Publisher Health

Cholesterol manufactured in the brain appears to play a key role in the development of Alzheimer’s disease, new research indicates.
Scientists from the University of Virginia School of Medicine and their collaborators found that cholesterol produced by cells called astrocytes is required for controlling the production of amyloid beta, a sticky protein that builds up in the brains of patients with Alzheimer’s. The protein accumulates into insoluble plaques that are a hallmark of the disease. Many efforts have targeted these plaques in the hope that removing or preventing them could treat or prevent Alzheimer’s.
The new findings offer important insights into how and why the plaques form and may explain why genes associated with cholesterol have been linked to increased risk for Alzheimer’s. The results also provide scientists with important direction as they seek to prevent Alzheimer’s.
“This study helps us to understand why genes linked to cholesterol are so important to the development of Alzheimer’s disease,” said researcher Heather A. Ferris, MD, PhD, of UVA’s Division of Endocrinology and Metabolism. “Our data point to the importance of focusing on the production of cholesterol in astrocytes and the transport to neurons as a way to reduce amyloid beta and prevent plaques from ever being formed.”
Alzheimer’s Plaques and Cholesterol
While cholesterol is often associated with clogged arteries and heart disease, it plays important roles in the healthy body. The body makes cholesterol naturally so it can produce hormones and carry out other important functions. The new discovery from Ferris and her collaborators adds a new entry to cholesterol’s list of responsibilities.
The work also sheds light on the role of astrocytes in Alzheimer’s disease. Scientists have known that these common brain cells undergo dramatic changes in Alzheimer’s, but they have been uncertain if the cells were suffering from the disease or contributing to it. The new results suggest the latter.
The scientists found that astrocytes help drive the progression of Alzheimer’s by making and distributing cholesterol to brain cells called neurons. This cholesterol buildup increases amyloid beta production and, in turn, fuels plaque accumulation.
Normally, cholesterol is kept quite low in neurons, limiting the buildup of amyloid beta. But in Alzheimer’s, the neurons lose their ability to regulate amyloid beta, resulting in plaque formation.
Blocking the astrocytes’ cholesterol manufacturing “robustly” decreased amyloid beta production in lab mice, the researchers report in a new scientific paper. It’s too soon to say if this could be mimicked in people to prevent plaque formation, but the researchers believe that further research is likely to yield important insights that will benefit the battle against Alzheimer’s.
The fact that amyloid beta production is normally tightly controlled suggests that it may play an important role in brain cells, the researchers say. As such, doctors may need to be careful in trying to block or remove amyloid beta. Additional research into the discovery could shed light on how to prevent the over-production of amyloid beta as a strategy against Alzheimer’s, the researchers believe.
“If we can find strategies to prevent astrocytes from over-producing cholesterol, we might make a real impact on the development of Alzheimer’s disease,” Ferris said. “Once people start having memory problems from Alzheimer’s disease, countless neurons have already died. We hope that targeting cholesterol can prevent that death from ever occurring in the first place.”
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Materials provided by University of Virginia Health System. Note: Content may be edited for style and length.

A new study from researchers at The University of Texas MD Anderson Cancer Center showed that stereotactic ablative radiotherapy (SABR) was as effective as surgery at providing long-term benefits to patients with operable early-stage non-small cell lung cancer (NSCLC) and generated minimal side effects. The study is the first of its kind to compare long-term results of SABR against surgical treatment in patients with operable early-stage NSCLC.
The findings from the single-arm, non-randomized STARS trial — led by Joe Chang, M.D., Ph.D., professor of Radiation Oncology, and Jack Roth, M.D., professor of Thoracic and Cardiovascular Surgery — were published today in The Lancet Oncology.
SABR is treatment that concentrates intense doses of radiation on a specific tumor site without damaging surrounding healthy tissue. It is used as standard treatment for inoperable early-stage NSCLC. Due to its effectiveness, convenience and noninvasiveness, there is growing interest in exploring SABR as a treatment for patients with operable diseases.
“After surgical resection, recovery may be prolonged and there can be significant loss of lung function depending on the amount of lung removed,” Chang said. “However, SABR functions as a non-invasive ‘knife’ to eliminate cancer with minimal side effects. Patients are treated in 30 minutes as an outpatient procedure, and they can return home or even work the same day after therapy is delivered. Lung function is preserved.”
