Ania Jastreboff: The Transformative Obesity Drugs

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get closer to the truth about health and healthcare.

Our guest today is Dr. Ania Jastreboff. But first, we like to check in on current or hot topics in health and healthcare. And first, Harlan, even before that, I have to say the most exciting thing that happened to me in the last week.

Harlan Krumholz: What was that, Howie? What was that?

Howard Forman: Air fryer.

Harlan Krumholz: “Air fryer.” Come on.

Howard Forman: My niece has been telling me to get air—

Harlan Krumholz: You’re late to the game here.

Howard Forman: I am. I know. I’ve realized that. I’ve become my father, I think, because my father, it took him until about 30 years ago to get a microwave and it was at my insistence. And now my niece has convinced me to get an air fryer. But I feel like it’s a health-related purchase as well, because I can now make things without any oil whatsoever, so I just thought I’d share that with you.

Harlan Krumholz: Yeah, but are we sure are outcomes going to improve?

Howard Forman: We’re going to have to do a trial.

Harlan Krumholz: Yeah, we’ll have to trial air fryers.

Howard Forman: So anyway, what’s on your mind, Harlan?

Harlan Krumholz: Look, I wanted take a few minutes just to talk about Apple’s what I think is a big leap in their healthcare work.

Howard Forman: Huge.

Harlan Krumholz: Of course, they’ve been there for a while with their wearables and the phone and all this stuff, as have other products as well, but this is pretty amazing. What if your earbuds could do more than play music? What if they could help you hear better, sleep better, and even detect life-threatening conditions? And I’m sounding promotional, but the idea that the kind of tools that we have right around us at sort of affordable price points as opposed to what it cost for us to get healthcare quality kinds of products that can actually do things for us health-wise is pretty amazing.

So first of all, they got FDA-approved on a sleep apnea detection on the Apple Watch. So this is, sleep apnea is a condition where your breathing repeatedly stops and starts during sleep, and it’s associated with obesity. Timely—we have Ania on today, talk about obesity and obesity treatment. Affects maybe 30 million people in the U.S. But most people who have it, and it’s a risk factor for all sorts of problems ’cause of course, if you’re breathing, stopping and starting, it’s causing all sorts of mischief. Most people don’t know they have it. And untreated, it just continues to progress and cause problems. There are ways to intervene, even drugs now that can reverse it if you treat the obesity, but until now, the diagnosis required expensive, cumbersome sleep studies in the lab or at-home tests costing hundreds and hundreds of dollars.

Look, Apple simplified this with a new sleep apnea detection feature for the watch, and again, cleared by the FDA. So they’re basically using the accelerometer in the watch. That is the function that sort of checks your moving. This thing is so good that even when you’re sleeping and still, it detects your breathing because there’s slight micro-movements of your body during sleep as you’re breathing, of course, and it can alert you if the data shows signs of moderate or severe sleep apnea and suggests that you should follow up with a doc.

And it was good enough, like I said, that the FDA has approved it, making sort of the detection of sleep apnea now kind of trivial as opposed to a whole big rigamarole. So that was one thing.

And then the other thing was about the pods. So that was with the watch and detecting a condition during sleep. The other thing was the pods and hearing. So first of all, hearing aids.

So hearing aids is also a big rigamarole. You go get tested. Even if you buy over the counter, this thing can cost you a lot of money. More than—again, something like the same number of sleep apnea, 30 million Americans have hearing loss. And we know this is associated with cognitive decline, dementia, whole range of things, social isolation. And hearing aids, and I had this with my father-in-law, they can be expensive and challenging to figure out what you can use.

Here’s Apple’s solution. You can actually use the pods. I think these are ... and I have no Apple stock. I’m not promoting the company. I’m just impressed by what they’re pushing forward on. They basically, the $250 AirPods can be used to apply a hearing test and then they can use the results of the hearing test to create an algorithm that enables these pods to be customized to you to be used as a hearing aid. And that’s pretty amazing. This sort of budget-friendly option is going to enable a lot of people to be able to afford to be able to hear better.

