Category: medicine and health

Harvard issues most self-abasing antiracist statement ever

April 10, 2021 • 12:00 pm

Not enough time has passed for us to understand why the tide of “progressive” political excess has risen so quickly. Yes, it accelerated after the death of George Floyd, but there are reasons why Floyd’s death unleashed what was already waiting to happen. I myself don’t really understand the phenomenon of “Wokeness”, and why so many people seem to have been driven mad.

Nobody wants to think of themselves as racist, but now we are told that not only are we all racists, but that we’re unconscious of that fact, and that the very structures of government, politics, and universities have racism embedded in their bones and sinews. And in this we’re all complicit. Some of this is true, as the voting rights bills suggest, and it behooves us to find the truth in all the shouting around us.

But the excesses—the shaming, the demonization, the self-abasement, the rush to judgment in every act, the drive to efface the past—often make me despair of the whole enterprise of antiracism, at least as conducted according to the Tenets of Critical Race Theory. It’s not so easy to separate the genuine inequalities that need to be fixed with the cries of the “progressive” left that we need to tear down the whole system and hand over political power to them.

But we can pretty much brush off extreme cases of self-abasement, so common in university “declarations” like the following. Harvard’s Medical School has a Program in Global Surgery and Social Change, and its goals are admirable: to extend what progress the “first world” countries have made in surgery to what they now call “the global South”: those countries with lower standards of living and insufficient medical care. Here are the program’s goals:

The Program in Global Surgery and Social Change (PGSSC) is a collaborative effort between Harvard Teaching Hospitals, the Department of Global Health and Social Medicine at Harvard Medical School, Boston Children’s Hospital and Partners In Health (PIH).

Our strategy is two-fold:

  1. Global surgical systems strengthening through Research, Advocacy, and Implementation Science, using the framework of the Lancet Commission on global surgery. You can learn more about the Lancet Commission on global surgery on the PGSSC Resources page.
  2.  To produce leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery. Through the Paul Farmer Global Surgery Fellowships and research associate positions, it aims to empower surgeons, surgical trainees and medical students around the world with the skills they need to improve the health of some of the world’s most impoverished people.

That is all well and good, but then the Program got mixed up in the anti-racism business, and in a pretty strident way, and issued this statement, which I reproduce only in part.

Racism murders. Racism destroys. Racism dehumanizes. We live in a racist world and all play active and passive roles in perpetuating racism: the system of prejudice and discrimination based on the ambiguous social construct of race backed by unequal and unjust power dynamics. Racism is inherent to every aspect of our lives; it is woven into the fabric of society and consequently its effects interface with our work as the research associates, fellows, and faculty at the Program in Global Surgery and Social Change. Therefore, the absence of conspicuous racist actions is not enough. We must be actively anti-racist. We absolutely, unapologetically denounce our wretched racist system and its proponents without exception.

Racism systemically places higher value and opportunity in the hands of a specific race, and as a direct consequence disadvantages another racial group. It is this benefiting of one group to the detriment of another that has led us to focus on anti-racism. The work of antiracism is allied to that of anti-discrimination and the evaluation of inequities based on gender, sexual orientation, caste, religion, ability, tribal affiliation or socioeconomic status. However, given the distinct relationship of racism, colonialism, and global health, we in the global health community have a moral imperative to shine a bright light specifically on racism within our sphere.​

Racism is inherently linked with colonialism. Our work in global health is rooted in colonialism, which provided power to white Europeans through subjugation and exploitation of others. Colonialism subsequently allowed for the creation of the construct of race to justify the dehumanization of those the colonizers exploited. This practice has lived on in global health through the racist belief that those same colonial powers possess medical knowledge that is superior to that of the cultures they denigrated. Consequently, global health is built on a foundation that, at its core, is antithetical to the principle of shared human dignity and respect. Affirming our commitment to anti-racism also affirms our commitment to being anti-colonial.

Academic institutions in high income countries are complicit in and the product of centuries of historic institutional colonialism and racism with over-representation of white voices that are heard on a global scale. We interact with a diverse group of international partners, but cannot truly be equitable partners until we acknowledge and address the place of power and privilege from which we operate.

Here we see the familiar denouncement of racism (seriously, is there any rational person who doesn’t already denounce it?), the chest-beating and self-abasement, and the accusations that all of us are complicit in perpetuating systemic racism. And, like Ibram Kendi, it argues that it’s not enough to refrain from being racist, but we must all actively work, and work in a certain way, to be “antiracists”. Whoever is not antiracist, says Kendi, is racist. It is as if there is only one issue in the world on which we should be working.

