Public Health

Avian flu in humans, H5N1 symptoms, mushroom chocolate recall and AMA Annual Meeting 2024 highlights


AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

How is bird flu transmitted? Is bird flu dangerous to humans? Are mushroom gummies safe? Why don't edibles list ingredients? What is the new AMA policy on public health?

Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.


  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

Advancing public health

AMA membership offers unique access to savings and resources tailored to enrich the personal and professional lives of physicians, residents and medical students.

Limited-time half-price dues when you join!

Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea.

Garcia: Thanks, Todd. It's great to be back.

Unger: Well, it's been a couple of weeks since we last talked because of AMA's Annual Meeting that was held in Chicago this past week. Andrea, before we dive into this week's headlines, any highlights from the Annual Meeting to share?

Garcia: Well, as usual, there was a lot of work happening at the policy level at that meeting with the focus, of course, on the AMA's key priorities, including Medicare payment reform, fixing prior auth, addressing inappropriate scope of practice expansions, and ensuring physicians have a voice in tech development, including AI. Many of these issues, as we know, are creating additional burdens for physicians and they're threatening patient access and safety.

Both our incoming and outgoing presidents discussed the toll that this takes on physicians, which contributes to burnout and ultimately puts health care in crisis. So while I think many physicians left the meeting feeling energized about the progress we've made, it's clear that we do still have a lot of work to do.

Unger: Absolutely. And Andrea, as you mentioned, a huge part of the meeting is devoted to health policy. What highlights do you have to share from your perspective on public health?

Garcia: Well, there's really so much policy work that gets done at this meeting that it's impossible to capture it all in a short conversation here. But one of the public health highlights I think that's worth mentioning focuses on minority communities and rural areas. We know this is important because more than 46 million people or 15% of our population live in rural areas in the U.S. And research shows that people in rural communities experience disproportionately higher rates of cardiovascular disease, stroke, cancer, diabetes and respiratory illness. And minority communities in rural areas are even higher risk for poor health outcomes.

The AMA's policy aims to improve these outcomes through efforts specifically tailored to these populations, including increased access to care and education on disease prevention. There are so many policies like this one that are aimed at improving public health. We will drop a link to this description of this episode where people can find out more.

Unger: All right. Well, thank you very much, Andrea, for that recap. And now turning to headlines from over the past couple of weeks. And just proof that just because we don't talk about it doesn't mean that it's gone. We'll start with where we left off, Andrea, and that's bird flu. Have things gotten any better or worse?

Garcia: Well, when we last talked, there were two farmworkers who had tested positive for H5N1 bird flu, and that number has now increased to three. Unlike the first two farmworkers who had high infections, the third farm worker reportedly also had respiratory symptoms, including a cough, sore throat, watery eyes. And that may increase the likelihood of transmission to other people. However, federal officials still say that the risk to the public remains low.

All three farm workers have fully recovered. And there was also a recent experiment that showed that the virus was less capable of spreading by respiratory droplets. Although we certainly know that could change as the virus evolves.

Unger: I'm just curious about what kind of experiment would be able to prove that.

Garcia: Well, this was an experiment that was done with ferrets, and that is a model that is often used to assess potential impact on people. Researchers at the CDC used the H5N1 virus taken from the farm worker in Texas who tested positive. And when three healthy ferrets were placed in the same enclosure with three of the infected ferrets, all of them became sick. So these animals could touch, they could nose, they could lick the sick animals. Those findings indicate that the virus spreads efficiently between ferrets who are in direct contact.

When three healthy ferrets were placed in an enclosure where they could breathe the same air as the sick ferrets but couldn't touch them, only one of those three animals became ill. And that suggests that the virus is currently less capable of spreading by respiratory droplets. According to the CDC, this is different than what we see for seasonal flu, which infects 100% of ferrets via respiratory droplets.

Unger: Well, let's hope that particular dynamic stays the same way. Andrea, is there anything else that we learned from these experiments?

Garcia: Well, unlike seasonal flu, which makes ferrets sick but doesn't kill them, the H5N1 killed all of the ferrets that were infected. Now, that's not really too surprising, as H5 viruses have historically been fatal to ferrets. The CDC did conclude that while three cases of H5N1 in the U.S. have been mild, it is possible that there will be serious illnesses among people. I think it's becoming increasingly clear that protecting the health of farm workers needs to be a top priority here, and wearing protective gear is especially important.