But not only that. They’re also being used for hearing protection. So imagine you’re at a concert, you put it in. There’s sort of a noise monitoring function that can also help save your hearing and help you. It could be used in restaurants also when there’s a lot of outside noise. I mean all this is amazing. Again, this hearing aid was also approved by the FDA.

They went through rigorous testing. They got their approval or authorization, in the case of the sleep apnea I think it was authorization through 510k. That’s the mechanism by which they’re regulating it. But pretty amazing, Howie.

Hey, let’s get to our guest. She’s terrific, and I think everyone’s going to enjoy hearing more about what’s going on in the world of obesity.

Howard Forman: Dr. Ania Jastreboff is the Director of the Yale Obesity Research Center, Co-Director of the Yale Center for Weight Management and an associate professor of endocrinology at the Yale School of Medicine. In addition to these roles, she is widely recognized as an obesity medicine specialist and an international leader in the research and clinical application of anti-obesity pharmacotherapeutics.

Dr. Jastreboff has been the lead author on some of the most important clinical outcome trials of anti-obesity drugs, including some of the most novel ones. Dr. Jastreboff worked to develop the 2016 Obesity Clinical Practice Guidelines, serves on the board of directors for the American Board of Obesity Medicine, and is a world-recognized expert in this area.

Dr. Jastreboff graduated from Bucknell University with her bachelor’s degree and received her medical degree from the University of Maryland, where she also completed her internship and residency. She holds a PhD in investigative medicine from Yale University. And this isn’t your first go-round with us on the podcast. In fact, I went back and looked, and it’s almost exactly two years ago that you joined us for the first time.

Harlan Krumholz: First, how did Howie do on your name?

Ania Jastreboff: Ania Jastreboff, that’s perfect.

Harlan Krumholz: That’s good.

Ania Jastreboff: And it’s wonderful to be back.

Harlan Krumholz: We pronounce names on campus, so I’m just...

Howard Forman: Yeah, no, we make a huge effort about names and about pronunciation. In the two years since we had you on the podcast, these drugs have not just proven to be effective at weight loss and in treating obesity in the various forms, but just have had an explosion in proof of concept for lots of other diseases and reducing risks and so on. How does that change your practice? Because you’re not a preventive cardiologist, you’re not a nephrologist, you’re not a psychiatrist, but these drugs do have an impact on lots of different body systems. How does that change the ecosystem for these drugs?

Ania Jastreboff: Yeah, I mean, I think that obesity is really a unique disease for many reasons. And one of them is that if we can effectively treat this one disease, this one neuro-metabolic disease, we can prevent, mitigate, or treat hundreds of other diseases. And you named some of those diseases.

I think it’s important to keep in mind that we’re both treating the disease in and of itself while at the same time doing all of these amazing things. I do think that treating obesity effectively is transformative for medicine and it’s transformative for the exact reasons that you just mentioned. So the transformation that is ongoing right now with these new agents is akin to what we saw with penicillin or what we saw with insulin. They are truly life-changing, they are truly transformative, and they are in many cases potentially saving people’s lives. They’re preventing disease progression. They are improving quality of life. So truly transformative therapies now that we have for obesity treatment.

And I’ll also add, so I’m an endocrinologist. I focus in on obesity treatment and obesity medicine specifically, but I’m very well aware and I focus on the health gains. So when we’re treating obesity, it’s not about weight loss, it’s not about weight reduction. It’s about optimizing health and the health gains that our patients experience as we treat their disease.

Harlan Krumholz: I wonder, are we really talking just about treating obesity because in many of the studies of these medications, the tirzepatide and semaglutide or Ozempic and Mounjaro and Zepbound and Wegovy, we’re seeing health benefits accrue that seem somewhat independent from or not fully explained by weight loss. And there are people in my field who are questioning whether or not these drugs, which have receptors all over the body in various different places, are having fundamental effects that are independent of their treatment of obesity.

