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Opinion and Commentary from TMA

New FDA-Approved Flu Drug Has Roots in Texas

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As you’re no doubt aware, last year’s flu season was particularly bad, with more than 11,000 related deaths statewide, including a record 180 children.

The 2018-19 season has started already, and health officials have reasons to believe this year likely won’t be as deadly.

For instance, the nasal spray vaccine FluMist is again an option, which should make it easier to vaccinate young children. Also, this year’s vaccine is expected to improve protection against two strains that were not well matched in last year’s vaccine.

So it was welcome news yesterday when word came out that the U.S. Food and Drug Administration (FDA) approved the use of Xofluza (baloxavir marboxil) as another tool for treating acute uncomplicated influenza in people 12 years and older.

You might have already heard about the drug, which has garnered a lot of media attention because of how effective it is in reducing flu symptoms.

"This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA in nearly 20 years. With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical. This novel drug provides an important, additional treatment option," FDA Commissioner Scott Gottlieb, MD, said in a news release.

But what you might not know is that the science behind what makes it work has roots right here in Texas, particularly The University of Texas at Austin (UT).

According to Medscape Medical News, “baloxavir marboxil prevents replication by inhibiting cap-dependent endonuclease activity of the viral polymerase.”

This is different from “neuraminidase inhibitors, such as oseltamivir (Tamiflu, Genentech), which inhibit the action of neuraminidase (an enzyme that frees viruses from the infected cells' surface),” Medscape said.

For those of you who’ve forgotten the gritty details of viral replication and dispersal, check out this article on UT’s College of Natural Sciences website

“Existing flu treatments, such as Tamiflu, attack the virus after it has replicated in host cells; they work by making it harder for daughter viruses to escape from the host cell. The new drug Xofluza, on the other hand, attacks the flu virus (by) blocking flu before it is able to create daughter viruses.”

You see, UT molecular biologist Robert Krug, PhD, and his team figured out years ago that the flu “grabs an early-stage messenger RNA in the host cell, cuts off a piece of the host cell messenger RNA including the cap and sticks it onto its own RNA strand to make a viral messenger RNA that looks like ones that the host cell makes.”

They called this process “cap-snatching” and began to wonder if a drug could be made that disrupts this early step in viral replication.

Years later, researchers in France and Japan put the missing links together, and another weapon in the fight against flu was born.


Stepping Away From Your Clinical Career? Key Points to Keep In Mind About Re-Entry

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This article originally appeared on physician-reentry.org

It is common for physicians to leave clinical practice for some period during their career and then seek to reenter clinical practice. 

Some physicians leave clinical practice to pursue a career opportunity or passion in a nonclinical setting. This could be either short term (just a few years) or for an indefinite period. Examples range from taking an administrative position at a hospital, to pursuing a full-time research opportunity, to doing mission work abroad. Physicians who are considering a nonclinical career should keep the following key points in mind.

Be Open to Possibilities 

Be aware that even a short-term sabbatical from clinical practice can make it difficult and expensive to just step back into clinical practice. Be open to the possibility that your professional future may include going back into clinical practice even if at the moment it is not something you see yourself doing. Being prepared for that option is important.

Licensure is a Privilege 

It is often hard to reinstate a license once it has expired. Before you leave clinical practice, contact your medical licensing board to find out about its policies regarding a leave of absence. Ask your board how it handles physicians who are not in clinical practice, if they issue limited licenses, and what statutes, if any, your state has in place to facilitate a return to practice. Overlooking regulatory issues can result in great difficulty and frustration when trying to reestablish a lapsed license.

Explore Ways to Not Leave Clinical Practice Completely 

Explore opportunities to moonlight or take call at local hospitals, ambulatory centers, and other clinical venues during your absence as a way of maintaining some clinical activity. Look into the possibility of doing volunteer work. Remember that preparation for maintenance of certification (MOC) may require some clinical work to meet criteria for renewal of your specialty board certification. Even some nonclinical roles in health care may require MOC status.

Seek Advice from those in Non-Clinical Careers and Others 

Consult with physicians who have chosen nonclinical careers and learn what their experience has been like. Seek support and insights from individuals who have been in similar situations, as well as from others, both professionals and nonprofessionals (mental health professionals, clergy, colleagues, career advisors, etc.).

Stay Connected With Your Clinical Colleagues 

Maintain paths to reconnect with clinical practice opportunities. You may also need to ask a clinical colleague to serve as a mentor when you return to clinical practice. Consider staying on or joining hospital committees and maintaining contacts within your community that may be useful should you decide to reenter clinical practice.

Keep Informed and Plan Ahead 

Stay aware of new developments in your specialty, as well as any regulatory issues that may influence a return to clinical practice. Check with local hospitals, specialty boards, and state licensing boards about any changes in requirements that may affect your ability to reenter clinical practice. In the interest of patient safety, be prepared to have to demonstrate your clinical competence. 

Beware that returning to clinical practice is a process that takes planning. It may take a year or more to return to clinical practice depending on your specialty, state, and time away from clinical practice.

See the official Texas Medical Association policy on “Physician Reentry Into Practice.

 

Wanted: You, to Be Featured in Your Magazine

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 Odessa-area physician Richard Bartlett, MD, takes his skills overseas to help those facing war and poverty

You’re a physician, so you and I both know you do plenty of good work for the people of Texas.

But here at the Texas Medical Association, we know you also do plenty of good work outside of your practice, and we’d like to highlight that work to your colleagues.

Do you do missionary work here in the United States or somewhere abroad?

Do you volunteer at a local nonprofit or other service such as Meals on Wheels, Habitat for Humanity, or the Red Cross?

Do you offer medical services at events such as rodeos, high school sports, or marathons?

Did you help rescue a cat from a neighbor’s tree?

Whatever good you’ve done this year, tell us about it, and we’ll tell readers of Texas Medicine magazine.

If you’re an avid reader of the magazine (like I know you are), you might’ve noticed a photo spread each month called “Imaging.”

Since the beginning of the year, that section has featured an assortment of stories told with photos: one of your colleagues testifying before state lawmakers, Texas Medicine covers featuring female physicians, and statewide events such as Hard Hats for Little Heads and Texas Two Step CPR, just to name a few.

For our December edition, we’d like to show off you and all the good things you’ve done.

It should be simple for you. Just send a photo (or a few!) to me at david.doolittle[at]texmed[dot]org and include a short description of what’s going on in the photo and the work that you do.

If your photos are chosen, you’ll be immortalized in the pages of the magazine of the greatest medical society in the nation. Now wouldn’t that be great!

So from all of us here at TMA, thank you for everything you do.