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12/17/2024

Dr. Stevens World Arthritis Day Lecture (1 Dec 2024): Noted below are the audience’s questions (as well as my responses) pertaining to my recent arthritis presentation to a group in Florida:
Audience Question #1: Do nightshade fruits and vegetables (e.g., tomatoes, peppers, eggplant, and/or potatoes) exacerbate arthritis?
Dr. Stevens Response #1: Nightshades are a diverse family of ~2,500 plants. All of them contain variable amounts of solanine (see https://en.wikipedia.org/wiki/Solanine), which is a glycoalkaloid poison they use to repel insects and herbivores. The highest concentration of this neurotoxin is usually present in the plant’s leaves and stems, which we don’t normally eat. Cattle, sheep, and pigs are particularly sensitive to solanine, and they can die from eating the vines and leaves of tomatoes and potatoes. It’s probably a good idea to steer clear of potatoes that have turned green because they contain higher amounts of solanine due to their exposure to sunlight while growing. The majority of the solanine in potato tubers is found in their outer layers. It, therefore, is best to eat peeled potatoes if you’re worried about ingesting this toxic glycoalkaloid. Regarding tomatoes, green tomatoes can have 100-fold more solanine than ripe ones. Returning to your question, there is no definitive scientific study I’m aware of that conclusively linked solanine to arthritis and joint pain. Having said that, people differ in their sensitivity to specific foods, and solanine is a neurotoxin. If you suspect you may be sensitive to a particular nightshade fruit or vegetable, remove it from your diet for two weeks. Then slowly introduce it back into your diet to determine its negative effects, if any. As I mentioned in my presentation, most clinicians (including rheumatologists) and nutritionists recommend the ‘Mediterranean diet’ for those with arthritis and other inflammatory diseases.
Audience Question #2: Do you recommend ingesting the dietary supplements glucosamine and/or chondroitin as proactive approaches for combating arthritis?
Dr. Stevens Response #2: The common feature of the different types of arthritis is proteolytic destruction and loss of aggrecan proteoglycans (PGs) in the cartilage of your affected joints. Each aggrecan PG contains ~100 chondroitin sulfate chains. Aggrecan PG monomers are ionically bound in cartilage to glucosamine-containing hyaluronic acid. The initial premise for these two dietary supplements was that the ingestion and metabolism of these components of aggregation PGs in your stomach would somehow promote their biosynthesis in distant cartilage, thereby slowing down arthritis pathology. The error in logic is the loss of aggrecan PGs in arthritic cartilage is not due to decreased rates of their biosynthesis. Rather, it’s due to increased rates of their catabolism. It also is not apparent how these dietary supplements can travel from one’s stomach to an arthritic joint. More relevant to your question, there is no scientific evidence I’m aware of that these dietary supplements have a significant beneficial role in any type of arthritis other than causing a superficial positive placebo drug effect. Of concern, the glucosamine in many of these dietary supplements originates from the shells of shrimp, lobster, and crab. The concern here is that shellfish-derived glucosamine could cause a life-threatening allergic reaction (anaphylaxis) in people with shellfish allergies.
Audience Question #3: You mentioned that non-strenuous exercise is beneficial for one’s longevity and resistance to arthritis and many other diseases. Would you please elaborate?
Dr. Stevens Response #3: Blue Zones are specific regions of the world [e.g., Okinawa (Japan) and Sardinia (Italy)] where their inhabitants live much longer, healthier lives than elsewhere in the world and sometimes in the same country. Several studies have revealed that one of the key factors that contribute to one’s longevity and quality of life (including arthritis susceptibility) in these Blue Zones is regular, non-strenuous physical activity like walking thirty minutes a day. A web search using the word ‘Blue Zone’ or ‘Centenarian’ will lead you to numerous reviews (e.g., https://pmc.ncbi.nlm.nih.gov/articles/PMC10643563/), books (e.g., ‘The Blue Zones - Lessons for Living Longer From the People Who've Lived the Longest’ by Dan Buettner), and documentaries on this subject. Regarding the latter, I recommend you check out the Netflix series ‘LIVE to 100 - Secrets of the Blue Zones’.