So do you take, for example, a recent paper that was looking at patients with heart failure was looking at its effect on inflammation. And the reductions in inflammation in the body were, I don’t want to say fully independent of, but at least partially independent of the amount of weight loss.

Now I know weight loss is an imprecise marker of the treatment of obesity. That’s another problem. So it’s not necessarily an exact proxy for treating obesity, but is it possible that these drugs are effectively treating obesity, which in its own right is an important thing and does account for over 200 diseases, as you’ve taught me, and a wide variety of problems that it can address, but that these drugs may also be having effects that we are yet to fully understand that may be mediated in other ways. What’s your view on that ’cause you’ve been involved in this from the beginning?

Ania Jastreboff: Yeah, I mean I agree with you 100%. And what I would say is, let’s use the example of diabetes, for example, or the prevention of diabetes. These medicines, in that case, we know there are direct effects on the islet, right? So they’re improving insulin secretion from the beta cells as well as other things. So there’s those direct or proximal effects. There’s also effects from the—

Harlan Krumholz: And that effect on the pancreas. Some people do say “islet,” we’re talking about the pancreas.

Ania Jastreboff: Yeah, in the pancreas. Yes, exactly. In the pancreas.

Harlan Krumholz: And that was one of the earliest things that was appreciated, right?

Ania Jastreboff: Yes.

Harlan Krumholz: When they isolated the drug from the Gila monster saliva, they were seeing this has effect on the pancreas. It produced insulin secretion, and that’s what led it to be used in diabetes in the first place.

Ania Jastreboff: Yes, absolutely. And you’re absolutely right. That is the first thing that was noted and found. So those are you could say the direct or the peripheral or the proximal effects on the pancreas, the islets, and specifically the beta cells, when we’re talking about insulin secretion.

There are also effects from the weight reduction. So for example, if you lose weight, you are improving insulin sensitivity. So you’re improving how your body uses insulin because you’re offloading the work that the beta cell has to do or that the islet has to do. So there are both direct effects on the islet, the beta cells, the pancreas, and there are effects from the weight reduction itself in terms of improving how your body is using that insulin that your body needs to make in order to control your blood sugars. I don’t think it’s one or the other. I think it’s both.

Diabetes is one example. And I know recently there were many publications that were brought forward specifically also looking at the heart. So I think whether it’s the heart, the liver, the kidney, where we’re seeing these beneficial effects with these medications, diabetes, we could keep on going. There are effects specifically from the drug, whether it’s on inflammation or other things. And there are also effects from the weight reduction itself. And the contributions of either one of those may be different for different diseases. So obstructive sleep apnea is yet another disease that we see improvement with tirzepatide. So I think it’ll be different for different diseases even within specialties.

Harlan Krumholz: In that case you’re making the point that you think that might be more about weight loss because of the obstruction versus direct effects. Is that the point you’re making?

Ania Jastreboff: It may be, right? It may very well be.

Harlan Krumholz: Although working centrally on the brain and that also may be—

Ania Jastreboff: Yes, exactly. And let me give another example. So many patients come in with joint pain. They come in with joint pain and is that joint pain from additional carried mass or is it joint pain from inflammation? And what we see, for example, when patients, if they stop a medicine, right? In general, most people start to gain back the weight. Now the pain in their joints may actually return before all the weight does. So that speaks to, there’s probably another process, not just mass, right?

So I think it’s likely a combination of both factors and the degree to which weight reduction versus direct effects of these agents themselves play is probably different for different diseases and for different people.

Harlan Krumholz: Ania, I wanted to ask you, among your many travels and things that you’ve done, you were on the stage with Oprah! You were on the stage with Oprah! So what was that like? I mean, first of all, they were picking who’s the best person in the world to talk to Oprah about these new medications and about the way we’re thinking about obesity, and that was you. So what was that like? Were you nervous? I mean, what was your experience?

Ania Jastreboff: Oprah is an amazing human, and I think that about sums it up. I think that the fact that she is using her platform and her amazing voice to really help shift that culture of shame and blame to one of compassion and care, I mean it’s amazing. It’s amazing. Which is why one of the first things I did on that stage was to thank her because I think that for her to share her story so vulnerably, right? I mean her story was in front of everyone for years.

