DEAR DR. ROACH: In a recent column, you referred to a U.K. source that stated “all-cause mortality is very significantly reduced in people who have had the COVID-19 vaccine, compared to unvaccinated people.” I wasn’t sure what you meant by all-cause? Does this mean any and all deaths, with or without COVID-19, for any reason, have been very significantly reduced just by getting the COVID-19 shot? Or does it mean that any and all deaths associated with COVID-19 have been reduced in those who have been vaccinated? If it is the first, then fewer people should be dying, people should be living longer, and we should not see a decrease in life expectancy (except for the addition of those dying from COVID-19, which brings the age down). Anyway, if the first is true, then I will definitely continue getting the COVID-19 shot just to live longer, with or without getting COVID-19! — C.P.
ANSWER: The U.K. study looked at all-cause mortality, which means anyone who dies from any reason. The study found that getting the COVID-19 vaccine reduced the likelihood of dying from COVID-19 and non-COVID-19 causes.
One potential problem studies face is assigning cause of death. If a person with a very serious cancer who is expected to pass away within a few months gets COVID-19 and dies, did the cancer kill them, or did COVID-19? If you have to choose just one cause, the answer could be misleading. That’s why the results of the U.K. study (and a Florida study that showed similar results) were so important. People who get the COVID-19 vaccine are less likely to die from any cause.
In the last few years in the U.S., the longstanding trend of improved mortality has reversed, and death rates are going up, partially due to COVID-19.
DEAR DR. ROACH: My husband has been diagnosed with cardiac amyloidosis. The doctor has started him on Vyndamax, a very expensive drug. Without this drug, he is lucky to live, at the most, two years. Is this drug a miracle, and does it guarantee that he will live many more years? — T.W.
ANSWER: There are several types of cardiac amyloidosis — a disease in which abnormal proteins are deposited in many tissues, including the heart, where the protein interferes with heart function and leads to heart failure. Tafadamis (also known by its brand name, Vyndamax) is used in transthyretin amyloid cardiomyopathy (ATTR, of which there are two types that both get treated with tafadamis).
Subjects in the trial on tafadamis were followed for two-and-a-half years. Half of the group were given tafadamis, while the other half were given a placebo, which looked like the real drug but had no activity. Of those who got the inactive placebo, 43 percent died in the two-and-a-half-year time span of the study, but of those who received tafadamis, 30 percent died. Thirteen percent, or about one in eight people, who received tafadamis lived, when they were expected to die. In addition, there were fewer hospitalizations and less loss of ability to exercise in those taking tafadamis, compared with the placebo. There were no serious side effects that were more frequent in the tafadamis group.
Tafadamis definitely affords a big improvement in the outcome of people with ATTR-CA. However, I would not call the drug a “miracle,” nor is there a guarantee of living many more years. To me, a miracle is when someone recovers when no doctor expected them to. I have seen a few in my career, and they are very powerful. I have seen many treatments that have incremental improvements in outcomes, and over time, that has led to dramatic improvements in many diseases.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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