The Epstein-Barr virus appears to be an important cause of multiple sclerosis

January 14, 2022 • 9:15 am

The Epstein-Barr virus has been associated with a variety of diseases; as Wikipedia notes (my emphasis, and I’ve left in the footnotes so you can consult 11-13, which I’ve put in bold):

The Epstein–Barr virus (EBV), formally called Human gammaherpesvirus 4, is one of the nine known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. EBV is a double-stranded DNA virus.[2]

It is best known as the cause of infectious mononucleosis (“mono” or “glandular fever”). It is also associated with various non-malignant, premalignant, and malignant Epstein–Barr virus-associated lymphoproliferative diseases such as Burkitt lymphoma, hemophagocytic lymphohistiocytosis,[3] and Hodgkin’s lymphoma; non-lymphoid malignancies such as gastric cancer and nasopharyngeal carcinoma; and conditions associated with human immunodeficiency virus such as hairy leukoplakia and central nervous system lymphomas.[4][5] The virus is also associated with the childhood disorders of Alice in Wonderland syndrome[6] and acute cerebellar ataxia[7] and, based on some evidence, higher risks of developing certain autoimmune diseases,[8] especially dermatomyositis, systemic lupus erythematosus, rheumatoid arthritis, Sjögren’s syndrome,[9][10] and multiple sclerosis.[11][12][13][14] About 200,000 cancer cases globally per year are thought to be attributable to EBV.[15][16]

Infection with EBV occurs by the oral transfer of saliva[17] and genital secretions. Most people become infected with EBV and gain adaptive immunity. In the United States, about half of all five-year-old children and about 90% of adults have evidence of previous infection.[18] Infants become susceptible to EBV as soon as maternal antibody protection disappears. Many children become infected with EBV, and these infections usually cause no symptoms or are indistinguishable from the other mild, brief illnesses of childhood. In the United States and other developed countries, many people are not infected with EBV in their childhood years.[19] When infection with EBV occurs during adolescence, it causes infectious mononucleosis 35 to 50% of the time.[20] In 2022, it has been shown that EBV infection increase the risk of developing multiple sclerosis by 32-fold.[21]

EBV infects B cells of the immune system and epithelial cells. Once EBV’s initial lytic infection is brought under control, EBV latency persists in the individual’s B cells for the rest of their life.[17][22]

Here are two EBV virl particles with some proteinaceous spheres (not nuclei!) containing the viruses’ genetic material.  I had mono about twenty years ago, so I’m probably carrying the virus, too.

It has spikes, like Covid-19:

Source

At any rate, note that the association with the virus (henceforth “EBV”) with multiple sclerosis (“MS”) has been suggested before (references 11-13, ref. 14 is this paper). I haven’t read the first three papers, but #14 is just out in Science, and I’ll mention it briefly today. It surely is, given the discussions, the strongest evidence to date for an EBV cause of MS.

The paper was called to my attention by the tweet below from Matthew. And, apparently, this is the strongest suggestion yet that EBV actually causes multiple sclerosis.  If this proves to be the case, and the evidence is pretty strong, then this opens the way to preventing MS, most likely via I suspect shots in the young, because once the diease develops, a shot wouldn’t work. In fact, Moderna is at this moment making an mRNA vaccine against the virus. (Although, coronaviruses like Covid-19 have RNA instead of DNA as their genetic material—EBV has DNA—it doesn’t matter what genetic material the virus uses to replicate, for the mRNA in a vaccine is used by the body to make viral protein that then activates the host’s immune system.)

One note: MS is a disease that appears when your immune system attacks the myelin sheath surrounding the nerves, which disrupts nerve impulses. That in turn can lead to multiple effects, including difficulty in breathing, walking, and seeing. All of us have known people with MS, and you’re probably aware that the disease varies widely in its severity, with of the afflicted dying very quickly and others living a life of nearly normal span. On average, MS takes away five to ten years from your life, and a lot of that life is unpleasant.

Here’s the tweet that alerted Matthew, and then me, to the new results:

The paper below with the nearly dispositive data is free; click screenshot for access or get the pdf here. The reference is at the bottom.

(There’s also a News and Views piece on this article, which you can get for free by clicking the screenshot):

Now the best way to see if the virus causes the disease is to inject virus-free humans with EBV, and see if the injected group gets MS more often than does a control (noninjected) group. But since 90% of adults are infected anyway, and this experiment is highly unethical, one has to find other ways.

These researchers did the next best thing: a retrospective analysis of blood serum left over from AIDS tests on more than 10 million U.S. military personnel.  The criterion for “causality” here is the philosophical one: A causes B if you never get B unless you have A beforehand. (This doesn’t mean, of course that A is the sole cause of B.) As the authors say, “causality implies that some individuals who developed MS after EBV infection would not have developed MS if they had not been affected by EBV.” Note that they say “some individuals”, as there may be other causes of MS. But this is more than an association study, as EBV negative individuals could be tested for infection status during their period of activity duty, and then screened for MS to see whether the disease is associated with earlier infection.

The ten million soldiers were screened over a period of 20 years, and the leftover serum, fortunately, had been stored.  All samples were analyzed for EBV infection and then the MS status of the individuals determined during the period of active duty.

5.3% of individuals whose blood were tested were EBV-negative (as I said, most of us are infected) and in a sample of ten million that’s about half a million people.

Among the personnel examined, 955 MS cases were identified, of which 801 cases had several blood samples available taken at differen times. For each one they looked at three serum samples taken BEFORE onset of the symptoms. Each case was matched with at least one non-MS-afflicted control individual of same age, sex, ethnicity, branch of service, and date of blood collection.