And then to come out and share it so vulnerably enables others to do the same, and truly enables us to recognize that this culture of shame and blame for a disease that is not any of our patients’ fault, it needs to shift to one of care and compassion and understanding that biology is driving this disease. Biology drives us to various behaviors including what we eat, how much we eat, when we eat, what we crave, how hungry we are. So biology drives this, and really understanding that takes that shame and blame away from our patients and enables us to then be able to care for them.

And we as healthcare providers, we are such a critical part of that. We need to understand that and we need to embrace caring for our patients in a completely nonjudgmental, compassionate way. And she allowed for that on that stage and she continues to. So she’s an incredible advocate for our patients and just an amazing human being. So it was a wonderful experience.

Howard Forman: You’re on the cutting edge of the actual science. And so you’ve been involved, I think it’s more than a year ago, maybe two years ago with the trial on retatrutide. But I’m wondering when you look out on the landscape, not guessing games, but based on what you know, what is sort of the big exciting things that people can look forward to in terms of oral versus injectable in terms of more effective, less side effects and so on, what do you think is happening in the next few years based on what you know?

Ania Jastreboff: So many, many exciting things to come and I think we’re at the tip of the iceberg. So I’ll say that first.

So yes, so semaglutide, that pivotal trial was in 2021. Tirzepatide, one of the studies that I led, the pivotal trial was in 2022 for obesity treatment. And as you mentioned, retatrutide, which is a triple hormone receptor agonist for GIP, GLP-1, and glucagon that the phase two came out in 2023.

There are other medications: survodutide, which is a GLP-1 glucagon receptor agonist. There are orals in development, orforglipron, which is a small molecule, so it’s a once-daily, and there are other small molecules in development. Oral semaglutide is already FDA-approved for diabetes and being looked at for obesity treatment, also oral daily.

There’s also a monthly injectable called maritide. So imagine taking a medication once a month, self-injectable once a month or even less, and being able to treat your obesity, as well as potentially prevent, mitigate or treat 200 other diseases.

That all is coming and that is under the umbrella of these nutrient-stimulated hormone-based therapies. They’re all based on these hormones that are stimulated when we eat. Okay?

Now that is one class of anti-obesity medications. There are others in development, and I forgot to mention there’s another one, CagriSema. So there are amylin analogs that are also in development and CagriSema, cagrilintide, is an amylin analog. So that’s probably going to be the next to read out in the next few months and then hit the market sometime thereafter. So I think those are from that class, that’s the next one.

But there are other classes in development. So there are myostatin/activin receptor inhibitors or pathway agents that impact that pathway. And those are agents that actually can increase or at least maintain lean mass while decreasing fat mass. So those are yet to be sorted out in terms of how they will work. But myostatin/activin pathway inhibitors, so look out for that class potentially coming to a forefront.

Howard Forman: And that’s probably because we are concerned that some of these drugs might reduce muscle mass while patients are losing adiposity, right?

Ania Jastreboff: Well, any form, any form of obesity treatment or weight reduction, which I separate the two, obesity treatment is not weight reduction alone, you will lose lean mass.

So if you have bariatric surgery, if you undergo bariatric surgery, you will lose lean mass in addition to fat mass. If you take these medications, you will lose both. If you eat less, you will lose both. So it’s the ratio that we’re looking at and it doesn’t look to be that there is a market difference. And so the question is, well, are there things we could do to maintain?

Well, exercise is one of those ways or eating nutritious food is another way or some people increase the amount of protein that they eat or things like that. But it’s really the quality of the nutritious food and the exercise. But are there other ways that we could do this?

And so one of the potential questions is can these new class of medications potentially do this, pairing them at the same time? Now you could pair those new classes of medications at the time that you undergo bariatric surgery or at the time that you start one of these medications like semaglutide or tirzepatide. That’s the question.

