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Administering immunotherapy in the morning seems to matter. Why?

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Re: Administering immunotherapy in the morning seems to matter. Why?

#151

Post by Panzer04 »

owenthejumper wrote: post #145
vlovich123 wrote: post #93

Earlier quoted context omitted.

If a study like this needs a complicated IRB approval or extra data collection vs what’s already being collected for health records, you’re doing it wrong and the process has become more important than the problem you’re trying to solve.

What happens if your study clearly hurts people? What happens if your study clearly helps people? You find out in the first few weeks, what do you do? How do you ensure you collected enough of a sample of a general population to make your study representative? How do you ensure your patients properly consented to the study (past shameful human experiments aside, you likely need many institutions participating, so you…

We can appreciate that process is important, but at some point you're falling down a slippery slope here, surely?

We're talking about a factor that no one has previously had reason to consider important.

Of course, I don't know hard it truly is to undertake a study. I have to imagine for something like this you could write up a basic study protocol in fairly short order.

Re: Administering immunotherapy in the morning seems to matter. Why?

#152

Post by vlovich123 »

vkou wrote: post #117
vlovich123 wrote: post #94

Earlier quoted context omitted.

Clearly they did it for one patient and it was a good result. Doctors and staff generally care about their patients and given there’s plausible scientific reasoning why this worked, they’d help figure out how to make staffing work for 3-5 more patients for a limited time. Additionally, positive results like this start to travel by word of mouth so if this is successful it means more funding for the hospital and more…

In any medical system in the world, you'll find that staff scheduling is the singular, most important constraint for patient care. That they did it for one patient does not mean that they can do it for everyone - especially when it's not clear if it actually helped, due to a small sample size.

I didn’t say everyone. I said do it as a pilot for 2-5 more patients so that you don’t write it off as a fluke, then give a talk at a conference. If you’re having good results then you can talk with the administrators how to make this a more serious program if there’s actually good results and desire to scale this up.

Nowhere do you start from 0 and go to 100. You take baby steps scaling up to see if the results hold.

Re: Administering immunotherapy in the morning seems to matter. Why?

#153

Post by vlovich123 »

owenthejumper wrote: post #145
vlovich123 wrote: post #93

Earlier quoted context omitted.

If a study like this needs a complicated IRB approval or extra data collection vs what’s already being collected for health records, you’re doing it wrong and the process has become more important than the problem you’re trying to solve.

What happens if your study clearly hurts people? What happens if your study clearly helps people? You find out in the first few weeks, what do you do? How do you ensure you collected enough of a sample of a general population to make your study representative? How do you ensure your patients properly consented to the study (past shameful human experiments aside, you likely need many institutions participating, so you…

I think once again - when the process becomes the metric it’s insane. What time things are being administered is already random and not regulated or organized. “What if it hurts” isn’t relevant for something like this because the reasoning is that the baseline is that “when” doesn’t matter, you’re still giving the same dosage. “What if it clearly helps?” What if. Then you publish a paper or give a talk at a conference and try to better mobile the medical community. Or see if the administrators are willing to help scale this up further.

> How do you ensure you collected enough of a sample of a general population to make your study representative?

You don’t need to. This would be a pilot study to check whether there’s maybe a there there before you do it larger scale to measure predictive power at population level.

> Do I keep going or is the IRB approval process clearer now? There is a reason it exists.

I think you’re completely failing to engage with the argument that this particular case about time shifting delivery of a drug should not need meaningful IRB engagement other than “I’d like to change the time I deliver the drug for 2 more patients because we had one patient respond positively and this isn’t believed to be a factor” “ok cool yup”.

You’ve jumped from no IRB to full IRB without considering the context of the problem being solved which is why I said when the process becomes the goal vs the problem you’re trying to solve - you’re imaging the worst and most complicated situations possible for a case that would never demand it.

Re: Administering immunotherapy in the morning seems to matter. Why?

#154

Post by stronglikedan »

bloqs wrote: post #122
raylad wrote: post #48

My father was on chemotherapy with fludarabine, a dna base analog. The way it functions is that it is used in DNA replication, but then doesn’t work, and the daughter cells die. Typically, patients who get this drug experience a lot of adverse effects, including a highly suppressed immune system and risk of serious infections. I researched whether there was a circadian rhythm in replication of either the cancer cells…

As a younger person what are the best habits to get into to maintain optimal long term immune health?

Don't be a germaphobe. Don't wash your hands a lot. Give your immune system a little work out each day by not babying it.

Try not to take any medicines unless you absolutely need them, and stay away from hand sanitizers. If you do need to clean anything, soap is more than enough and water is usually enough.

I thought it was normal to be over 50 and not take any medicines, but all the doctors and staff were surprised by this when I got my colonoscopy recently.