Now eliminating global inequality in medical care is an excellent goal, but I fail to see how these kinds of statements will help solve the problem. What we need is the kind of recognition of moral deserts that got Dr. King and his associates the civil rights laws they sought. Why shouldn’t we be helping others who are human and suffer in ways we understand? What we get instead is annoying hectoring, coupled with the strange declaration that promoting global health in Harvard’s way is racist because the practice of medicine in First World Countries is more advanced than in underdeveloped countries. (The fellowships given out by Harvard’s programs are, after all, spent learning at Harvard.)  I call your attention to goal #2 of the program given above:

To produce leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery. Through the Paul Farmer Global Surgery Fellowships and research associate positions, it aims to empower surgeons, surgical trainees and medical students around the world with the skills they need to improve the health of some of the world’s most impoverished people.

This is the exportation of Harvard-style medicine to other countries. Isn’t that the conscious promulgation of “superior medical knowledge”?

This is, of course, a species of medical colonization, for who determines what skills medical workers in poorer countries need? It’s not colonization in the sense of taking advantage of poorer nations, but it’s colonization in the sense of believing that one indeed has “medical knowledge superior to that of the countries they  [once] denigrated.”

There’s a lot more, as well as three subsections swearing what Harvard will do to promote antiracism in various areas, including “People,” “Culture”, and “Civic Engagement”, which itself has two sub-subsections, “Academia” and “Economic Injustice”.  Here’s the Academia part.  I reproduce it because I think it’s misleading about the degree of racism in academia, at least in my experience:

Academia: We acknowledge the role that academia plays in perpetuating structural racism. Academic excellence requires equity, yet despite statements denouncing prejudice, many academic systems are fraught with biases. Notably, it is often Black, Indigenous, and People of Color who are expected to be, and inevitably are, the most engaged in issues of structural racism in academia. This engagement results in activities and efforts leading “diversity, equity and inclusion” initiatives that are not traditionally valued in academic promotion criteria. This reality highlights the need for a paradigm shift in two ways – who shoulders anti-racism efforts, and how anti-racism work is valued and supported institutionally to ensure that personal and professional goals are being met. We will engage in the broader academic system, outside of our specific purview of global health, to catalyze meaningful change in the culture of academia.

Anybody familiar with academia will sense the tension in this statement.  And I’ll finish by adding that inequities (differential representation of groups) in academia does not constitute prima facie evidence for structural racism present in academia now.

New post by Dr. Alex Lickerman: Should you get the Johnson & Johnson vaccine?

April 2, 2021 • 10:00 am

Dr. Alex Lickerman, my GP, has a new post on his website about the coronavirus and vaccines, the twelfth since he began posting during the pandemic. Click on the screenshot below to read it (it’s free).

The short answer to the title question is “yes”, but there are lots of other questions answered (and some raised without known answers). One is whether you can be an asymptomatic carrier if you’ve been vaccinated. Alex’s answer:

The study didn’t present enough data to prove the vaccine prevents asymptomatic infection. Nor did it assess whether subjects who developed COVID-19 despite vaccination are less likely to transmit the virus. Thus, it’s not yet clear how effective the vaccine will be in containing the spread of the infection. (A recent study from the CDC, however, strongly suggests that both mRNA vaccines—Pfizer’s and Moderna’s—do indeed prevent even asymptomatic COVID-19 infection by 90 percent in real-world circumstances, which is great news. We need more studies to learn if this is also the case for J & J’s vaccine.)

Summary paper on the vaccines with Fauci as senior author

January 20, 2021 • 10:45 am

Reader Simon sent me a link to this free paper about coronavirus vaccines written by several researchers, including Anthony Fauci (“senior author” means “last author”, and the convention that this spot is occupied by the Boss or lab head). It’s a useful summary of where we are, which other vaccines are coming, and what we don’t know, and is understandable by the layperson. (Here’s a link to one term you might not know: “mucosal immunity“, while “parenterally” refers to medicines taken outside the digestive tract, usually through injection.)

Click on the screenshot to read:

There’s a useful table of vaccines already used compared to those in development. Of the five remaining vaccines, three involve viruses: mostly inactivated viruses that can’t replicate but can produce the spike protein that activates your antibodies, while two others involve injecting spike proteins themselves, made in insect cells. Click to enlarge:

 

Here’s a figure I’ve posted before showing the protection you get from the two vaccines in use in America now: the Pfizer/BioNTech and Moderna formulations.

