Friday, March 27, 2020

The SMELL CHANGE STATUS CHECK -- A Quick Way to Assess Recent Smell Loss in Suspected COVID-19

There have been numerous anecdotal reports of smell loss in people with COVID-19. It’s not surprising to find transient or even permanent smell loss associated with upper respiratory tract infections—in fact, it’s one of the leading causes of smell loss. However, in cases of flu, head cold, and sinus infection, the smell loss usually occurs at the same time, or following, the emergence of symptoms. What’s interesting here is the suggestion that the SARS-CoV-2 virus may trigger smell loss before full-blown COVID-19 disease is apparent. Thus, it might be evident in otherwise symptom-free people. If so, smell loss could be a useful marker in deciding whether to test someone for the virus, allow them back to work, etc.

Most people in the medical and chemosensory communities are aware of these possibilities. What has been unaddressed, thus far, is how exactly front-line medical personnel should probe for recent smell changes in potential patients.

Commercially available smell tests, such as the UPSIT and Sniffin’ Stick kits, are designed for full evaluation of smell function (although there are brief versions of each). However, they are relatively time-consuming to administer, at least in the context of evaluating people in the middle of a viral pandemic. They also require close patient contact with the test materials, which raises concerns about virus transfer and hazardous waste disposal.

My old friend and colleague Mark Greenberg, a neuropsychologist with a clinical practice in Boston, were talking about this earlier in the week and decided what was needed was a brief, verbal assessment using standardized questions, to determine if a person has experienced a recent change in smell function. We came up with three questions modified from the NHANES health survey, and added another of our own.

We call the resulting 4-item screener the SMELL CHANGE STATUS CHECK, or SCSC. We’ve made it available via a Creative Commons license. You can download it at this link. We hope healthcare professionals will find it useful. It may help in compiling data regarding how often smell loss is associated with SARS-CoV-2 infection, and when it emerges during the typical clinical course.

Monday, January 27, 2020

Annals of Hype: Yet Another Health Claim for CBD

The alarm on the FirstNerve Bogosity Meter™ has been blaring nonstop since New Year’s Day. It hasn’t recorded base levels this high since the Dot Com bubble at the turn of the century. Most of the triggering events are coming from the cannabis sector, and have to do with health claims for cannabis and its constituent cannabinoids and terpenes.

This morning’s alarm was set off by a tweet from a weed website called The Fresh Toast:

“Research suggests CBD could help manage varicose veins via influence on the cardiovascular system.”

Well, that sounds interesting. I wonder who did the research? After all, it’s notoriously difficult to use federal grant money to research weed or any of its components, especially using human subjects. (For the uninitiated, CBD is cannabidiol, a cannabinoid that occurs in marijuana and hemp. It has little or none of the psychoactive kick of its chemical relative THC, although it may interact with the human body’s endogenous cannabinoid receptors.)

The tweet links this article posted on The Fresh Toast, a website that bills itself as “the most trusted name in cannabis.” It was written by one Kate-Madonna Hindes. Her post is slugged “Here’s what we know about CBD’s effects on varicose veins.” Hindes sets things up with some general info about varicose veins before revealing her big piece of evidence:
A study published by the British Journal of Clinical Pharmacology in 2013 showed promise for cannabidiol as therapy for the cardiovascular system. The study gave insight into CBD’s benefits and offered that in some cases, cannabidiol could cause a reduction in vascular tension or, “vasorelaxation.”
So the hook behind the tweet and post was not a new finding but a seven-year-old paper. Further, it was not a clinical study or even an experimental report; in fact, it contained no new data at all. It was a review paper that examined previously published work relevant to the question “Is the cardiovascular system a therapeutic target for cannabidiol?

Well, nuts. But the review might still discuss research on CBD and varicose veins, right? Wrong. Varicose veins are not mentioned in the review. The cardiovascular disorders is does consider are diabetes, myocardial infarction, stress, stroke, and encephalitis. And the CBD-relevant evidence on these conditions is drawn from studies on dissociated human cells, rats, mice, and Mongolian gerbils.

In summarizing these studies, the authors of the review paper conclude:
Together, these data suggest that the cardiovascular system is indeed a valid therapeutic target for CBD. However, the target sites of action for CBD remain to be established for most of these responses. Whether these responses to CBD will translate into the human cardiovascular system also remains to be established.
In other words, they are very cautious and make no claim for CBD as a potential treatment for any human vascular disorder whatsoever.

But what does Kate-Madonna Hindes conclude?
With the introduction of CBD into the market, professionals and patients are taking notice of CBD’s benefits for varicose veins, but does research support its use?

The short answer is: Maybe.
I’d say the short answer is: No.

Hindes does her readers no favor by giving them the impression that there is any evidence at all for CBD as a treatment for varicose veins. She merely adds to the tsunami of online stories that tout CBD’s potential as a treatment for everything that ails you.

No wonder the Bogosity Meter is working overtime.