08/25/2023

Stevens Lecture: Low Back Pain (LBP) Caused by Intervertebral Disc (IVD) Degeneration – The Leading Cause of Disability Worldwide (22 Aug 2023)

Audience Questions and My Responses
Question #1: Because I don’t want to damage my IVDs, should I lift weights at my health club? If the answer is ‘YES’, how much weight should I lift?
RLS response #1: Everyone is different. Because your question depends on the muscle you want to exercise, you need advice from a knowledgeable personal trainer and/or physical therapist. While non-strenuous exercise is usually beneficial to our well-being, overdoing it can sometimes cause more problems than doing nothing.

Question #2: Should I ride a stationary bike at my health club?
RLS response #2: Once again, you need advice from a knowledgeable personal trainer. Having said that, ideally, you should not lean forward when riding an exercise bike for long periods because you’re adding unnecessary strain to your spine and IVDs.

Question #3: Thank you for pointing out numerous ways I can minimize the chances of inducing IVD degeneration. I didn’t realize the importance of correct posture when sitting at my computer or even in my car. Is there something else you could recommend that would also be beneficial?
RLS response #3: Due to the time restriction, I couldn’t emphasize the importance of carrying out varied stretching exercises before you carry out a physical activity.

Question #4: What are human stem cells, and how are they used therapeutically to treat a disease?
RLS Response #4: Stem cells are undifferentiated cells that, in theory, can give rise to every cell type in the human body. Adult stem cells are usually obtained from the bone marrow. They can replicate into cells ex vivo that form the musculoskeletal system, such as tendons, ligaments, articular cartilage, and IVD. They often are obtained from the iliac crest of the pelvic bone by inserting a needle and extracting the from there. Once isolated, they can be expanded and induced to differentiate into the appropriate cell type using a cell-culture approach.
It’s my understanding that stem cell therapy is being investigated in animal experiments in an attempt to reverse intervertebral disc degeneration. For example, it would be interesting to know if mouse stem cells can reverse cigarette smoke-induced damage to the mouse IVD.
The long-term goal of using stem cells in a complex disease like IVD degeneration is to isolate undifferentiated stem cells from your bone marrow, then culture them sterilely in media that contains the appropriate combination of growth factors to induce them to become chondrocytes. The differentiated chondrocytes are then injected into the relevant degenerated disc in the hope of replacing the dead chondrocytes, thereby reversing IVD degeneration.
This contemplated therapeutic approach is still in the experimental stage. Only a few FDA-approved stem cell-based therapies are available (see https://www.fda.gov/consumers/consumer-updates/fda-warns-about-stem-cell-therapies). The most common stem-cell therapeutic approach is used to treat those with a life-threatening leukemia. In this procedure, healthy bone marrow stem cells are isolated from your body. Once the leukemia cells are destroyed using radiation and chemotherapy approaches, the previously isolated healthy stem cells are injected back into your body in the hope that they can proliferate, differentiate, and replace your leukemia cells with the appropriate healthy cells.
Please note that one cannot inject peripheral blood stem cells from another human into your body because the foreign cells will be rejected by our immune surveillance system.
Like all FDA-approved treatments, the stem cell transplant procedures used to treat leukemia patients resulted from rigorous research and testing conducted over many years. The FDA website notes that stem cell therapy can lead to severe site reactions. These include the ability of the stem cells to move from placement sites and change into inappropriate cell types, the failure of cells to work as expected, and the growth of tumors. There are numerous other safety risks. For example, there is a risk of bacterial contamination of the stem cells before they are injected back into your body. Finally, stem cell therapy is costly. No doubt, it will take years for the FDA to approve the use of bone marrow-derived stem cells to reverse IVD degeneration.