Note that you’ve already gotten substantial protection before you get to the second jab. For both vaccines the efficacy (the reduction in the chance you’ll catch the virus if exposed) is about 95%.

The paper raises several concerns about the vaccines and people’s willingness to take them.

A.)  What are the side effects? Monitoring of those injected has only taken place for several months, and there may be long-term effects we don’t know about. The authors note, though, that some of the vaccinated would have had stuff like cancer and heart attacks anyway—effects having nothing to do with the injection. The frequencies of such incidents and diseases need to be compared to those in unvaccinated groups or base rates already known.

B.) We don’t know the efficacy in some important groups, including “children, pregnant women, individuals with underlying illnesses, and those taking medications that might influence the immune response to a disease.”

C.) The duration of protection provided by the vaccines. We know that the efficacy of flu vaccines wanes substantially between six months and a year after injection. Will we have to get yearly injections of coronavirus vaccines as we do with flu shots?  Of course they will continue developing vaccines, so they will get better over time.

D.) How well do the vaccines protect against (asymptomatic) infection and transmission of the virus? We should have the answer to this question in a while, and the authors consider this the most important unknown in trying to stem the pandemic. If after injection you can get infected and not show symptoms, as well as transmit the virus, this will dramatically curtail efforts to stop the pandemic cold, and mandate different strategies, like testing those already injected.

And a paragraph from the paper, which is disturbing given that roughly half of Americans plan to get vaccinated. That is INSANE! Tell your worried friends to get their jabs, as it’s better than getting coronavirus.

The point made is that the vaccines currently in use don’t provide immunity in the mucosal membranes (as in the nose), while polio vaccine did bestow that immunity, but only if made with live weakened virus. (Current flu vaccines don’t provide it either.) Active immunity in the mucosa kills the virus in the respiratory system before it has a chance to get into the blood. The coronavirus vaccines now available don’t seem to provide mucosal immunity and, as the authors say, we need vaccines that will do that. A summary:

Given that recent polling suggests that only 40% to 60% of people in the United States are currently planning to get vaccinated, it is conceivable that without some impact on transmission, the virus will continue to circulate, infect, and cause serious disease in certain segments of the unvaccinated population. Administration of parenterally administered vaccines alone typically does not result in potent mucosal immunity that might interrupt infection or transmission. In the case of poliovirus, induction of mucosal immunity through vaccination with the live attenuated oral polio vaccine, in contrast to the parenterally administered inactivated vaccine, was thought to have played a critical role in interruption of transmission and control of poliovirus epidemics. For these reasons, additional data regarding protection from infection should be generated as soon as possible. If these vaccines do not provide durable, high levels of protection from infection, and do not drive the prevalence of virus in the community to near zero, a thorough analysis of shedding and transmission will need to be done through additional study. Armed with such data, public health officials can make decisions regarding prioritization of populations to receive the vaccine, and researchers could potentially improve upon the first wave of vaccines.

A woke Hippocratic Oath

January 15, 2021 • 11:30 am

It’s often assumed that medical students take the Hippocratic Oath when they graduate or during the “white coat ceremony“—when they get their Official Doctor Coats at orientation. In fact, there’s a report from the Association of American Medical Colleges (AAMC) that most medical students never take that famous oath, and many classes write their own. Although there are still some “standard” oaths, the AAMC notes this:

. . . it was only around 20 years ago that schools began to allow students to craft their own promises.

Nancy Angoff, MD, remembers the decision to discard Yale’s long-standing oath back in 2000. “Some students and I didn’t care for the language,” says Angoff, associate dean for student affairs. “It seemed very impersonal, cold, and too pat.” At first, they considered reverting to the Hippocratic Oath.

“We debated it,” recalls Angoff. “The students didn’t want to promise things they couldn’t deliver on” that the ancient oath included, so they opted to write their own pledge.

Now Yale is among the 17% of surveyed schools that have an annual process for writing, revising, or selecting an oath. At Yale, the oath is written during a pregraduation course, explains Angoff. Each year, she says, “the students end up with a really personal and beautiful oath.”

You can see why they’ve ditched the original Hippocratic Oath if you read it here. There are parts that are really outmoded, such as this bit, which rules out assisted suicide and abortion:

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

Now I’m not sure why the students write oaths rather than the faculty, for the faculty surely have a better idea of what good physicianship is all about. And of course the students, who are quite young, can go hog wild, as they apparently did at Pitt. And you know already what they did—and what’s probably happening all over the U.S. They pledged themselves as doctors to engage in social-justice activism.

