Knee Deep in Punicillin, Part 1 feat. Guest Dr. Thalia McCann aka @supplementhal

In this episode, Cady and Sharilyn sit down with Dr. Thalia McCann, an infectious disease specialist, for a deep dive into the messy, fascinating world of public health and medicine. From the dangers of C. diff to the promise of phage therapy, they unpack the latest in infectious disease research and policy.

The conversation explores the human side of healthcare - how intersectionality shapes patient experiences, the critical role of mentorship for marginalized communities, and the challenges of navigating medical systems. Dr. McCann also breaks down the importance of antimicrobial stewardship in fighting superbugs, the impact of climate change on disease spread, and cutting-edge advancements in HIV prevention.

If you've ever wondered how public health policies shape our everyday lives - or just love a good science-meets-social-justice discussion - this one's for you! 🚑💊🔥

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Chapters

• 12:30 Welcome Dr. Thalia McCann
• 27:56 A Day in the Life of an Infectious Disease Pharmacist
• 35:17 WTF is Antimicrobial Stewardship
• 47:18 The Role of ID Pharmacists in Sexual Health
• 58:29 Is there Any GOOD News??
• 1:03:58 Doxy PeP for AFAB People - DOES IT WORK?!
• 1:14:06 SILLIES with Cady & Sharilyn (Thal's in Part 2!)

Transcript

Sharilyn Wester (00:00)

Ehh, ehh, ehh, ehh, ehh, ehh, ehh, ehh, ehh, ehh, ehh,

Cady Moore (00:00)

We're doing it.

Welcome to Knee Deep in the Passenger Seat, our GayDHD podcast where we talk all about sex, dating, non-monogamy, queer culture, and literally whatever we want. I am Cady. I'm a queer, neuro-spicy, hyperbolist, AASECT-certified sexuality educator, and snake milf. I love fantasy novels, playing Stardew Valley.

and my husband's girlfriend who is with me here today.

Sharilyn Wester (00:36)

Hi, that was really sweet. Heavy on the snake milf because all of the pictures I've been getting from you and Bee lately, Cady's other partner, with Lilith around you or just pictures of her have been just delightful because she has such a cute little puppy face. I'm Sharilyn I am an aunt to a snake.

Cady Moore (00:38)

You

She does, she has the sweetest little face.

Sharilyn Wester (00:59)

I am queer, am a poly, I am a student of social work, I'm a poet, photographer, makeup artist, blah blah blah blah blah, all the arts and crafty stuff, who loves gaming, writing, reading, and surgically dissecting think pieces on art, prose, social justice, and I also have an amazing metamour who's one of my beautiful best friends and my co-host Cady.

Cady Moore (01:25)

I love you so much and I love this little project of ours. What are we here doing today, Sharilyn?

Sharilyn Wester (01:28)

I love you. Me too.

We, well, first of all, we're going to bring you the kind of stream of consciousness chaos that only two neurodivergent best friends can bring of all of the stuff that goes in on our brain, on in our brain unfiltered, usually excitably.

Cady Moore (01:52)

It's true and today specifically we are diving into the intersection of neurodivergence, intersectionality and public health. Our guest is none other than Dr. Thalia McCann, one of our besties She is an infectious disease specialist who is passionate about antimicrobial stewardship, women's and LGBTQIA plus intersectional healthcare.

Sharilyn Wester (02:08)

Yes.

Cady Moore (02:18)

as well as science and health communication used to dismantle anti-science propaganda.

Sharilyn Wester (02:25)

Yes, we are so lucky, I have to reiterate again, we are so lucky to know the coolest fucking people ever and Dr. McCann is no different. She describes herself as a neurotypical, LGBTQ, polyamorous, sadist slash masochist, rigger, SA survivor, she's a relational anarchist, she's dedicated to destructing hegemonic mythologies to prioritize community.

and mutualism that's like kind of her thing as well as just being like the most badass, coolest person we know.

Cady Moore (02:59)

And just

like, and y'all will get to experiences for yourself soon, like she, I mean, she wrote that bio and the way she speaks, I just like watch and I'm like salivating her diction and vocab. I'm like, say, say hegemonic one more time, please.

Sharilyn Wester (03:10)

Yeah.

Absolutely. If I could just like download her lexicon into chat GPT so it gives me answers that are very like of the essence of her I feel like I would just be so excited to learn more which she's going to teach us so much today. She's going to teach us about antimicrobial stewardship. She's going to talk about her experience going from being a child in a socio-economically challenged space to having this really

Cady Moore (03:21)

Mmm.

Sharilyn Wester (03:43)

prolific career in infectious diseases and the ways that she is spearheading so many different things within her organization and within the particular culture she belongs to being a physician and also being very heavily involved in research.

Cady Moore (04:01)

Yeah, it's it's badass as hell and we actually ended up having to split this episode into two because we got like an hour into interviewing her and And I was just like, okay, I'm not cutting us off. Like we're just gonna this is a two-parter. So And yeah, there's so much here. I don't want to neglect to mention now that dr. McCann is also

Sharilyn Wester (04:18)

It's so interesting.

Cady Moore (04:26)

the mother to the sweetest little old lady chihuahua named Darla who is like actually my favorite dog that I've ever met which is maybe a hot take and if my sibling listens to this I'm sorry I love your babies too but Darla is just the sweetest little girl. We're gonna have a great time so grab your favorite bevy, grab your craft, your fidget, whatever you need.

Sharilyn Wester (04:30)

You

Wee.

Absolutely.

Cady Moore (04:53)

or I hope you're enjoying your drive right now and settle in for our conversation that is going to just be deeply nerdalicious is the word for it. But before we do that, Sharilyn what is in your passenger seat today?

Sharilyn Wester (04:57)

Ha.

Yes

well, as of today, I will be done my quarter semester. I take

school and I take them in quarters. So like one semester is split into two. So I have three classes for two months and then typically three classes for another two months. So I'm finished my second to last quarter before I get my associate's of science in social work, which is exciting. So today I have like one more thing to do and then I'll have like a week off, which I'm super excited about.

before I head into this next semester, right, which is this next.

Cady Moore (05:41)

Boing, boing. Flash your titties.

Sharilyn Wester (05:50)

Sorry, you guys have to subscribe to Patreon to get to see that part. But yeah, next going into next semester, it's going to be my busiest semester that I've ever had. taking on an extra course, which I had to get written approval from in order to take in order to finish in time. So I'm good.

Cady Moore (06:08)

Sharilyn, didn't know

this.

Sharilyn Wester (06:11)

Yes. And so I am just, I'm very excited for this week off. literally have, I'm the kind where if I don't have something scheduled, I'll just bed rot and scroll all day. So I have things planned for every single day off that I have. have books I want to read. I have shows I want to watch. I have fantasy novels I need to catch up on. I have poetry that I need to write because I'm working on a poetry book, which is really exciting. I have like so much that I'm

Cady Moore (06:38)

Hmm.

Sharilyn Wester (06:41)

trying to fit in in this week off that well, yeah. Yes. So basically I'm coming to the end. I'm having a little breather for the next week. Thank goodness. And then we'll be back in it. So on that note, what about you, Cady? What's what's on your passenger seat today? What's got what's tickling your beautiful brain? Sorry, beautiful big brain.

Cady Moore (06:41)

And resting, right? You're gonna rest also, Active rest, active rest counts.

dude,

I mean it can be a little point too. God listening to you, it's just so skinny.

Sharilyn Wester (07:09)

She's so skinny! A skinny

Cady Moore (07:14)

Well, but before I dive into my passenger seat, I feel like this is a good time to and hearing about your semester is a good time to update our listeners that we have decided that we're going to be operating in seasons.

So this gives our NeuroSpicySelves chance to like catch up on other stuff because turns out running a podcast is a lot of work. It's a lot of fun and we're really enjoying it. And your girls need some time off. Yeah. So we have this episode and then we'll have the part two of our interview with Dr. McCann for our next episode. And then we will have our 10th episode be something fun and a recap of all the things. So.

Sharilyn Wester (07:39)

We want to do well.

Cady Moore (07:56)

just in time for Sharilyn's crazy schedule to really get going. But yeah, so for me, what's in my passenger seat today, I've been

I've been really concentrating on readjusting my morning routine so that I have a slower start. I tend to reach for my phone first thing in the morning just to see what's been going down since I went to bed at 9.30 the night before.

and that ends up usually leading me to social media like before I've even gotten out of bed and it just wasn't working for me. So my mornings have been very slow and peaceful and restful and I've been doing a lot more reading in the mornings which has been really nice. But today, I don't even remember why but I did open Instagram and I was like, wait a second, I'm so glad I did this because I learned today that the FDA just approved a new

Sharilyn Wester (08:36)

Yes!

Cady Moore (08:51)

copper IUD, which is important because IUDs, intrauterine devices, are one of the most effective forms of larks, which are long acting reversible contraception. And previously, your only options were hormonal IUDs in various sizes. And I was gonna say shapes, they're all shaped the same. They're all shaped like a little as are.

Sharilyn Wester (09:14)

one in a

heart.

Cady Moore (09:15)

on a hot shaped IUD. Our partner this morning was like, oh, it's an Aries favorite form of contraception, right? And I just looked at him and I was like, who are you? But either way, so you had hormonal IUDs, which were localized hormones, but still hormonal and they often stop your menstruation completely. Or you had the copper IUD called a Paragard, which I got in 2016 when Trump was elected.

Sharilyn Wester (09:17)

Yeah.

Cady Moore (09:44)

And I knew going in that the copper IUD tends to make your periods heavier, tends to make them crampier. It can make your periods longer. like none. just, it wasn't fun. And it only, I only lasted like two years with it or, or yeah, like two years. And then I switched to a hormonal IUD, which stopped my period, which I really hated.

And that was part of what led me to deciding to get my tubal ligation in August of 2022 was, um, I just was like, I was sick of it. So like, and then Ro got overturned after I'd had my console and I was like, Oh, I'm so glad I got in here before the, before the wait list got too long. But so this new copper IUD is smaller and has half the dose of copper, which should make the impact on

period significantly less, which is just so exciting because I just like,

Sharilyn Wester (10:38)

you

Cady Moore (10:39)

I love that other people are going to have an option that is long acting and can protect them without them having to like remember or think about anything that is not hormonal. You know, I'm, I feel very confident in my decision to have my tubal, but not everybody feels that way. And I'm just really grateful that there are going to be other folks who can, who can get this specific IUD. So that's what's in my passenger seat. And I'm, I'm really,

I'm stoked about it.

Sharilyn Wester (11:11)

Yeah, think in this current, on that note, like to remark upon that, I think in this current political climate, there's no ifs, ands, or buts about the fact that largely marginalized groups are who are being targeted for a lot of legislation that's going through. And of course, women always fall on that.

Any win I feel like as far as being able to provide contraception and health care options to women is a huge fucking thumbs up so I love that. Yeah, absolutely.

Cady Moore (11:38)

Mm-hmm.

Hell yeah. Yeah, we're stoked.

It's definitely good news. And speaking of access to healthcare, marginalized communities, we're gonna take a quick sponsor break and then we will head into our interview with Dr. McCann. So we'll see y'all in a jiffy. Bisexual finger guns.

Sharilyn Wester (11:48)

Yeah!

Yeah, I mean.

Cady Moore (12:30)

Today we are so excited to welcome Dr. Thalia McCann to the pod. Thalia holds a doctorate of pharmacy and is an infectious disease specialist, a subject matter expert and co-chair of the Vaccine System Pharmacy and Therapeutics Committee.

She is a pharmacy lead and works in outpatient antimicrobial stewardship. She is passionate about antimicrobial stewardship in addition to women's and LGBTQIA plus intersectional healthcare and using science and health communication to dismantle anti-science propaganda. She loves to backpack, she loves to hike, and she also loves to tie people up for fun, whether it is her fun or theirs.

thalia mccann (13:11)

Yes.

Sharilyn Wester (13:11)

That

intro, I feel like if you guys have watched Game of Thrones, was like Khaleesi, breaker of chains. She's the mother of dragons, the breaker of the wheel, all of this. And I'm so wet for it. Welcome to our podcast. my God, that like rap sheet. Welcome. So after that rap sheet,

thalia mccann (13:20)

I'm sorry.

Cady Moore (13:26)

So hot welcome

thalia mccann (13:27)

savior of humanity,

dealer of drugs.

So good. Thanks guys. Wow. Thank you.

Sharilyn Wester (13:39)

Thal would you explain to us a little bit about who you are, your pronouns, what titles you prefer using out of that rap sheet? I know Mother of Dragons is probably right up there at the top.

thalia mccann (13:52)

Pinnacle. So sorry. Yeah, I'm Thalia. I'm a doctorate of pharmacy, which you can call me Dr. McCann. I usually exclusively require that of my, like, septuagenarian and above, like, physician colleagues, that forget that I am also a doctor.

Cady Moore (14:12)

It's so hot, it's

literally so hot we should call you Dr. McCann this whole time.

thalia mccann (14:16)

I'm technically also a master of science, but I feel like being called master has like some weight to it. And I think that requires a higher level of negotiation. So we could pause that for a moment.

Sharilyn Wester (14:17)

put it in every opportunity I could.

Cady Moore (14:30)

my gosh, can you tell us your pronouns before we get too excited? I know I used some in your intro, but...

Sharilyn Wester (14:30)

You

thalia mccann (14:31)

of my pruna. Yes.

Yeah, pronouns are she they. Yeah, thank you. Of course.

Cady Moore (14:41)

Amazing. Thank you so much. And what

Sharilyn Wester (14:43)

we

love.

Cady Moore (14:44)

do you do? What? Tell us what you do.

thalia mccann (14:46)

Yeah.

Perfect. So I am an infectious diseases clinical pharmacy specialist, which means that I have entirely too much education and I'm here to ramble about it today. What that looks like is really confusing for most people. So just to give you an idea of what that looks like,

Cady Moore (14:57)

Yes.

Sharilyn Wester (14:57)

Absolutely.

thalia mccann (15:04)

am not working in a Walgreens. I don't even count by fives and sort pills for a living. It's really, it's really luxe. I actually...

Sharilyn Wester (15:11)

Me either.

Cady Moore (15:14)

She can't. I never learned.

Sharilyn Wester (15:15)

yeah.

thalia mccann (15:16)

Really helpful with ADHD. I actually have direct patient care and then through these advanced collaborative practice agreements and therapeutic drug monitoring programs, I actually manage patients fairly independently for like very difficult to treat disease states, disease states that require the use of antimicrobials that are extremely toxic or very long courses of therapy that are generally poorly tolerated. So.

Cady Moore (15:18)

Thanks

thalia mccann (15:43)

Thinking about that, besides just my patient load, I also am essentially a consultant to physicians, including ID specialist physicians. Because of my background where I did.

Cady Moore (15:55)

What does that

stand for? infectious disease. Never mind, I answered my own question. Yeah!

thalia mccann (15:59)

Yeah,

I might say that a lot because infectious diseases is such a mouthful. And so, yeah, I do that. And then am the chair of the Outpatient Antimicrobial Stewardship Committee and then a co-chair and subject matter expert on the Vaccine P &T Committee, which is sort of like

the group of people who make decisions about what goes onto a formulary within a health system. And I am in this subject matter expert role for the UC health system, which is the largest provider of healthcare in the state of Colorado.

Cady Moore (16:24)

Hmm.

Sharilyn Wester (16:34)

That's incredible. okay. I was gonna say there's so much there. I wanna know, obviously you're in this very, like from what it sounds like to any layman, very prolific role and very niche role. How did you get into this role? Cause I imagine as a little girl, weren't like, I wanna work in infectious diseases. So what did that?

Cady Moore (16:34)

Damn, you have so much power.

thalia mccann (16:35)

The power!

Sharilyn Wester (17:01)

pathway look like for you? And how did you get here? How are you here? How are you this Khaleesi?

thalia mccann (17:05)

Yeah, really.

Well, OK, I also want to shamelessly plug that Cady and Sharilyn helped me survive the end of residency. So I wouldn't be here without either of you today. I want to say that. But also, yeah, the the

Cady Moore (17:16)

Ugh, you're amazing.

thalia mccann (17:21)

I mean, the road has been twisty. I didn't take a traditional course. actually started off wanting to do research. I've wanted to be a science babe since I was like, you know, big enough to realize I was too large to be an astronaut.

Cady Moore (17:36)

Damn, as another 5'10 girly relatable, you're taller. Are you 5'11 or are 6'?

thalia mccann (17:37)

Yeah, yeah, yeah, yeah.

Sharilyn Wester (17:38)

Yeah.

thalia mccann (17:43)

I'm 5'10 and I wear heels. You know the vibe. And also, yeah, like I don't, I'm not gonna sustain multiple G's of force well. Like I get sick on roller coasters. So we weren't gonna be an astronaut. We wanted to go into STEM. And I initially wanted to do wildlife veterinary medicine. And then I realized I couldn't kill small animals. And then I decided to do science and I wanted to do more like systems and like ecosystems work. And then I got...

Cady Moore (17:46)

Yeah, she do. Yeah, she do.

thalia mccann (18:09)

pulled into this

sort of niche area of cancer biology and biochemistry where it's called the seed and soil hypothesis. So it's not just treating tumor cells, but actually looking at the way that they interact with an entire micro environment and recruit other cells to make them more difficult to treat and survive more extreme conditions. so somewhere I realized I was studying humans and I was volunteering at a VA.

Sharilyn Wester (18:35)

Yeah.

thalia mccann (18:39)

because my dad's a disabled veteran and I ran into an oncology pharmacist who was like, you are wasted under fluorescent lighting. Like you need to come to the light and like interact with patients. And there's just so much more out here for you instead of having like this, you know, modern biochemistry and molecular biology research is like an inch wide and as far deep as anyone in humanity can go. And I'm much more

Cady Moore (19:04)

Mm-hmm.

Sharilyn Wester (19:04)

just like a very linear

path.

thalia mccann (19:06)

Well, and it's just so narrow, actually, what your specialty is. And

Cady Moore (19:08)

Mm-hmm.