The study builds on the pooled analyses of two randomized studies (STARS and ROSEL trials), published in 2015, that investigated the advantages of SABR versus a surgical procedure called video-assisted thoracoscopic surgical lobectomy with mediastinal lymph node dissection (VATS L-MLND).
For the current study, the researchers enrolled 80 newly diagnosed patients with early-stage NSCLC with tumor sizes 3 cm or smaller from Sept. 1, 2015, through Jan. 31, 2017, and compared their results to propensity-matched patients undergoing surgery during the same time period. The final follow-up was Sept. 30, 2020, with a median follow-up of 5.1 years.

A newly developed, low-cost sensor can detect and accurately measure the amount of the widely used and controversial herbicide, glyphosate, in droplets of liquid in a laboratory test.
Washington State University and DL ADV-Tech engineers developed the sensor device, which uses nano-sized tubes, and tested it on samples of orange juice and rice beverages that they spiked with the herbicide for the study. The glyphosate sensor uses technology that is similar to that used in glucose tests that can quickly measure blood sugar levels from a pinprick of blood.
Ultimately, that is the goal for this sensor: to test human samples for monitoring glyphosate exposure, but in the study published in Biosensors and Bioelectronics, researchers first showed the sensor’s potential for testing beverages.
“We started to develop this sensor for health monitoring, but it also can be used for food safety and environmental monitoring,” said Yuehe Lin, professor in WSU’s School of Mechanical and Materials Engineering and the study’s corresponding author. “We designed it to be portable and used 3D-printing to make it small and compact, so that it can be used anywhere — in the lab or in the field.”
Before this new development, methods of detecting and measuring herbicides like glyphosate often relied on meticulous preparation of samples and expensive scientific equipment like mass spectrometers. Other methods involve using biological antibodies to attract and bind the herbicide molecules, which is also expensive with materials that need to be carefully stored to prevent degradation of the natural components.
The sensor developed by the research team uses electrically conducting polymer nanotubes that are imprinted with molecule-sized cavities that can bind glyphosate molecules — essentially mimicking the biological antibodies. These nanotubes are then coated on a 3D-printed sensor device that uses an electric current to quantify the glyphosate concentration. Because it uses an artificial antibody instead of biological one, the sensor doesn’t need special storage, and the sensing materials are relatively inexpensive.
The researchers tested the sensor on samples of orange juice and rice beverages that they spiked with known levels of glyphosate. They found the sensor had the ability to detect the herbicide with high sensitivity and specificity.
“For the next step, we want to use the sensor to detect glyphosate in some human samples such as blood, saliva or urine,” said Shichao Ding, a WSU doctoral candidate in Lin’s lab and first author on the paper. “We will also continue to develop some new nanomaterials to enhance its sensing performance.”
Glyphosate has been approved for use by many regulatory agencies including the U.S. Environmental Protection Agency, which issued a statement in 2020 that it is safe for use at recommended levels. Yet, some groups and studies have raised concerns about glyphosate’s health and environmental risks, and the World Health Organization’s International Agency for Research on Cancer has classified it as “probably carcinogenic to humans.”
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Materials provided by Washington State University. Original written by Sara Zaske. Note: Content may be edited for style and length.

Hospitalized COVID-19 patients are substantially more likely to harbor autoantibodies — antibodies directed at their own tissues or at substances their immune cells secrete into the blood — than people without COVID-19, according to a new study.
Autoantibodies can be early harbingers of full-blown autoimmune disease.
“If you get sick enough from COVID-19 to end up in the hospital, you may not be out of the woods even after you recover,” said PJ Utz, MD, professor of immunology and rheumatology at Stanford Medicine.
Utz shares senior authorship of the study, which will be published Sept. 14 in Nature Communications, with Chrysanthi Skevaki, MD, PhD, instructor of virology and laboratory medicine at Philipps University Marburg in Germany, and Eline Luning Prak, MD, PhD, professor of pathology and laboratory medicine at the University of Pennsylvania. The study’s lead authors are Sarah Chang, a former technician in Utz’s lab; recent Stanford undergraduate Allen Feng, now a technician in the Utz lab; and senior research investigator Wenshao Meng, PhD, and postdoctoral scholar Sokratis Apostolidis, MD, both at the University of Pennsylvania.
The scientists looked for autoantibodies in blood samples drawn during March and April of 2020 from 147 COVID-19 patients at the three university-affiliated hospitals and from a cohort of 48 patients at Kaiser Permanente in California. Blood samples drawn from other donors prior to the COVID-19 pandemic were used as controls.