The results were pretty compelling. Under the causation scenario, you’d expect MS to develop almost entirely in the group that were initially EBV negative but then got infected, and only then did they develop MS.

And that’s what they found. To quote the paper:

Only one of the 801 MS cases occurred in an individual who was EBV-negative in the last sample, which was collected at a median of 1 year before MS onset [hazard ratio (HR) for MS comparing EBV-positive versus EBV-negative = 26.5; 95% confidence interval (CI): 3.7 to 191.6; P = 0.001, conditional logistic regression]. At baseline, 35 MS cases and 107 controls were EBV-negative. All but one of these 35 EBV-negative MS cases became infected with EBV during the follow-up, and all seroconverted before the onset of MS (fig. S3). The median time from the first EBV-positive sample to MS onset was 5 years (range: 0 to 10 years), and the median time from estimated EBV seroconversion, defined as the midpoint between the last seronegative sample and the first seropositive sample, to MS onset was 7.5 years (range: 2 to 15 years).

Remember, all of the 801 cases were EBV negative at the first sampling. Then all but one of the individuals who developed MS had gone from EBV negative to EBV positive. (The authors discuss the one outlier case, but you can read that for yourself.) To see if it was really EBV that was associated with the onset of MS, they looked at other viruses as well, and also looked at other disease markers that could show whether MS had already begun (but without physical symptoms) when the patients were still EBV-negative. (They didn’t find that.)

They did other tests as well trying (like good scientists) to try to rule out a causal role of EBV in MS. They ruled out “confounding by unknown factors” because of the strong association between EBV infection and later development of MS. No risk factor could account for the huge increase in MS propensity among those who went from EBV negative to EBV positive.

The other factor was “reverse causation”: perhaps EBV doesn’t cause MS, but the early development of MS, not detected clinically, could make a patient more susceptible to EBV infection. This is ruled out because only the EBV virus was associated with the pathology, while one would expect the “reverse causation” syndrome to make MS patients more susceptible to other viruses.  That wasn’t seen.

I won’t go on except to show this graph, which displays significant differences in the level of antibodies against various human viruses between controls and those who got MS (remember, these are all EBV negative people at the start of the trial.) The blue bars represented antibodies against viral proteins that showed higher levels in controls than in those who got MS, while the orange bars represent the level of antibodies  significantly higher in the blood samples of those those who got MS than the controls. As you see, the level of antibodies against EBV is much, much higher in the pre- and post-MS-onset blood samples than in the control (no MS) samples. In other words, no other virus beside EBV was associated with MS either before or after the symptoms appeared.

The last paragraph of the Science paper suggests MS therapy with monoclonal antibodies against the viral proteins might be better than current therapies, and in fact we’re using monoclonal antibodies now to help patients already infected with Covid-19.

But a better tactic would be not to get the disease in the first place, and the tweet below suggests a vaccine that might do this is in development. And if EBV is associated with all those diseases mentioned above, like cancer and inflammatory bowell disease then a jab when young might stave those off, too!

________________________

Reference:

Bjornevek, K. et al. 2022. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science,10.1126/science.abj8222(2022).

Guest post: Censorship at a Canadian Medical Journal

January 2, 2022 • 11:15 am

I received a long email from reader Leslie MacMillan, and I suggested that he turn it into a post for our readers. He kindly agreed. I asked him to write me a brief biography, which is below:

Leslie is a retired physician who worked as an academic clinician-teacher and in hospital practice.  Now in obscurity, he enjoys dinner with his family at a reasonable hour, playing the piano, and indulging his grandchildren.”

And here’s his contribution:


Canadian Medical Association Journal yields to external religious pressure, censors published letter

by Leslie MacMillan

The Canadian Medical Association Journal (CMAJ, “the Journal”) has retracted a Letter to the Editor following orchestrated religious pressure that accused the Journal and the author of “Islamophobia”.

“Islamophobia” is one of those words hurled at people without a definition of what it means.  Unlike many slurs, though, this one does have a definition.  “-phobia” means “fear of”.  A phobia can be irrational or it can be well founded.  Islamophobia, then, indicates only a fear of the implications of the tenets of Islam or the intentions of its adherents.  It cannot by the fact alone be equated with hate speech or, obviously, racism.  Yet it so often is.  Sometimes speakers will say, “tantamount to hate speech”, pulling their punches and evading the implication of an accusation of an offence under the Criminal Code of Canada and some other countries.  Fear can be thought of as unease or suspicion that professed views of love and tolerance are not sincere; it is then rational to withhold trust, the trust that liberal societies need to function.  If one is accused of Islamophobia, one ought to be able to respond, “Yes, I am.  Here’s why.”

For the cover page of its 8 Nov 21 on-line issue, the Journal used this stock photo.  There was no contextual link to any one article in the issue.  It seems to have been a generic free-standing cover photo in that it appears on the sidebar for each of the articles in the issue.