Sharilyn Wester (19:08)

Yeah.

thalia mccann (19:11)

kind of limited in what your impact can be because most people never actually do something that changes the course of humanity, right? We're all trying, but it's like 1 % of 1 % ends up going anywhere if you wanted to treat people versus having a day in and day out where you're making an impact in people's lives. And so really that was the scales that I weighted and decided to pursue a clinical career. So between

Cady Moore (19:13)

Mm-hmm.

Mmm, mm-hmm.

Mm-hmm.

thalia mccann (19:36)

pharmacy school and like completing my masters where I was doing the scene soil hypothesis actually tested grapevines and marijuana plants for viruses and bacteria and molds and I sold wedding dresses, which is kind of hilarious of the Hosts of this podcast know I do not believe in matrimony. So that was an interesting choice and and so I

Sharilyn Wester (19:47)

This is amazing. I love this fact.

Cady Moore (19:58)

You

But sometimes we

gotta do what we gotta do under capitalism, you know?

thalia mccann (20:03)

girls gotta eat and it turns

out that if you're like the cool girl that like doesn't actually give a shit about selling something you're really good at selling something all of a sudden yeah yeah yes yeah

Cady Moore (20:11)

Yes, because people can smell the sincerity if you need it too much and they're like, no, I'm turned off by that. Yeah.

Sharilyn Wester (20:12)

my god, you're so good at it.

They can smell the desperation. Yeah, when I was in college, I

So you had the concepts of like what you wanted to do. It was just getting there took lots of twists and turns and something I've actually heard from a couple of our guests that we've had who work within public health or healthcare is that

thalia mccann (20:26)

Yeah.

Sharilyn Wester (20:34)

they often found their paths by someone else almost advocating for them or almost seeing their potential and recognizing that

thalia mccann (20:40)

Yeah.

Sharilyn Wester (20:42)

and like pushing them towards that. And I know Thal you have had some experience from even when I was staying with you at one point where you're almost guiding others in their residency or like supervising. What kind of role does that play in your position as well in also being the person now to be pulling people into the field or guiding them?

thalia mccann (20:55)

Mm-hmm.

Yeah, that's such

profound question. Because I mean, truly, one of the things that I have always believed in

from looking at the people who've made an important impact in my life, right? Like I came from poverty. I came from a medically underserved community. Gals like me didn't end up where I was. Like this was not even a career path that I had envisioned. So it really was a series of mentors and people who illuminated to me where my strengths are. Like I came from this weird background in ecosystems and the person who convinced me that ID was the best choice for me was someone who was like, hey,

Like you can have an impact on an entire ecosystem through antimicrobial stewardship if you think about it. And you're also helping people's lives. And I would have never made that connection because you just don't really know what practice looks like. So now I often take, you know, pre-health and science people that are interested to come and just like check out what I do. Cause so many people don't know I'm in like this weird.

Cady Moore (21:54)

Hmm.

thalia mccann (22:07)

non-existent to the public eye realm of pharmacy practice that's very advanced. I'd say I'm probably like one of a handful maybe of pharmacists that are practicing at the level that I'm practicing and doing what I'm doing specifically. I mean there's many ID pharmacists but not many in my space and my niche. then I, yeah pharmacy students like I have had one this past month and I just have them shadow me.

I also am involved in training new residents that are in the position that I was just two years ago. And I think that that's really impactful, you know, because I kind of bring the reels. Like I'm like, hey, I had a, had a student who, you know, identifies as LGBTQ. And they were like, you know, on rotation with me in early January. And I was like, Hey, like, let's just check in.

Cady Moore (22:45)

Mm.

thalia mccann (22:58)

How are you today? And is this what you need right now? Or do you need something else right now? And they were like, you're the only person who has asked me that today. Health care training is so brutal and really requires that you zap so much humanity out of yourself to show up for it. That I think that's one of the things that I've really tried to bring in. And then just also, like I said, leaving the door open behind me.

Cady Moore (22:59)

Mm-hmm.

Mmm.

Mm-hmm.

thalia mccann (23:23)

explaining to like people from rural backgrounds or from poverty that like they deserve to be here. You know when you interact with them you can kind of smell it sometimes other people that are like I haven't you know imposter syndrome.

Sharilyn Wester (23:30)

Absolutely.

my god I was going to say

Cady Moore (23:37)

I love what you were talking about, the idea of like residency and the American medical system and medical education system, zapping the humanity from people, because I think that that is something that we see often. I was lamenting about this with my sibling today about like how doctors are, you

thalia mccann (23:54)

But.

Cady Moore (23:59)

giving them the credit that they deserve, that they're doing their best, most of them, but like they have been trained to be almost an automaton moving through their job. so like that keeping that human piece is something that I think more and more is going to be so important for everyone, especially like, mean, spoiler alert, we're going to be talking later about like how healthcare providers can communicate with their patients, but like the way that doctors interact with their patients, like.

thalia mccann (24:00)

Yeah.

Cady Moore (24:28)

they should, doctors should be asking their patients, hey, how are doing? You okay? Like everything, you good?

Sharilyn Wester (24:34)

Yeah.

Yeah.

thalia mccann (24:39)

Well,

okay, and this is the sad part, Cady. Like, I swear to goodness, I mean, I work in the outpatient space, so I'm really lucky that I see providers who really have chosen to interact directly with patients and they weren't like, you know what, I'd really rather everybody be under anesthesia by the time that I interact with them or they're like on a ventilator and can't talk back, right? So I'm getting the good ones.

Sharilyn Wester (24:57)

Yeah.

thalia mccann (25:01)

But it's almost like they put their like selkie skins of humanity back on when they like go and visit a patient and that's the nicest that they are that day.

Cady Moore (25:01)

Mm-hmm.

Cady Moore (25:11)

So Selkies are these mythical seal people from Scottish and Irish folklore who shed their seal skins to walk on land as humans and then put their skins back on in order to return to the water. But if someone steals their skin, they are trapped, unable to return to the sea. So in this context, Dr. McCann's colleagues are basically just a bunch of seals walking around pretending to be human when they're with their patients.

thalia mccann (25:34)

Then they take it off and they're like exhausted and depleted and it's just about the, there's so many layers to this, like really toxic training environments that are sort of akin to like a boot camp. Like there's this kind of weird perverse romanticization of like a brutality and like punishment and like.

Cady Moore (25:46)

huh.

thalia mccann (25:56)

working too late and being in the trenches. Yeah, right? And then on top of that, you add just like really untenable work conditions because even though I work in like a nonprofit health sector, the ideology is very much driven by capitalism. So they are squeezing the most work that they possibly can out of the people that are doing the work in healthcare.

Cady Moore (25:58)

It's giving best, guys.

Like.

thalia mccann (26:23)

so that they can have more overhead and more profit at the top. And so that means that you have providers, there are healthcare systems like some Kaisers where primary care providers are supposed to see 80 patients a day. And that's with note taking and like, you're not gonna connect with anyone meaningfully for that. Yeah, I know. That's why there have been strikes. But like.

Cady Moore (26:44)

What?

Ugh. Ugh. Yeah,

solidarity.

thalia mccann (26:52)

Yeah,

so I will say that I think I see it from both sides, right? And I will say that we have a

of just entrenched systematic things that prevent real connection and having people, there are good ones. There are people out here. One of my things that I've done is I have trained a chat bot just to make letters to fight with insurance companies. And I will crank out appeals for people like,

Cady Moore (27:09)

Mm-hmm.

That's amazing.

thalia mccann (27:21)

to get them meds. Like I even have friends in my personal life that will like be like, Dr. McCann, please write me a letter. And I'll be like, you just need to give this to your primary care provider and have them sign it and we'll send it. And so there are good ones. You just have to find the people that are not so burnt

Cady Moore (27:23)

That is incredible.

Sharilyn Wester (27:37)

Yeah.

Cady Moore (27:40)

Mmm.

Sharilyn Wester (27:40)

So

I think in like, obviously you're working in this very high level, in this very niche position. And so you have all of these credentials, all of this work and research, all of this experience, and then you're also working with the general public. could you, and especially like you said, like you try to bring empathy not only to your patients, but like to your coworkers and bringing people in. So what does a typical...

thalia mccann (27:54)

Yeah. Mm-hmm.

Sharilyn Wester (28:04)

day look like for you working within this field and within all of these hats that you have to wear? What does that look like?

thalia mccann (28:13)

Yeah, so I have

about five disease states that I manage.

Primary ones are anti-fungal therapy. So anyone who has an invasive fungal infection, patients who have mycobacterial infections, so that includes tuberculosis in the active and latent form, as well as non-tuberculosis mycobacterial infections. And then I also treat transplant-related viral infections. So on any given day, like we have like a Mycobacterial Monday.

portion of clinic where in the afternoon we like do most of the labs and any patients that are coming in for labs, I will try to space them out over the month to do inpatient interviews and encounters. So that way, like you're already coming in for your labs. While you're there, you get to talk to a medication expert who's helping you to make sure you're taking all of your medications appropriately. If you're having difficulty taking meds, there are some little like tricks of the trade so that you can tolerate them better. Can you imagine being on

antimicrobial therapy for nine months or a year for some of these patients. And then some of them are on antivirals, you know, in addition to all these other toxic medications that are eliminating someone's immune system. They're on antivirals, they're on antifungals, right? They just have a new organ transplanted that came with unexpected surprises. And now we're treating all of that. so having someone to really get into the nitty gritty of your medications is not only beneficial because it

protects the patients from oversight that frankly we just catch so many things. there's kind of safety and repetition and going through it a few times, but also there's someone who kind of can like meet with you more frequently than a physician can and make sure that you're actually tolerating things and like

Cady Moore (29:48)

Mm-hmm.

thalia mccann (30:03)

okay, you know?

Cady Moore (30:04)

Yeah,

and that your quality of life isn't suffering more than it has to. Like, I mean,

thalia mccann (30:07)

Right. Right.

Cady Moore (30:09)

as someone who's probably over-medicated, I have had to teach myself when to take things by trial and error. Like, oh, I should not take my diuretic medication after 2 p.m. or else I'm gonna be up all night peeing. And that's the kind of thing that like you can catch when someone is like, yeah, I'm like mostly okay, but here's some of the stuff I'm dealing with. You're like, oh, I know exactly why that's happening.

thalia mccann (30:20)

Yes.

Yes,

Cady Moore (30:30)

Here's, yeah, ugh, that's amazing.

thalia mccann (30:30)

totally, totally. And a lot of people

want to take like herbal supplements and vitamins and they think that these are just like benign things, but they can actually interact really like impactfully with some of the therapeutic modalities that we will be giving patients. And so those are just things that you're not going to really touch on in a 30 minute visit with a specialist, you know.

Cady Moore (30:54)

Mm-hmm, who's

thalia mccann (30:54)

And so, so I have that kind of direct impact. Every day of the week, there are antimicrobial stewardship rounds. And so we tackle difficult cases, patients who have positive blood cultures. Since I'm the outpatient side, I look at patients that showed up to the ED, they had something, they get like a urine culture or a blood culture done.

and they're sent out with empiric antimicrobials. And then sometimes the thing that grows isn't what we thought it was gonna be. So like you've now discharged someone into the wild and they're not on the medication that they need to be on for their infection. And so I like try to track down these patients or like coordinate with our care team and like nurse practitioners that assist with transitions of care out of the ED to make sure that people are safe.

which I mean, arguably it's good that we do that because people aren't just being admitted while we're waiting for something to cook and it's 99.9 % of the time exactly what we anticipate it's gonna be. But the other thing is sometimes patients are on medications that are like, you know, the full nuclear option and they could really be on something a lot more benign that is less likely to cause them toxicity and harm. And so we're weighing that risk benefit. Exactly.

Cady Moore (31:42)

Mm-hmm.

Sharilyn Wester (32:02)

All right, I give them those like side effects.

thalia mccann (32:06)

So maybe you're only on that for a day because someone like me calls

and goes, hey boo, you could just be on like a friendly amoxicillin Yeah.

Sharilyn Wester (32:11)

Hey! Yeah, yeah, we don't need to completely, like, eradicate your entire immune system

and, have you shitting blood? Just saying. Bestie, what's

thalia mccann (32:23)

Yeah, literally.

Cady Moore (32:24)

It's just

casual C-diff, it's fine, it's fine.

thalia mccann (32:24)

like, C. diff. Don't even get me. Yes, this is like a whole thing.

Sharilyn Wester (32:27)

Yes, absolutely.

Cady Moore (32:32)

Okay, so C. diff or Clostridioides difficile is a nasty little bacteria that can wreak havoc in your gut. Most of the time C. diff is just chilling in the environment, hanging out, not bothering anybody. But if it finds its way into your intestines and you've recently taken antibiotics, things can get messy quite literally. See, antibiotics are like this indiscriminate bouncer at a club. They kick out the troublemakers and the good guys.

Your gut has a whole ecosystem of bacteria that help keep things balanced. But when you take antibiotics to wipe out the good bacteria, C. diff sees an opportunity. It multiplies like crazy, producing toxins that can cause severe diarrhea, inflammation, and in extreme cases, life threatening complications. C. diff is contagious and it can live outside the body on surfaces for weeks to months.

and it's spread through the fecal-oral route, meaning that if someone goes to the bathroom and they don't wash their hands very well, they can contaminate surfaces, food, and other people. So if you have wiped out your good gut bacteria with antibiotics, it can take up to three months for your gut microbiome to return to normal, and you can take probiotics to help speed up that process of kind of bulking up your good guys again, but just...

Keep in mind that if you've taken antibiotics, may be susceptible to C. diff. So wash your hands really well, especially before you eat.

thalia mccann (34:00)

So yeah, I do stuff like that. And then, you know, I'm like mentor trainees, I assist with physicians that need help on complex cases. Like, we have a very different population of people that come into our clinic than who are represented in some of these clinical trials.

And some of the people that we have studied, the pharmacokinetics or the movement of the drug through the body, in like clinical trials, there'll be like 70 kilogram white dudes. And then my patient in front of me is an 89 year old that has a BMI of 50 and is missing a quarter of one of their limbs. And I'm trying to figure out what that means about like their renal function and what that means about what dose we can safely give them.

Cady Moore (34:34)

Mm-hmm.

thalia mccann (34:50)

And so I get to, it's like very intellectually, yes, so stimulating. I practice and I'm so grateful that I have a team. not in it alone. of, all of the rest of my colleagues that are ID pharmacists in my campus are all inpatient, but we collaborate on really difficult cases, which is really nice.

Cady Moore (34:54)

Puzzle solving.

Yeah!

Sharilyn Wester (35:15)

That's amazing. my gosh.

Cady Moore (35:17)

So you've used this word so many times now, and before we take a quick sponsor break, can you please explain what the fuck antimicrobial stewardship is? What does that mean? What is that?

thalia mccann (35:30)

Yes, totally.

Totally. So antimicrobials, which includes antibiotics, antifungals, and antivirals. And then stewardship, the sort of like shepherding, which is really related to cultivating the responsible use of these agents. And the idea is that we have recognized globally, the WHO, for example, has a whole webpage about the global threat to humanity that is superbugs.

Cady Moore (35:47)

Mm.

thalia mccann (35:59)

these antimicrobes that are resistant to literally most of, if not all of the treatment options that are available for them. And we're in this constant race of evolution between these superbugs and the production of antimicrobials, which is not really, not really profitable in the current system of capitalism that we have, right? Because you make something that is like for this very niche use.

Cady Moore (36:00)

Mm-hmm.

Mmm. Ugh.

thalia mccann (36:27)

And then there are people like me whose whole job is to be like, hey, can we not use that actually? Because I really want to save it for like when we need it. And so they're not making sale, you know, profits. If they are, like it's a problem. It's because like now we need something even bigger. And so, yeah, so really antimicrobial stewardship is like a concerted effort to save humanity from superbugs.

Sharilyn Wester (36:40)

Quotas, yeah, exactly.

Cady Moore (36:40)

Mm-hmm.

Sharilyn Wester (36:47)

Yeah.

Cady Moore (36:48)

Yikes.

thalia mccann (36:56)

to have people not taking medications that are unnecessarily broad that could cause them harm or toxicity. The C. difficile like infections is an outcome of that, which is very unfortunate.

Cady Moore (37:09)

like the time that I

was prescribed clindamycin for an ear infection and I went, I'm sorry, I'm not doing that because I know what clindamycin does and I don't need that for an ear infection, urgent care nurse.

thalia mccann (37:21)

The odds ratio

is like 30 for clindamycin and C. difficile. Like it's 30. That's insane. Yeah, sure.

Cady Moore (37:32)

which I'll put an aside here. I'll put an aside here about what C. diff is and what it does to people.

So I'll put an aside here about diarrhea among other things. We love that. We love a pooping aside. I feel okay. I have so many follow-up questions, but let's take a quick break and then we will be right back y'all.

thalia mccann (37:40)

Perfect.

Cady Moore (38:02)

welcome back everybody. Hope you enjoyed our sponsors. We have so many sponsors, it's amazing. Thal was telling us that she has some additional antimicrobial stewardship lore before we transition to talking about queer healthcare. Thal, would you like to spill the tea?

Sharilyn Wester (38:08)

You

thalia mccann (38:17)

Yes, okay, so here's the tea. And I just think that this is so fascinating. So I think most of us know in like the

1940s, we came up with penicillin and that sort of hilarious story about like the sandwich bread that was like left out on the countertop and then there was fungus that grew on it and then it fought the bacteria. It's probably didn't happen that way.

But we love it and I think that it highlights a really interesting tenet, which is that the fight between organisms to survive pre-exists us as a species and is ancient, right? And so bacteria and fungus have found ways to carve out their own environmental niches in cohabitation, but also in some ways in competition.

Cady Moore (38:56)

I'm getting goosebumps.

thalia mccann (39:06)

And even earlier than all of that, like ancient viruses have been infecting bacteria and have been affecting fungi forever. So you have actually, I think the primordial players that have all been duking it out. And then we just like pop up and become like this beautiful host organism for all kinds of infections related to that,

And so then with the mass production and use of penicillin, we went from being able to treat like many, many bugs.

Cady Moore (39:28)

Mmm.

thalia mccann (39:35)

to essentially now, penicillin has very niche uses and they're kind of wimpy ones and our beautiful treponemal species, syphilis. It's a little ribbon, that's why I did that. Anyways, I think that we've always thought that the larger the volume of antimicrobial use, which unfortunately also includes like very, very broad use in agriculture, the larger the environmental

Cady Moore (39:46)

We love syphilis.