The researchers identified and measured levels of antibodies targeting the virus; autoantibodies; and antibodies directed against cytokines, proteins that immune cells secrete to communicate with one another and coordinate their overall strategy.

The most comprehensive analysis of the 3D structure of SARS-CoV-2 to date has revealed new insight on how the virus infects human cells and replicates.
Led by Professor Sean O’Donoghue, from the Garvan Institute of Medical Research and CSIRO’s Data61, researchers compiled more than 2000 different structures involving the coronavirus’s 27 proteins. The analysis identified viral proteins that ‘mimic’ and ‘hijack’ human proteins — tactics that allow the virus to bypass cell defences and replicate.
These structural models can be freely accessed from the Aquaria-COVID resource, a website designed by the team to help the research community ‘zoom in’ on potential new targets on the virus for future treatments or vaccines, and crucially investigate new virus variants.
“Our resource contains a level of detail of SARS-CoV-2’s structure that is not available anywhere else. This has given us an unprecedented insight into the virus’s activity,” says Professor O’Donoghue, first author of a paper in the journal Molecular Systems Biology detailing the team’s findings.
“Our analysis has highlighted key mechanisms used by the coronavirus; these mechanisms, in turn, may guide the development of new therapies and vaccines.”
Structural insights
To better understand biological processes, researchers determine the 3D shape of individual proteins — the building blocks that make up cells or viruses.

There is no suggestion the booster jab programme will have to reoccur every six months, the chair of the vaccines advisory body (JCVI) has said.Speaking at a briefing, the UK’s chief medical officers read out their latest advice about coronavirus vaccinations and the plan to offer over-50s a booster jab.Prof Wei Shen Lim also said the advice did not imply that all healthy under-50s would necessarily be called for a third dose.

SharecloseShare pageCopy linkAbout sharingThe NHS is preparing to offer Covid booster jabs from next week, the health secretary has said. Sajid Javid told the Commons the government had accepted advice from the the JCVI that around 30 million people should be offered a third dose. This includes over-50s, younger adults with health conditions and frontline health and social care workers. The Pfizer jab is recommended and it should be given at least six months after the second dose. It is part of the government’s plan for managing Covid through the autumn and winter.The recommendation from the JCVI (Joint Committee on Vaccination and Immunisation) comes amid concern about waning immunity.There are some signs protection offered by the vaccine may start dropping off several months after the second dose – with the most vulnerable groups most at risk of this.The JCVI said it was still unclear exactly how much protection does slip, but it wanted to take a precautionary approach and ensure the most vulnerable people maintain high levels of protection.Will children get the vaccine and will I need a booster?Pfizer and AZ approved as Covid booster vaccinesCovid jab rollout to start in schools in EnglandNo plans for October lockdown, says governmentThe advice is separate to the recent recommendation of third doses for people with severely weakened immune systems – something that is already being rolled out. Those eligible for a booster jab include:Those living in residential care homes for older adultsAll adults aged 50 years or overFrontline health and social care workersAll those aged 16 to 49 years with underlying health conditions that put them at higher risk of severe COVID-19Adult household contacts of immunosuppressed individualsThere is a huge amount of uncertainty about what winter will bring. In fact, it’s not even clear what the next month will bring.It was feared September could see Covid cases rise, but there are no signs of that happening yet.Big surges in infection levels are probably behind us, given the amount of immunity built up in the population.But if current levels are sustained throughout winter, the NHS will struggle. And even a small dip in vaccine effectiveness could make a big difference to admissions – hence the booster announcement.Then there is the concern about the return of other respiratory viruses. They were kept at bay last year by lockdowns and social distancing, but that has meant immunity to them has waned.A virus called RSV – the leading cause of respiratory illness in young children – is already circulating at very high levels. Flu could also take off. Trials have been carried out in the UK looking at the use of booster jabs.The JCVI said these showed Pfizer was well-tolerated and provoked a good immune response, including against new variants of the virus, such as Delta, regardless of which Covid vaccine had been given for the first two doses.It said where Pfizer was not available a half-dose of Moderna could also be used.For people who cannot have the Pfizer or Moderna because of issues like allergies, the AstraZeneca vaccine can be used as a booster.A gap of six months between the second dose and the booster shot was considered the most effective for boosting protection.The trials also showed the flu vaccine can also be given at the same time as the booster jab where that is practical – some people will be offered a flu jab