From PittWire, a publication of the University of Pittsburgh, we have a report of one new oath  (click on screenshot to read):

There was a committee to write an oath (always a bad idea), and they produced an oath that was sent to me by reader Ginger K., who commented, “Some of this is quite reasonable, such as the commitment to research and mentoring, collegiality, and personal health. But the woke vocabulary dilutes the good stuff.” Indeed.  The titer of real physicianship is quite low here.

Read the oath for yourself. Right off the bat I was distressed by the ubiquitous ritual invocation of George Floyd, who has nothing to do with medical school or prospective doctors (The Floyd Invocation also initiates “antiracism” statements on some of the University of Chicago’s departmental websites that violate our University principles):

One gets the impression from this statement that medicine is more a social justice mission—fixing racial inequities, fostering allyship and so on—than a mission to bring health and save lives. There’s more about social justice here, including the au courant “self care”, than there is about caring for patients per se, or practicing ethical behavior towards all patients. (And where is the confidentiality clause that was in the Hippocratic oath?)

I’m not going to make too much of this, as students probably enjoy producing their own oaths. But in the end this seems to be an act of virtue signaling, for most of the physicians will be engaged in the quotidian duties of simply helping the afflicted rather than fixing racial inequality.

I do admire those who sacrifice a comfortable existence to help the oppressed and poor, but this is an individual choice, not something to be decreed with a pledge recited by everyone.  For surely not all students agree with this oath—just like not all professors at the University of Chicago agree with their departments’ “anti-racism” statements.

Take this as a sign of the times, and of the racialization of everything. For some students it may be a genuine pledge, but for many of the others it’s performative wokeness, something to be forgotten as soon as they pass their boards.

 

h/t Ginger K

My birthday trip to the dentist

December 30, 2020 • 2:00 pm

I’ll make this post short as it’s about a medical (or rather, dental) procedure.

A few days ago, an old crown on one of my lower molars popped off, and there wasn’t much tooth left (when some of it sticks to the inside of the crown, you’re screwed). The dentist was closed, but there was no pain (I later found that I’d had a root canal in the tooth), and when I called after hours my dentist told me to come in today. Of course, it was my birthday. And as I was scheduled for an hour and a half, I figured they planned to to pull the tooth. For me, that means getting an implant.

Dental implants, though pricey, are a fantastic advance in the practice. Right after they pull the tooth (which was painless for me, though time-consuming because they had to dig out the roots), they drill a titanium screw into your jaw, as well as filling the tooth hole with bone-graft material (I think they use powdered pig bone or human cadaver bone). After three months, the titanium has integrated with the bone, and they make a crown to put atop the screw. The results sort of look like this:

Afterwards, it looks and feels like a normal tooth, and requires just the usual care: brushing and flossing (though you dab a bit of disinfecting solution around it each night).

Because I have familial soft teeth (but great gums), this is the third implant I’ve had, and it’s not a big deal save the hit in the pocketbook, and the results are great. I’ve never had a problem with an implant.

I also quite like my dentist, whom I’ve had since I first came to Chicago. When they closed the excellent dental clinic at the U of C hospital, where he was head, he went into private practice and I followed him. Of all the dentists I’ve had in my life, he’s by far the best; a miminalist, a kind and skillful man, and very patient when there’s a difficult procedure, as there was today. (As he told me when I asked if he’d ever met a tooth he couldn’t extract, he replied, “The tooth never wins”.)

He’s also the official dentist of the Chicago Blackhawks hockey team, which means he has to be at every game (hockey players are always busting their teeth). I was told there’s a dental clinic in the United Center, where the Blackhawks play.

By the way, if you haven’t been to the dentist during the pandemic: things have changed. There is constant sanitizing, temperature-taking, and wearing of personal protective equipment. I was told that there have been no covid incidents in this dental practice, which has about four dentists and a passel of assistants and hygienists.

Anyway, I’m in no pain, but have to take antibiotics for a week and have a couple of stitches in the gum. At my age, it could be worse! But it is my birthday, which was noted by the receptionist with surprise when I made my next appointment. It’s not the best of birthdays, as I can’t eat and drink exactly what I want, but I’ve simply postponed the final day of Coynezaa until next week.