Mmm.

thalia mccann (40:04)

sort of pressure on bacteria, the more resistant that they will become. But then in addition, overuse in humans we know can increase your risk of resistance because you and yourself are your own ecosystem, right? So this is all well and good. Humanity's the cause of all of this super mega resistant nasty

right? And then someone goes into the Carlsbad Caverns to a place that has never been touched by humanity.

Cady Moore (40:23)

All the problems.

thalia mccann (40:32)

has no communication of water sources. It's a section of an ice dwelling cave that has not been touched by humanity. It's the first time anyone has ever gone there and they take a sample and in this ice is a newly

species that is resistant to most of the antimicrobials that we have.

Cady Moore (40:54)

Whoa.

thalia mccann (40:56)

So like wrap your mind around this. Like these bugs exist. They're communicating with each other. We are a problem and I'm doing what I can on our end. But I want us to just take a moment to appreciate the intersection of what that means with climate change because these ice caves are gonna start melting. Right? Yes. Yes. And viruses.

Cady Moore (41:00)

Yeah.

Sharilyn Wester (41:03)

They're dormant.

Cady Moore (41:15)

fuck.

Sharilyn Wester (41:19)

All of these like dormant bacteria that have been frozen for, you know, millions or however many years

are now entering our water systems and the animals.

thalia mccann (41:25)

Mm hmm. Yes. And

there are funguses. So have you seen, is it the last of us with like the cordyceps? Right. Okay. So cordyceps cannot inhabit humans. But at the very beginning, there is a clip about how in modern society, human temperature, temperature is lowering. And actually with the rise of climate change, the ranges of these endemic fungi that can infect humans has

Sharilyn Wester (41:36)

Last of Us with cordyceps.

thalia mccann (41:55)

basically expanded with the erratic water patterns and storm patterns and then drought seasons. And so I think we're coming up after this El Niña period to a time where we're gonna have unprecedented exposures to certain endemic fungi just because of climate change. And so part of my job is to make sure that while we're appropriately prophylaxing people for coverage, we're also not overusing things for like.

fungal infections that aren't true infections. We just like see something growing somewhere and then we give it to people because we don't have that many antifungal agents that are safe for humans to use. And so I'm trying to think like in 25 years, I want to make sure that we have agents on board for when we're in, you know, a two centigrade increase in shit.

Cady Moore (42:45)

Fuck. Huh?

Sharilyn Wester (42:46)

Absolutely. So it's like

thalia mccann (42:47)

Anyways.

Sharilyn Wester (42:48)

you're constantly currently battling what is happening actively while preparing for this inevitable evolution of the human species that is self-induced as well as the self-induced like overuse of antibiotics and preparing for a future that you know is like it's not gonna get easier. Your job isn't gonna get easier essentially.

Cady Moore (42:50)

panic.

thalia mccann (43:11)

It's not.

the cool, one of the cool things is that we're actually essentially recognizing that viruses do it better than we do. So we've actually figured out ways to train phages to act with antimicrobials to knock out super bugs like that are bacteria because they, mm-hmm, bacteriophages. It's called phage therapy. Yeah, it's really, really cool.

Cady Moore (43:24)

Cool.

Sharilyn Wester (43:30)

like macrophages and I'm learning about that in my biology.

Cady Moore (43:34)

That's cool. I was gonna say, oh, someone's in

a bio class. Yeah, girl. You're literally so smart.

Sharilyn Wester (43:38)

I knew a word, you guys! I knew a word! Yeah!

thalia mccann (43:41)

Yeah!

Your lips so

Cady Moore (43:46)

So here's the deal with bacteriophages, or just phages for short. They are viruses that infect and destroy bacteria. Since I love bacteria analogies, let's say that they are like nature's microscopic hitmen. They've evolved alongside bacteria for billions of years. And while antibiotics are like that indiscriminate bouncer that we mentioned in the last analogy, killing both good and bad bacteria alike,

phages are like hitmen targeting only the bacteria that they are designed to attack. Phage therapy was actually discovered in the early 1900s, but when antibiotics came along, we kind of forgot all about it. Now with antibiotic resistant infections on the rise, scientists are bringing phages back into the spotlight. The idea is pretty simple. If antibiotics don't work, let's send in the phages to hunt down the bad bacteria that are left behind.

It is still experimental in many places, but phage therapy has already saved lives in cases where nothing else worked. And the coolest part is since phages evolve alongside bacteria, they really might be a long-term solution to antibiotic resistance. Basically, if bacteria are the bad guys in this movie, the phages are the monster hunters. So yay, go phage therapy.

Cady Moore (44:59)

I... Oh, wow.

thalia mccann (45:00)

So anyways, there is

Sharilyn Wester (44:59)

guys. my god.

thalia mccann (45:02)

hope we're

gonna keep being smart. But like, yeah, this is a race that has pre existed us and is going to continue to persist long after we're gone.

Cady Moore (45:10)

Hmm,

which honestly in some ways is

I that whole time was taking this as like cue the panic and actually when you phrase it like that that is like deeply reassuring. It's well, you know, we are actually insignificant in many ways. I mean, we're not statistically but

thalia mccann (45:23)

Mm-hmm.

Cady Moore (45:30)

you know what I mean.

thalia mccann (45:30)

Right, like we can just learn, like nature has been figuring this shit out and we could just be like learning from it instead of like doing all this crazy shit. Right, yeah. Anyways, so.

Cady Moore (45:34)

Yeah. Yeah.

freaking out about it. Yeah. Which is like honestly a whole thing that

Sharilyn Wester (45:38)

Because we're part of nature, yeah!

Cady Moore (45:45)

I and I, talk a lot about drugs on this podcast also, but one of my last mushroom trips that I went on, I came out of it and was like, I'm also part of nature. I'm not like, I'm not the problem. Like, I mean, I am in some ways, I'm sure, but like, I deserve to be here too. And my therapist was very proud of me for that.

thalia mccann (45:56)

Yeah.

I love that. That's really beautiful. I mean, I think that that's, that's what psychedelic therapy offers us, right? Is a connection to something bigger than us that I think we forget and we just like have kind of amnesia about in like the way that we have such an anthropocene, whatever, know, anthropocentric.

Cady Moore (46:07)

I am nature.

Mm-hmm.

thalia mccann (46:26)

Is that the right? Are those the Latins that go together?

Cady Moore (46:28)

I don't know, was gonna, I was, I'm gonna be Googling it and putting it

aside.

thalia mccann (46:34)

I'll

I'm just making up words now anthropocentric Society and world anyways

Cady Moore (46:37)

Love it. Anthropocentric. No,

Cady Moore (46:44)

Anthropocentric, considering human beings as the most significant entity of the universe.

thalia mccann (46:51)

Yes

Cady Moore (46:52)

it's it's

true. And this is why I try to do them every two to three months, because I forget every time what I learned. I'm like, right. We're going to learn the same thing again. OK, that's cool. Yeah, exactly. There always is. So amazing. Thank you for the answering what the fuck is antimicrobial stewardship with so much lore and like

thalia mccann (47:00)

Yeah.

Well, and there's like new layers. Anyways.

Yeah.

Cady Moore (47:16)

Yeah, my brain is reeling a little bit. Can

you tell us more about the role that infectious disease pharmacists play when it comes to reproductive and sexual health, especially for our queer and trans folks in the world? This is a, well, this isn't a sex ed podcast, but I'm a sex educator. So I'm like, let's talk about sex now. So can you tell us more about the role that infectious disease pharmacists play in that?

thalia mccann (47:37)

Yeah. Yeah.

Totally. I think by first blush, most people would not realize what the intersection is. But I think one of the really important things to remind everyone is that ID pharmacists are also your local

experts. And so a large section of my job outside of what I'm managing independently is I'm a consultant for people who have difficult cases. Either they are

Cady Moore (47:59)

Mmm.

thalia mccann (48:11)

sort of part of our legacy patients that are living with HIV, and they have been around since before we had highly active antiretroviral therapy, and so they often have more resistant disease. And then there's also opportunistic infections that go, and sometimes they're sort of the red herring, where we realize that someone actually

advanced HIV or AIDS.

because they end up having this kind of infection. And so those are often very difficult to manage, like weird fungal infections and viral infections. And so I see a lot of that. think also one of the things to think about is pharmacists are actually the most immediately accessible healthcare provider. You can walk into technically any pharmacy and you can talk to somebody who has a doctorate degree and who has been trained

Cady Moore (48:57)

Mmm. Damn.

thalia mccann (49:06)

in medication management and knows enough anatomy to, you know, and all of that to provide medical advice. And that is not something that you can say for pretty much anyone else you need an appointment. And many states are actually creating these collaborative practice agreements that are statewide to allow the provision of PEP, PrEP, DoxyPep by pharmacists in community settings because of the importance

Cady Moore (49:14)

Mm-hmm.

Mm-hmm.

Cool.

thalia mccann (49:36)

of it, I was gonna say that is federally recognized, but I don't know, make that past tense.

Sharilyn Wester (49:44)

Yeah.

Cady Moore (49:45)

It's fine. It's fine. Everything's fine. We're okay.

thalia mccann (49:46)

But actually most of that is

dictated at a state level, So most of the progressive states that actually have pretty progressive politics will also have that. what's interesting is that a lot of states that actually have large swaths of their population are greatly medically underserved.

Sharilyn Wester (49:48)

screaming internally.

thalia mccann (50:07)

have realized that they can leverage pharmacist services to render important care like that.

Cady Moore (50:13)

Mmm.

thalia mccann (50:16)

I think is obviously a set of maladies that disproportionately affect queer folks. And I think that also one of the things that's really interesting is that patients who are experiencing homelessness are also more likely to have exposure to certain types of viruses. People who have substance use disorders are more likely to have exposure to hepatitis. ID Pharmacy intersects with all of these.

Cady Moore (50:42)

Mm-hmm.

thalia mccann (50:45)

And so I think one of the things that's most important to me in my job is recognizing that the people who are going to be most affected by climate injustice, the people who are going to be most affected by discriminatory laws, people that are going to

Cady Moore (50:45)

Mm-hmm.

Mm.

thalia mccann (51:01)

lower reserves and resilience because they're fighting systematic systems of oppression, like chronically, who have statistically higher rates of mental illness, those folks.

have a harder time getting into care, being retained into care, having access to insurance, being able to pay for medication. And as we know, the rates of new HIV infections that are affecting our trans community members and our queer community members are disproportionate and even higher magnitude when you think about it intersectionally.

Cady Moore (51:16)

Mm-hmm.

thalia mccann (51:39)

I believe that trans women of color are currently that demographic that is the most at risk of new HIV infections in this country. And a lot of that has to do with a lack of care that is not discriminatory and like not shitty and, you know, lack of insurance and everything else.

Cady Moore (51:52)

Mm-hmm.

Mm-hmm. Mm-hmm.

thalia mccann (51:58)

so I feel like it is a privilege and an honor to be able to be specialized in something that unfortunately is just going to

Sharilyn Wester (51:59)

accessible.

thalia mccann (52:09)

continue to be ignored and not prioritized for the next four years. And I think on a global level, this is gonna become an increasingly large problem because the administration is cutting funding for USAID, which provides antiretroviral therapy to large swaths of our most vulnerable communities in the world. and fun news, guys. I mean, we're getting all the fun vintage stuff. We've got syphilis.

Cady Moore (52:30)

Yeah.

Sharilyn Wester (52:37)

I love.

thalia mccann (52:37)

And now we have multiple centers of tuberculosis outbreaks that the CDC cannot publicly comment on because of the new muzzling by the administration. And so as someone who manages tuberculosis infections, I mean, on one hand, I have job security. On the other, I am

Sharilyn Wester (52:50)

Yeah, with the wipe.

Cady Moore (52:50)

We love this.

Yeah

thalia mccann (53:00)

I'm very concerned. I'm sorry.

Cady Moore (53:01)

Well, there anything that you

Sharilyn Wester (53:01)

You're like, what even is my job now?

Cady Moore (53:04)

would like to share with us and our listeners that we cannot get from the CDC right now that we need to know? is that not sound like, is it a much bigger, is that question odd?

thalia mccann (53:14)

Well, there have been outbreaks

that we've identified in Kansas City and Montana and then I think Louisiana. I'm not sure, don't quote me on that last one, but like multiple large sections of the country are having outbreaks. And I think that unfortunately,

Cady Moore (53:25)

Okay.

thalia mccann (53:37)

where the spaces that we know that are most likely to have active outbreaks are also places like prisons. And I'm also going to say ICE detention centers because you're going to have large groups of people who are more likely to have been exposed to tuberculosis from the portions of the world that are more impacted by it and in dense living environments with poor circulation of air. So I think we just need to buckle up for this.

Cady Moore (53:48)

Mm, great.

Ugh, fuck. Okay. Thank you very much for sharing and indulging that fun, fun rabbit hole. No, you're nothing to apologize for. this, this...

thalia mccann (54:10)

Yeah. Sorry.

I'm like the worst

at cocktail parties because I'm like, hey, so know, humanity's fucked, right? And people are like, yeah, you're.

Sharilyn Wester (54:21)

You're like,

hey, let me tell you about this piece of ice that someone took from this place that no one had been at and also climate change. But honestly, I think these are good things to know, especially during a time when it's not even misinformation and disinformation that's being spread. It's no information. It's a complete muzzling and like a wiping clean of information that is accessible so that experts like you have a harder time.

Cady Moore (54:38)

Yeah.

Sharilyn Wester (54:47)

sharing a lot of this information. think it's why like platforms like this are so important even if it just reaches a few people so they have some awareness of what's going on in the world.

thalia mccann (54:49)

Yeah.

Yeah. I will say one of the most inspiring things is that the Infectious Diseases Society of America and other groups of organized healthcare professionals are taking a stand.

They've downloaded all of the information from the CDC website that has been impacted by these ridiculous executive orders, and they are hosting a platform to have all of the same information. And I'm just so happy that that exists. mean, there are women in STEM that are solidifying sub stacks with all of this information. And so I will say that the medical community is taking a stand, and I'm here for it. I think that

Cady Moore (55:07)

Mmm.

Sharilyn Wester (55:19)

I saw that, yep.

Cady Moore (55:26)

Mm-hmm.

Yeah. Mm-hmm.

thalia mccann (55:35)

There's a lot of in-group fighting that like maybe now we can all get behind one bad guy.

Cady Moore (55:39)

Yeah, I mean, I will say that is one thing that we are all learning now, especially depending on what, because I mean, like I'm a sex educator, but there's plenty of like weird shit in my field also about like who is allowed to be here and who isn't. And it feels like we are finally hitting a point of like, there is no gray anymore. You are either with us or you are not. And that's it.

thalia mccann (55:55)

Mm-hmm.

Yeah.

Mm-hmm. Yeah.

Cady Moore (56:09)

And if you're not with us, then get the fuck out or go hang out in your

own corner somewhere and you can keep doing you. But like we, as the rest of the community are going to continue to band together and make sure that the resources that are crucial for the people in our communities are accessible to them because that is what we are on this planet to do. And you can't silence us. You can try, but it's not going to fucking work.

thalia mccann (56:15)

Hmm.

Yep.

Totally.

Yeah, and

like,

I will also say that ID is like the home of the rabble rousers, right? Like there were people who completely denied that retroviruses were a thing. There were people who were laughed out of the rest of the medical community and the infectious diseases community that came back and were like, you guys, like, I know this doesn't follow the central dogma. And then they got a Nobel Prize 10 years later for proving

Cady Moore (56:38)

You

Mmm.

thalia mccann (56:58)

that this existed. And then like when the entire AIDS pandemic hit, there was so much polarization. Like people were refusing to pay physicians for taking a stand with communities that were affected by this virus, showing that like they weren't lepers that you could go into wards and not be wearing masks and you could touch people. like, and so, I mean, if there's a group that I'm happy to be affiliated with for...

Cady Moore (57:18)

Mm-hmm.

thalia mccann (57:26)

all of the disgusting medical science trauma BS I mean Tuskegee like the entire history of OB-GYN like

Cady Moore (57:31)

Yeah.

Mm-hmm.

thalia mccann (57:36)

Don't even get me started. I think now the modern iteration of like ID is very much with it. Like we're gonna stand with queer folks. We're gonna stand with marginalized communities. We understand the risk that this is not just about corporate gain. This is about the wellbeing and longevity of humanity. Like we're in it. We really

Cady Moore (57:55)

Yeah.

thalia mccann (57:56)

that.

Cady Moore (57:56)

And well,

and then, and that the most vulnerable populations are, and this is, this may be a like trite comparison, but it's the canary in the coal mine. Like, because the least resourced people are going to be the first ones to suffer, but that doesn't mean that we're not going to the rest of the, the folks who have access to these things. We're going to be fucked by the same super bugs. It's just going to happen a little later. So yeah.

thalia mccann (58:05)

Right.

Yep. Totally.

Cady Moore (58:22)

Well, for

thalia mccann (58:23)

Yeah.

Cady Moore (58:23)

the sake of keeping us on track here, before we change topics, are there any recent advancements in medicine or pharmacy that are like, let's talk about some good news. Are there any exciting things that, yeah, hit us with

thalia mccann (58:35)

Yes, I do have good news for you.

Sharilyn Wester (58:37)

Yes.

Cady Moore (58:39)

good news?

thalia mccann (58:40)

cool. So I think that one of the biggest boons in my field has actually been the prevention of new HIV infections, right? PrEP is an incredible concept, proof of principle that we have rolled out so successfully to protect our marginalized communities when it is used effectively. The caveat is that

It's really hard to take a medication every single day for something that isn't actively killing you, right? It's particularly difficult for, you know, women, cis women of color, trans women, right? We are really failing those groups. And one of the things that I have found that's really interesting is that a lot of these are based on global studies that are not happening in the US, but we were...

Cady Moore (59:09)

Mm-hmm.

thalia mccann (59:32)

really under-representing modern PrEP for cis women in the world. The very first PrEP medication that came out is notorious for causing osteoporosis and nephrotoxicity and all kinds of electrolyte disturbances that are just not fun called TDF or tenofovir disproxyl fumarate, if you're curious at all. And we came up with a less toxic version of that that was supposed to have higher intracellular concentrations.