Dr. Sherif Emil, a senior academic surgeon in pediatrics at Montréal Children’s Hospital and McGill University wrote to the editor of the Journal objecting to depicting such a young child wearing a hijab.  He quoted Yasmine Mohammed, a Vancouver activist who has championed equality for Muslim women:  “The cover of @CMAJ features a little girl in hijab. How disheartening to see my so-called liberal society condone something that is only happening in the most extremist of religious homes.”   Emil then acknowledged his respect for the women he sees in his practice who wear the hijab—mothers and some adolescent patients.  He continued (direct quotations indented hereafter):

But respect does not alter the fact that the hijab, the niqab and the burka are also instruments of oppression for millions of girls and women around the world who are not allowed to make a choice. We are currently being reminded of this daily, as we see the tragic return of the Taliban in Afghanistan, and its effect on the subjugation of women and girls. Girls as old as those in the picture are being sold into marriage to old men — institutionalized child rape. The mentality that allows this to happen shares much with the one that leads to covering up a toddler. But even in so-called moderate Islamic countries, such as the one I grew up in, societal pressures heavily marginalize women who choose not to wear the hijab. In addition, women in these countries who are not Muslim and do not wear the hijab are often subject to intense harassment and discrimination. I know that because some of these women are in my family. I respect the women who see the hijab as liberating. But we must also remember the women and girls who find it oppressive and misogynistic.

Ironically, the article [which he interpreted the photo as referring to] explores evaluating interventions to address social risks to health. A young girl such as the one depicted in the image is typically also banned from riding a bike, swimming or participating in other activities that characterize a healthy childhood. She is taught from an early age, directly or indirectly, that she is a sexual object, and it is her responsibility to hide her features from the opposite sex, lest she attract them. A heavy burden for modesty is placed squarely on her shoulders.  So many women have been traumatized by such an upbringing, which, I believe, frankly borders on child abuse. Is that not a social risk to health? Are these children not a vulnerable population?

This link includes a citation to the tweet by Ms Mohammed quoted in the letter.  (Link found and posted by Retraction Watch commenter Andrew.)

The letter appeared in the Journal’s 20 Dec online issue under the heading, “Don’t use an instrument of oppression as a symbol of diversity and inclusion”, a form of words of the editor’s choosing, not the author’s.

Advocacy groups claiming to represent the interests of Muslims in Canada and Québec vigorously protested the publication of the letter and called for its retraction.  Dr. Emil received abuse personally on Twitter as well, as noted by Retraction Watch (q.v.)

The CMAJ editor responsible, Kirsten Patrick, apologized particularly for her choice of words in the heading.  The uproar, a lengthy happy-talk on why hijab is not oppressive, and the Journal’s efforts at damage control, are reported in a long CTV news article of 20 Dec from which I’ve taken a small snippet:

[Lina] El Bakir [Quebec advocacy officer for the National Council of Canadian Muslims] argues that publishing the letter was irresponsible, especially during a pandemic when doctors who wear a hijab are dealing with prejudices in their daily practice. . . .

A pre-written response to the CMAJ, included on the national council’s website as part of an online letter-writing campaign, cites a few sections in the Canadian ‘Medical Association’s Code of Ethics and Professionalism that medical professionals must adhere to.

“This article falls short of these standards,” the response states.

“We are asking CMAJ to retract this article immediately and issue a public apology before it does any further harm to a demographic that has been targeted by some of the most violent forms of Islamophobia in this country.  [Emphases mine,–LM]

The Canadian Medical Association itself, which owns and publishes the Journal, piled on with an official and gratuitous swipe at the author.

Islamophobia and other forms of hate [there’s that incorrect conflation again –L.M.] must not be tolerated in the health care profession or in our society. Like CMAJ, the Canadian Medical Association deeply regrets the harm caused by the publication of an opinion letter in CMAJ on Dec. 20, 2021.

CMAJ is operated independently of the Canadian Medical Association with its own governance structure and editorial board. While we will always uphold the editorial independence of CMAJ, we feel a responsibility to speak out and express our sincere apologies for the harm caused.

On 23 Dec., the Journal buckled to this pressure and not only retracted the letter but removed it from its website.  It made no visible effort to send the commentary to the author, publish some of it, and invite a response before doing so.  Click on the screenshot or read the text below.

The letter “Don’t use an instrument of oppression as a symbol of diversity and inclusion” (DOI: https://doi.org/10.1503/cmaj.80742; author: Sherif Emil)1 published in the Dec. 20, 2021, issue of CMAJ has been retracted by the interim editor-in-chief of CMAJ because the editorial process for the article was flawed and biased, and the letter should not have been published.

CMAJ acknowledges and is deeply sorry for the considerable hurt that many people across Canada have experienced from reading this letter. A formal apology from the interim editor-in-chief has been published at https://www.cmaj.ca/content/193/51/E1935.

Retraction Watch criticized the removal, contrary to guidelines from the Committee on Publication Ethics, which recommended marking it as retracted (as the PubMed copy is)

The author of the letter has posted his own conciliatory statement at the Canadian Healthcare Network here.

CTVnews reported further on 24 Dec:

Tabassum Wyne, executive director of the Muslim Advisory Council of Canada, [said] she was glad the CMAJ “took the necessary steps to correct that mistake” and hear from diverse voices. . . .The council had a virtual meeting with the CMAJ’s interim editor-in-chief, Wyne said, during which it was suggested that the journal look at anti-Islamophobia training in the future.

Wyne also expressed concerns about having anyone on the internet read the letter in an accredited journal.   “And that’s why we pushed so hard to have it retracted, and we’re happy with the results.”

It gets worse.  The CMAJ editorial group “seeks to remedy” the current lack of Islamic representation on its Editorial Advisory Board.  The Muslim advocacy organizations clearly seek to exercise prior restraint instead of merely complaining about it afterward.

The National Council of Canadian Muslims has since thanked the CMAJ for removing the letter, saying it appreciates “the efforts of the editor in chief for taking action and doing the right thing” and looks forward to working with her to “ensure this never happens again.”