One problem with going to the dentist is that I pass about three Dunkin Donuts stores on the way (it’s downtown), and I can’t have a donut on my way there because I don’t want food in my mouth when I arrive, and afterwards I’m usually not supposed to eat for a while. Normally I’d treat myself to a donut after a medical procedure

But others don’t have to eschew the donuts. Rather, they chew them, and today I saw this classic scene on my way to the dentist.

Note the parking space in front is “reserved for police vehicles.”

Why we shouldn’t be worried (yet) about the new strain of Covid-19

December 23, 2020 • 10:30 am

Reader Jim Batterson sent me this 25-minute video with the comment:

I know you prefer to read rather than watch a video, but I wanted to make you aware of a 24-minute YouTube video from Vince Racaniello, a virologist at Columbia University who leads a cast of virology geezers and one younger immunologist in a weekly zoomcast production of “This Week in Virology”.  He did this standalone presentation to rant a bit on the way that this latest variant in the UK is being hyped to the world. I think he does a pretty good job for any viewer who has had a biology course in the past five or so years.
The point is that viruses are mutating constantly, and yet none the coronavirus mutations have yielded a new “strain”—that is, a mutant type that has new biological properties. The property touted for the new virus is its purportedly increased “spreadability”, but, as Racaniello notes repeatedly, that simply hasn’t been demonstrated. As he shows, you can get some variants spreading more widely than others simply by accident: the variant may not have any effect on spreadability itself but can increase in frequency as a byproduct of “superspreader events”—the main way the virus spreads—because only a small subset of all viruses get passed to other humans.

Racaniello then shows the changes in the new mutant “strain”, noting that only one of the several mutants in the spike protein is even a candidate for a change in spreadability, but there is not an iota of evidence that any of those mutations actually make the strain more spreadable.  Nevertheless, all of us are inundated with media scare stories about this “superspreader virus”.

Racaniello’s point is that though there are epidemiological data showing a correlation between the presence of the mutant in some areas and a greater spread of the virus, that’s just  a correlation without evidence of causation. And there could be several causes, including accidents. To show this mutant is a “super virus”, you simply have to do lab experiments; epidemiological correlations show nothing.

Racaniello doesn’t rule out that this mutant spreads faster than its ancestors, but he’s not convinced it is, and doesn’t think that we yet have a reason to be concerned. In fact, he suggests that the changes in the new strain may make it less spreadable. Let me add that Racaniello knows what he’s talking about, as he’s co-author on a well known textbook of virology.

Like all good scientists, Racaniello isn’t declaring that this virus is “neutral” compared to its competitors—he’s simply saying that we don’t have any data suggesting it’s more nefarious. In fact, the same story happened earlier with a different mutant that spread widely, but nothing ever came of that.  We need experimental cell-culture data from the lab on viral shedding, and that doesn’t exist.

His final comment:

“We should move on from the scary headlines, and get ahead with vaccination programs, which are underway—and that is going to be the way we get away from this pandemic.”

Anyway, this is a good and clear mini-lecture, and listening to it should calm you down a bit if the media have gotten you worried.

Dr. Lickerman on the Moderna vaccine

December 22, 2020 • 10:30 am

My GP has written another post on vaccines, this time on the new Moderna vaccine, which has just been approved by the FDA.  Click on the screenshot to read it, or you’ll likely be satisfied with the conclusions and unanswered questions below, which were remarkably similar to his take on the Pfizer vaccine.

That’s because, except for a difference in storage conditions (the Moderna vaccine requires far less cold than does the Pfizer one), the trials show both are about equally effective (94.1% for Pfizer, 95% for Moderna, which are probably not statistically significant. Both are also mRNA vaccines that inject the code for making part of the virus’s spike protein into the body, where part of the protein is made, activating antiviral antibodies, and then the mRNA is degraded. (See below for an article about how these vaccines work.) There’s a slightly higher incidents of side effects with the Moderna vaccine as well: muscle pain and joint pain after the jabs are about 20% higher for Moderna’s vaccine (an incidence of around 40%) than for Pfizer’s (incidence about 20%). But these aren’t severe side effects.

The Pfizer vaccine was tested on individuals older than 16, while Moderna’s on individuals older than 18, so efficacy in that two-year age range remains an unanswered question for Moderna.

Finally, the two doses of Moderna’s vaccine were spaced 28 days apart rather than Pfizer’s 21, but this may not be important since there seems to be a leeway of a few days. Consult your doctor.