Cady Moore (1:00:02)

So Dr. McCann did a great job of explaining this, but just as a quick aside, TDF is an antiretroviral medication that's been around since the early 2000s. It works by blocking an enzyme that HIV needs to replicate, which stops the virus in its tracks. You will find TDF in combination meds like Truvada, which is used both for PrEP or pre-exposure prophylaxis to prevent HIV and as a part of treatment regimens for people already living with HIV.

The problem is that while TDF is effective, long-term use can sometimes cause kidney issues and bone density loss, which is why this newer version, TAF or tenofovir alafenamide was developed. It is a lower dose, safer alternative, but TDF is still widely used because it is cheaper and effective.

thalia mccann (1:00:52)

And we were like, this is awesome. And then all of the trials that included cis women in that group, they were not showing a significant reduction compared to background for new HIV diagnosis. And they were like, maybe it's because it's not concentrating in vaginas. So they tried to figure that out. And they were like, maybe.

it's not working because, or we can't detect a difference because the rates are so much lower. And then they were like, no, no, no, we're studying this in an area where like there's a signal and we should be able to find it. What's going on? And then they just realized that women are literally so burdened to take care of their communities, to take care of other people, that they are often neglecting their own wellbeing. That's one barrier. And then the other is that hegemonic patriarchal violence means that

women are often actually denied care by the men that are directly responsible for them. And so we were failing cis women. so girls and women were having disproportionate lack of access and protection to new HIV infections until there have been two new studies called Purpose One and Purpose Two. Purpose One was specifically targeting

cis women and it's a new antiretroviral that is an injectable that is long acting and it's two injections in a year. So it's like highly, highly accessible. Women could come from wherever to get it once every six months. So the adherence is a hundred percent as long as you're getting the injections within a margin of like a couple months. And then we compared that to women that were taking oral PrEP medications and then the background.

Cady Moore (1:02:16)

Wow!

Sharilyn Wester (1:02:17)

that's so good.

thalia mccann (1:02:37)

for new HIV diagnoses and the effectiveness was two cases in over almost 3,000 women and that was associated with problems with adherence usually. so that was 99.9 % effective prep for women for the first time that we've had. that's, mean...

Cady Moore (1:02:48)

Bye!

Sharilyn Wester (1:02:48)

Wow.

Cady Moore (1:02:57)

Wow.

Sharilyn Wester (1:02:57)

That's

insane.

thalia mccann (1:03:01)

The rates for the oral PrEP went from like in the 90s to like the 60s by the time that they got to the third year of the study because of this like issue with adherence and accessibility. And in an age where global politics means that there's difficulty reliably getting oral medications to some parts of the planet, I just feel like this is a boon. So there are so many like logistics and complications in rolling this out and getting it paid for because it's very expensive as you can imagine, but

Cady Moore (1:03:10)

Yeah.

Yeah.

Yeah. The shit that works often is.

thalia mccann (1:03:30)

I, this one's a win.

Yeah. And then they did purpose too, which included a lot of trans folks and demonstrated also. Fantastic efficacy, better improvement. And I think that this is really something that we need to be like pushing out to our most marginalized folks that have the most difficulty sustaining contact with the healthcare system.

Sharilyn Wester (1:03:55)

Absolutely.

Cady Moore (1:03:55)

That is a

beacon of hope. Thank you. I have a follow up. I'm like nerding out. I have a follow up question. Can you please answer once and for all, does DoxyPep work for people with vaginas?

Sharilyn Wester (1:04:00)

Yeah.

thalia mccann (1:04:13)

Ugh.

Cady Moore (1:04:16)

Okay, so maybe not once and for all. I also love this reaction. This means this was a good question.

thalia mccann (1:04:22)

It's such a good

And I personally do not understand mechanistically again, right? Like what, what is happening with modern science? We are not allowed to study it, right? Like what the magical mythical vagina just like rejects antibiotics. That's how it works. Right. And so I think, I think that it would be effective. I think that we ran into the same problems that we ran into most of the other studies of cis women. A, the background rate to have a basically

Cady Moore (1:04:36)

Yeah, that's not how works.

Mm-hmm.

thalia mccann (1:04:52)

with statistics for the people who are listening who aren't nerds about biostatistics. And it's easier to see an effect with a smaller group of people that you're studying if the effect is very large, right? If you're changing something by 40 % or 90%, you only need to study a few hundred people. If the effect difference, like if your background rate of something happening is low enough, it becomes really difficult to determine a difference. You combine that with issues with

Cady Moore (1:05:03)

Mm-hmm.

Mm-hmm.

thalia mccann (1:05:21)

medication access because the women who are going to be at the most risk of that are also going to be the women that are most at risk of not having access to healthcare, right? Reliably. so I just honestly don't... I have qualms with how I was studied and I don't think we have the full picture. And technically right now it is not medically recommended to give to folks that are having receptive vaginal intercourse.

Cady Moore (1:05:22)

Mm-hmm.

Mm, okay.

thalia mccann (1:05:49)

for the same purposes. It may not be as effective.

Cady Moore (1:05:53)

Okay, thank you for that. I teach a queer sex ed course and I brought up that if you have a vagina, DoxyPep may not work for you. And there was understandably pushback where people were like, no, you definitely can. I am the, as the resource person in this room, like I have to go with what has been studied even though I don't know that I believe it. So thank you. I appreciate you. This gives me a fun anecdote to.

thalia mccann (1:06:05)

Yeah.

I'm with you, I'm with you. Totally.

Cady Moore (1:06:22)

This is be a

thalia mccann (1:06:24)

And I'm not even gonna mention like that there have been some patients that have had like weird recurrent cellulitis and have had, you know, a few courses of doxycycline that they just have in case for no other reason.

Cady Moore (1:06:23)

anecdote to talk about.

Which is casual. It's fine. It's fine.

Sharilyn Wester (1:06:38)

just in case.

thalia mccann (1:06:39)

even though they have vaginas, because...

Right?

Sharilyn Wester (1:06:44)

Mm-hmm.

thalia mccann (1:06:44)

What are you gonna say to the person that is clearly at high risk? Yes, correct.

Cady Moore (1:06:49)

Yeah, nothing. This is for my acne.

This is for my acne. This is for my ear infection. Me me me me me.

Sharilyn Wester (1:06:56)

I know I was going to say,

thalia mccann (1:06:56)

Yeah.

Sharilyn Wester (1:06:58)

Thal, that I

can see this congruence between this passion you have for studies like this, that you have a problem and you have a subgroup of people or a demographic of people. And there is a medication that could answer that problem, but culturally, there are issues that prevent people from accessing it. So do you find that

thalia mccann (1:07:13)

Mm-hmm.

Sharilyn Wester (1:07:23)

You almost get to practice this day to day when you're working individually with people and you have that face to face time with them and they might come in with a certain ID or they might have a specific issue and you can actually tailor medication to them that might be better for their lifestyle. Specific to them, like you said, like cis women who culturally might have more demands on them who might not be able to get

thalia mccann (1:07:31)

Yeah.

Yep.

Sharilyn Wester (1:07:50)

to the pharmacy once a month to get re-ups on medication. Like, is this something that really drives you in your field when you're working face-to-face with people?

thalia mccann (1:07:57)

Yeah, mean, so medications work as well as you take them, right? And so the other thing is that one of the things that I really bring forward is a very strong sense of empowering a patient to have medical agency and respecting that, not being patronizing, which I think is something that women are more subjected to often. And so if...

Sharilyn Wester (1:08:01)

Absolutely.

We talk about this a

thalia mccann (1:08:22)

and making their own decisions and have bodily autonomy, then it is your job to educate them. Here's what is gonna happen if we treat this thing. This is what's gonna happen if we don't treat this thing. There is only one disease state in the United States you can go to jail for not treating. Wanna guess what it is? We've talked about it a lot. It's very vintage. Syphilis. You cannot be medically penalized for not treating your HIV. Every other...

Cady Moore (1:08:38)

What is it? HIV. If, it is syphilis because congenital.

thalia mccann (1:08:49)

Well, and sorry, I guess also tuberculosis. Tuberculosis is one. Tuberculosis will actually put you in tuberculosis jail.

Cady Moore (1:08:52)

Is that only for someone who can get pregnant?

Okay.

thalia mccann (1:08:59)

Syphilis, they will hunt you down. I won't say they'll put you in jail, but they will be like, they're going to chase you with a penicillin shot.

Cady Moore (1:09:07)

And

Sharilyn Wester (1:09:07)

Yeah.

Cady Moore (1:09:08)

is that because of the mental decline that it causes or is that because congenital syphilis is such a problem or is it just like long standing?

thalia mccann (1:09:16)

Yeah, we have like the Department

of Health like being like, hey, have you seen this patient? This is this

like complete therapy, blah, blah. It's because of the rates of congenital syphilis and also because it is just actually very, they call syphilis the great imitator because it can present as like a ton of different vague symptoms. And a lot of people will just hang out until they have late latent syphilis and never realize that they had an infection.

Sharilyn Wester (1:09:43)

Right.

Cady Moore (1:09:44)

Mm-hmm.

thalia mccann (1:09:44)

Yeah,

so they won't put you in jail for Syphilis I want to say like they will put you in tuberculosis jail. But they will, the Department of Public Health will be like,

Sharilyn Wester (1:09:50)

I will say like that's, that seems like a great like.

thalia mccann (1:09:54)

like two things of penicillin.

Sharilyn Wester (1:09:58)

was

gonna say that sounds like a great like subset area of your careers being a syphilis headhunter like you're wearing your rider black you have a gun loaded with syphilis shots like okay I got a sight hunting them down like they they're about to get their car repoed

Cady Moore (1:10:09)

Bye.

thalia mccann (1:10:12)

Yeah, guys, if I tell bad dad jokes while I do that, could I just call it punicillin?

Cady Moore (1:10:17)

Yeah, yeah, yeah. Yeah. Okay, on

thalia mccann (1:10:19)

You

Sharilyn Wester (1:10:19)

You wouldn't

be a female main character if you wouldn't.

Cady Moore (1:10:24)

amazing note, we're gonna take another break. We will be right back to talk about Sci Comm and HealthComm and anti-Science propaganda and all sorts of fun things. So be right back, y'all.

thalia mccann (1:10:34)

off.

Sharilyn Wester (1:10:38)

Wee!

Cady Moore (1:10:40)

Okay, so we actually ended up turning this episode into two episodes because we just had so much juicy stuff to talk about with Dr. McCann. But before we take a break and go into our outro with Sharilyn, I wanted to touch base on what we were just talking about, which sounds like a dystopian sci-fi plot, but is actually a real public health policy, detaining people who refuse treatment for contagious diseases. So let's start with tuberculosis or TB.

TB is an airborne bacterial infection, meaning that it spreads when an infected person coughs, sneezes, or speaks. It is treatable with antibiotics, but treatment can take at least six months. And if someone stops too soon, the bacteria can become drug resistant, which makes it much harder and sometimes impossible to cure. Most people take their meds, but when someone with active contagious TB refuses or repeatedly fails to follow their treatment, public health officials can legally detain them in a medical facility

sometimes against their will until they are no longer a risk to others. Patients are usually placed in hospital isolation rooms or specialized public health detention facilities. Some states may have dedicated TB units in hospitals while others repurpose jail-like spaces. In extreme cases, individuals have been detained in actual jails, though this is widely criticized for obvious reasons. The detention period lasts until the person completes enough treatment to no longer be infectious. So that can mean weeks,

months or even over a year for drug-resistant TB. Now, as we discussed, TB is not the only disease that can get you locked up. Syphilis has also led to forced medical detention, especially for people who repeatedly refuse treatment. Syphilis is curable with antibiotics, but if it's left untreated, it can cause severe neurological damage, organ failure, and even death. Public health officials are particularly worried about congenital syphilis.

where an untreated pregnant person passes the infection to their baby, leading to stillbirth or severe birth defects. In some states, officials have used public health laws to detain people with infectious syphilis, sometimes in hospitals, but in some cases in locked wards or even jails. Unlike TB, syphilis treatment is quick, usually just a single injection of penicillin. So detention lasts days to weeks instead of months. However,

This causes an obvious ethical dilemma because detaining people for curable diseases raises serious civil rights concerns. While public health officials argue that detention is a last resort used only when someone is actively endangering other people, critics point out that forced medical isolation disproportionately affects vulnerable populations. So that's people experiencing homelessness, sex workers, folks with mental health conditions.

or people who may be struggling to access healthcare. At its core, this is a debate between body autonomy and public safety. No one wants to strip people of their freedom, but when an infectious disease spreads unchecked, detaining one person could prevent an outbreak that impacts thousands of people. With the rising antibiotic resistance that we've been seeing, more of these cases may be coming up in the future. So keep your eye out and please take your antibiotics as directed.

Sharilyn Wester (1:14:08)

Okay, well that was amazing and we have more to come. So thank you so much Dr. McCann. Stay tuned you guys for part two of this interview where we're gonna dig into access to healthcare and how that impacts queer and trans communities, how doctors like Dr. McCann can take better care of and be better advocates for their queer and trans patients and some spicy convos about cryptids.

Cady Moore (1:14:37)

I When you put Cady in charge of sillies you get weird-ass shit And and on that note I was in charge of sillies for for this episode and in honor of Michelle Trachtenberg's passing and her iconic film ice princess if You could design your dream figure skating outfit. What would it look

Sharilyn Wester (1:15:04)

Yes. my god. I love this so much. Do you want to answer first? Okay.

Cady Moore (1:15:08)

Yeah, yeah, I can answer first. And

this is for like me, this is for me now. the first thing that came to mind obviously was pink glitter. I was like, I knew I needed pink glitter. I knew that I wanted the fishnet tights with like the little rhinestones on it. I'm like, yes, me the glitter. And so I kind of like started feeling some like rhinestone cowgirl energy. Probably not with like fake denim.

Sharilyn Wester (1:15:14)

Yes.

Mm-hmm.

Cady Moore (1:15:35)

because that feels a little too like 2001. But yeah, like going for the, yeah, just a little too much, but like a rhinestone fringe, like let's fucking go. And as I was thinking about it, it made me realize that now I wanna see someone do a figure skating routine to casual because I feel like it would be so dramatic. yeah.

Sharilyn Wester (1:15:37)

No, yeah.

It's a little too on the nose.

Mmm.

Maybe someone has.

Cady Moore (1:16:01)

I looked it up and I found a couple hot to-go's and then one good luck babe, but no, no casual, but maybe I need to go on YouTube directly instead of using Google. So stay tuned. If I find one, it'll be in the show notes. If I don't, then it won't be.

Sharilyn Wester (1:16:11)

Mmm.

Yes. Okay, so the energy is

very pop. We're doing pink, we're doing rhinestones, we're doing glitter. No fake denim. I think we made that clear. Get your fake denim away from me. No, thank you. Not hungry. Has to be chapel-rone. What is your ending pose? Is it something big or is it something like demure?

Cady Moore (1:16:22)

Yeah. Yeah. No figtano.

big for sure. I'm thinking like truly like like like hands up like full star superstar arms

Sharilyn Wester (1:16:39)

Yeah.

Yes.

Yes,

Patrick Star Arms. my God. I love that. Okay, so real quick, I actually have a direct outfit reference. If y'all are listening to this, keep this open on your Spotify, Apple, whatever. Go on Google real quick. Go on images. Yeah, you got that open. Okay, look up Tessa Virtue, Scott Moir, M-O-I-R, 2018.

Cady Moore (1:16:49)

Mm-hmm, mm-hmm.

Yeah, what are you?

Sharilyn Wester (1:17:16)

Mulan Rouge. did this at the Pyeongchang Olympics and they did a routine to Moulin Rouge's Roxanne. And it is sheer. It is deep crimson. It's sexy. It's elegant. It's mysterious. It's devastating. It's something that a female main character would wear as she saws off an enemy's head. It's like the deep color with the song is so good.

Cady Moore (1:17:28)

So hot.

Sharilyn Wester (1:17:44)

I don't know if I would do it to Roxanne. That's pretty, that's, that's, I feel like for, with a partner, obviously it works really well. I would, my routine would be something a little more sultry and sexy and like dark, like to, I'm thinking like Streets by Doja Cat or,

Cady Moore (1:18:03)

Mmm.

Sharilyn Wester (1:18:06)

something a little more sexy like Mount Everest by labyrinth or Tia Tamera by Doja Cat those ones with like kind of the darker. I love it. I would do

Cady Moore (1:18:14)

huh. I'm getting You Should

See Me in a Crown by Billie Eilish. Yeah. Yeah.

Sharilyn Wester (1:18:19)

Yes. Oh my gosh. Yes. That total

energy that, yeah, I love those like very fluid, sexy, like mysterious. I love that. I love when they can infuse that into a performance and then they get off the ice and they're like just the most bubbly, like happy person ever. I love that. So that would be mine. Yeah. I'm like, I thought you were a man eater and instead you are a little bunny.

Cady Moore (1:18:36)

Mm-hmm.

Yeah, and you're like, wait, I'm confused. Hell yeah.

Yeah, did they win, did they win a, did they win a medal for that?

Sharilyn Wester (1:18:48)

would happen.

did they? Yeah. Yep. Yeah, and I'm telling y'all, go watch the routine on YouTube. I watch it at least once a month because it's so moving and it's so good. It's so good. They just, if you like musical theater, if you like Mulan Rouge, you're gonna love this ice routine. Hell yeah.

Cady Moore (1:18:57)

Oh yeah, yeah, for Canada. Wow, Mazel Tov.

Hell yeah, okay, super excited, yeah.

They, um, they skated a 199.86, which actually I don't know what the max is, so that doesn't, um, it doesn't matter. We'll stop nerding out now. Well anyway.

Sharilyn Wester (1:19:32)

They- this, yeah.

You

Cady Moore (1:19:37)

Anyway,

thank you everybody for listening. Thank you for being here. Yeah, we're super, we're super excited. If you loved what you heard, please don't forget to rate, review, and subscribe. You don't need to write a review. Even just giving us the stars is helpful. If you do write a review, we should start reading them out loud on the pod. I think that'd be cute. So we'll start doing that.