before they become eligible for a Covid booster.’Bumpy winter’ predictedJCVI chair Prof Wei Shen Lim said: “The UK’s Covid vaccination programme has been hugely successful in protecting people against hospitalisation and death, and the main aim of the booster programme is to prolong that protection and reduce serious disease as we head towards the colder months.”He said even a small tip in vaccine effectiveness could have a big impact on hospital admission numbers given the size of the population.He said those under 50 were likely to have a more long-lasting immune response to the first two doses of vaccine so may not need a booster – although he did not rule it out happening completely.image source, EPAEngland’s deputy chief medical officer Prof Jonathan Van Tam said the UK was likely to be in for a “bumpy winter” with Covid, coupled with other respiratory viruses, such as flu, returning – previously lockdowns and social distancing meant these were kept at very low levels.He said the booster programme was about “staying on top of Covid” and could make a “very substantial impact” on hospitalisations and deaths.Around 85% of deaths in recent weeks have been among the over 60s.But Prof Van Tam added it was also important that those who had not yet come forward for jab did so – more than 5 million adults have not yet had their first dose yet.Government ‘trying to avoid restrictions’The announcement comes after the government confirmed on Monday that all children aged 12 to 15 in England would be offered one dose of the Pfizer jab, with invitations going out from next week. It follows advice from the UK’s chief medical officers, who say the jab will help reduce disruption to education.A rollout is yet to be confirmed in Scotland, Wales and Northern Ireland.In a statement before the announcement on the booster programme, Prime Minister Boris Johnson said while the pandemic “is far from over”, the “phenomenal vaccine programme, new treatments and testing” mean the UK is “able to live with the virus without significant restrictions on our freedoms”. The PM, who is holding a coronavirus press conference later, said he would lay out a strategy for the months ahead “when the virus has a natural advantage, to protect the gains we have made”.

The cruelty of their unequal outcomes — with one pair freed of disabling symptoms and the other’s suffering unabated — stayed with me.Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together.As a medical reporter, I regularly write about terrible illnesses and about treatments that can help some, though not most, patients. But the cruel injustice of inequities in access to medical advances in sickle cell disease took my breath away.I didn’t plan it this way, but I ended up writing about two families who, at the start, were strikingly similar. Each had two teenage daughters with sickle cell disease. All four girls suffered episodes of intense pain, damage to organs and bones, and life-threatening lung complications. And one pair of the sisters had strokes.But in one family, both girls were freed from their symptoms and are now living normal lives. In the other, the sisters are still suffering and yearning for the chance to rid themselves of the disease.I followed one of the families for two years and the other for over a year, and I am haunted by the disparities.Helen Obando at the hospital the day she got the good news that her gene therapy was working. Two years later, she is rid of her symptoms of sickle cell.Hilary Swift for The New York TimesThe tale of these two families reveals in a microcosm the state of the science for this terrible disease. Sickle cell is caused by a single mutation in a globin gene needed to make red blood cells. The cells turn sickle shaped and can get stuck in blood vessels, injuring them and impeding blood flow. An estimated 100,000 Americans have the disease — most of them Black and many of modest means. Although the cause of the disease has been known for more than half a century, research has been slow and underfunded. Even discoveries that could improve patients’ lives are often not used.There is a bone-marrow transplant that gives the patient the blood system of a healthy person. But it is rarely used because few sickle cell patients have a donor whose genetics are close enough to the patient’s for the marrow to avoid being rejected as foreign.In the family whose teenagers were rid of their suffering, the mother, Sheila Cintron, was so desperate to find a bone-marrow donor for her daughters that she and her husband drained their bank account and maxxed out their credit cards to repeatedly attempt in vitro fertilization and genetic testing of embryos, hoping to have a baby who could be a donor for her girls.She succeeded at last, but her baby was genetically similar to only one of her daughters, Haylee Obando. Haylee had a bone-marrow transplant with her younger brother’s cells and was cured.The other daughter, Helen, was left behind until she was accepted into a clinical trial at Boston Children’s Hospital testing gene therapy for sickle cell disease.Helen Obando has a new life in a new city and is no longer suffering from sickle cell.Ash Ponders for The New York TimesShe too no longer suffers from the disease.I cheered Helen’s gene therapy. Being freed of the disease turned her from a taciturn adolescent whose future held pain, suffering and death at an early age into a teenager like any other. She told me she no longer