(This CTVnews article misleadingly shows a photo of someone protesting Québec’s  laïcité law, la Loi 21.  This affair has nothing to do with that law and the author says he disagrees with it anyway.)

If the CMAJ follows through on this, there will be religious oversight of what an academic medical journal is permitted to publish.

Action

I have written the CMAJ and the CMA criticizing them for their lack of integrity in this episode. I encourage readers, particularly Canadian physicians, to do the same, even if you are not members of the CMA (as I am not), and even if you would not have published the letter in the first place were you the editor.  The Journal has received comments from readers mostly criticizing the decision to retract and censor —see the retraction e-letters link below—but I don’t see awareness of the undertaking to invite Muslim advocates to exercise prior restraint on publication.  This hidden censorship is especially dangerous.  I recommend that letters specifically call this out so the CMAJ knows you are watching.

Contacts for responding:

This site refers to the retraction announcement, not the original letter. You can submit e-letters there.

At this site you can contact the Canadian Medical Association.

John Locke argued that it is better for a society to be governed around religious tolerance because this would lead to less social disorder than for the state to enforce adherence to one religion and, necessarily, to suppress all others.  This works only if the religions themselves are compelled by secular laws to tolerate people who reject or even mock their every teaching—otherwise you have a state religion sneaking in the back door under the guise of stamping out (in this case) Islamophobia.

Growing up in secular Canada, I was always glad that believers could enjoy their freedom of religion but was even gladder that I enjoyed my freedom from religion.  Religious differences just never came up in ordinary or professional life.  The idea that someone should be enjoined from doing something because it offended someone else’s religious views, and that could be called “harm”, was unthinkable.  Increasingly it looks as if we risk losing this freedom out of fearful acquiescence of our institutions to intolerant and censorious religious pressure.  Islamophobia (my correct definition) afflicts them, too, and they don’t even notice it.  It’s up to us to open their eyes.

Travails of the aged

January 1, 2022 • 6:17 pm

As always, I made my Christmas and New Year’s Eve calls and emails to old friends, and asked several of them two questions:

1.) What did you have for Christmas dinner?

2.) Are you staying up to see in 2022?

The answers were uniform: Everyone whom I asked about dinner gave the same answer: fish (almost everyone had salmon). This group comprised at least five people.

Also, NOBODY I know stayed up to see in the New Year. Dr. Cobb, who is a regular here, emailed me at 11:20 his time and said he was going to bed.

I should add that the friends I talked to are all within ten years of my age.

The conclusions are obvious.  The older we get, the more we see food as medicine—or at least a way to extend our longevity as the Reaper draws near  (I did not have salmon, but I did go to bed early last night.) Further, the older you get, the less you care about fairly meaningless events like the end of a year. We just can’t be bothered, and we’re tired. 

I grow old … I grow old …
I shall wear the bottoms of my trousers rolled.

Shall I part my hair behind?   Do I dare to eat a peach?
I shall wear white flannel trousers, and walk upon the beach.
I have heard the mermaids singing, each to each.

I do not think that they will sing to me.

Two bits of Irish woo

December 23, 2021 • 11:15 am

There’s a time when “blarney” becomes crazy and harmful, and we have two cases that appeared at the same time.  The first represents the New York Times‘s recent presentation of woo in extenso, with almost no critical remarks. The editors are soft on astrology, they’re soft on dowsing, they’re soft on religion, and now they’re soft on a mixture of religion and spiritual healing. Click the screenshot to read:

As the article reports, there are a number of faith healers in Ireland who have what they call “the cure”. It’s nothing new; it’s the old “laying on of hands” by believers, often accompanied by prayer, holy water, etc., to effect cures. The guy in the photo above, Joe Gallagher in Pullough, is the seventh son of a seventh son (not that rare in Catholic Ireland, but increasingly rarer), and this is supposed to give him special healing abilities. Here’s how the author, Megan Specia, describes “The Cure”:

Mr. Gallagher is just one of hundreds of men and women across Ireland who are healers, or have “the cure,” an approach to health care that interweaves home remedies with mysticism, superstition, religion and a sprinkle of magic.

It’s part of a belief in folk medicine, curing charms and faith healers that is still a way of life for many in Ireland, if a fading one.

Some who are believed to have the cure are seventh sons, like Mr. Gallagher, a birth order long thought to bestow special powers.

Others are keepers of family customs that range from rituals, prayers and charms to herbal tinctures, offered up as treatments for everything from burns and sprains to rashes and coughs.

Since his childhood, people have sought out Mr. Gallagher. “I think you must have the belief,” he said, acknowledging that the process doesn’t always work. “I wouldn’t say that I can do miracles.”

Indeed!

People come from miles around to see healers like Gallagher, who are reputed to cure things like:

  • burns
  • sprains
  • coughs
  • rashes
  • warts
  • shingles
  • ringworm (in dogs, too!)

An example:

Bart Gibbons, 57, who owns a grocery store in the village of Drumshanbo in County Leitrim, has a cure for warts that was passed down from his father and his father’s father before him.

It involves taking a bundle of rushes and saying a combination of prayers as they are held over the affected area. Then, he buries the reed-like plants. The belief is that when they decay, the warts are gone.

They don’t get paid, so at least that’s good, but have they done controlled trials with these shamans? I don’t think so. At least they’re cheaper than doctors, but isn’t there a form of national healthcare in Ireland? And, as you know, warts sometimes go away by themselves.

The only comments that are negative in this longish piece are these:

Attributing positive outcomes of the cure to something like a placebo effect makes sense to Ronald Moore, an associate professor of public health at University College Dublin who has spent years researching folk cures and who emphasized there is little scientific evidence for the efficacy of these practices.

