Category: medicine and health

Ivermectin: still horsewash

September 26, 2021 • 10:30 am

Yes, I know that ivermectin is used against human lice, rosacea, and worms, and is safe when used properly. And it’s also used against worms in horses, though the veterinary formula appears to differ from the human drug, so those people who buy and swallow animal ivermectin are just dumb.

What I do not know, because the data are unclear, is whether ivermectin is a palliative or preventive of Covid-19. Some studies say that, but none of the studies published so far adhere to the gold standards of drug testing: double-blind randomized tests with very large sample sizes, carried out over a decent length of time. If you look at the FDA link to existing studies below, you’ll see that only one study used a placebo, and only a couple used “standard care”, (i.e. neither vaccination nor drug given).  Most studies appear to be retrospective analyses of ivermectin treatments without controls, and those are worthless.

Because of this, the FDA has definitely warned against ivermectin’s use against covid (and gives a link to existing tests). FDA says this:

Here’s What you Need to Know about Ivermectin. 

  • The FDA has not authorized or approved ivermectin for use in preventing or treating COVID-19 in humans or animals. Ivermectin is approved for human use to treat infections caused by some parasitic worms and head lice and skin conditions like rosacea.
  • Currently available data do not show ivermectin is effective against COVID-19. Clinical trials assessing ivermectin tablets for the prevention or treatment of COVID-19 in people are ongoing.
  • Taking large doses of ivermectin is dangerous.
  • If your health care provider writes you an ivermectin prescription, fill it through a legitimate source such as a pharmacy, and take it exactly as prescribed.
  • Never use medications intended for animals on yourself or other people. Animal ivermectin products are very different from those approved for humans. Use of animal ivermectin for the prevention or treatment of COVID-19 in humans is dangerous.

It also notes that ivermectin, though safe when taken as directed by itself, can interact negatively with other drugs taken by humans.

And here’s one other thing I don’t know for sure, but strongly suspect: if you have a choice of getting vaccinated with any of the major vaccines, and not taking ivermectin, versus another choice of not getting vaccinated but taking ivermectin, your chances of illness and death will be higher if you choose the latter, and that includes possible side effects of both treatments. I don’t think there’s been a controlled study of this, but we’ll have the data some day.

Sure, it’s possible that ivermectin may have some useful effects against Covid-19, preventing or mitigating its symptoms. But we can’t say that with confidence until the results of large studies in progress are completed. They’re not, so those who tell you to take ivermectin and avoid “dangerous” vaccinations are, insofar as they’re influencing anyone, putting lives at risk.

A new letter by five researchers in Nature Medicine (below) examines the studies combined in meta-analyses that purport to show the efficacy of ivermectin for Covid-19. The researchers find flaws in some of them that are so serious that they probably invalidate the conclusions. Click on the screenshot to read for free:

I’ve left out the references, but you can see them in the original letter. Here’s the gist of the author’s conclusions:

Research into the use of ivermectin (a drug that has an established safety and efficacy record in many parasitic diseases) for the treatment and/or prophylaxis of COVID-19 has illustrated this problem [relying on “high volumes of recent, often unpublished trial data of variable quality”] well. Recently, we described flaws in one randomized control trial of ivermectin, the results of which represented more than 10% of the overall effect in at least two major meta-analyses. We described several irregularities in the data that could not be consistent with them being experimentally derived. That study has now been withdrawn by the preprint server on which it was hosted. We also raised concerns about unexpected stratification across baseline variables in another randomized controlled trial for ivermectin, which were highly suggestive of randomization failure. We have requested data from the authors but, as of 6 September 2021, have not yet received a response. This second ivermectin study has now been published, and there is still no response from the authors in a request for data.

It is highly unethical for scientists to withhold published data from other researchers! The letter continues:

The authors of one recently published meta-analysis of ivermectin for COVID-19 have publicly stated that they will now reanalyze and republish their now-retracted meta-analysis and will no longer include either of the two papers just mentioned. As these two papers were the only studies included in that meta-analysis to demonstrate an independently significant reduction in mortality, the revision will probably show no mortality benefit for ivermectin.

Several other studies that claim a clinical benefit for ivermectin are similarly fraught, and contain impossible numbers in their results, unexplainable mismatches between trial registry updates and published patient demographics, purported timelines that are not consistent with the veracity of the data collection, and substantial methodological weaknesses. We expect further studies supporting ivermectin to be withdrawn over the coming months.