Sharilyn Wester (1:19:40)

Yes, we're going to catch you guys in part two.

Honestly, I've

gotten some really sweet ones.

Cady Moore (1:20:01)

Yeah, that's you know what? That's what we're going to do in our recap episode now. So write a review if you want to be in our recap episode. If you have listener questions, slide into our DMs or shoot us an email at kneedeeppodcastmailbag at gmail.com. You can find all that information in the show notes. You are welcome to give us guest suggestions, topic suggestions. We love all the input. So thank you all so much for being here. Have a wonderful rest of your day and we will see you for part two in two weeks.

Sharilyn Wester (1:20:30)

See you soon.

Sharilyn Wester (00:00)
Ehh, ehh, ehh, ehh, ehh, ehh, ehh, ehh, ehh, ehh, ehh,

Cady Moore (00:00)
We're doing it.

Welcome to Knee Deep in the Passenger Seat, our GayDHD podcast where we talk all about sex, dating, non-monogamy, queer culture, and literally whatever we want. I am Cady. I'm a queer, neuro-spicy, hyperbolist, AASECT-certified sexuality educator, and snake milf. I love fantasy novels, playing Stardew Valley.

and my husband's girlfriend who is with me here today.

Sharilyn Wester (00:36)
Hi, that was really sweet. Heavy on the snake milf because all of the pictures I've been getting from you and Bee lately, Cady's other partner, with Lilith around you or just pictures of her have been just delightful because she has such a cute little puppy face. I'm Sharilyn I am an aunt to a snake.

Cady Moore (00:38)
You

She does, she has the sweetest little face.

Sharilyn Wester (00:59)
I am queer, am a poly, I am a student of social work, I'm a poet, photographer, makeup artist, blah blah blah blah blah, all the arts and crafty stuff, who loves gaming, writing, reading, and surgically dissecting think pieces on art, prose, social justice, and I also have an amazing metamour who's one of my beautiful best friends and my co-host Cady.

Cady Moore (01:25)
I love you so much and I love this little project of ours. What are we here doing today, Sharilyn?

Sharilyn Wester (01:28)
I love you. Me too.

We, well, first of all, we're going to bring you the kind of stream of consciousness chaos that only two neurodivergent best friends can bring of all of the stuff that goes in on our brain, on in our brain unfiltered, usually excitably.

Cady Moore (01:52)
It's true and today specifically we are diving into the intersection of neurodivergence, intersectionality and public health. Our guest is none other than Dr. Thalia McCann, one of our besties She is an infectious disease specialist who is passionate about antimicrobial stewardship, women's and LGBTQIA plus intersectional healthcare.

Sharilyn Wester (02:08)
Yes.

Cady Moore (02:18)
as well as science and health communication used to dismantle anti-science propaganda.

Sharilyn Wester (02:25)
Yes, we are so lucky, I have to reiterate again, we are so lucky to know the coolest fucking people ever and Dr. McCann is no different. She describes herself as a neurotypical, LGBTQ, polyamorous, sadist slash masochist, rigger, SA survivor, she's a relational anarchist, she's dedicated to destructing hegemonic mythologies to prioritize community.

and mutualism that's like kind of her thing as well as just being like the most badass, coolest person we know.

Cady Moore (02:59)
And just

like, and y'all will get to experiences for yourself soon, like she, I mean, she wrote that bio and the way she speaks, I just like watch and I'm like salivating her diction and vocab. I'm like, say, say hegemonic one more time, please.

Sharilyn Wester (03:10)
Yeah.

Absolutely. If I could just like download her lexicon into chat GPT so it gives me answers that are very like of the essence of her I feel like I would just be so excited to learn more which she's going to teach us so much today. She's going to teach us about antimicrobial stewardship. She's going to talk about her experience going from being a child in a socio-economically challenged space to having this really

Cady Moore (03:21)
Mmm.

Sharilyn Wester (03:43)
prolific career in infectious diseases and the ways that she is spearheading so many different things within her organization and within the particular culture she belongs to being a physician and also being very heavily involved in research.

Cady Moore (04:01)
Yeah, it's it's badass as hell and we actually ended up having to split this episode into two because we got like an hour into interviewing her and And I was just like, okay, I'm not cutting us off. Like we're just gonna this is a two-parter. So And yeah, there's so much here. I don't want to neglect to mention now that dr. McCann is also

Sharilyn Wester (04:18)
It's so interesting.

Cady Moore (04:26)
the mother to the sweetest little old lady chihuahua named Darla who is like actually my favorite dog that I've ever met which is maybe a hot take and if my sibling listens to this I'm sorry I love your babies too but Darla is just the sweetest little girl. We're gonna have a great time so grab your favorite bevy, grab your craft, your fidget, whatever you need.

Sharilyn Wester (04:30)
You

Wee.

Absolutely.

Cady Moore (04:53)
or I hope you're enjoying your drive right now and settle in for our conversation that is going to just be deeply nerdalicious is the word for it. But before we do that, Sharilyn what is in your passenger seat today?

Sharilyn Wester (04:57)
Ha.

Yes

well, as of today, I will be done my quarter semester. I take

school and I take them in quarters. So like one semester is split into two. So I have three classes for two months and then typically three classes for another two months. So I'm finished my second to last quarter before I get my associate's of science in social work, which is exciting. So today I have like one more thing to do and then I'll have like a week off, which I'm super excited about.

before I head into this next semester, right, which is this next.

Cady Moore (05:41)
Boing, boing. Flash your titties.

Sharilyn Wester (05:50)
Sorry, you guys have to subscribe to Patreon to get to see that part. But yeah, next going into next semester, it's going to be my busiest semester that I've ever had. taking on an extra course, which I had to get written approval from in order to take in order to finish in time. So I'm good.

Cady Moore (06:08)
Sharilyn, didn't know

this.

Sharilyn Wester (06:11)
Yes. And so I am just, I'm very excited for this week off. literally have, I'm the kind where if I don't have something scheduled, I'll just bed rot and scroll all day. So I have things planned for every single day off that I have. have books I want to read. I have shows I want to watch. I have fantasy novels I need to catch up on. I have poetry that I need to write because I'm working on a poetry book, which is really exciting. I have like so much that I'm

Cady Moore (06:38)
Hmm.

Sharilyn Wester (06:41)
trying to fit in in this week off that well, yeah. Yes. So basically I'm coming to the end. I'm having a little breather for the next week. Thank goodness. And then we'll be back in it. So on that note, what about you, Cady? What's what's on your passenger seat today? What's got what's tickling your beautiful brain? Sorry, beautiful big brain.

Cady Moore (06:41)
And resting, right? You're gonna rest also, Active rest, active rest counts.

dude,

I mean it can be a little point too. God listening to you, it's just so skinny.

Sharilyn Wester (07:09)
She's so skinny! A skinny

Cady Moore (07:14)
Well, but before I dive into my passenger seat, I feel like this is a good time to and hearing about your semester is a good time to update our listeners that we have decided that we're going to be operating in seasons.

So this gives our NeuroSpicySelves chance to like catch up on other stuff because turns out running a podcast is a lot of work. It's a lot of fun and we're really enjoying it. And your girls need some time off. Yeah. So we have this episode and then we'll have the part two of our interview with Dr. McCann for our next episode. And then we will have our 10th episode be something fun and a recap of all the things. So.

Sharilyn Wester (07:39)
We want to do well.

Cady Moore (07:56)
just in time for Sharilyn's crazy schedule to really get going. But yeah, so for me, what's in my passenger seat today, I've been

I've been really concentrating on readjusting my morning routine so that I have a slower start. I tend to reach for my phone first thing in the morning just to see what's been going down since I went to bed at 9.30 the night before.

and that ends up usually leading me to social media like before I've even gotten out of bed and it just wasn't working for me. So my mornings have been very slow and peaceful and restful and I've been doing a lot more reading in the mornings which has been really nice. But today, I don't even remember why but I did open Instagram and I was like, wait a second, I'm so glad I did this because I learned today that the FDA just approved a new

Sharilyn Wester (08:36)
Yes!

Cady Moore (08:51)
copper IUD, which is important because IUDs, intrauterine devices, are one of the most effective forms of larks, which are long acting reversible contraception. And previously, your only options were hormonal IUDs in various sizes. And I was gonna say shapes, they're all shaped the same. They're all shaped like a little as are.

Sharilyn Wester (09:14)
one in a

heart.

Cady Moore (09:15)
on a hot shaped IUD. Our partner this morning was like, oh, it's an Aries favorite form of contraception, right? And I just looked at him and I was like, who are you? But either way, so you had hormonal IUDs, which were localized hormones, but still hormonal and they often stop your menstruation completely. Or you had the copper IUD called a Paragard, which I got in 2016 when Trump was elected.

Sharilyn Wester (09:17)
Yeah.

Cady Moore (09:44)
And I knew going in that the copper IUD tends to make your periods heavier, tends to make them crampier. It can make your periods longer. like none. just, it wasn't fun. And it only, I only lasted like two years with it or, or yeah, like two years. And then I switched to a hormonal IUD, which stopped my period, which I really hated.

And that was part of what led me to deciding to get my tubal ligation in August of 2022 was, um, I just was like, I was sick of it. So like, and then Ro got overturned after I'd had my console and I was like, Oh, I'm so glad I got in here before the, before the wait list got too long. But so this new copper IUD is smaller and has half the dose of copper, which should make the impact on

period significantly less, which is just so exciting because I just like,

Sharilyn Wester (10:38)
you

Cady Moore (10:39)
I love that other people are going to have an option that is long acting and can protect them without them having to like remember or think about anything that is not hormonal. You know, I'm, I feel very confident in my decision to have my tubal, but not everybody feels that way. And I'm just really grateful that there are going to be other folks who can, who can get this specific IUD. So that's what's in my passenger seat. And I'm, I'm really,

I'm stoked about it.

Sharilyn Wester (11:11)
Yeah, think in this current, on that note, like to remark upon that, I think in this current political climate, there's no ifs, ands, or buts about the fact that largely marginalized groups are who are being targeted for a lot of legislation that's going through. And of course, women always fall on that.

Any win I feel like as far as being able to provide contraception and health care options to women is a huge fucking thumbs up so I love that. Yeah, absolutely.

Cady Moore (11:38)
Mm-hmm.

Hell yeah. Yeah, we're stoked.

It's definitely good news. And speaking of access to healthcare, marginalized communities, we're gonna take a quick sponsor break and then we will head into our interview with Dr. McCann. So we'll see y'all in a jiffy. Bisexual finger guns.

Sharilyn Wester (11:48)
Yeah!

Yeah, I mean.

Cady Moore (12:30)
Today we are so excited to welcome Dr. Thalia McCann to the pod. Thalia holds a doctorate of pharmacy and is an infectious disease specialist, a subject matter expert and co-chair of the Vaccine System Pharmacy and Therapeutics Committee.

She is a pharmacy lead and works in outpatient antimicrobial stewardship. She is passionate about antimicrobial stewardship in addition to women's and LGBTQIA plus intersectional healthcare and using science and health communication to dismantle anti-science propaganda. She loves to backpack, she loves to hike, and she also loves to tie people up for fun, whether it is her fun or theirs.

thalia mccann (13:11)
Yes.

Sharilyn Wester (13:11)
That

intro, I feel like if you guys have watched Game of Thrones, was like Khaleesi, breaker of chains. She's the mother of dragons, the breaker of the wheel, all of this. And I'm so wet for it. Welcome to our podcast. my God, that like rap sheet. Welcome. So after that rap sheet,

thalia mccann (13:20)
I'm sorry.

Cady Moore (13:26)
So hot welcome

thalia mccann (13:27)
savior of humanity,

dealer of drugs.

So good. Thanks guys. Wow. Thank you.

Sharilyn Wester (13:39)
Thal would you explain to us a little bit about who you are, your pronouns, what titles you prefer using out of that rap sheet? I know Mother of Dragons is probably right up there at the top.

thalia mccann (13:52)
Pinnacle. So sorry. Yeah, I'm Thalia. I'm a doctorate of pharmacy, which you can call me Dr. McCann. I usually exclusively require that of my, like, septuagenarian and above, like, physician colleagues, that forget that I am also a doctor.

Cady Moore (14:12)
It's so hot, it's

literally so hot we should call you Dr. McCann this whole time.

thalia mccann (14:16)
I'm technically also a master of science, but I feel like being called master has like some weight to it. And I think that requires a higher level of negotiation. So we could pause that for a moment.

Sharilyn Wester (14:17)
put it in every opportunity I could.

Cady Moore (14:30)
my gosh, can you tell us your pronouns before we get too excited? I know I used some in your intro, but...

Sharilyn Wester (14:30)
You

thalia mccann (14:31)
of my pruna. Yes.

Yeah, pronouns are she they. Yeah, thank you. Of course.

Cady Moore (14:41)
Amazing. Thank you so much. And what

Sharilyn Wester (14:43)
we

love.

Cady Moore (14:44)
do you do? What? Tell us what you do.

thalia mccann (14:46)
Yeah.

Perfect. So I am an infectious diseases clinical pharmacy specialist, which means that I have entirely too much education and I'm here to ramble about it today. What that looks like is really confusing for most people. So just to give you an idea of what that looks like,

Cady Moore (14:57)
Yes.

Sharilyn Wester (14:57)
Absolutely.

thalia mccann (15:04)
am not working in a Walgreens. I don't even count by fives and sort pills for a living. It's really, it's really luxe. I actually...

Sharilyn Wester (15:11)
Me either.

Cady Moore (15:14)
She can't. I never learned.

Sharilyn Wester (15:15)
yeah.

thalia mccann (15:16)
Really helpful with ADHD. I actually have direct patient care and then through these advanced collaborative practice agreements and therapeutic drug monitoring programs, I actually manage patients fairly independently for like very difficult to treat disease states, disease states that require the use of antimicrobials that are extremely toxic or very long courses of therapy that are generally poorly tolerated. So.

Cady Moore (15:18)
Thanks

thalia mccann (15:43)
Thinking about that, besides just my patient load, I also am essentially a consultant to physicians, including ID specialist physicians. Because of my background where I did.

Cady Moore (15:55)
What does that

stand for? infectious disease. Never mind, I answered my own question. Yeah!

thalia mccann (15:59)
Yeah,

I might say that a lot because infectious diseases is such a mouthful. And so, yeah, I do that. And then am the chair of the Outpatient Antimicrobial Stewardship Committee and then a co-chair and subject matter expert on the Vaccine P &T Committee, which is sort of like

the group of people who make decisions about what goes onto a formulary within a health system. And I am in this subject matter expert role for the UC health system, which is the largest provider of healthcare in the state of Colorado.

Cady Moore (16:24)
Hmm.

Sharilyn Wester (16:34)
That's incredible. okay. I was gonna say there's so much there. I wanna know, obviously you're in this very, like from what it sounds like to any layman, very prolific role and very niche role. How did you get into this role? Cause I imagine as a little girl, weren't like, I wanna work in infectious diseases. So what did that?

Cady Moore (16:34)
Damn, you have so much power.

thalia mccann (16:35)
The power!

Sharilyn Wester (17:01)
pathway look like for you? And how did you get here? How are you here? How are you this Khaleesi?

thalia mccann (17:05)
Yeah, really.

Well, OK, I also want to shamelessly plug that Cady and Sharilyn helped me survive the end of residency. So I wouldn't be here without either of you today. I want to say that. But also, yeah, the the

Cady Moore (17:16)
Ugh, you're amazing.

thalia mccann (17:21)
I mean, the road has been twisty. I didn't take a traditional course. actually started off wanting to do research. I've wanted to be a science babe since I was like, you know, big enough to realize I was too large to be an astronaut.

Cady Moore (17:36)
Damn, as another 5'10 girly relatable, you're taller. Are you 5'11 or are 6'?

thalia mccann (17:37)
Yeah, yeah, yeah, yeah.

Sharilyn Wester (17:38)
Yeah.

thalia mccann (17:43)
I'm 5'10 and I wear heels. You know the vibe. And also, yeah, like I don't, I'm not gonna sustain multiple G's of force well. Like I get sick on roller coasters. So we weren't gonna be an astronaut. We wanted to go into STEM. And I initially wanted to do wildlife veterinary medicine. And then I realized I couldn't kill small animals. And then I decided to do science and I wanted to do more like systems and like ecosystems work. And then I got...

Cady Moore (17:46)
Yeah, she do. Yeah, she do.

thalia mccann (18:09)
pulled into this

sort of niche area of cancer biology and biochemistry where it's called the seed and soil hypothesis. So it's not just treating tumor cells, but actually looking at the way that they interact with an entire micro environment and recruit other cells to make them more difficult to treat and survive more extreme conditions. so somewhere I realized I was studying humans and I was volunteering at a VA.

Sharilyn Wester (18:35)
Yeah.

thalia mccann (18:39)
because my dad's a disabled veteran and I ran into an oncology pharmacist who was like, you are wasted under fluorescent lighting. Like you need to come to the light and like interact with patients. And there's just so much more out here for you instead of having like this, you know, modern biochemistry and molecular biology research is like an inch wide and as far deep as anyone in humanity can go. And I'm much more

Cady Moore (19:04)
Mm-hmm.

Sharilyn Wester (19:04)
just like a very linear

path.

thalia mccann (19:06)
Well, and it's just so narrow, actually, what your specialty is. And

Cady Moore (19:08)
Mm-hmm.

Sharilyn Wester (19:08)
Yeah.

thalia mccann (19:11)
kind of limited in what your impact can be because most people never actually do something that changes the course of humanity, right? We're all trying, but it's like 1 % of 1 % ends up going anywhere if you wanted to treat people versus having a day in and day out where you're making an impact in people's lives. And so really that was the scales that I weighted and decided to pursue a clinical career. So between

Cady Moore (19:13)
Mm-hmm.

Mmm, mm-hmm.

Mm-hmm.

thalia mccann (19:36)
pharmacy school and like completing my masters where I was doing the scene soil hypothesis actually tested grapevines and marijuana plants for viruses and bacteria and molds and I sold wedding dresses, which is kind of hilarious of the Hosts of this podcast know I do not believe in matrimony. So that was an interesting choice and and so I

Sharilyn Wester (19:47)
This is amazing. I love this fact.