But importantly in that it’s not just amount of muscle or the amount of lean mass, it’s the quality and the function. So we have to not only assess how much lean mass or muscle mass someone has, but how well it works. And I think that’s where we’re moving to next with a lot of these agents and trials.

And so those are two examples of classes. So we’re the farthest along with the nutrient-stimulated hormone-based class, that’s the farthest along. Then the myostatin/activin pathway inhibitors. They’re somewhere, some of them are in Phase II and moving forward, and there’ll be an important trial that reads out with one of those agents, bimagrumab, that’ll read out sometime in the next few months as well. Hopefully we’ll have to see.

So there are many things that are coming to a forefront. There are other pathways, there are other mechanisms that are being explored. So these are just two. So that’s why literally I’m saying this is just the tip of the iceberg and we have so much more to come.

Harlan Krumholz: There are more than 50 compounds that are already moving along and it’s going to be amazing. Wanted to ask you this. I know, we’re kind of...let’s just stretch the time, Howie. She’s so good. Just a little bit. So you’ve been traveling around the world. You were in Seoul, Madrid. You’ve been a wonderful ambassador. Can you just tell us, so what are you hearing around the world?

I mean, we kind of see what’s going on in the U.S., but what’s going on elsewhere? How are docs thinking about this? How are health systems coping with the costs? You’re talking in many countries where they’ve got a single payer. What are you learning as you’re going around the world? Are there places that are resistant to this idea of obesity as a disease and treatment, or is everyone on board? What are you seeing?

Ania Jastreboff: I think everybody is amazed and really open to this transformative time. And I always say with everything, we have to proceed cautiously, carefully. We have to look at long-term outcomes. And again, for diabetes treatment, GLP-1 receptor agonists have been around for over 20 years. Each of these new hormone pathways that is being targeted, they haven’t been around as long. So we have to do our due diligence. We have to be careful and we have to look at outcomes. Nothing is ever all good. But again, so far with these medications, it looks like there’s so many transformative beneficial effects.

So I think in most places there’s a lot of excitement, there’s a lot of buildup, there’s a lot of waiting because sometimes the medicine could be approved, for example, in Korea, semaglutide and tirzepatide are approved, but they don’t have them yet.

Harlan Krumholz: They don’t have them?

Ania Jastreboff: They don’t have them yet. So there are instances like that, whereas in various countries, other countries—

Harlan Krumholz: Does China have them available?

Ania Jastreboff: I don’t know. I don’t know that. I have not—

Harlan Krumholz: But clearly, it’s not being equally distributed around the globe at this point.

Ania Jastreboff: Well, and again, I think the other question, to the other question in terms of countries that have single-payer systems and other ways of covering them, I was in Australia, I guess it was a year and a half ago, and they had semaglutide and it was somewhere around, I don’t know, $35 a month, and in the UK it was $100 a month. So there are definitely market differences in terms of the cost but also in terms of access. So are the medicines being delivered in a single-dose injector like we have with the obesity versions of semaglutide and tirzepatide in the United States versus multi-dose pens, which are much better in terms of treatment and being able to titrate the dose to what the patient needs in terms of decreasing the dose, if they’re having side effects or increasing if they need more of a dose, which gets—

Harlan Krumholz: There’s so much I want to add. Let me just get this one in, then. What do you think about Lilly distributing vials instead of the pens, ’cause I heard that they’re going to start doing that?

Ania Jastreboff: So there’s a release of, or they announced this just recently, that for the 2.5- and the 5.0-milligram dose of tirzepatide, they’ll have single-dose vials, that if somebody doesn’t have insurance coverage, they can be purchased. So that is coming online. I think it’s just becoming available now.

Harlan Krumholz: That means people do it like they do insulin. They used to do insulin a long time ago, which is, they’ll be pulling it out.

Ania Jastreboff: Yeah, you could still do that. Yeah. Yeah. So they would just have insulin, a syringe, not insulin, but a syringe and a vial. But it’s single-dose. And part of that is, if we think about it, we want to ensure that people and patients are safe so that they have the appropriate dose at the appropriate time. So anyway, so they are releasing that as an alternative of something—

Harlan Krumholz: Is that because they have a shortage of the pens themselves, so this is addressing the shortage of the pens?