The overall take (these quoted from the post):

  1. The vaccine is highly effective in preventing symptomatic COVID-19 infection.
  2. The vaccine is safe. Adverse reactions, both local and systemic, are mostly minor. Though the study hasn’t yet gone on long enough to prove there are no serious long-term adverse affects, such adverse affects, if they exist, are likely to be rare and non-life-threatening based on other Phase I and II studies of other RNA vaccines.
  3. We recommend everyone who is eligible to receive the vaccine should receive it when it becomes available to them.
  4. It very well may take all of 2021 to get everyone who’s willing to be vaccinated to receive the shots, which means it likely won’t be until early 2022 that life returns to pre-pandemic normal. In the meantime, continue to wear a mask when indoors with anyone you don’t live with, wash your hands frequently, and refrain from dining indoors at restaurants.

And the unanswered questions:

  1. While suggested by the study, still left unproven is whether BNT162b2 prevents severe COVID-19 infection, whether it prevents COVID-19 infection after just one dose, and whether it prevents COVID-19 infection in subjects who’ve already had COVID-19.
  2. The study didn’t look to see if the vaccine prevents asymptomatic infection. Nor did it assess whether subjects who developed COVID-19 despite vaccination are less likely to transmit the virus. Thus, it’s not yet clear how effective the vaccine will be in containing the spread of the infection.
  3. The study hasn’t gone on long enough to tell if subjects who were vaccinated yet still contracted COVID-19 have a lower risk of long-term effects of COVID-19.
  4. We don’t yet know if the vaccine reduces the risk of dying from COVID-19.
  5. There was insufficient data to draw conclusions about safety and efficacy of the vaccine in children younger than 18, pregnant or lactating women, and patients who are immunocompromised.
  6. We don’t yet know how long immunity lasts and whether or not booster shots will be necessary.

As far as which one you should take, I think Alex’s recommendation would be to take whichever one is offered to you. The news last night said that big pharmacies like CVS may well stock both types, in which case you should consult your doctor.

Here’s a new NYT article by Jonathan Corum and Carl Zimmer about how Moderna’s vaccine works (click on the screenshot; I think the article is free for all). It’s a comic-book-like series of graphics which are very good, and I’ve put a summary at the bottom.

You’ll have to click on the screenshot below, perhaps twice, if you want the whole story in one place.

Guest post: The New Yorker suggests that “other ways of knowing” can cure Covid-19

December 17, 2020 • 9:15 am

A few years ago I got an email from a colleague who was disturbed about the anti-science attitudes of the New Yorker, which include an emphasis on “other ways of knowing” —often through the arts and literature. But first I’ll repeat my colleague’s analysis:

The New Yorker is fine with science that either serves a literary purpose (doctors’ portraits of interesting patients) or a political purpose (environmental writing with its implicit critique of modern technology and capitalism). But the subtext of most of its coverage (there are exceptions) is that scientists are just a self-interested tribe with their own narrative and no claim to finding the truth, and that science must concede the supremacy of literary culture when it comes to anything human, and never try to submit human affairs to quantification or consilience with biology. Because the magazine is undoubtedly sophisticated in its writing and editing they don’t flaunt their postmodernism or their literary-intellectual proprietariness, but once you notice it you can make sense of a lot of their material.

. . . Obviously there are exceptions – Atul Gawande is consistently superb – but as soon as you notice it, their guild war on behalf of cultural critics and literary intellectuals against scientists, technologists, and analytic scholars becomes apparent.

Today’s topic, though, is “other ways of knowing through folk wisdom“. In particular: ways of healing used by indigenous people. Now this shouldn’t be rejected out of hand; after all, many modern remedies, like quinine, derive from plants used by locals. But that doesn’t imply a wholesale endorsement of “the collective lived experience” touted in this video about plant-based healing. For the “collective lived experience”, after all, sometimes includes shamanism and, in the example below, “spiritual elements” as a way of curing disease. And here the disease that “lived experience” tackles is something the Siekipai of Ecuador have never experienced: Covid-19.

Reader Jeff Gawthorpe saw a New Yorker video at the link below; I’m not sure whether you’ll have free access, but you will using the yahoo! finance link at the bottom, where the video was republished.

Jeff is about as distressed as I by the fulminating wokeness of the magazine and delivered his critical “review” of the video, which I asked if I could put up in full, including his name. (I don’t like paraphrasing other people’s words, especially when they’re as good as the analysis below). Jeff said that was fine, and so here is his take, indented. I have to say that I agree with it, and have a few comments of my own at the bottom.