even thinks about sickle cell.But the pace of the gene therapy trials seems glacial, with few patients enrolled each year. F.D.A. approval is a year or more away, at best.No one expects gene therapy to be the answer for most patients. The cost — which is likely to be $1 million to $2 million for each patient — will be a barrier. And the grueling treatment requires chemotherapy and a month in a specialized hospital.The other family breaks my heart. Dana Jones, is divorced and raising her daughters, Kami and Kyra, alone. Both had disabling strokes before she learned that there was a simple test the girls should have had every year that identifies children with sickle cell at high risk for strokes — strokes that can largely be prevented with a treatment of blood transfusions. The girls are smiley, solicitous and delightful company. But their suffering is immense — weeks and weeks of hospitalizations every year, missed school, and a life of near constant pain that they have learned to accept and not mention until it’s unbearable.Kami and Kyra, still suffering from sickle cell, receive blood transfusionsIlana Panich-Linsman for The New York TimesI asked Ms. Jones if she would want the girls to have gene therapy.“Oh God yes,” she said.She watches Kami and Kyra bravely hide their pain. She has seen emergency room doctors accuse them of faking it to get narcotics. She has seen her girls struggle in school because their strokes impeded their ability to learn. She sees their disease wreaking more damage on their bodies every day.She called and wrote Boston Children’s, asking if Kami and Kyra could enter its trial. They would have to go to Boston for the arduous treatment, but Ms. Jones, who lives in San Antonio, would gladly take them there.She made sure the girls’ names were on a lengthy waiting list for slots in the trial.Now all she can do is wait. And pray.

Many who feel they need more coronavirus protection have managed to obtain an extra dose. “I did feel bad about it. But I didn’t feel bad enough,” one woman said.Amy Piccioni is not a doctor or a scientist, but as word of breakthrough coronavirus infections in vaccinated people started spreading this summer, she waded through an array of technical and often contradictory information about the need for coronavirus booster shots. Then she decided for herself: She would not wait for federal regulators to clear them before finding one.“It takes a long time for scientists to admit that some people need a booster,” said Ms. Piccioni, 55, who received the one-dose Johnson & Johnson vaccine last November through a clinical trial and timed her booster around a visit to her father in July, thinking it would protect her on the plane. She walked into her local Walgreens, asked for a Pfizer shot and got it, no questions asked.“All I could think about was how low the vaccination rate is in some areas,” said Ms. Piccioni, who lives near Del Mar, Calif., and is in good health. “Those doses don’t last forever, so I felt no guilt about taking one that probably would have expired.”While tens of millions of Americans continue to decline even a first Covid-19 vaccine, a small but growing number have sought out additional shots even though the Food and Drug Administration has not yet approved them and it remains unclear who precisely needs one and when.Studies in the United States have found that the vaccines continue to provide robust protection against severe Covid-19, especially for those younger than 65, even as evidence grows that their effectiveness against infection wanes over time. A review published on Monday by an international group of scientists, including two from the F.D.A., found that none of the data so far provided credible evidence in support of boosters for the general population.Still, many seeking early boosters fear that breakthrough infections could inconvenience or sicken them — or worse, they say, someone they love. Most do not feel they are taking a dose from someone else, as vaccines are widely available in the United States and a local pharmacy is not in a position to shift shots to nations that need them.The number of Americans who are not immunocompromised but have obtained extra shots is unclear. About 1.8 million people have done so since mid-August, according to the Centers for Disease Control and Prevention, but that count is likely to include many with weakened immune systems. The Food and Drug Administration authorized additional shots for that group last month.Also last month, the Biden administration announced that it hoped to start offering boosters on Sept. 20 to people who had received a second dose of the Pfizer-BioNTech or Moderna vaccine at least eight months before. But the leaders of the F.D.A. and the C.D.C. then said they needed more time to evaluate safety and other data. Janet Woodcock, the acting F.D.A. commissioner, has urged people not to seek booster shots on their own, but to wait for a regulatory ruling that they are safe and necessary.For many Americans — particularly those over 65, who were among the first to be vaccinated — the shifting plans were just another case of inconsistent information from the government about the pandemic.“Frankly, I did not trust the government to act on the science,” said Lynn Hensley, who assigned herself a booster in July, six months after her second shot. “I’m 78 and consider myself at a greater risk. I feel like I can just read what’s out there and make up my own mind.”She went to a temporary county vaccine clinic in the Fox River Valley area of Wisconsin.