Ania Jastreboff: Well, I don’t know the inner workings of those types of decisions. I do know that there is difficulty in terms of getting medicine into the single-dose injectors ’cause that’s an additional step, an additional cost. I think overall, the multi-dose injector pens are really, that is where we should be moving if we’re not already, because then again, it’s easy for the patient to have it with them, to take it with them wherever they’re going. Even though it’s once weekly, right? Everybody’s not always in one location at a certain period of time, they can easily titrate the dose.

We do, and again, this is off-label, but we can use clicks to really be able to titrate the dose to exactly what the patient needs, and it’s just a good way to deliver the medication. So I think multi-dose pens is really the optimal way to deliver these, but that does take that additional step of transferring that medication into those multi-dose pens.

Howard Forman: This is amazing. You are a jewel, and we are so lucky to have you. And I wanted to just have an open invitation that you can come back anytime you want if you have the time ’cause we always learn from you. So thank you very much.

Ania Jastreboff: Great. I’ll come back. I’ll come back.

Harlan Krumholz: Howie’s just saying if you want to take my place on the podcast, that’s on the table.

Howard Forman: That too. That too.

Ania Jastreboff: I’d be happy to come back for visit number three. Thank you for having me for visit number two.

Howard Forman: Thank you.

Harlan Krumholz: Well, that was terrific as usual, Howie. She’s—

Howard Forman: She’s great—

Harlan Krumholz: ... a rock star. She’s just a rock star. But now, da da da, Howie, what’s on your mind this week?

Howard Forman: Polio is back in the news again. Over two years ago on the podcast, we talked about a serious polio threat in the New York area when one person developed paralytic polio and wastewater detected the virus in several adjoining and nearby counties. Less than 1% of all infections with poliovirus result in paralytic polio. So when we see wastewater-evidence polio, we know people are being infected. But generally only when we see actual clinical poliomyelitis paralytic polio do we know precisely who was infected.

So that outbreak extinguished itself without more harm, good news. But throughout the world, we have continued to see vaccine-related, vaccine-derived polio outbreaks, which is one of the main reasons why richer nations, including our own, have shifted to a different vaccine, an inactivated polio vaccine. And we talked about this earlier. But these vaccines can only be very effective at extremely high uptake rates and when polio is nearly eradicated. And I’ll refer our listeners back to episode 45 to understand more of that nuance.

But in brief, oral polio vaccine, that’s the one that Harlan and I took, but for which the country now does not take, but the rest of the world does, that is the vaccine of choice for the Global Polio Eradication Initiative because it provides superior mucosal immunity that’s in our GI tract against subsequent infection and spread of the wild poliovirus. It spreads from vaccinees—those who have been vaccinated—to close contacts and thus immunizes some individuals that were not reached by the vaccination program. It can be rapidly administered by volunteers in the form of little oral drops, and it’s relatively affordable by an order of 10-to-1.

But today I’m not talking about a vaccine-derived polio outbreak. And for those that may be interested, there was an outbreak in the Gaza Strip recently, and I did a TikTok, which we can link on our show notes today about that one. But for the first time in several years, we have a worsening outbreak of wild type, the original polio in Pakistan.

Wild type polio has been on the cusp of eradication except for one major region in the world, that being Pakistan and Afghanistan. But even here, there has been enormous progress with fewer than two dozen cases for several years running. But even that progress is being partially undone now. In Islamabad, the capital of Pakistan, where over 1 million people live, a single case has been detected and wastewater detection has been there and in many other regions in Pakistan right now. In Afghanistan, many more cases are circulating, including vaccine-related cases.