Cady Moore (19:58)
You

But sometimes we

gotta do what we gotta do under capitalism, you know?

thalia mccann (20:03)
girls gotta eat and it turns

out that if you're like the cool girl that like doesn't actually give a shit about selling something you're really good at selling something all of a sudden yeah yeah yes yeah

Cady Moore (20:11)
Yes, because people can smell the sincerity if you need it too much and they're like, no, I'm turned off by that. Yeah.

Sharilyn Wester (20:12)
my god, you're so good at it.

They can smell the desperation. Yeah, when I was in college, I

So you had the concepts of like what you wanted to do. It was just getting there took lots of twists and turns and something I've actually heard from a couple of our guests that we've had who work within public health or healthcare is that

thalia mccann (20:26)
Yeah.

Sharilyn Wester (20:34)
they often found their paths by someone else almost advocating for them or almost seeing their potential and recognizing that

thalia mccann (20:40)
Yeah.

Sharilyn Wester (20:42)
and like pushing them towards that. And I know Thal you have had some experience from even when I was staying with you at one point where you're almost guiding others in their residency or like supervising. What kind of role does that play in your position as well in also being the person now to be pulling people into the field or guiding them?

thalia mccann (20:55)
Mm-hmm.

Yeah, that's such

profound question. Because I mean, truly, one of the things that I have always believed in

from looking at the people who've made an important impact in my life, right? Like I came from poverty. I came from a medically underserved community. Gals like me didn't end up where I was. Like this was not even a career path that I had envisioned. So it really was a series of mentors and people who illuminated to me where my strengths are. Like I came from this weird background in ecosystems and the person who convinced me that ID was the best choice for me was someone who was like, hey,

Like you can have an impact on an entire ecosystem through antimicrobial stewardship if you think about it. And you're also helping people's lives. And I would have never made that connection because you just don't really know what practice looks like. So now I often take, you know, pre-health and science people that are interested to come and just like check out what I do. Cause so many people don't know I'm in like this weird.

Cady Moore (21:54)
Hmm.

thalia mccann (22:07)
non-existent to the public eye realm of pharmacy practice that's very advanced. I'd say I'm probably like one of a handful maybe of pharmacists that are practicing at the level that I'm practicing and doing what I'm doing specifically. I mean there's many ID pharmacists but not many in my space and my niche. then I, yeah pharmacy students like I have had one this past month and I just have them shadow me.

I also am involved in training new residents that are in the position that I was just two years ago. And I think that that's really impactful, you know, because I kind of bring the reels. Like I'm like, hey, I had a, had a student who, you know, identifies as LGBTQ. And they were like, you know, on rotation with me in early January. And I was like, Hey, like, let's just check in.

Cady Moore (22:45)
Mm.

thalia mccann (22:58)
How are you today? And is this what you need right now? Or do you need something else right now? And they were like, you're the only person who has asked me that today. Health care training is so brutal and really requires that you zap so much humanity out of yourself to show up for it. That I think that's one of the things that I've really tried to bring in. And then just also, like I said, leaving the door open behind me.

Cady Moore (22:59)
Mm-hmm.

Mmm.

Mm-hmm.

thalia mccann (23:23)
explaining to like people from rural backgrounds or from poverty that like they deserve to be here. You know when you interact with them you can kind of smell it sometimes other people that are like I haven't you know imposter syndrome.

Sharilyn Wester (23:30)
Absolutely.

my god I was going to say

Cady Moore (23:37)
I love what you were talking about, the idea of like residency and the American medical system and medical education system, zapping the humanity from people, because I think that that is something that we see often. I was lamenting about this with my sibling today about like how doctors are, you

thalia mccann (23:54)
But.

Cady Moore (23:59)
giving them the credit that they deserve, that they're doing their best, most of them, but like they have been trained to be almost an automaton moving through their job. so like that keeping that human piece is something that I think more and more is going to be so important for everyone, especially like, mean, spoiler alert, we're going to be talking later about like how healthcare providers can communicate with their patients, but like the way that doctors interact with their patients, like.

thalia mccann (24:00)
Yeah.

Cady Moore (24:28)
they should, doctors should be asking their patients, hey, how are doing? You okay? Like everything, you good?

Sharilyn Wester (24:34)
Yeah.

Yeah.

thalia mccann (24:39)
Well,

okay, and this is the sad part, Cady. Like, I swear to goodness, I mean, I work in the outpatient space, so I'm really lucky that I see providers who really have chosen to interact directly with patients and they weren't like, you know what, I'd really rather everybody be under anesthesia by the time that I interact with them or they're like on a ventilator and can't talk back, right? So I'm getting the good ones.

Sharilyn Wester (24:57)
Yeah.

thalia mccann (25:01)
But it's almost like they put their like selkie skins of humanity back on when they like go and visit a patient and that's the nicest that they are that day.

Cady Moore (25:01)
Mm-hmm.

Cady Moore (25:11)
So Selkies are these mythical seal people from Scottish and Irish folklore who shed their seal skins to walk on land as humans and then put their skins back on in order to return to the water. But if someone steals their skin, they are trapped, unable to return to the sea. So in this context, Dr. McCann's colleagues are basically just a bunch of seals walking around pretending to be human when they're with their patients.

thalia mccann (25:34)
Then they take it off and they're like exhausted and depleted and it's just about the, there's so many layers to this, like really toxic training environments that are sort of akin to like a boot camp. Like there's this kind of weird perverse romanticization of like a brutality and like punishment and like.

Cady Moore (25:46)
huh.

thalia mccann (25:56)
working too late and being in the trenches. Yeah, right? And then on top of that, you add just like really untenable work conditions because even though I work in like a nonprofit health sector, the ideology is very much driven by capitalism. So they are squeezing the most work that they possibly can out of the people that are doing the work in healthcare.

Cady Moore (25:58)
It's giving best, guys.

Like.

thalia mccann (26:23)
so that they can have more overhead and more profit at the top. And so that means that you have providers, there are healthcare systems like some Kaisers where primary care providers are supposed to see 80 patients a day. And that's with note taking and like, you're not gonna connect with anyone meaningfully for that. Yeah, I know. That's why there have been strikes. But like.

Cady Moore (26:44)
What?

Ugh. Ugh. Yeah,

solidarity.

thalia mccann (26:52)
Yeah,

so I will say that I think I see it from both sides, right? And I will say that we have a

of just entrenched systematic things that prevent real connection and having people, there are good ones. There are people out here. One of my things that I've done is I have trained a chat bot just to make letters to fight with insurance companies. And I will crank out appeals for people like,

Cady Moore (27:09)
Mm-hmm.

That's amazing.

thalia mccann (27:21)
to get them meds. Like I even have friends in my personal life that will like be like, Dr. McCann, please write me a letter. And I'll be like, you just need to give this to your primary care provider and have them sign it and we'll send it. And so there are good ones. You just have to find the people that are not so burnt

Cady Moore (27:23)
That is incredible.

Sharilyn Wester (27:37)
Yeah.

Cady Moore (27:40)
Mmm.

Sharilyn Wester (27:40)
So

I think in like, obviously you're working in this very high level, in this very niche position. And so you have all of these credentials, all of this work and research, all of this experience, and then you're also working with the general public. could you, and especially like you said, like you try to bring empathy not only to your patients, but like to your coworkers and bringing people in. So what does a typical...

thalia mccann (27:54)
Yeah. Mm-hmm.

Sharilyn Wester (28:04)
day look like for you working within this field and within all of these hats that you have to wear? What does that look like?

thalia mccann (28:13)
Yeah, so I have

about five disease states that I manage.

Primary ones are anti-fungal therapy. So anyone who has an invasive fungal infection, patients who have mycobacterial infections, so that includes tuberculosis in the active and latent form, as well as non-tuberculosis mycobacterial infections. And then I also treat transplant-related viral infections. So on any given day, like we have like a Mycobacterial Monday.

portion of clinic where in the afternoon we like do most of the labs and any patients that are coming in for labs, I will try to space them out over the month to do inpatient interviews and encounters. So that way, like you're already coming in for your labs. While you're there, you get to talk to a medication expert who's helping you to make sure you're taking all of your medications appropriately. If you're having difficulty taking meds, there are some little like tricks of the trade so that you can tolerate them better. Can you imagine being on

antimicrobial therapy for nine months or a year for some of these patients. And then some of them are on antivirals, you know, in addition to all these other toxic medications that are eliminating someone's immune system. They're on antivirals, they're on antifungals, right? They just have a new organ transplanted that came with unexpected surprises. And now we're treating all of that. so having someone to really get into the nitty gritty of your medications is not only beneficial because it

protects the patients from oversight that frankly we just catch so many things. there's kind of safety and repetition and going through it a few times, but also there's someone who kind of can like meet with you more frequently than a physician can and make sure that you're actually tolerating things and like

Cady Moore (29:48)
Mm-hmm.

thalia mccann (30:03)
okay, you know?

Cady Moore (30:04)
Yeah,

and that your quality of life isn't suffering more than it has to. Like, I mean,

thalia mccann (30:07)
Right. Right.

Cady Moore (30:09)
as someone who's probably over-medicated, I have had to teach myself when to take things by trial and error. Like, oh, I should not take my diuretic medication after 2 p.m. or else I'm gonna be up all night peeing. And that's the kind of thing that like you can catch when someone is like, yeah, I'm like mostly okay, but here's some of the stuff I'm dealing with. You're like, oh, I know exactly why that's happening.

thalia mccann (30:20)
Yes.

Yes,

Cady Moore (30:30)
Here's, yeah, ugh, that's amazing.

thalia mccann (30:30)
totally, totally. And a lot of people

want to take like herbal supplements and vitamins and they think that these are just like benign things, but they can actually interact really like impactfully with some of the therapeutic modalities that we will be giving patients. And so those are just things that you're not going to really touch on in a 30 minute visit with a specialist, you know.

Cady Moore (30:54)
Mm-hmm, who's

thalia mccann (30:54)
And so, so I have that kind of direct impact. Every day of the week, there are antimicrobial stewardship rounds. And so we tackle difficult cases, patients who have positive blood cultures. Since I'm the outpatient side, I look at patients that showed up to the ED, they had something, they get like a urine culture or a blood culture done.

and they're sent out with empiric antimicrobials. And then sometimes the thing that grows isn't what we thought it was gonna be. So like you've now discharged someone into the wild and they're not on the medication that they need to be on for their infection. And so I like try to track down these patients or like coordinate with our care team and like nurse practitioners that assist with transitions of care out of the ED to make sure that people are safe.

which I mean, arguably it's good that we do that because people aren't just being admitted while we're waiting for something to cook and it's 99.9 % of the time exactly what we anticipate it's gonna be. But the other thing is sometimes patients are on medications that are like, you know, the full nuclear option and they could really be on something a lot more benign that is less likely to cause them toxicity and harm. And so we're weighing that risk benefit. Exactly.

Cady Moore (31:42)
Mm-hmm.

Sharilyn Wester (32:02)
All right, I give them those like side effects.

thalia mccann (32:06)
So maybe you're only on that for a day because someone like me calls

and goes, hey boo, you could just be on like a friendly amoxicillin Yeah.

Sharilyn Wester (32:11)
Hey! Yeah, yeah, we don't need to completely, like, eradicate your entire immune system

and, have you shitting blood? Just saying. Bestie, what's

thalia mccann (32:23)
Yeah, literally.

Cady Moore (32:24)
It's just

casual C-diff, it's fine, it's fine.

thalia mccann (32:24)
like, C. diff. Don't even get me. Yes, this is like a whole thing.

Sharilyn Wester (32:27)
Yes, absolutely.

Cady Moore (32:32)
Okay, so C. diff or Clostridioides difficile is a nasty little bacteria that can wreak havoc in your gut. Most of the time C. diff is just chilling in the environment, hanging out, not bothering anybody. But if it finds its way into your intestines and you've recently taken antibiotics, things can get messy quite literally. See, antibiotics are like this indiscriminate bouncer at a club. They kick out the troublemakers and the good guys.

Your gut has a whole ecosystem of bacteria that help keep things balanced. But when you take antibiotics to wipe out the good bacteria, C. diff sees an opportunity. It multiplies like crazy, producing toxins that can cause severe diarrhea, inflammation, and in extreme cases, life threatening complications. C. diff is contagious and it can live outside the body on surfaces for weeks to months.

and it's spread through the fecal-oral route, meaning that if someone goes to the bathroom and they don't wash their hands very well, they can contaminate surfaces, food, and other people. So if you have wiped out your good gut bacteria with antibiotics, it can take up to three months for your gut microbiome to return to normal, and you can take probiotics to help speed up that process of kind of bulking up your good guys again, but just...

Keep in mind that if you've taken antibiotics, may be susceptible to C. diff. So wash your hands really well, especially before you eat.

thalia mccann (34:00)
So yeah, I do stuff like that. And then, you know, I'm like mentor trainees, I assist with physicians that need help on complex cases. Like, we have a very different population of people that come into our clinic than who are represented in some of these clinical trials.

And some of the people that we have studied, the pharmacokinetics or the movement of the drug through the body, in like clinical trials, there'll be like 70 kilogram white dudes. And then my patient in front of me is an 89 year old that has a BMI of 50 and is missing a quarter of one of their limbs. And I'm trying to figure out what that means about like their renal function and what that means about what dose we can safely give them.

Cady Moore (34:34)
Mm-hmm.

thalia mccann (34:50)
And so I get to, it's like very intellectually, yes, so stimulating. I practice and I'm so grateful that I have a team. not in it alone. of, all of the rest of my colleagues that are ID pharmacists in my campus are all inpatient, but we collaborate on really difficult cases, which is really nice.

Cady Moore (34:54)
Puzzle solving.

Yeah!

Sharilyn Wester (35:15)
That's amazing. my gosh.

Cady Moore (35:17)
So you've used this word so many times now, and before we take a quick sponsor break, can you please explain what the fuck antimicrobial stewardship is? What does that mean? What is that?

thalia mccann (35:30)
Yes, totally.

Totally. So antimicrobials, which includes antibiotics, antifungals, and antivirals. And then stewardship, the sort of like shepherding, which is really related to cultivating the responsible use of these agents. And the idea is that we have recognized globally, the WHO, for example, has a whole webpage about the global threat to humanity that is superbugs.

Cady Moore (35:47)
Mm.

thalia mccann (35:59)
these antimicrobes that are resistant to literally most of, if not all of the treatment options that are available for them. And we're in this constant race of evolution between these superbugs and the production of antimicrobials, which is not really, not really profitable in the current system of capitalism that we have, right? Because you make something that is like for this very niche use.

Cady Moore (36:00)
Mm-hmm.

Mmm. Ugh.

thalia mccann (36:27)
And then there are people like me whose whole job is to be like, hey, can we not use that actually? Because I really want to save it for like when we need it. And so they're not making sale, you know, profits. If they are, like it's a problem. It's because like now we need something even bigger. And so, yeah, so really antimicrobial stewardship is like a concerted effort to save humanity from superbugs.

Sharilyn Wester (36:40)
Quotas, yeah, exactly.

Cady Moore (36:40)
Mm-hmm.

Sharilyn Wester (36:47)
Yeah.

Cady Moore (36:48)
Yikes.

thalia mccann (36:56)
to have people not taking medications that are unnecessarily broad that could cause them harm or toxicity. The C. difficile like infections is an outcome of that, which is very unfortunate.

Cady Moore (37:09)
like the time that I

was prescribed clindamycin for an ear infection and I went, I'm sorry, I'm not doing that because I know what clindamycin does and I don't need that for an ear infection, urgent care nurse.

thalia mccann (37:21)
The odds ratio

is like 30 for clindamycin and C. difficile. Like it's 30. That's insane. Yeah, sure.

Cady Moore (37:32)
which I'll put an aside here. I'll put an aside here about what C. diff is and what it does to people.

So I'll put an aside here about diarrhea among other things. We love that. We love a pooping aside. I feel okay. I have so many follow-up questions, but let's take a quick break and then we will be right back y'all.

thalia mccann (37:40)
Perfect.

Cady Moore (38:02)
welcome back everybody. Hope you enjoyed our sponsors. We have so many sponsors, it's amazing. Thal was telling us that she has some additional antimicrobial stewardship lore before we transition to talking about queer healthcare. Thal, would you like to spill the tea?

Sharilyn Wester (38:08)
You

thalia mccann (38:17)
Yes, okay, so here's the tea. And I just think that this is so fascinating. So I think most of us know in like the

1940s, we came up with penicillin and that sort of hilarious story about like the sandwich bread that was like left out on the countertop and then there was fungus that grew on it and then it fought the bacteria. It's probably didn't happen that way.

But we love it and I think that it highlights a really interesting tenet, which is that the fight between organisms to survive pre-exists us as a species and is ancient, right? And so bacteria and fungus have found ways to carve out their own environmental niches in cohabitation, but also in some ways in competition.

Cady Moore (38:56)
I'm getting goosebumps.

thalia mccann (39:06)
And even earlier than all of that, like ancient viruses have been infecting bacteria and have been affecting fungi forever. So you have actually, I think the primordial players that have all been duking it out. And then we just like pop up and become like this beautiful host organism for all kinds of infections related to that,

And so then with the mass production and use of penicillin, we went from being able to treat like many, many bugs.

Cady Moore (39:28)
Mmm.

thalia mccann (39:35)
to essentially now, penicillin has very niche uses and they're kind of wimpy ones and our beautiful treponemal species, syphilis. It's a little ribbon, that's why I did that. Anyways, I think that we've always thought that the larger the volume of antimicrobial use, which unfortunately also includes like very, very broad use in agriculture, the larger the environmental

Cady Moore (39:46)
We love syphilis.

Mmm.

thalia mccann (40:04)
sort of pressure on bacteria, the more resistant that they will become. But then in addition, overuse in humans we know can increase your risk of resistance because you and yourself are your own ecosystem, right? So this is all well and good. Humanity's the cause of all of this super mega resistant nasty

right? And then someone goes into the Carlsbad Caverns to a place that has never been touched by humanity.

Cady Moore (40:23)
All the problems.

thalia mccann (40:32)
has no communication of water sources. It's a section of an ice dwelling cave that has not been touched by humanity. It's the first time anyone has ever gone there and they take a sample and in this ice is a newly

species that is resistant to most of the antimicrobials that we have.