Around 30 minutes ago I happened across a dreadful video on the New Yorker‘s website, which drove my temptation to meet head with keyboard through the roof. This piece of ‘journalism’ was entitled: “Fighting COVID-19 with Ancestral Wisdom in the Amazon”. And yes, It’s as bad as it sounds: unscientific, irresponsible nonsense. Complete tosh.

The message which the piece attempts to convey is that COVID-19 can be dealt with by ‘lived experience’, ancient ‘ways of knowing’, and a few bits of boiled tree bark. Then, if you hadn’t had enough already, Just before the end, a caption pops up saying: “With a new stock of plants, the Siekopai are prepared to address future outbreaks of the virus according to their traditions.” Urrrhhgg.

You’ll notice that they are canny enough to maintain a degree of plausible deniability by making no definite claims. To me this demonstrates the very worst of journalism:

  • Conveying mistruths to support an ideology
  • Lacking the courage to commit to claims by asserting them as supportable facts

That’s bottom of the barrel journalism at the best of times, but now it’s irresponsible, reckless even. It presents a clear message that indigenous knowledge and ancient wisdom are perfectly acceptable ways of dealing with the pandemic. At no point is it mentioned that these ‘remedies’ are not backed by evidence, clinical or otherwise.

As you know, many western societies have huge anti-vax movements which often distrust and denounce mainstream medicine. Unfortunately, this video just adds fuel to the anti-vaxers fire. By failing to mention that these plant ‘remedies’ have zero efficacy, they are providing implicit support to the anti-science, anti-vax groups. Worse still, they are acting like digital snake oil salesmen, imbuing members of the public with false confidence that that they can avoid or fight off this virus with a couple of well chosen tree bark specimens. It’s dangerous, irresponsible nonsense.

Click below to see the video:

My own comments are few. First, it looks like the “remedy” includes cinchona bark, the source of quinine, as a palliative (the remedy seems directed at symptomatic relief rather than a cure).

Second, even “lived experience”, while useful, is no substitute for double-blind clinical trials. Granted, the Siekipai can’t do that, but they sure as hell should take the vaccination when it gets to them.  And, like Jeff, I think it’s totally irresponsible of The New Yorker to present this video without any kind of caveat. After all, when Trump skirts the truth, they don’t hesitate to correct him.  I guess “lived experience of indigenous people” is a different matter—it’s not as if they’re recommending drinking bleach or anything.

My doctor’s new post about the Pfizer vaccine: your questions answered (and you can ask the doc if you have others)

December 14, 2020 • 10:15 am

My GP, Dr. Alex Lickerman, has once again put up a coronavirus post on his practice’s website, and allowed me to reference it here. It’s timely because it’s all about the new Pfizer vaccine. (A ICU nurse in New York may have been the first to get the shot.) How effective is it, and how do we know that? Is it safe? What about kids under 16, who weren’t part of the clinical trials? And pregnant women, who also weren’t tested? Since this is a mRNA rather than a killed-virus vaccine, should we have extra concerns about safety? What adverse reactions have been reported? If you were already infected, does the vaccination also reduce your risk of getting reinfected?  When will “normal” people who aren’t healthcare workers or nursing-home patients be able to get their jabs?

Alex has kindly agreed, as he has before, to answer readers’ questions about the new vaccine, so put your questions in the comments section below and he’ll address them as he has time. Alex has read all the relevant scientific literature, as well as the data from the vaccine trials, so ask away! But do read his 4-page summary beforehand, as it has a lot of information.

I’m not going to put up his whole post; you can go to his site to see it,  which you can do by clicking on the screenshot below:

I’ll just post Alex’s recommendations, followed by his list of “unanswered questions” (indented). The short message: GET THE SHOT AS SOON AS YOU CAN!

CONCLUSIONS

  1. The vaccine is highly effective in preventing symptomatic COVID-19 infection.
  2. The vaccine is safe. Adverse reactions, both local and systemic, are mostly minor. Though the study hasn’t yet gone on long enough to prove there are no serious long-term adverse affects, such adverse affects, if they exist, are likely to be rare and non-life-threatening based on other Phase I and II studies of other RNA vaccines.
  3. We recommend everyone who is eligible to receive the vaccine should receive it when it becomes available to them.
  4. It very well may take all of 2021 to get everyone who’s willing to be vaccinated to receive the shots, which means it likely won’t be until early 2022 that life returns to pre-pandemic normal. In the meantime, continue to wear a mask when indoors with anyone you don’t live with, wash your hands frequently, and refrain from dining indoors at restaurants.