So both wild type and vaccine-related cases can be eradicated through high penetration of vaccination, but that’s where the problem begins. There are many reasons why the people of Pakistan have seen declining rates of immunization, but one of them relates to the U.S. government’s effort to find Osama bin Laden. They were using a fake vaccination program to identify bin Laden’s location. And in 2014, the U.S. government acknowledged this and promised not to do this again, but the damage was done. There are obviously many more reasons for individuals to become skeptical, but this one really stings.

And this week, as if to make matters worse, the Taliban, the de facto ruling entity of Afghanistan, banned most of their polio vaccination programs. This too is a very concerning move. If we’re going to have successful vaccination programs, whether we’re talking about the U.S., Pakistan, or Afghanistan, we need to make certain that politics are minimized and the public’s questions are answered early and often. So for the moment, Pakistan is engaging in a truly massive vaccination campaign as the rest of the world watches and hopes for a quick reversal to the current outbreak. But Afghanistan has paused in many efforts with worsening data as well.

So we can eradicate polio. We really have the means to do this, but it requires global cooperation and not one nation, not a few nations, but all nations have to decide they’re going to make this work together if we’re going to be successful.

Harlan Krumholz: Howie, it’s a real tragedy for anyone to be affected by this disease when we really have within our reach to be able to prevent it, and disheartening that we just can’t eliminate it because it really should be something. It’s really a political problem more than it is a medical...

Howard Forman: It is.

Harlan Krumholz: ...public health problem. Just since you’re talking about, I wonder if you’re prepared to say anything about what’s going on in Gaza because was there an outbreak in Gaza? I mean, what was it that led this to say was an imperative to vaccinate in Gaza?

Howard Forman: So for those that want to see more, we’ll link in the notes the TikTok, but one case, one paralytic polio case was in Gaza, much like we had one case in the United States last year. It was of an Egyptian strain. It was a strain that was linked to Egyp,t where there is ongoing small numbers of vaccine-derived polio.

And so the World Health Organization in collaboration with a lot of countries swooped into Gaza, which is a war zone, and was able to do a massive vaccination campaign. And they’re going to go back there two more times to complete that campaign and hopefully eradicate this before it spreads to more. But they’re still at risk in the same way other countries have been over time, but they had gone 25 years without a case.

Harlan Krumholz: I thought that was a case of in the midst of war, disease knows no borders. And so it’s in everyone’s interest to work together to make sure that this doesn’t come out. They can’t agree on anything, but they did agree on this vaccination program. I mean, basically it’s hard for them to agree on things, but this is, I thought—

Howard Forman: Yeah, too important.

Harlan Krumholz: Yeah, it was really too important for them to ... if we can only get them together on other things too, it would be good. But thank you, Howie. Great update. Great update.

You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.

Howard Forman: So how did we do? To give us your feedback or to keep the conversation going, you can email us at health.veritas@yale.edu or follow us on LinkedIn, Threads, or Twitter.

Harlan Krumholz: And we always want to hear your feedback or questions that you have or any experiences you have that may relate to things we’ve talked about on the show. If you like us or even if you don’t like us, rate us and review us. It helps other people find us, and we really appreciate it.

Howard Forman: Yeah. If you have questions about the MBA for Executives program at the Yale School of Management, reach out via email for more information or check out our website at som.yale.edu/emba.

Harlan Krumholz: Howie, I wanted to tell you that I’d like to encourage people. We really like it when people come up to us and say they listen to the podcast. I was at a conference this morning and just out of the blue, someone came up to me and said how much they enjoy listening to you in the podcast. And anyway, just encouraging. Go ahead.

Howard Forman: We’ve had some nice exchanges with our listeners by email as well. You and I had a nice exchange with a man that had been emailing us over the last couple of years, and so we’re happy to take thoughtful contributions and give back to you and try to incorporate it into the podcast in the future.

Harlan Krumholz: Yeah, that’s great. Health & Veritas is produced at the Yale School of Management in the Yale School of Public Health. Thanks to our researchers, Ines Gilles and Sophia Stumpf, and to our producer, Miranda Shafer. Talk to you soon, Howie.

Howard Forman: They are awesome. Thank you very much, Harlan. Talk to you soon.