Cady Moore (40:54)
Whoa.

thalia mccann (40:56)
So like wrap your mind around this. Like these bugs exist. They're communicating with each other. We are a problem and I'm doing what I can on our end. But I want us to just take a moment to appreciate the intersection of what that means with climate change because these ice caves are gonna start melting. Right? Yes. Yes. And viruses.

Cady Moore (41:00)
Yeah.

Sharilyn Wester (41:03)
They're dormant.

Cady Moore (41:15)
fuck.

Sharilyn Wester (41:19)
All of these like dormant bacteria that have been frozen for, you know, millions or however many years

are now entering our water systems and the animals.

thalia mccann (41:25)
Mm hmm. Yes. And

there are funguses. So have you seen, is it the last of us with like the cordyceps? Right. Okay. So cordyceps cannot inhabit humans. But at the very beginning, there is a clip about how in modern society, human temperature, temperature is lowering. And actually with the rise of climate change, the ranges of these endemic fungi that can infect humans has

Sharilyn Wester (41:36)
Last of Us with cordyceps.

thalia mccann (41:55)
basically expanded with the erratic water patterns and storm patterns and then drought seasons. And so I think we're coming up after this El Niña period to a time where we're gonna have unprecedented exposures to certain endemic fungi just because of climate change. And so part of my job is to make sure that while we're appropriately prophylaxing people for coverage, we're also not overusing things for like.

fungal infections that aren't true infections. We just like see something growing somewhere and then we give it to people because we don't have that many antifungal agents that are safe for humans to use. And so I'm trying to think like in 25 years, I want to make sure that we have agents on board for when we're in, you know, a two centigrade increase in shit.

Cady Moore (42:45)
Fuck. Huh?

Sharilyn Wester (42:46)
Absolutely. So it's like

thalia mccann (42:47)
Anyways.

Sharilyn Wester (42:48)
you're constantly currently battling what is happening actively while preparing for this inevitable evolution of the human species that is self-induced as well as the self-induced like overuse of antibiotics and preparing for a future that you know is like it's not gonna get easier. Your job isn't gonna get easier essentially.

Cady Moore (42:50)
panic.

thalia mccann (43:11)
It's not.

the cool, one of the cool things is that we're actually essentially recognizing that viruses do it better than we do. So we've actually figured out ways to train phages to act with antimicrobials to knock out super bugs like that are bacteria because they, mm-hmm, bacteriophages. It's called phage therapy. Yeah, it's really, really cool.

Cady Moore (43:24)
Cool.

Sharilyn Wester (43:30)
like macrophages and I'm learning about that in my biology.

Cady Moore (43:34)
That's cool. I was gonna say, oh, someone's in

a bio class. Yeah, girl. You're literally so smart.

Sharilyn Wester (43:38)
I knew a word, you guys! I knew a word! Yeah!

thalia mccann (43:41)
Yeah!

Your lips so

Cady Moore (43:46)
So here's the deal with bacteriophages, or just phages for short. They are viruses that infect and destroy bacteria. Since I love bacteria analogies, let's say that they are like nature's microscopic hitmen. They've evolved alongside bacteria for billions of years. And while antibiotics are like that indiscriminate bouncer that we mentioned in the last analogy, killing both good and bad bacteria alike,

phages are like hitmen targeting only the bacteria that they are designed to attack. Phage therapy was actually discovered in the early 1900s, but when antibiotics came along, we kind of forgot all about it. Now with antibiotic resistant infections on the rise, scientists are bringing phages back into the spotlight. The idea is pretty simple. If antibiotics don't work, let's send in the phages to hunt down the bad bacteria that are left behind.

It is still experimental in many places, but phage therapy has already saved lives in cases where nothing else worked. And the coolest part is since phages evolve alongside bacteria, they really might be a long-term solution to antibiotic resistance. Basically, if bacteria are the bad guys in this movie, the phages are the monster hunters. So yay, go phage therapy.

Cady Moore (44:59)
I... Oh, wow.

thalia mccann (45:00)
So anyways, there is

Sharilyn Wester (44:59)
guys. my god.

thalia mccann (45:02)
hope we're

gonna keep being smart. But like, yeah, this is a race that has pre existed us and is going to continue to persist long after we're gone.

Cady Moore (45:10)
Hmm,

which honestly in some ways is

I that whole time was taking this as like cue the panic and actually when you phrase it like that that is like deeply reassuring. It's well, you know, we are actually insignificant in many ways. I mean, we're not statistically but

thalia mccann (45:23)
Mm-hmm.

Cady Moore (45:30)
you know what I mean.

thalia mccann (45:30)
Right, like we can just learn, like nature has been figuring this shit out and we could just be like learning from it instead of like doing all this crazy shit. Right, yeah. Anyways, so.

Cady Moore (45:34)
Yeah. Yeah.

freaking out about it. Yeah. Which is like honestly a whole thing that

Sharilyn Wester (45:38)
Because we're part of nature, yeah!

Cady Moore (45:45)
I and I, talk a lot about drugs on this podcast also, but one of my last mushroom trips that I went on, I came out of it and was like, I'm also part of nature. I'm not like, I'm not the problem. Like, I mean, I am in some ways, I'm sure, but like, I deserve to be here too. And my therapist was very proud of me for that.

thalia mccann (45:56)
Yeah.

I love that. That's really beautiful. I mean, I think that that's, that's what psychedelic therapy offers us, right? Is a connection to something bigger than us that I think we forget and we just like have kind of amnesia about in like the way that we have such an anthropocene, whatever, know, anthropocentric.

Cady Moore (46:07)
I am nature.

Mm-hmm.

thalia mccann (46:26)
Is that the right? Are those the Latins that go together?

Cady Moore (46:28)
I don't know, was gonna, I was, I'm gonna be Googling it and putting it

aside.

thalia mccann (46:34)
I'll

I'm just making up words now anthropocentric Society and world anyways

Cady Moore (46:37)
Love it. Anthropocentric. No,

Cady Moore (46:44)
Anthropocentric, considering human beings as the most significant entity of the universe.

thalia mccann (46:51)
Yes

Cady Moore (46:52)
it's it's

true. And this is why I try to do them every two to three months, because I forget every time what I learned. I'm like, right. We're going to learn the same thing again. OK, that's cool. Yeah, exactly. There always is. So amazing. Thank you for the answering what the fuck is antimicrobial stewardship with so much lore and like

thalia mccann (47:00)
Yeah.

Well, and there's like new layers. Anyways.

Yeah.

Cady Moore (47:16)
Yeah, my brain is reeling a little bit. Can

you tell us more about the role that infectious disease pharmacists play when it comes to reproductive and sexual health, especially for our queer and trans folks in the world? This is a, well, this isn't a sex ed podcast, but I'm a sex educator. So I'm like, let's talk about sex now. So can you tell us more about the role that infectious disease pharmacists play in that?

thalia mccann (47:37)
Yeah. Yeah.

Totally. I think by first blush, most people would not realize what the intersection is. But I think one of the really important things to remind everyone is that ID pharmacists are also your local

experts. And so a large section of my job outside of what I'm managing independently is I'm a consultant for people who have difficult cases. Either they are

Cady Moore (47:59)
Mmm.

thalia mccann (48:11)
sort of part of our legacy patients that are living with HIV, and they have been around since before we had highly active antiretroviral therapy, and so they often have more resistant disease. And then there's also opportunistic infections that go, and sometimes they're sort of the red herring, where we realize that someone actually has advanced HIV or AIDS.

because they end up having this kind of infection. And so those are often very difficult to manage, like weird fungal infections and viral infections. And so I see a lot of that. think also one of the things to think about is pharmacists are actually the most immediately accessible healthcare provider. You can walk into technically any pharmacy and you can talk to somebody who has a doctorate degree and who has been trained

Cady Moore (48:57)
Mmm. Damn.

thalia mccann (49:06)
in medication management and knows enough anatomy to, you know, and all of that to provide medical advice. And that is not something that you can say for pretty much anyone else you need an appointment. And many states are actually creating these collaborative practice agreements that are statewide to allow the provision of PEP, PrEP, DoxyPep by pharmacists in community settings because of the importance

Cady Moore (49:14)
Mm-hmm.

Mm-hmm.

Cool.

thalia mccann (49:36)
of it, I was gonna say that is federally recognized, but I don't know, make that past tense.

Sharilyn Wester (49:44)
Yeah.

Cady Moore (49:45)
It's fine. It's fine. Everything's fine. We're okay.

thalia mccann (49:46)
But actually most of that is

dictated at a state level, So most of the progressive states that actually have pretty progressive politics will also have that. what's interesting is that a lot of states that actually have large swaths of their population are greatly medically underserved.

Sharilyn Wester (49:48)
screaming internally.

thalia mccann (50:07)
have realized that they can leverage pharmacist services to render important care like that.

Cady Moore (50:13)
Mmm.

thalia mccann (50:16)
I think is obviously a set of maladies that disproportionately affect queer folks. And I think that also one of the things that's really interesting is that patients who are experiencing homelessness are also more likely to have exposure to certain types of viruses. People who have substance use disorders are more likely to have exposure to hepatitis. ID Pharmacy intersects with all of these.

Cady Moore (50:42)
Mm-hmm.

thalia mccann (50:45)
And so I think one of the things that's most important to me in my job is recognizing that the people who are going to be most affected by climate injustice, the people who are going to be most affected by discriminatory laws, people that are going to

Cady Moore (50:45)
Mm-hmm.

Mm.

thalia mccann (51:01)
lower reserves and resilience because they're fighting systematic systems of oppression, like chronically, who have statistically higher rates of mental illness, those folks.

have a harder time getting into care, being retained into care, having access to insurance, being able to pay for medication. And as we know, the rates of new HIV infections that are affecting our trans community members and our queer community members are disproportionate and even higher magnitude when you think about it intersectionally.

Cady Moore (51:16)
Mm-hmm.

thalia mccann (51:39)
I believe that trans women of color are currently that demographic that is the most at risk of new HIV infections in this country. And a lot of that has to do with a lack of care that is not discriminatory and like not shitty and, you know, lack of insurance and everything else.

Cady Moore (51:52)
Mm-hmm.

Mm-hmm. Mm-hmm.

thalia mccann (51:58)
so I feel like it is a privilege and an honor to be able to be specialized in something that unfortunately is just going to

Sharilyn Wester (51:59)
accessible.

thalia mccann (52:09)
continue to be ignored and not prioritized for the next four years. And I think on a global level, this is gonna become an increasingly large problem because the administration is cutting funding for USAID, which provides antiretroviral therapy to large swaths of our most vulnerable communities in the world. and fun news, guys. I mean, we're getting all the fun vintage stuff. We've got syphilis.

Cady Moore (52:30)
Yeah.

Sharilyn Wester (52:37)
I love.

thalia mccann (52:37)
And now we have multiple centers of tuberculosis outbreaks that the CDC cannot publicly comment on because of the new muzzling by the administration. And so as someone who manages tuberculosis infections, I mean, on one hand, I have job security. On the other, I am

Sharilyn Wester (52:50)
Yeah, with the wipe.

Cady Moore (52:50)
We love this.

Yeah

thalia mccann (53:00)
I'm very concerned. I'm sorry.

Cady Moore (53:01)
Well, there anything that you

Sharilyn Wester (53:01)
You're like, what even is my job now?

Cady Moore (53:04)
would like to share with us and our listeners that we cannot get from the CDC right now that we need to know? is that not sound like, is it a much bigger, is that question odd?

thalia mccann (53:14)
Well, there have been outbreaks

that we've identified in Kansas City and Montana and then I think Louisiana. I'm not sure, don't quote me on that last one, but like multiple large sections of the country are having outbreaks. And I think that unfortunately,

Cady Moore (53:25)
Okay.

thalia mccann (53:37)
where the spaces that we know that are most likely to have active outbreaks are also places like prisons. And I'm also going to say ICE detention centers because you're going to have large groups of people who are more likely to have been exposed to tuberculosis from the portions of the world that are more impacted by it and in dense living environments with poor circulation of air. So I think we just need to buckle up for this.

Cady Moore (53:48)
Mm, great.

Ugh, fuck. Okay. Thank you very much for sharing and indulging that fun, fun rabbit hole. No, you're nothing to apologize for. this, this...

thalia mccann (54:10)
Yeah. Sorry.

I'm like the worst

at cocktail parties because I'm like, hey, so know, humanity's fucked, right? And people are like, yeah, you're.

Sharilyn Wester (54:21)
You're like,

hey, let me tell you about this piece of ice that someone took from this place that no one had been at and also climate change. But honestly, I think these are good things to know, especially during a time when it's not even misinformation and disinformation that's being spread. It's no information. It's a complete muzzling and like a wiping clean of information that is accessible so that experts like you have a harder time.

Cady Moore (54:38)
Yeah.

Sharilyn Wester (54:47)
sharing a lot of this information. think it's why like platforms like this are so important even if it just reaches a few people so they have some awareness of what's going on in the world.

thalia mccann (54:49)
Yeah.

Yeah. I will say one of the most inspiring things is that the Infectious Diseases Society of America and other groups of organized healthcare professionals are taking a stand.

They've downloaded all of the information from the CDC website that has been impacted by these ridiculous executive orders, and they are hosting a platform to have all of the same information. And I'm just so happy that that exists. mean, there are women in STEM that are solidifying sub stacks with all of this information. And so I will say that the medical community is taking a stand, and I'm here for it. I think that

Cady Moore (55:07)
Mmm.

Sharilyn Wester (55:19)
I saw that, yep.

Cady Moore (55:26)
Mm-hmm.

Yeah. Mm-hmm.

thalia mccann (55:35)
There's a lot of in-group fighting that like maybe now we can all get behind one bad guy.

Cady Moore (55:39)
Yeah, I mean, I will say that is one thing that we are all learning now, especially depending on what, because I mean, like I'm a sex educator, but there's plenty of like weird shit in my field also about like who is allowed to be here and who isn't. And it feels like we are finally hitting a point of like, there is no gray anymore. You are either with us or you are not. And that's it.

thalia mccann (55:55)
Mm-hmm.

Yeah.

Mm-hmm. Yeah.

Cady Moore (56:09)
And if you're not with us, then get the fuck out or go hang out in your

own corner somewhere and you can keep doing you. But like we, as the rest of the community are going to continue to band together and make sure that the resources that are crucial for the people in our communities are accessible to them because that is what we are on this planet to do. And you can't silence us. You can try, but it's not going to fucking work.

thalia mccann (56:15)
Hmm.

Yep.

Totally.

Yeah, and

like,

I will also say that ID is like the home of the rabble rousers, right? Like there were people who completely denied that retroviruses were a thing. There were people who were laughed out of the rest of the medical community and the infectious diseases community that came back and were like, you guys, like, I know this doesn't follow the central dogma. And then they got a Nobel Prize 10 years later for proving

Cady Moore (56:38)
You

Mmm.

thalia mccann (56:58)
that this existed. And then like when the entire AIDS pandemic hit, there was so much polarization. Like people were refusing to pay physicians for taking a stand with communities that were affected by this virus, showing that like they weren't lepers that you could go into wards and not be wearing masks and you could touch people. like, and so, I mean, if there's a group that I'm happy to be affiliated with for...

Cady Moore (57:18)
Mm-hmm.

thalia mccann (57:26)
all of the disgusting medical science trauma BS I mean Tuskegee like the entire history of OB-GYN like

Cady Moore (57:31)
Yeah.

Mm-hmm.

thalia mccann (57:36)
Don't even get me started. I think now the modern iteration of like ID is very much with it. Like we're gonna stand with queer folks. We're gonna stand with marginalized communities. We understand the risk that this is not just about corporate gain. This is about the wellbeing and longevity of humanity. Like we're in it. We really

Cady Moore (57:55)
Yeah.

thalia mccann (57:56)
that.

Cady Moore (57:56)
And well,

and then, and that the most vulnerable populations are, and this is, this may be a like trite comparison, but it's the canary in the coal mine. Like, because the least resourced people are going to be the first ones to suffer, but that doesn't mean that we're not going to the rest of the, the folks who have access to these things. We're going to be fucked by the same super bugs. It's just going to happen a little later. So yeah.

thalia mccann (58:05)
Right.

Yep. Totally.

Cady Moore (58:22)
Well, for

thalia mccann (58:23)
Yeah.

Cady Moore (58:23)
the sake of keeping us on track here, before we change topics, are there any recent advancements in medicine or pharmacy that are like, let's talk about some good news. Are there any exciting things that, yeah, hit us with

thalia mccann (58:35)
Yes, I do have good news for you.

Sharilyn Wester (58:37)
Yes.

Cady Moore (58:39)
good news?

thalia mccann (58:40)
cool. So I think that one of the biggest boons in my field has actually been the prevention of new HIV infections, right? PrEP is an incredible concept, proof of principle that we have rolled out so successfully to protect our marginalized communities when it is used effectively. The caveat is that

It's really hard to take a medication every single day for something that isn't actively killing you, right? It's particularly difficult for, you know, women, cis women of color, trans women, right? We are really failing those groups. And one of the things that I have found that's really interesting is that a lot of these are based on global studies that are not happening in the US, but we were...

Cady Moore (59:09)
Mm-hmm.

thalia mccann (59:32)
really under-representing modern PrEP for cis women in the world. The very first PrEP medication that came out is notorious for causing osteoporosis and nephrotoxicity and all kinds of electrolyte disturbances that are just not fun called TDF or tenofovir disproxyl fumarate, if you're curious at all. And we came up with a less toxic version of that that was supposed to have higher intracellular concentrations.

Cady Moore (1:00:02)
So Dr. McCann did a great job of explaining this, but just as a quick aside, TDF is an antiretroviral medication that's been around since the early 2000s. It works by blocking an enzyme that HIV needs to replicate, which stops the virus in its tracks. You will find TDF in combination meds like Truvada, which is used both for PrEP or pre-exposure prophylaxis to prevent HIV and as a part of treatment regimens for people already living with HIV.