Well, then, why not just give the people sugar pills? And the statement above is quickly followed by this:

But that doesn’t mean the medical community completely dismisses potential benefits, with some doctors known to send their patients for the cure, often for skin issues or other minor troubles.

“Modern practices on the one hand pooh pooh this, as scandalous and outrageous and quackery,” Dr. Moore said. “But in fact, and in reality, they utilize it.”

Those doctors are shameful. At least they don’t send patients to the Irish shamans for maladies like cancer and heart disease. (Shamans may, however, try to cure people of more serious stuff.)

Although the practice is “deeply religious”, it works on dogs, too!  Can dogs lose their ailments by “The Cure”? I thought Edward Feser maintained that dogs don’t have souls. But here’s the last picture of healing in the piece; I’ve included the paper’s caption. The picture makes me laugh out loud: a real LOL:

Mr. Keane performing the cure for ringworm on one of the dogs from a neighboring house in Cloghans.Credit…Paulo Nunes dos Santos for The New York Times

Once again the New York Times is touting quackery by publicizing it and only bringing in one lone dissenter, who is immediately countered by a physician enthusiast. What is going on with this newspaper?

****************

This article with its hilarious title is a serious piece in another Times—the Irish Times. Being a Catholic coutry and all, I suppose papers there have more article like this one. If you read the piece, you’ll see that “lay theologian” (indeed!) Brendan Butler is deeply besotted with God and baby Jesus, the “eternal Cosmic Christ.” And Jesus is said to be the “culmination of 13.8 billion years of evolution.” This implies that evolution in humans has stopped, but yet we’re still evolving and so is every other species.  Read and weep to find out why Jesus is the End of Evolution:

Okay, here’s the whole scientific explanation of why Jesus is the culmination of evolution (it’s part of a longer piece that sounds like a sermon):

How to reconcile a human and a divine nature in one person became the subject of controversy until it was resolved in 431 at the council of Ephesus by declaring Mary as ‘Theotokos’ – the mother of God.

But this led to another question: why did the eternal creator God become a mortal and fragile human creature? Various explanations were put forward, with the most common being that it was necessary for God the Son to become human and die on a cross for the sins of the human race.

However, another explanation associated with the Franciscan theologian John Dun Scotus, fits in with our post-Darwin, post-Einstein and post-Hubble world. In this view the baby Jesus, born in Bethlehem, was the culmination of 13.8 billion years of the evolutionary process.

He was born with the substance of the stars and molecules of prehistoric life present and active in his body. In this Christology the baby is not just a child of the universe but the eternal Cosmic Christ who released that primal energy which burst forth and created the universe.

Evolutionary process

This Christ remained an integral part of the evolutionary process, sustaining it and driving it forward towards greater and greater complexity until the apex of that movement emerged as homo sapiens.

It was always God’s plan that the creator Christ, already present in the universe as an invisible presence, would become fully human and be born as a human being.

I think Mr. Butler should take a course in evolution, where he’d learn that there is no evidence that evolution is teleological, and that it was going on for 3.5 billion years before Baby Jesus was born. Who sustained evolution until then?  But I’m pleased to learn that Jesus, like the rest of us, was made of billion-year-old carbon. Still, he’s got to get himself back to the garden (of Eden).

It’s just tripe, of course, but why would the Irish times give a millimeter of space to stuff like this?

Below: the author with the paper’s caption; Butler is apparently Jesus’s ghostwriter:

Brendan Butler is a lay theologian and author of My Story by Jesus of Nazareth

h/t: Kieran, Alexandra

A funny title but a serious point about ivermectin and Covid-19

December 16, 2021 • 9:30 am

Reader Martim sent me a link to this article in The Economist, which is pretty much paywalled but includes a paragraph and two graphs you can see. Click on the screenshot below to see what’s viewable:

And the figures, which buttress the title’s assertion:

Just using Fisher’s Exact Test* on the directionality above (dots to left or right of line), the difference is not statistically significant, but it is in a suggestive direction. We need more data to see if this disparity is statistically significant and thus “real” (i.e. not produced by chance under an equal frequency null hypothesis).

Now this is basically all of the article I’m allowed to read, but it hints at why some studies may show a positive effect of Ivermectin on patients infected with Covid-19. To put it simply, worms are a “comorbidity”, that might be eliminated with ivermectin. If having worms makes raises your chances of dying or hospitalization from having the virus, then taking ivermectin could help save your life not by affecting the virus, but by ramping up your immune system after the worms have gone.  Ivermectin would not, then, be of any use in treating patients unless they’re known to be affected with roundworms. (Ivermectin helps get rid of roundworms that cause intestinal strongyloidiasis and onchocerciasis, conditions that weaken your immune system.)

The graphs above suggest what one might predict: ivermectin would be more efficacious against Covid-19 in countries with a higher prevalence of worms, specifically the kind of worms killed by ivermectin. And that’s what the graphs show.

Of course, some of the studies above, both positive and negative, may already have been discredited by subsequent inspection (I haven’t checked), but I’m surprised that nobody has suggested this explanation before. (If they have, I haven’t seen it.)

In a month or two we should know the results of the properly conducted Oxford study on the effects of ivermectin on Covid-19 mortality. I’m almost positive that if the drug does have a positive effect on the disease, it will be minor—certainly much less than that of vaccination or the new Pfizer antiviral pill. But we will wait patiently. I tried to bet my doctor on 3:1 odds (if I won, I’d get $10, while if he won, and Ivermectin had a big positive effect, he’d get $30) that ivermectin wouldn’t show a greater preventive or curative effect than jabs and the new treatments, but he rejected that as a “sucker bet”!