Unger: All right, Andrea. Has there been any change among the spread among cattle?

Garcia: In fact, there has, Todd. Wyoming, Iowa and Minnesota all announced their first detections of the virus in the past few days. We now have more than 80 dairy herds who are testing positive across at least 12 states.

Wastewater surveillance is still showing limited spread in the U.S. overall. The CDC is asking that physicians remain vigilant for signs and symptoms of influenza virus infection over the summer and to maintain those high rates of testing. They're also encouraging physicians to forward any specimens that test positive for influenza A to public health labs for additional testing.

Unger: All right. And that's something we'll continue to track as the summer progresses. Andrea, the CDC also issued a health advisory earlier this week to warn of something completely different that we haven't talked about. What do we need to know?

Garcia: Yeah, as you mentioned, we have not talked about this previously. But according to that health alert from the CDC, the CDC, FDA, America's poison centers, state and local partners are investigating reports of severe acute illness potentially associated with consuming Diamond Shruumz brand chocolate bars, cones and gummies. These are being marketed as containing a proprietary blend of mushroom.

As of June 11, there have been 12 total illnesses, Ten hospitalizations reported in eight states with ongoing efforts to identify other potential cases. Although the cause of the reported illness is not known at this time, individuals are being advised not to eat, sell or serve any flavors of Diamond Shruumz brand chocolate bars, cones or gummies, and they should discard products that have been purchased. CDC and FDA are also working to determine whether other products from this company have been associated with adverse health effects.

Unger: All right, Andrea, for those of us who have never heard of the brand Diamond Shruumz or familiar with that at all, can you share a little bit more background? How do people even get these products and what kind of illnesses are we seeing?

Garcia: While many of the conditions are serious and patients have experienced central nervous system depression with sedation, seizures, muscle rigidity, clonus, tremor, abnormal heart rate, abnormal blood pressure, GI effects, skin flushing, diaphoresis and metabolic acidosis with an increased anion gap. Ten patients were hospitalized. Several even required intubation, mechanical ventilation and admission to the ICU. Thankfully, none have died. These products are mostly distributed online and retailers include those that sell hemp derived and smoke or vape products.

Unger: All right. Is this indicative, say, of a larger trend and you expect to see more of these types of health advisories?

Garcia: That wouldn't surprise me. As we know, products containing psychoactive compounds such as cannabis or mushroom extract are being made increasingly available. These edibles are often sold as gummy candies, chocolate or other snack foods. But they may actually contain undisclosed ingredients, including illicit substances, other adulterants or potentially harmful contaminants that are not approved for use in food. Mushroom-containing products, in particular, have been marketed for promoting health, but some could, in fact, lead to the opposite effects and make you sick.

Unger: All right, Andrea, then given the situation out there, what do physicians need to know and be on the lookout for?

Garcia: So the CDC is asking physicians to counsel patients, caregivers or guardians, not to purchase, consume or serve Diamond Shruumz brand chocolate bars, cones or gummies, to avoid consuming any mushroom-containing edible products that are claiming to produce neurologic, cognitive or psychoactive effects altogether.

Patients should be aware that edibles or food-like products marketed with these non-specific health benefits or implied psychoactive effects might contain these undisclosed, misformulated or unapproved ingredients that can cause severe adverse health effects. Physicians should also have a high index of suspicion for severe illness. And any patient who recently consumed any of these products and early consultation with a medical toxicologist with expertise in managing these patients with acute ongoing ingestion is also really important. Any suspected cases or adverse effects after consuming any Diamond Shruumz brand products should be reported to the poison helpline and that number is 1-800-222-1222.

Unger: Again, that poison helpline, 1-800-222-1222. Keep an eye out there for this situation. Andrea, all good to know. And that wraps up today's episode. Thanks so much for being here and keeping us informed. We'll be back in a few days for another episode where we're going to get further updates on Mpox and what to expect with COVID this summer and more. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at

We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at Thanks for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

Subscribe to AMA Update

Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.

AMA Update podcast logo