The problem is that while TDF is effective, long-term use can sometimes cause kidney issues and bone density loss, which is why this newer version, TAF or tenofovir alafenamide was developed. It is a lower dose, safer alternative, but TDF is still widely used because it is cheaper and effective.

thalia mccann (1:00:52)
And we were like, this is awesome. And then all of the trials that included cis women in that group, they were not showing a significant reduction compared to background for new HIV diagnosis. And they were like, maybe it's because it's not concentrating in vaginas. So they tried to figure that out. And they were like, maybe.

it's not working because, or we can't detect a difference because the rates are so much lower. And then they were like, no, no, no, we're studying this in an area where like there's a signal and we should be able to find it. What's going on? And then they just realized that women are literally so burdened to take care of their communities, to take care of other people, that they are often neglecting their own wellbeing. That's one barrier. And then the other is that hegemonic patriarchal violence means that

women are often actually denied care by the men that are directly responsible for them. And so we were failing cis women. so girls and women were having disproportionate lack of access and protection to new HIV infections until there have been two new studies called Purpose One and Purpose Two. Purpose One was specifically targeting

cis women and it's a new antiretroviral that is an injectable that is long acting and it's two injections in a year. So it's like highly, highly accessible. Women could come from wherever to get it once every six months. So the adherence is a hundred percent as long as you're getting the injections within a margin of like a couple months. And then we compared that to women that were taking oral PrEP medications and then the background.

Cady Moore (1:02:16)
Wow!

Sharilyn Wester (1:02:17)
that's so good.

thalia mccann (1:02:37)
for new HIV diagnoses and the effectiveness was two cases in over almost 3,000 women and that was associated with problems with adherence usually. so that was 99.9 % effective prep for women for the first time that we've had. that's, mean...

Cady Moore (1:02:48)
Bye!

Sharilyn Wester (1:02:48)
Wow.

Cady Moore (1:02:57)
Wow.

Sharilyn Wester (1:02:57)
That's

insane.

thalia mccann (1:03:01)
The rates for the oral PrEP went from like in the 90s to like the 60s by the time that they got to the third year of the study because of this like issue with adherence and accessibility. And in an age where global politics means that there's difficulty reliably getting oral medications to some parts of the planet, I just feel like this is a boon. So there are so many like logistics and complications in rolling this out and getting it paid for because it's very expensive as you can imagine, but

Cady Moore (1:03:10)
Yeah.

Yeah.

Yeah. The shit that works often is.

thalia mccann (1:03:30)
I, this one's a win.

Yeah. And then they did purpose too, which included a lot of trans folks and demonstrated also. Fantastic efficacy, better improvement. And I think that this is really something that we need to be like pushing out to our most marginalized folks that have the most difficulty sustaining contact with the healthcare system.

Sharilyn Wester (1:03:55)
Absolutely.

Cady Moore (1:03:55)
That is a

beacon of hope. Thank you. I have a follow up. I'm like nerding out. I have a follow up question. Can you please answer once and for all, does DoxyPep work for people with vaginas?

Sharilyn Wester (1:04:00)
Yeah.

thalia mccann (1:04:13)
Ugh.

Cady Moore (1:04:16)
Okay, so maybe not once and for all. I also love this reaction. This means this was a good question.

thalia mccann (1:04:22)
It's such a good

And I personally do not understand mechanistically again, right? Like what, what is happening with modern science? We are not allowed to study it, right? Like what the magical mythical vagina just like rejects antibiotics. That's how it works. Right. And so I think, I think that it would be effective. I think that we ran into the same problems that we ran into most of the other studies of cis women. A, the background rate to have a basically

Cady Moore (1:04:36)
Yeah, that's not how works.

Mm-hmm.

thalia mccann (1:04:52)
with statistics for the people who are listening who aren't nerds about biostatistics. And it's easier to see an effect with a smaller group of people that you're studying if the effect is very large, right? If you're changing something by 40 % or 90%, you only need to study a few hundred people. If the effect difference, like if your background rate of something happening is low enough, it becomes really difficult to determine a difference. You combine that with issues with

Cady Moore (1:05:03)
Mm-hmm.

Mm-hmm.

thalia mccann (1:05:21)
medication access because the women who are going to be at the most risk of that are also going to be the women that are most at risk of not having access to healthcare, right? Reliably. so I just honestly don't... I have qualms with how I was studied and I don't think we have the full picture. And technically right now it is not medically recommended to give to folks that are having receptive vaginal intercourse.

Cady Moore (1:05:22)
Mm-hmm.

Mm, okay.

thalia mccann (1:05:49)
for the same purposes. It may not be as effective.

Cady Moore (1:05:53)
Okay, thank you for that. I teach a queer sex ed course and I brought up that if you have a vagina, DoxyPep may not work for you. And there was understandably pushback where people were like, no, you definitely can. I am the, as the resource person in this room, like I have to go with what has been studied even though I don't know that I believe it. So thank you. I appreciate you. This gives me a fun anecdote to.

thalia mccann (1:06:05)
Yeah.

I'm with you, I'm with you. Totally.

Cady Moore (1:06:22)
This is be a

thalia mccann (1:06:24)
And I'm not even gonna mention like that there have been some patients that have had like weird recurrent cellulitis and have had, you know, a few courses of doxycycline that they just have in case for no other reason.

Cady Moore (1:06:23)
anecdote to talk about.

Which is casual. It's fine. It's fine.

Sharilyn Wester (1:06:38)
just in case.

thalia mccann (1:06:39)
even though they have vaginas, because...

Right?

Sharilyn Wester (1:06:44)
Mm-hmm.

thalia mccann (1:06:44)
What are you gonna say to the person that is clearly at high risk? Yes, correct.

Cady Moore (1:06:49)
Yeah, nothing. This is for my acne.

This is for my acne. This is for my ear infection. Me me me me me.

Sharilyn Wester (1:06:56)
I know I was going to say,

thalia mccann (1:06:56)
Yeah.

Sharilyn Wester (1:06:58)
Thal, that I

can see this congruence between this passion you have for studies like this, that you have a problem and you have a subgroup of people or a demographic of people. And there is a medication that could answer that problem, but culturally, there are issues that prevent people from accessing it. So do you find that

thalia mccann (1:07:13)
Mm-hmm.

Sharilyn Wester (1:07:23)
You almost get to practice this day to day when you're working individually with people and you have that face to face time with them and they might come in with a certain ID or they might have a specific issue and you can actually tailor medication to them that might be better for their lifestyle. Specific to them, like you said, like cis women who culturally might have more demands on them who might not be able to get

thalia mccann (1:07:31)
Yeah.

Yep.

Sharilyn Wester (1:07:50)
to the pharmacy once a month to get re-ups on medication. Like, is this something that really drives you in your field when you're working face-to-face with people?

thalia mccann (1:07:57)
Yeah, mean, so medications work as well as you take them, right? And so the other thing is that one of the things that I really bring forward is a very strong sense of empowering a patient to have medical agency and respecting that, not being patronizing, which I think is something that women are more subjected to often. And so if...

Sharilyn Wester (1:08:01)
Absolutely.

We talk about this a

thalia mccann (1:08:22)
and making their own decisions and have bodily autonomy, then it is your job to educate them. Here's what is gonna happen if we treat this thing. This is what's gonna happen if we don't treat this thing. There is only one disease state in the United States you can go to jail for not treating. Wanna guess what it is? We've talked about it a lot. It's very vintage. Syphilis. You cannot be medically penalized for not treating your HIV. Every other...

Cady Moore (1:08:38)
What is it? HIV. If, it is syphilis because congenital.

thalia mccann (1:08:49)
Well, and sorry, I guess also tuberculosis. Tuberculosis is one. Tuberculosis will actually put you in tuberculosis jail.

Cady Moore (1:08:52)
Is that only for someone who can get pregnant?

Okay.

thalia mccann (1:08:59)
Syphilis, they will hunt you down. I won't say they'll put you in jail, but they will be like, they're going to chase you with a penicillin shot.

Cady Moore (1:09:07)
And

Sharilyn Wester (1:09:07)
Yeah.

Cady Moore (1:09:08)
is that because of the mental decline that it causes or is that because congenital syphilis is such a problem or is it just like long standing?

thalia mccann (1:09:16)
Yeah, we have like the Department

of Health like being like, hey, have you seen this patient? This is this

like complete therapy, blah, blah. It's because of the rates of congenital syphilis and also because it is just actually very, they call syphilis the great imitator because it can present as like a ton of different vague symptoms. And a lot of people will just hang out until they have late latent syphilis and never realize that they had an infection.

Sharilyn Wester (1:09:43)
Right.

Cady Moore (1:09:44)
Mm-hmm.

thalia mccann (1:09:44)
Yeah,

so they won't put you in jail for Syphilis I want to say like they will put you in tuberculosis jail. But they will, the Department of Public Health will be like,

Sharilyn Wester (1:09:50)
I will say like that's, that seems like a great like.

thalia mccann (1:09:54)
like two things of penicillin.

Sharilyn Wester (1:09:58)
was

gonna say that sounds like a great like subset area of your careers being a syphilis headhunter like you're wearing your rider black you have a gun loaded with syphilis shots like okay I got a sight hunting them down like they they're about to get their car repoed

Cady Moore (1:10:09)
Bye.

thalia mccann (1:10:12)
Yeah, guys, if I tell bad dad jokes while I do that, could I just call it punicillin?

Cady Moore (1:10:17)
Yeah, yeah, yeah. Yeah. Okay, on

thalia mccann (1:10:19)
You

Sharilyn Wester (1:10:19)
You wouldn't

be a female main character if you wouldn't.

Cady Moore (1:10:24)
amazing note, we're gonna take another break. We will be right back to talk about Sci Comm and HealthComm and anti-Science propaganda and all sorts of fun things. So be right back, y'all.

thalia mccann (1:10:34)
off.

Sharilyn Wester (1:10:38)
Wee!

Cady Moore (1:10:40)
Okay, so we actually ended up turning this episode into two episodes because we just had so much juicy stuff to talk about with Dr. McCann. But before we take a break and go into our outro with Sharilyn, I wanted to touch base on what we were just talking about, which sounds like a dystopian sci-fi plot, but is actually a real public health policy, detaining people who refuse treatment for contagious diseases. So let's start with tuberculosis or TB.

TB is an airborne bacterial infection, meaning that it spreads when an infected person coughs, sneezes, or speaks. It is treatable with antibiotics, but treatment can take at least six months. And if someone stops too soon, the bacteria can become drug resistant, which makes it much harder and sometimes impossible to cure. Most people take their meds, but when someone with active contagious TB refuses or repeatedly fails to follow their treatment, public health officials can legally detain them in a medical facility

sometimes against their will until they are no longer a risk to others. Patients are usually placed in hospital isolation rooms or specialized public health detention facilities. Some states may have dedicated TB units in hospitals while others repurpose jail-like spaces. In extreme cases, individuals have been detained in actual jails, though this is widely criticized for obvious reasons. The detention period lasts until the person completes enough treatment to no longer be infectious. So that can mean weeks,

months or even over a year for drug-resistant TB. Now, as we discussed, TB is not the only disease that can get you locked up. Syphilis has also led to forced medical detention, especially for people who repeatedly refuse treatment. Syphilis is curable with antibiotics, but if it's left untreated, it can cause severe neurological damage, organ failure, and even death. Public health officials are particularly worried about congenital syphilis.

where an untreated pregnant person passes the infection to their baby, leading to stillbirth or severe birth defects. In some states, officials have used public health laws to detain people with infectious syphilis, sometimes in hospitals, but in some cases in locked wards or even jails. Unlike TB, syphilis treatment is quick, usually just a single injection of penicillin. So detention lasts days to weeks instead of months. However,

This causes an obvious ethical dilemma because detaining people for curable diseases raises serious civil rights concerns. While public health officials argue that detention is a last resort used only when someone is actively endangering other people, critics point out that forced medical isolation disproportionately affects vulnerable populations. So that's people experiencing homelessness, sex workers, folks with mental health conditions.

or people who may be struggling to access healthcare. At its core, this is a debate between body autonomy and public safety. No one wants to strip people of their freedom, but when an infectious disease spreads unchecked, detaining one person could prevent an outbreak that impacts thousands of people. With the rising antibiotic resistance that we've been seeing, more of these cases may be coming up in the future. So keep your eye out and please take your antibiotics as directed.

Sharilyn Wester (1:14:00)
Okay, well that was amazing and we have more to come. So thank you so much Dr. McCann. Stay tuned you guys for part two of this interview where we're gonna dig into access to healthcare and how that impacts queer and trans communities, how doctors like Dr. McCann can take better care of and be better advocates for their queer and trans patients and some spicy convos about cryptids.

Cady Moore (1:14:29)
I When you put Cady in charge of sillies you get weird-ass shit And and on that note I was in charge of sillies for for this episode and in honor of Michelle Trachtenberg's passing and her iconic film ice princess if You could design your dream figure skating outfit. What would it look

Sharilyn Wester (1:14:56)
Yes. my god. I love this so much. Do you want to answer first? Okay.

Cady Moore (1:15:00)
Yeah, yeah, I can answer first. And

this is for like me, this is for me now. the first thing that came to mind obviously was pink glitter. I was like, I knew I needed pink glitter. I knew that I wanted the fishnet tights with like the little rhinestones on it. I'm like, yes, me the glitter. And so I kind of like started feeling some like rhinestone cowgirl energy. Probably not with like fake denim.

Sharilyn Wester (1:15:06)
Yes.

Mm-hmm.

Cady Moore (1:15:27)
because that feels a little too like 2001. But yeah, like going for the, yeah, just a little too much, but like a rhinestone fringe, like let's fucking go. And as I was thinking about it, it made me realize that now I wanna see someone do a figure skating routine to casual because I feel like it would be so dramatic. yeah.

Sharilyn Wester (1:15:29)
No, yeah.

It's a little too on the nose.

Mmm.

Maybe someone has.

Cady Moore (1:15:53)
I looked it up and I found a couple hot to-go's and then one good luck babe, but no, no casual, but maybe I need to go on YouTube directly instead of using Google. So stay tuned. If I find one, it'll be in the show notes. If I don't, then it won't be.

Sharilyn Wester (1:16:03)
Mmm.

Yes. Okay, so the energy is

very pop. We're doing pink, we're doing rhinestones, we're doing glitter. No fake denim. I think we made that clear. Get your fake denim away from me. No, thank you. Not hungry. Has to be chapel-rone. What is your ending pose? Is it something big or is it something like demure?

Cady Moore (1:16:14)
Yeah. Yeah. No figtano.

big for sure. I'm thinking like truly like like like hands up like full star superstar arms

Sharilyn Wester (1:16:31)
Yeah.

Yes.

Yes,

Patrick Star Arms. my God. I love that. Okay, so real quick, I actually have a direct outfit reference. If y'all are listening to this, keep this open on your Spotify, Apple, whatever. Go on Google real quick. Go on images. Yeah, you got that open. Okay, look up Tessa Virtue, Scott Moir, M-O-I-R, 2018.

Cady Moore (1:16:41)
Mm-hmm, mm-hmm.

Yeah, what are you?

Sharilyn Wester (1:17:08)
Mulan Rouge. did this at the Pyeongchang Olympics and they did a routine to Moulin Rouge's Roxanne. And it is sheer. It is deep crimson. It's sexy. It's elegant. It's mysterious. It's devastating. It's something that a female main character would wear as she saws off an enemy's head. It's like the deep color with the song is so good.

Cady Moore (1:17:20)
So hot.

Sharilyn Wester (1:17:36)
I don't know if I would do it to Roxanne. That's pretty, that's, that's, I feel like for, with a partner, obviously it works really well. I would, my routine would be something a little more sultry and sexy and like dark, like to, I'm thinking like Streets by Doja Cat or,

Cady Moore (1:17:55)
Mmm.

Sharilyn Wester (1:17:58)
something a little more sexy like Mount Everest by labyrinth or Tia Tamera by Doja Cat those ones with like kind of the darker. I love it. I would do

Cady Moore (1:18:06)
huh. I'm getting You Should

See Me in a Crown by Billie Eilish. Yeah. Yeah.

Sharilyn Wester (1:18:11)
Yes. Oh my gosh. Yes. That total

energy that, yeah, I love those like very fluid, sexy, like mysterious. I love that. I love when they can infuse that into a performance and then they get off the ice and they're like just the most bubbly, like happy person ever. I love that. So that would be mine. Yeah. I'm like, I thought you were a man eater and instead you are a little bunny.

Cady Moore (1:18:28)
Mm-hmm.

Yeah, and you're like, wait, I'm confused. Hell yeah.

Yeah, did they win, did they win a, did they win a medal for that?

Sharilyn Wester (1:18:40)
would happen.

did they? Yeah. Yep. Yeah, and I'm telling y'all, go watch the routine on YouTube. I watch it at least once a month because it's so moving and it's so good. It's so good. They just, if you like musical theater, if you like Mulan Rouge, you're gonna love this ice routine. Hell yeah.

Cady Moore (1:18:49)
Oh yeah, yeah, for Canada. Wow, Mazel Tov.

Hell yeah, okay, super excited, yeah.

They, um, they skated a 199.86, which actually I don't know what the max is, so that doesn't, um, it doesn't matter. We'll stop nerding out now. Well anyway.

Sharilyn Wester (1:19:24)
They- this, yeah.

You

Cady Moore (1:19:29)
Anyway,

thank you everybody for listening. Thank you for being here. Yeah, we're super, we're super excited. If you loved what you heard, please don't forget to rate, review, and subscribe. You don't need to write a review. Even just giving us the stars is helpful. If you do write a review, we should start reading them out loud on the pod. I think that'd be cute. So we'll start doing that.

Sharilyn Wester (1:19:32)
Yes, we're going to catch you guys in part two.

Honestly, I've

gotten some really sweet ones.

Cady Moore (1:19:53)
Yeah, that's you know what? That's what we're going to do in our recap episode now. So write a review if you want to be in our recap episode. If you have listener questions, slide into our DMs or shoot us an email at kneedeeppodcastmailbag at gmail.com. You can find all that information in the show notes. You are welcome to give us guest suggestions, topic suggestions. We love all the input. So thank you all so much for being here. Have a wonderful rest of your day and we will see you for part two in two weeks.

Sharilyn Wester (1:20:22)
See you soon.