09/18/2022

Stevens Lecture “Monkeypox Virus (West African Clade II)” (11 Sept. 2022)
Audience Questions and RLS Responses
Audience Question #1: Is there a genetic susceptibility among humans to the monkeypox virus (MPV), as well as the subsequent formation of keloid scars from their skin lesions?
RLS Response: Blacks and Hispanics are ~5- and ~3-fold more likely to be infected by MPV than Whites and Asians in the United States. Keloid scars occur ~15 times more frequently in people of sub-Saharan African descent than in people of European descent.
Audience Question #2: Are keloid scars permanent?
RLS Response: Keloid scars can get smaller, but they rarely disappear entirely.
Audience Question #3: Why haven’t pharmaceutical companies developed vaccines against MPV, Ebola, and other deadly pathogens in Africa? Have they concluded it’s not financially profitable?
RLS Response: No doubt pharmaceutical companies concluded in the past it wasn’t profitable to create a vaccine against a deadly pathogen that resides primarily in the third world. Having said that, the situation has changed dramatically in the last decade due to the realization that a deadly pathogen can escape Africa. The additional realization by the United States government that a pathogen (e.g., the smallpox virus VAR) can be used by a single terrorist as a “Weapon of Mass Destruction” resulted in the creation of the Strategic National Stockpile of vaccines. The orthopoxvirus vaccinia is protective against VAR even though it’s a live virus. If a terrorist released a small vial of VAR in a large city like New York or Los Angles, that biological attack could result in the deaths of millions. To guard against that possibility, the U.S. Department of Health & Human Services [via its Administration for Strategic Preparedness & Response (ASPR) purchased 100 million doses of ACAM2000, which is essentially the vaccinia orthopoxvirus. I don’t know how much that cost the government, but it could have been $5 billion (100 million doses of ACAM2000 x $50/dose = $5 billion). The death rate for an Ebola outbreak is 25-90%. Based on the ACAM2000 example, the United States should be willing to purchase 100 million doses of any vaccine that would be effective against Ebola, VAR, or even the deadly Congo Basin variant of MPV for its Stockpile.
Audience Question #4: What are the chances that the more deadly Congo Basin MPV gets out of Africa? What about Ebola?
RLS Response: Both will inevitably get out of Africa. That’s why the National Institutes of Health, the Center for Disease Control, the World Health Organization, and other major health agencies worldwide already should have developed vaccines and pharmaceuticals against these deadly pathogens. Because MPV and VAR express ~200 proteins, it probably would take 3-5 years to create a better vaccine against these pathogens. If the mRNA-nanoparticle approach is going to be used to create a safer and more efficient vaccine, the relevant protein on the surfaces of MPV and VAR that are used by these viruses to infect human cells must be identified and then targeted to create the desired vaccine. Once that is done, clinical trials must be conducted in Africa since that’s where these pathogens currently reside. Next, each vaccine must get FDA approval. Finally, a large pharmaceutical company must scale up its vaccine production so that 100 million doses, or more, of the created vaccine can be stored in our Strategic National Stockpile.
Audience Question #5: Why must I get a booster shot against Covid-19 every six months but not against another pathogen like VAR?
RLS Response: Vaccines only are effective if the pathogen of interest doesn’t undergo rapid mutation. Although we have known about HIV-1 for five decades, it hasn’t been possible to create an HIV-1 vaccine to prevent AIDS. The reason is that HIV-1 mutates so fast that any created vaccine quickly becomes useless. Covid-19 also mutates but not as fast as HIV-1. That’s why a vaccine developed against the initial Wu-Hu variant of Covid-19 is still effective two years after it was created. Unfortunately, a Covid-19 vaccine has a limited shelf life because Covid-19 is mutating considerably faster than VAR. That’s why the next Covid-19 booster shot is directed against the more recent omicron mutant.
Audience Question #6: I was immunized against the smallpox virus VAR sixty years ago. Am I still protected today against VAR and MPV?
RLS Response: Orthopoxviruses like VAR and MPV are closely related. Thus, antibodies generated against one usually protect against the other. It remains to be determined how long one is protected when immunized against VAR. Nevertheless, nearly every MPV-infected person who developed symptoms in the current outbreak was younger than 45. Since smallpox was eliminated in 1980, no one has been vaccinated against that pathogen in the past 40 years. Before 1980, children were required to be immunized against VAR in most states before entering school. That’s the likely reason older Americans aren’t showing symptoms when infected with the current outbreak of MPV.