Re: Administering immunotherapy in the morning seems to matter. Why?

#156

Post by webstrand »

stronglikedan wrote: post #154
bloqs wrote: post #122

Earlier quoted context omitted.

As a younger person what are the best habits to get into to maintain optimal long term immune health?

Don't be a germaphobe. Don't wash your hands a lot. Give your immune system a little work out each day by not babying it. Try not to take any medicines unless you absolutely need them, and stay away from hand sanitizers. If you do need to clean anything, soap is more than enough and water is usually enough. I thought it was normal to be over 50 and not take any medicines, but all the doctors and staff were surprised…

By hand sanitizers, do you mean something other than the isopropyl-gel based hand sanitizers? If not, I would have guessed that would be little different than using a strong soap.

That said, unfortunately there's some element of luck to it. There's compelling evidence that C-section babies have abnormal immune responses and less diverse body flora. And I imagine childhood circumstance affects things too, city vs country affecting the childhood exposure to pathogens and non-pathogens for training.

Re: Administering immunotherapy in the morning seems to matter. Why?

#157

Post by amluto »

rendaw wrote: post #6

I'm doing CedarCure. You're required to not exercise or bath/shower for 2h after taking, which is fairly difficult in the morning, so I asked the doc if I could do it in the evening instead (despite explicit instructions to do it in the morning). The doc said it was fine, confirmed by the pharmacist. I should know better by now than to trust doctors to act based on research and not gut feeling, but I hope this doesn'…

If the reasoning in the OP is right, then one might infer that the evening is the right time to take it. The goal of cancer immunotherapy is to convince your body to treat the cancer as harmful. The goal of allergy immunotherapy is to convince your body to tolerate allergens. If you are more likely to consider antigens harmful in the morning and tolerable in the evening, then evening is better.

As a giant confounding effect, it seems that allergy immunotherapy might work, at least in part, by convincing your body to make large amounts of IgG antibodies to the allergen, and IgG antibodies are in the “kill it but don’t sneeze at it” category, which isn’t same thing as having your T cell population tolerate the antigen.

Re: Administering immunotherapy in the morning seems to matter. Why?

#158

Post by mschuster91 »

bloqs wrote: post #122
raylad wrote: post #48

My father was on chemotherapy with fludarabine, a dna base analog. The way it functions is that it is used in DNA replication, but then doesn’t work, and the daughter cells die. Typically, patients who get this drug experience a lot of adverse effects, including a highly suppressed immune system and risk of serious infections. I researched whether there was a circadian rhythm in replication of either the cancer cells…

As a younger person what are the best habits to get into to maintain optimal long term immune health?

- Get vaccinated fully and regularly. Any kind of infection is much harder to deal with for the body than a vaccine. Particularly important are the measles and Covid shots, an infection with either of the actual pathogens can wipe out your immune system history and you lose a lot of protection.

- practice safe sex, get tested regularly (even if both you and your partners are exclusive) and get that HPV shot. Yes, even if you're male. Cancer on your bits ain't pretty.

- keep the drug consumption reasonable, especially smoking and alcohol

- the better quality the food, the better your health. Should be a no-brainer and I know about food deserts, lack of time etc

Re: Administering immunotherapy in the morning seems to matter. Why?

#159

Post by FollowingTheDao »

goda90 wrote: post #150
bloqs wrote: post #122

Earlier quoted context omitted.

As a younger person what are the best habits to get into to maintain optimal long term immune health?

Sleep, exercise, a balanced diet of mostly whole fruits and vegetables, and a moderate amount of whole grains, legumes and fresh meat/fish/eggs if you're not choosing a vegan lifestyle. Avoid ultra processed foods, cured meats, alcohol and other recreational drugs. Make sure you get enough vitamin D, which can be hard with certain diets if you're not supplementing, or getting the right amount of sunlight(latitude and…

Maybe your schema will work for someone who’s on the very top point of the bell curve of human population but human genetic and environmental variability will over rule your advice for the majority of people.

Re: Administering immunotherapy in the morning seems to matter. Why?

#160

Post by kmarc »

stronglikedan wrote: post #154
bloqs wrote: post #122

Earlier quoted context omitted.

As a younger person what are the best habits to get into to maintain optimal long term immune health?

Don't be a germaphobe. Don't wash your hands a lot. Give your immune system a little work out each day by not babying it. Try not to take any medicines unless you absolutely need them, and stay away from hand sanitizers. If you do need to clean anything, soap is more than enough and water is usually enough. I thought it was normal to be over 50 and not take any medicines, but all the doctors and staff were surprised…

Above 50? My 30+ year old American friends are all running on pills, daily, many different of them. I was shocked.

So I am rather with you. It should be normal not to take medicines.

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