypto

An Evidence-Based Approach to Covid-19 Vaccination | NEJM This article from the FDA compares broad U.S. recommendations on Covid vaccination with those from other countries and announces the adoption of an evidence-based approach to such recommendations.

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TL;DR:
✅ Covid boosters: now targeted
✅ RCTs required for low-risk groups
✅ Trust in vaccines needs rebuilding
✅ FDA finally walking the evidence-based walk
Let’s hope it’s the beginning of a more measured era.
📄 @nejm.org article: www.nejm.org/doi/full/10....
#Covid19 #Vaccine #PublicHealth

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Parallel to trials, we must invest in restoring vaccine confidence: clear risk communication, community outreach, and rebuilding trust in public health, especially in communities hit hardest by Covid and misinformation.
#VaccineEquity #PublicHealth

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As the FDA shifts to evidence-based booster approvals, we must urgently launch RCTs per FDA guidance:
✅ include 50–64 yr-olds
✅ allow prior Covid infection
✅ follow ≥6 months, and
✅ measure real-world outcomes (symptomatic illness, hospitalization, death).

#Covid19 #Vaccines #RCT #FDA

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Downsides? This framework assumes “risk” is static and easily classified. Social vulnerability, exposure risk, and inequities (e.g., multigenerational households, essential workers) aren’t fully captured by medical comorbidity lists.

Oversimplification can cost lives.
#HealthEquity #Covid

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This should encourage efforts to initiate pragmatic, rapid clinical trials - something we excelled in #ICMR during the early phase of the pandemic.

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While the FDA’s new booster policy favors evidence-based rigor, delaying access to boosters for low-risk groups until RCTs are done could undermine protection for younger adults with long COVID risk or caretaking roles: filling evidence gaps shouldn’t justify inaction.
#Covid19 #Vaccines

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Will this shift save the credibility of U.S. vaccine policy?

Maybe it’s a start. Better than overt, unconditional vaccine denialism.

But transparency, clear communication, and trust-building will remain essential. More so, as we face a future rife with inevitable pandemic risks.

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It also recognizes that public health messaging must respect people's intelligence.

Rejecting the idea that Americans can’t understand nuanced recommendations is key to rebuilding credibility.

Given the resistance towards vaccine mandates, can clinical trial data help change people's beliefs?

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This move may help reverse growing vaccine hesitancy. By demanding gold-standard evidence and being transparent about benefit-risk uncertainty, the FDA is signaling a return to evidence-based medicine over blanket precautionism.

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The policy says that it strikes a balance:
✅ Speedy access for high-risk groups
✅ Scientific rigor for low-risk populations
✅ Incentives for manufacturers to generate evidence
✅ Encourages public trust by being honest about what we don’t yet know

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The high-risk group is broad, per CDC:
✅ Obesity, diabetes, pregnancy
✅ Mental health (e.g., depression)
✅ Cancer, HIV, heart/lung/liver/kidney diseases
✅ Smoking, physical inactivity, immunosuppression

An estimated ~100–200 million Americans still qualify for boosters.

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Trials should begin with the 50–64 age group, where global expert consensus is still in flux (“equipoise”).
✅ Placebo-controlled design
✅ ≥6-month follow-up
✅ Inclusion of people with past Covid
✅ Primary outcome: symptomatic Covid
✅ Key secondaries: severe illness, hospitalization, death

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This policy highlights the scientific uncertainty around whether additional doses benefit low-risk individuals who’ve already had Covid multiple times and received multiple vaccine doses.

That uncertainty must now be addressed with real-world data.

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But for healthy people aged 6mo–64yr with no risk factors, the FDA now wants randomized controlled trial #RCT evidence on clinical outcomes like symptomatic illness, hospitalization, and death, not just antibody levels, before recommending future boosters.

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The new FDA policy focuses on evidence generation and risk stratification.
Here’s how it works:
✔️ Adults 65+
✔️ Anyone 6mo+ with risk factors for severe Covid
→ Eligible for annual boosters based on antibody data (immunogenicity)

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At this point, I must say, I was reassured to read: “…a reluctance to vaccinate that is affecting even vital immunization programs such as that for measles–mumps–rubella (MMR) vaccination, which has been clearly established as safe and highly effective.”

Reminder: #vaccineswork.

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More worryingly, public trust in vaccines overall declined.
This included drops in MMR vaccine uptake, jeopardizing programs that are proven to save lives.

Results? The ongoing #measles #outbreak in the U.S.: a case of unintended consequences, perhaps.

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In practice, the existing policy was poorly adhered to.

Booster uptake in the U.S. had plummeted.
➡️ Less than 25% of Americans received boosters in the past two seasons.
➡️ <10% of children under 12 were vaccinated in 2024–25.
➡️ Even health care workers opted out: <1/3 got the 2023–24 booster.

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Per the authors, the U.S. took a one-size-fits-all approach, recommending Covid boosters to everyone aged 6 months and older.

This diverged sharply from Europe & Canada, where boosters were only recommended for older adults or those with high-risk conditions.