09/18/2022

Stevens Lecture “Monkeypox Virus (West African Clade II)” (11 Sept. 2022)
Audience Questions and RLS Responses
Audience Question #1: Is there a genetic susceptibility among humans to the monkeypox virus (MPV), as well as the subsequent formation of keloid scars from their skin lesions?
RLS Response: Blacks and Hispanics are ~5- and ~3-fold more likely to be infected by MPV than Whites and Asians in the United States. Keloid scars occur ~15 times more frequently in people of sub-Saharan African descent than in people of European descent.
Audience Question #2: Are keloid scars permanent?
RLS Response: Keloid scars can get smaller, but they rarely disappear entirely.
Audience Question #3: Why haven’t pharmaceutical companies developed vaccines against MPV, Ebola, and other deadly pathogens in Africa? Have they concluded it’s not financially profitable?
RLS Response: No doubt pharmaceutical companies concluded in the past it wasn’t profitable to create a vaccine against a deadly pathogen that resides primarily in the third world. Having said that, the situation has changed dramatically in the last decade due to the realization that a deadly pathogen can escape Africa. The additional realization by the United States government that a pathogen (e.g., the smallpox virus VAR) can be used by a single terrorist as a “Weapon of Mass Destruction” resulted in the creation of the Strategic National Stockpile of vaccines. The orthopoxvirus vaccinia is protective against VAR even though it’s a live virus. If a terrorist released a small vial of VAR in a large city like New York or Los Angles, that biological attack could result in the deaths of millions. To guard against that possibility, the U.S. Department of Health & Human Services [via its Administration for Strategic Preparedness & Response (ASPR) purchased 100 million doses of ACAM2000, which is essentially the vaccinia orthopoxvirus. I don’t know how much that cost the government, but it could have been $5 billion (100 million doses of ACAM2000 x $50/dose = $5 billion). The death rate for an Ebola outbreak is 25-90%. Based on the ACAM2000 example, the United States should be willing to purchase 100 million doses of any vaccine that would be effective against Ebola, VAR, or even the deadly Congo Basin variant of MPV for its Stockpile.
Audience Question #4: What are the chances that the more deadly Congo Basin MPV gets out of Africa? What about Ebola?
RLS Response: Both will inevitably get out of Africa. That’s why the National Institutes of Health, the Center for Disease Control, the World Health Organization, and other major health agencies worldwide already should have developed vaccines and pharmaceuticals against these deadly pathogens. Because MPV and VAR express ~200 proteins, it probably would take 3-5 years to create a better vaccine against these pathogens. If the mRNA-nanoparticle approach is going to be used to create a safer and more efficient vaccine, the relevant protein on the surfaces of MPV and VAR that are used by these viruses to infect human cells must be identified and then targeted to create the desired vaccine. Once that is done, clinical trials must be conducted in Africa since that’s where these pathogens currently reside. Next, each vaccine must get FDA approval. Finally, a large pharmaceutical company must scale up its vaccine production so that 100 million doses, or more, of the created vaccine can be stored in our Strategic National Stockpile.
Audience Question #5: Why must I get a booster shot against Covid-19 every six months but not against another pathogen like VAR?
RLS Response: Vaccines only are effective if the pathogen of interest doesn’t undergo rapid mutation. Although we have known about HIV-1 for five decades, it hasn’t been possible to create an HIV-1 vaccine to prevent AIDS. The reason is that HIV-1 mutates so fast that any created vaccine quickly becomes useless. Covid-19 also mutates but not as fast as HIV-1. That’s why a vaccine developed against the initial Wu-Hu variant of Covid-19 is still effective two years after it was created. Unfortunately, a Covid-19 vaccine has a limited shelf life because Covid-19 is mutating considerably faster than VAR. That’s why the next Covid-19 booster shot is directed against the more recent omicron mutant.
Audience Question #6: I was immunized against the smallpox virus VAR sixty years ago. Am I still protected today against VAR and MPV?
RLS Response: Orthopoxviruses like VAR and MPV are closely related. Thus, antibodies generated against one usually protect against the other. It remains to be determined how long one is protected when immunized against VAR. Nevertheless, nearly every MPV-infected person who developed symptoms in the current outbreak was younger than 45. Since smallpox was eliminated in 1980, no one has been vaccinated against that pathogen in the past 40 years. Before 1980, children were required to be immunized against VAR in most states before entering school. That’s the likely reason older Americans aren’t showing symptoms when infected with the current outbreak of MPV.

04/12/2022

Stevens Lecture “One-year Update of Covid-19/SARS-CoV-2 and its Delta and Omicron Variants” (20 March 2022)
Audience Questions and RLS Responses
Audience Question #1: Is there a connection between Covid-19 disinformation in the USA and the Russian government?
RLS Response: I’m not aware of any Russian-mediated Covid-19 disinformation in this country. Regarding the example I gave in my presentation concerning the irrational politics of Covid-19 mRNA vaccines, the Florida Department of Health (not the Russian government) decided every child who enters the State’s public schools must be vaccinated against seven pathogens but not Covid-19 (see http://www.floridahealth.gov/programs-and-services/immunization/children-and-adolescents/school-immunization-requirements/index.html).