UPDATE: I’ve just managed to subscribe for free and so have seen the rest of the article; it appears that some have considered worms as a comorbidity. A quote (emphasis is mine):

Yet ivermectin’s advocates insist that there is solid science demonstrating the drug’s efficacy. One well-documented website lists and links to 65 different papers on the subject, many of which, on the surface, seem to support this claim. Could this many studies all be wrong? Recent analysis by Avi Bitterman, a dermatologist in New York, and Scott Alexander, a prominent blogger, suggests that the answer is nuanced. Ivermectin probably does help one subset of covid-19 patients: those who are also infected by the worms it was designed to fight.

Wading through the papers whose methodologies appeared sound, Dr Bitterman noticed that the studies that looked best for ivermectin tended to cluster in regions with high rates of infections by strongyloides, a parasitic worm. Common in much of Africa, Asia and Latin America, strongyloides can cause, among other things, diarrhoea, fatigue and weight loss. However, they only pose a graver threat if their numbers grow out of control. Such “hyper-infection”, which is often fatal, becomes far more likely if a patient is receiving corticosteroids, which both suppress the immune system and appear to make female worms more fertile. And dexamethasone, a corticosteroid, is now a standard treatment for severe covid-19, because it prevents the immune system from going into overdrive and attacking the body’s own cells.

Building on observations by David Boulware, a professor of medicine at the University of Minnesota, Dr Bitterman concluded that strongyloides may account for the conflicting results of studies about the effectiveness of ivermectin as a treatment for covid-19. In trials conducted in countries where the parasites are common, many people could have both covid-19 and strongyloides infections. Covid-19 might already have weakened their bodies’ defences against the worms; treating the coronavirus with corticosteroids would let the parasites run wild.

In the groups who received ivermectin during trials, the drug would keep strongyloides in check. But patients in control groups would be left at the worms’ mercy. This would make it look as if ivermectin were preventing deaths caused solely by covid-19, when in fact it was preventing those caused by the parasites or by a combination of the two infections. This mechanism would explain why most studies conducted in places where strongyloides are rare showed no benefit from taking ivermectin. “Ivermectin doesn’t treat covid,” Dr Bitterman wrote. “It treats parasites (shocker) that kill people when they get steroids that treat covid.” He concluded that “taking strongyloides endemic populations, putting them into a control group with corticosteroids is a death sentence”.

In July 2020 a group of doctors argued in the Journal of the American Medical Association that it was “reasonable to consider presumptive treatment with ivermectin for moderate- to high-risk patients not previously tested or treated for strongyloides”, and said that the risk of infection by the worms in covid-19 patients should be “based on factors such as country of origin and long-term residence”. The World Health Organisation also recommends ivermectin in this context. However, most people in rich Western countries like America—where demand for ivermectin, driven by advocates on social media, is so high that some people have resorted to taking the equine version of the drug—do not fit this description. At least when treating patients who have never been to countries with widespread strongyloides, the evidence suggests that mainstream doctors in such places are right to avoid prescribing ivermectin.

None of this, of course, suggests that vaccinations are less efficacious than ivermectin in preventing death from the virus alone, much less, as Bret Weinstein and Heather Heying suggest, you’re better off not getting vaccinated than getting vaccinated. Just get tested for worms if you get covid and live in a roundworm-infested part of the world!

 

*Note that Fisher has been canceled.

Talking sense about the Omicron variant

December 1, 2021 • 12:00 pm

Reader Tom sent me this 19½-minute video about Omicron from health science expert and nurse John Campbell, who’s apparently been dispensing sound information on the coronavirus for a long time. Tom said this:

Dr. John Campbell has been my go-to-guy for the past 14 months on a nearly daily basis.  He’s lucid, authoritative, clear, concise and engaging, just a superb source of reasonable advice.

When I asked for more information because Campbell’s Wikipedia bio was scanty, Tom added this:

He’s had a YouTube channel since 2008 and is an evidence-based medicine proponent to the bone.  His videos are daily, usually about 20 minutes long and shot in a spare room of his home.  Just him wielding a sharpie, an overhead camera, printed sheets of the day’s topic and a calm, no nonsense discussion delivered in a clipped English accent.  No histrionics.  Like visiting a well-loved teacher during office hours.

Now remember, we know very little about this virus—neither about its infectivity or its virulence (which really encompasses severity and spreadability).  So take this with a grain of salt. However, Campbell readily admits our ignorance while claiming, with support, that this variant will be the dominant strain throughout the world.

He does sound a note of hope, i.e., the vaccinated, when infected with Omicron, seem to get generally mild cases, and hypothesis that its spreadability is negatively correlated with how sick it makes peope.

John also gives us a pessimistic timeline for a vaccination (early to mid-2022). He summarizes where all the cases are (everywhere), and the mortality rate (thankfully, zero).  Remember, it’s early days.

Sleepless in Chicago

November 14, 2021 • 9:15 am

Posting may be lighter during the next several weeks as I struggle to overcome a case of chronic insomnia (or “semi-chronic insomnia”) that started a couple of months ago but has been exacerbated (as is intended) by therapy.  I’m not looking for sympathy here—insomnia isn’t nearly as bad as many maladies—but I’m trying to explain why posting may decline in frequency and in quality for a while. (It’s hard to think and write on four hours of sleep per night.)