“They did ask me if it was my first or second shot, and I told them it was my first,” she said. “I did feel bad about it. But I didn’t feel bad enough.”Amy Piccioni at her home in Solana Beach, Calif. She received a booster without being asked questions from a pharmacy.Ariana Drehsler for The New York TimesThe Maryland Department of Health decided to take action ahead of the F.D.A.: It issued an order last week permitting immediate boosters for all residents 65 and older who live in group settings like nursing homes. Michael Ricci, a spokesman for Gov. Larry Hogan, pointed to the C.D.C.’s recommendation last month that “moderately to severely immunocompromised” people should have extra shots.“We are relying on that expansive view to deem the seniors in congregate settings as immunocompromised,” he said. “We are directing those facilities to offer the booster shot to anyone who wants one.”Federal guidance on masks, vaccine mandates, the risk of outdoor transmission and other virus-related issues have shifted often over the course of the pandemic. At times, within both the Trump and Biden administrations, there has been open disagreement among health officials on how to proceed, and confusing guidance that has subsequently been reversed.As a result, Americans across the political spectrum are relying on pieces of information, like an announcement by Israel’s Ministry of Health in July that the effectiveness of the Pfizer-BioNTech vaccine against symptomatic infection — though not against serious illness — waned over time. Others have trusted their intuition, whether that means taking dangerous livestock medications to “cure” the virus or seeking a booster before it is officially recommended.“This is a result of poor risk communication and lack of political and scientific transparency over the last 18 months,” said Rachael Piltch-Loeb, a researcher and fellow in public health emergency preparedness and response at the Harvard School of Public Health. “It is also a reflection of people feeling a total lack of control of what is happening in society at this point. One of the things that can do to protect themselves is to take science into their own hands.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media 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a:hover{-webkit-text-decoration:none;text-decoration:none;}For vaccinated people living in areas where many have shunned shots and masks, proactively grabbing a booster feels like buying insurance on a rental car: They might not need it, but it makes them feel more secure.Many have found willing partners in pharmacies and health care providers.Bruni Baeza, 83, walked into a CVS in Miami, flashed the white vaccine card that showed seven months had passed since her last shot and was immediately given a booster, she said in an email from her birthday cruise — the impetus, she said, to get the third shot.Pharmacies deny that they are knowingly letting people flout the guidelines. “Patients are asked to attest that all information provided, including health status, is truthful and accurate while scheduling a vaccination appointment on CVS.com and when they receive their vaccination,” said Ethan Slavin, a spokesman for the company. “Mr. Slavin said that “we can’t speak to anecdotal reports” that CVS is giving boosters to customers like Ms. Baeza, who shared a record of her third dose with a reporter.Public health experts generally take a dim view of booster self-selection. Like vaccine refusal, they say, it does not take into consideration the broader fight against the pandemic, which they believe should be focused on vaccinating the 25 percent of Americans who are eligible but unvaccinated, or on vaccinating people in poor nations.“This flies in the face of what is required in a pandemic,” said Dr. Kirsten Bibbins-Domingo, an epidemiologist at the University of California, San Francisco. “The challenge is, particularly in a pandemic, individual choice is important but the entire strategy has to do with our collective choices and responsibility.”Isabella, an healthy 18-year-old freshman at Colorado College, decided to get a second Moderna vaccine in order to protect immune-compromised friends and others.“I feel like I can’t put the responsibility of being safe on anyone else,” said Isabella, who asked to be identified only by her first name because she had been dishonest about her health status, telling a pharmacist that she was immunocompromised. “I don’t want to contribute to illness in my community. Maintaining my immunity status is something I can do to protect my peers and myself, across all political views, so the legality of my booster shot isn’t important to me.”Dr. Bibbins-Domingo saw another downside in this method: “With everyone out there lying about being immunocompromised, lying about their status, this will just wreak havoc with the data. We want public health decisions to be based on good data. It is a disserve to treat medicine like a restaurant where we go in and order from a menu.”Still, people like Ms. Piccioni, the California woman who supplemented her Johnson & Johnson vaccination with a Pfizer one, feel it is better to be safe than sorry, even if the evidence has been mixed. “I was nervous,” she said, but concluded, “For someone like myself, someone who had an old vaccine, it was OK to boost with two.”She got her second Pfizer shot last month.