Audience Question #2: What’s your opinion about Florida Governor DeSantis decision to advocate Regeneron’s and Lilly’s first-generation monoclonal antibodies to treat those Covid-19-infected Americans who refuse to get vaccinated. Shouldn’t he encourage every Florida adult to get immunized before becoming infected?
RLS Response: While these commercial monoclonal antibodies were somewhat effective against reference/original Covid-19 in unvaccinated Americans who subsequently experienced a life-threatening Covid-19 infection, they weren’t as effective as the vaccine approach in preventing hospitalization and death. They also were more expensive than the vaccine shots. More relevant to your question, Regeneron’s and Lilly’s first-generation monoclonal antibodies are useless against the Omicron BA.1 and BA.2 variants. The reason is that the amino acid sequences within reference Covid-19’s spike protein recognized by each monoclonal antibody are no longer present in the Omicron variants.

Audience Question #3: If an unvaccinated person was infected with Covid-19 in 2020, why does he/she need to be vaccinated in 2022? Shouldn’t that person already have antibodies that recognize Covid-19?
RLS Response: Humans have innate immunity and acquired immunity. When infected with a pathogen like Covid-19, the ability to initially combat the coronavirus is entirely dependent on one’s innate immunity. Because it takes 2-3 weeks for an infected person to develop antibodies to the pathogen via acquired immunity, some who quickly recovered from a Covid infection in 2020 (namely children and young adults) probably never produced immunoprotective Covid-19 antibodies. Thus, they can be infected again. The mRNA Covid-19 vaccines do not affect one’s innate immunity. Instead, they induce adaptive immunity to the coronavirus by generating IgG antibodies that recognize hundreds of peptide sequences within Covid-19’s spike protein. Even if an unvaccinated human became Covid-19 infected for months, the induction of Covid-19-specific neutralizing antibodies via the mRNA vaccine approach is more efficient. The vaccines generate hundreds (if not thousands) of antibodies against different regions in the coronavirus’s spike protein. Useless antibodies aren’t produced against Covid-19’s other twenty-eight proteins. In one study, vaccinated humans generated seventeen times more anti-Covid-19 antibodies that recognize its spike protein than what occurred in infected, non-vaccinated humans.
The CDC concluded that the Covid-19-induced hospitalization and death rates were 50-fold higher for unvaccinated Americans than for vaccinated Americans in November and December 2021. Because nearly all of the 500k Covid deaths that occurred this year were unvaccinated Americans, the Covid-19 vaccines saved the lives of at least 25 million Americans this year alon (50 x 500k = 25m).

Audience Question #4: What are the adverse reactions to the Pfizer-BioNTech and Moderna Covid-19 vaccines, if any.
RLS Response: Humans express five types of antibodies, namely IgA, IgD, IgE, IgG, and IgM. The goal of the vaccine approach was (and still is) to generate harmless IgG antibodies specific for Covid-19’s spike protein. Because the mRNA vaccine technology was new, there was concern in Feb. 2021 that some vaccinated humans might generate dangerous IgE antibodies to the virus’s spike protein. If that occurred, those vaccinated humans might experience systemic anaphylaxis. Two hundred and fifteen million Americans have received two vaccine shots (as of 20 March 2021). In addition, many of these Americans received a booster shot. Thus, >500 Pfizer-BioNTech/Moderna vaccine shots have been administered in this country alone. Fortunately, severe adverse reactions to these mRNA vaccines were rare.