UNANSWERED QUESTIONS

  1. While suggested by the study, still left unproven is whether BNT162b2 [Pfizer’s name for the vaccine] prevents severe COVID-19 infection, whether it prevents COVID-19 infection after just one dose, and whether it prevents COVID-19 infection in subjects who’ve already had COVID-19.
  2. The study didn’t look to see if the vaccine prevents asymptomatic infection. Nor did it assess whether subjects who developed COVID-19 despite vaccination are less likely to transmit the virus. Thus, it’s not yet clear how effective the vaccine will be in containing the spread of the infection.
  3. The study hasn’t gone on long enough to tell if subjects who were vaccinated yet still contracted COVID-19 have a lower risk of long-term effects of COVID-19.
  4. We don’t yet know if the vaccine reduces the risk of dying from COVID-19.
  5. There was insufficient data to draw conclusions about safety and efficacy of the vaccine in children younger than 16, pregnant or lactating women, and patients who are immunocompromised.
  6. We don’t yet know how long immunity lasts and whether or not booster shots will be necessary.

Pfizer vaccine deemed safe and effective by the FDA, and a question for readers

December 8, 2020 • 8:45 am

Ripped from the headlines of CNN!  Click on the screenshot to read:

Many of us know that the FDA is meeting Thursday to decide whether to approve the Pfizer vaccine for general use. If the approval occurs, vials of vaccine will be making their way across the U.S., ready for immediate transfer into the arms of Americans.

Now, judging by the headline above, it looks almost certain that the FDA will indeed approve the vaccine in two days, and the first ranks of Americans will start getting vaccinated. Who gets it first appears to vary from state to state, but, rightly, healthcare workers and nursing-home patients (and their carers) will almost always be the first in line—and that’s what the FDA recommended as well.  After all, if the vaccine is safe and effective, why wouldn’t it be approved?

The good news gets even better: it appears that some immunity is conferred even after the first dose, which appears by itself to be 50% effective (two are required for the 95% effectiveness). Flu vaccine—the single shot we should all have gotten already this year, is only between 40% and 60% effective. “Effectiveness” is the reduction of risk that you get when you are vaccinated.

From CNN:

An advisory committee to the US Food and Drug Administration on Tuesday released a briefing document detailing data on Pfizer and BioNTech’s Covid-19 vaccine candidate, which will be considered this week for emergency use authorization in the United States.

The document confirms that the vaccine’s efficacy against Covid-19 was 95%, occurring at least seven days after the second dose – an efficacy that had been previously reported by Pfizer. The proposed dosing regimen for the vaccine is to administer two 30-microgram doses 21 days apart.

However, the document also notes that the vaccine, called BNT162b2, appears to provide “some protection” against Covid-19 following just one dose.

The document describes the efficacy of Pfizer’s vaccine in the time between the first and second dose as 52.4%, but the document notes that “the efficacy observed after Dose 1 and before Dose 2, from a post-hoc analysis, cannot support a conclusion on the efficacy of a single dose of the vaccine, because the time of observation is limited by the fact that most of the participants received a second dose after three weeks.”

In other words, “the trial did not have a single-dose arm to make an adequate comparison.”

The document goes on to detail the safety profile of the vaccine as “favorable” and notes that the most common adverse reactions to the vaccine have been reactions at the injection site, fatigue, headache, muscle pain, chills, joint pain and fever.

Severe adverse reactions occurred in less than 4.6% of participants, were more frequent after the second dose and were generally less frequent in older adults as compared to younger participants, according to the document. The document adds that swollen lymph nodes also may be related to vaccination.

That’s good enough for me, and I’ll be taking the shots as soon as my doc recommends it—which I presume will be as soon as I’m permitted to get them.

A STAT-Harris Poll published last month, however, showed that the proportion of Americans willing to get vaccinated depends on the vaccine’s efficacy, but only weakly.  Below are those data in graphic form.  What’s disturbing is that if the vaccine were 50% effective, only 60% of Americans would be likely to get the shots. And even with over 90% effectiveness, which is the case with all the vaccines about to hit the market, the willingness rises to only about 63%—a pathetically low figure. I’ve heard that the acquisition of herd immunity in the U.S. to coronavirus requires that 70% of Americans have immunity; even counting those who were infected, the figures on willingness to get vaccinated doesn’t give us that level of immunity. However, it will protect those smart people who get the shots.

So here’s the question: assuming you can get the shots because you don’t have a condition that bars them, are you going to get vaccinated? (I’m assuming that the Pfizer vaccine, or one with similar effectiveness, is the one on offer.) If not, why not?