Backstory: I’ve had bouts of insomnia twice in my life, both associated with stress. One was at the University of Maryland when I began my first job and was anxious to make good.  The stress took the form of me being unable to get to sleep. I went to a doctor who prescribed a change in behavior. “If you can’t get to sleep,” he told me, “Get out of bed and do pushups until you’re worn out with them. Then get back into bed. Repeat every 20 minutes until you sleep.”

I suppose the idea was that I would get so revolted by having to do pushups that my body would force me to sleep.

It didn’t work: I was still an insomniac, but with an impressive set of triceps. Eventually the insomnia went away.  It turns out, though, that getting out of bed if you can’t sleep is the basis for the kind of therapy I’m trying now, called CBT-I, or “cognitive behavioral therapy for insomnia.” Everyone says that it has a high success rate (about 70%), and it doesn’t involve drugs, which I don’t like to take. (My doc and I have tried to find a good sleep doctor who knows about medication for sleep, but so far without success. And I don’t know if those drugs would be efficacious—some of them have the side effect of making you get fatter!)

My current sleep issues began about two or three months ago.  The issue this time was not getting to sleep, as I always dozed off within ten minutes of turning off the lights, but waking up early in the morning and trying, unsuccessfully, to get back to sleep. Sometimes I’d wake up at 1:00 a.m. and and struggle for hours to get back to sleep. (I’m told that many people had sleep disruption during the pandemic.)

I pushed my bedtime back farther and farther, until 8:30 p.m. (which of course puts a crimp in your social life), but all that meant is that I’d wake up even earlier.  I was getting about 5-6 hours of sleep per night, and I know from experience that I need at least 6.5 hours to function decently and 7-8 to be in top form. (And you supposedly need more sleep as you get older.)

As for the cause of this bout of insomnia, I have no idea. I’m not particularly stressed over anything, though when I (and many people) wake up in the middle of the night, worries and dark thoughts sometimes run through the head.  Eventually I trained myself to dispel this midnight anxiety by simply pushing the thoughts out of my head. But that didn’t help my sleep, either. I’d lie in bed awake thinking of nothing in particular, the hours would turtle by, and eventually I’d give up and get up for the day.

Finally, my doctor referred me to a psychologist who specialized in CBT-I, a method you can read about here. I’m told that the regimen will take 5-7 weeks, though it could be longer or shorter, and the rate of
“clinically significant improvement” in sleep (I’m not sure what that means) is about 70%.  Right now I’m starting with “sleep restriction”, which is BRUTAL. Here’s what the link says about it:

This method sets strict limits on the time you spend in bed. The initial limit used is the same as the amount of sleep you tend to get on a nightly basis. For example, you may only get five hours of sleep even though you spend seven hours in bed at night. Two hours in bed are spent trying to fall asleep or go back to sleep after waking up. In this case, your initial limit would be set so that you spend only five hours in bed at night. This means that you are likely to get less than five hours of sleep.

This sleep loss will make you even more tired at first. However, it will also help you fall asleep faster and wake up fewer times in the night. This will allow a solid period of sleep and a more stable sleep pattern. As your sleep improves, the limit on your time in bed is slowly increased. The goal is to reach the point where you get the amount of sleep you need without reducing the quality of your sleep.

For two weeks I kept a sleep log, recording bedtimes, waking-up times in the night (you can’t look at a clock, so you have to estimate), and what time I finally get out of bed, as well as how I feel the next day and whether I napped the previous day. Under the regimen above, NO NAPS ARE ALLOWED! That’s the toughest part—aside from feeling half-dead. Oh, and I need to exercise regularly as part of “sleep hygiene.” I’m taking very fast walks for several hours each week, but it’s not easy when you’re dopey.

From the sleep log, the psychologist determined that I was getting about six hours of sleep per night, including naps. Ergo, the prescription: go to bed at 8:30 and get up for the day at, yes, 2:30 a.m.  If you wake up in the night and can’t get back to sleep in 20 minutes, go into another room and read a book for five minutes. Then go back to bed. Lather, rinse, and repeat.  If you don’t get to sleep doing this, you still have to get up at 2:30 a.m.

Oh, and you aren’t supposed to be in bed for any purpose other than sleeping. That’s tough for me, as I always read in bed, write a lot of this site in bed, and am often horizontal when I’m home, even when awake. Now I don’t go near the bedroom until it’s time to sack out for the night.

You may have wondered how I know when it’s 2:30 if I’m not allowed to look at a watch or clock. I set my phone with an alarm. I’ve always hated alarms, and never used them since I always woke up at the same time. They’re intrusive!

They weren’t kidding when they used the phrase above: “this sleep loss will make you even more tired at first”.  The first day I got about 4 hours of sleep. And getting up at 2:30 a.m. is no picnic, let me tell you. There’s nothing on t.v., so I read or simply go to work. The second night I was so tired that I almost passed out, and slept the entire 6 hours without awakening. That was very encouraging, but last night was another 4-hour rest again. I’m not sure how long I can keep this up, but I’m determined to follow the regimen because it’s been shown to have a high success rate.

Well, all that is by way of explanation, but I also find the experience interesting though debilitating. But I know that lack of sleep can injure your health, so I’m worried about that, too.  The upshot is that trying to work or think or write often seem like insuperable tasks when you’re this tired, but I’m soldiering on.

Again, I’m not writing this to solicit pity (or prayers!), but to explain what’s going on.  I’ve found that just writing this down made me feel better—though not less tired.

Readers may wish to weigh in with their own tales of insomnia. (Please don’t prescribe things for me to do or swallow, though, as I want to stick with the plan we’ve settled on.) The disorder is said to be quite common.