Audience question #5: I’ve had three shots of the Moderna anti-Covid-19 vaccine. I got the booster shot last September. When should I get another booster?
RLS response: There is no simple answer to your question because not everyone is identical. You, therefore, need to get guidance from your primary care physician. I also recommend you follow the recommendations of the Center for Disease Control (CDC) at its website (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html?s_cid=11747:covid%20vaccine%20schedule:sem.ga:p:RG:GM:gen:PTN:FY22). You can sign up at the CDC website to stay informed of its decisions via E-mail. Another source of helpful information on this subject is the Food and Drug Administration (FDA).
Dr. Fauci and other Covid-19 health experts in this country recently stated that most Americans probably would need a second booster shot. When and what will be the composition of that follow-up booster shot has to be decided. Presently, the Pfizer/BioNTech and Modera mRNA vaccines are effective against all known variants of Covid-19, including its Delta, Omicron BA.1, and Omicron BA.2 variants. Nevertheless, a new variant might appear this year that is not recognized effectively in immunized Americans. In such a scenario, it would be better to get a booster shot that is more specific for the mutated spike protein in the new variant. While that’s a decision the FDA and CDC will make, Moderna already has begun clinical trials with an Omicron-specific vaccine.
It’s been reported that the Biden administration wants to offer a second booster shot next week for those over fifty. However, the only Americans currently authorized for a second booster shot are those with a weakened immune system. That includes teenagers and adults who received organ or stem cell transplants, are undergoing chemotherapy for cancer, have AIDS, or are on immunosuppressive drugs. If you fall into that category, you need to discuss your specific situation with your primary care physician. The CDC also has a hotline (1-800-232-4636).

Audience question #6: What’s the FDA’s current position concerning the therapeutic use of ivermectin and hydroxychloroquine for treating those who have been infected with Covid-19?
RLS response: Ivermectin is a drug given to horses infected with certain types of parasitic worms, whereas hydroxychloroquine is given to humans infected with malaria. Due to their ineffectiveness, ivermectin and hydroxychloroquine don’t have FDA approval for their use in Covid-19-infected humans.

04/12/2022

Stevens Lecture “Adaptive Immunity to Covid-19: mRNA-Lipid Nanoparticle Vaccines” (Feb 2021)
Covid-19 uses its surface spike protein to infect human epithelial cells. This follow-up Covid-19 lecture focuses on the history of vaccine development, emphasizing the newly created mRNA vaccines that target the pathogen’s spike protein.

04/12/2022

Stevens Lecture “Pathogenesis of the Coronavirus Covid-19” (Feb 2021)
Coronaviruses are a group of RNA viruses that have crown-like spike proteins on their outer surfaces. Seven coronaviruses have been identified that infect humans. The newest family member is SARS-Cov-2/Covid-19 which first appeared in Wuhan, China, in December 2019. Covid-19 is less lethal than its related coronavirus family members SARS and MERS. Nevertheless, because it’s more infectious, there is essentially no place in the world today (Feb 2021) that is Covid-19 free. Common symptoms of a Covid-19 infection include fever, cough, fatigue, and substantial breathing difficulties. Other symptoms include headaches, loss of smell and taste, sore throat, muscle pain, joint pain, chills, nausea, and diarrhea. Those requiring hospitalization often experience internal blood clots and a life-threatening cytokine-chemokine storm-induced inflammation. The latter is caused by the body’s immune system overreacting to the pathogen. This lecture focuses on the pathogenesis of Covid-19.

04/12/2022

Stevens Lecture: Red Tide: A Serious Problem of Our Coastal Waters (18 July 2021)
Red tides [more precisely known as Harmful Algae Blooms (HABs)] occur in coastal ocean waters during the summer. In Florida’s and New England’s waters, the primary culprits are Karenia brevis and Alexandrium fundyense, respectively. In contrast, Alexandrium catenella is the primary culprit in the coastal waters off Japan, Australia, South America, and North America’s West Coast. Blooms of these unicellular, photosynthetic, dinoflagellate phytoplanktons give oceans their characteristic red-brown colors. The release of 215 million gallons of Piney Point’s nitrogen- and phosphorus-rich wastewater from a former fertilizer plant into Tampa Bay to prevent the collapse of the reservoir at that site caused a Red-tide bloom. This lecture focuses on these harmful phytoplanktons, including the factors that regulate their growth and viability. Karenia brevis and the Alexandrium phytoplanktons produce brevetoxin and saxitoxin, respectively. The clinical consequences of exposure to these dangerous neurotoxins are reviewed, as well as their mechanisms of action at the molecular level.

Richard Stevens Professor EmeritusDepartment of MedicineHarvard Medical SchoolBoston, MA &Owner, Stevens Scientific...
04/12/2022

Richard Stevens
Professor Emeritus
Department of Medicine
Harvard Medical School
Boston, MA
&
Owner, Stevens Scientific Services LLC
Bradenton, FL

08/24/2020

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