NO LOOKING AT THE CLOCK!

Chicago Tribune: No religious exemptions for vaccines

November 8, 2021 • 12:45 pm

This Chicago Tribune op-ed is unusual in that it proposes an ironclad rule: no religious exemptions from vaccination requirements. I happen to agree with that; my view is that the only exemptions from mandatory vaccination, where it is decreed for health reasons, should be ones for people whose lives or health are endangered by getting the injection. So good for author Steve Chapman!

Click to read. If you’re paywalled, make a judicious inquiry

Now I disagree with Chapman on one point: he thinks that people should be exempted from the Covid vaccination if they provide “persuasive evidence that they are acting on the iron imperatives of faith rather than personal whim.” But he does note that proving such evidence is very dicey, and that “the number of people who could legitimately qualify is too tiny to be worth the bother”. In the main then, we both think that you should not bother. No religious exemptions—only medical ones.

He makes several other points, some of which have been discussed here (I’ve added one or two myself). Direct quotes are in quotes:

1.) “No major faith bars its followers from being immunized against disease. Even Jehovah’s Witnesses, which rejects blood transfusions, and Christian Science, which discourages medical treatment, don’t forbid it.”

2.) “A lot of the holdouts have never claimed religious objections to other vaccines. Most, it’s safe to say, couldn’t articulate any halfway plausible rationale to refuse.”

3.)  All states have mandatory childhood vaccinations—sometimes more than a dozen shots—to attend public school.

4.) Some states do not allow religious exemptions for these childhood vaccinations; they include (this is a comprehensive list) Mississippi, West Virginia, California, Connecticut, Maine, and New York. There should be fifty states on that list.

5.) There is a reason for mandatory vaccination for both children and, for Covid, for adults. This is of course to protect us against a pandemic, and to protect you from infecting others who haven’t gotten the shot or can’t get the shot. In my view, there is no reasonable religious excuse that can override that. To a diehard atheist, saying that “my faith in God prevents me from considering the vaccine” sounds like “my faith in Santa Claus prevents me from considering the vaccine”.

6.) There is no stipulation in federal law that you are allowed to get an exemption because of religion. As Chapman notes:

“In 1990, the Supreme Court ruled that the Constitution’s guarantee of religious freedom doesn’t mean believers are exempt from laws that apply to everyone else.

To rule otherwise, the court said, would lead to ‘religious exemptions from civic obligations of almost every conceivable kind — ranging from compulsory military service to the payment of taxes’ and, yes, ‘compulsory vaccination laws.’ The author of the court’s majority opinion? Conservative hero Antonin Scalia.”

Privileging faith over the common good doesn’t make sense. Matthew 22:21 says “”Render unto Caesar the things that are Caesar’s, and unto God the things that are God’s”. The public well-being is Caesar’s. The idea that a delusion should make you exempt from things required by others does of course have purchase in other areas, for the U.S. is hyperreligious. But we have to think about how far we want to privilege faith while still allowing freedom of worship. We don’t allow people to beat up others because their faith decrees it. Why should we allow people to endanger others because their faith decrees it?

Advice from my primary care doc: Should you get a booster? If so, which one?

October 25, 2021 • 10:45 am

If you’re contemplating getting a booster shot, as I did (the Pfizer), you should read this blog post by Dr. Alex Lickerman, my primary care doc who has, as you may know, written a whole series on Covid-19 for the layperson.  This is post #16.  Click on the screenshot below to read his booster take and see links to the other posts.  NOTE: Alex has kindly agreed, as he often does, to answer readers’ questions about Covid, so fire away in the comments section below.

Here’s the intro, the short take, and then below I’ll list the topics he takes up:

In this post, we explore the pros and cons of getting a third booster shot (or second booster shot if you got the J&J vaccine) against COVID-19. As usual, if you’re less interested in how we got to our conclusions than you are in the conclusions themselves, feel free to skip to the BOTTOM LINE in each section and the CONCLUSION at the end.

Question: Should you get a third booster shot?

Answer: It depends on how likely you are to have a bad outcome if you contract COVID-19 as well as your specific goals in getting vaccinated.

The topics of the post:

ESTIMATES OF CONTINUING VACCINE EFFECTIVENESS

WHAT DOES WANING EFFECTIVENESS MEAN IN THE REAL WORLD?

BENEFITS OF A THIRD SHOT

RISKS OF A THIRD SHOT

WHAT THIRD SHOT SHOULD YOU GET?

I got my booster because I’m older and thereby in the ‘at risk’ group, but I’m also going to Antarctica on a ship for a month in March, and wanted the extra protection.  Note: Alex also recommends in his post which of the possible boosters will boost you the most. But you’ll have to see that for yourself.

My hand is healing (I hope)

October 18, 2021 • 12:30 pm

TRIGGER WARNING!

I thought you might like to see how my hand is healing after the mishap I had last Wednesday (there are comparison pictures of my hand at this link and pictures of the scene here). In short, when I was trying to break a fall, my hand went through a pane of glass on my office bookcase, causing two deep lacerations that required 18 stitches in toto.

Every day the lacerations are dressed, which involves putting Neosporin on the gashes and then taping a gauze pad over them. I keep my hand dry and when I shower I put it in two plastic bags secured with two rubber bands around my wrist.  Try washing your hair that way, or washing your right armpit when your left hand is encased in plastic bags!

Anyway, it appears to be healing okay, with no signs of infection except a slight redness, and, fortunately, the flap of skin in the first photo did not die (the nurse practitioner told me that was a possibility).

I get the stitches removed Friday morning.

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