Since the above primary studies were published, many hundreds of thousands of patients have been dosed with ivermectin, relying on an evidence base that has substantially evaporated under close scrutiny.

All I know is that I wouldn’t take ivermectin without FDA or CDC approval, and if you’re doing so in lieu of getting vaccinated, you’re foolish.

The researchers also suggest a different way besides large double-blind tests or meta-analysis to analyze data (assuming it’s good data):

Most, if not all, of the flaws described above would have been immediately detected if meta-analyses were performed on an individual patient data (IPD) basis. In particular, irregularities such as extreme terminal digit bias and the duplication of blocks of patient records would have been both obvious and immediately interrogable from raw data if provided.

We recommend that meta-analysts who study interventions for COVID-19 should request and personally review IPD in all cases, even if IPD synthesis techniques are not used. In a similar vein, all clinical trials published on COVID-19 should immediately follow best-practice guidelines and upload anonymized IPD so that this type of analysis can occur. Any study for which authors are not able or not willing to provide suitably anonymized IPD should be considered at high risk of bias for incomplete reporting and/or excluded entirely from meta-syntheses.

Hurdles to the release of IPD from clinical trials are well described, and generally addressable with careful anonymization and integration of data sharing plans at the ethical approval stage of trial planning.

We recognize that this is a change to long-accepted practice and is substantially more rigorous than the standards that are typically currently applied, but we believe that what has happened in the case of ivermectin justifies our proposal: a poorly scrutinized evidence base supported the administration of millions of doses of a potentially ineffective drug globally, and yet when this evidence was subjected to a very basic numerical scrutiny it collapsed in a matter of weeks. This research has created undue confidence in the use of ivermectin as a prophylactic or treatment for COVID-19, has usurped other research agendas, and probably resulted in inappropriate treatment or substandard care of patients.

Meta-analyses, of course, usually combine the results of different studies of a treatment to arrive at an overall conclusion, while IPD uses each patient across many studies as an individual datum to get an overall conclusion. I haven’t investigated the niceties of this analysis, but you can go here or here to see how it’s done.  I am not necessarily recommending this type of analysis, as I haven’t studied it, and those combined patients could also represent data that is dubious but undetectably so. I would therefore still recommend a large number of random, double-blind tests of ivermectin, each including large samples of patients as well as a control group given a placebo.

In the meantime, don’t listen to the neigh-sayers about vaccines. If you don’t have medical contraindications, get your jabs! (This is my recommendation as a doctor, though the wrong kind of doctor.)

Should there be religious exemptions from vaccine mandates?

September 7, 2021 • 9:15 am

The other day I had a bright idea for a post on my drive to the store, and, since my short-term memory has always been lousy, I should have made a note to myself. SInce I didn’t do that, I promptly forgot it, though I knew the topic was interesting.

I was, however, just reminded of what I’d thought of by seeing the title below of a NYT op-ed by Curtis Chang (identified as “a co-founder of Christians and the Vaccine, a consulting faculty member at Duke Divinity School and the C.E.O. of CWR, a management consultancy serving secular nonprofits and government agencies”).

I haven’t yet read this op-ed except for the title, so let me first give my own view before I parse the article.

First, I agree with the title wholeheartedly.  The only people who should be exempted from vaccine mandates are those who might be injured by vaccines, including the immunocompromised.  Now adults above a certain age should be allowed to make medical decisions if those decisions don’t endanger anyone else. Thus, if you have appendicitis and are one of those sects that don’t accept medical intervention (Christian Science is supposed to be one, but members often sneak around the restrictions), it’s okay by me if you reject the operation and endanger yourself. (If you have a wife and kids, however, that may be another matter, largely because the kids, who could be left without a parent, don’t get to choose their faith.)

But with vaccinations, you’re endangering not only yourself by rejecting science-based medicine, but others as well. Thus, if you refuse the Covid shot on religious grounds, you’re endangering other people because you might get infected and spread the virus. Even if nearly everyone else is vaccinated, you could still infect the few who aren’t. Even the Bible talks about rendering unto Caesar. Well, Caesar is the state, and to the state belongs the purview of preventing pandemics and epidemics.

The fact that religious people are allowed to refuse medical care for their kids in some places, or get a slap on the wrist when they do—even when the child dies—is absolutely unconscionable. It’s one of the unjustified forms of “respect” that we afford to religious beliefs. The subject of religion and healthcare is largely the subject of the last chapter of my book Faith Versus Fact, and I tell some horrific stories of those who believe in faith healing letting their children die in the vain hope that God would save them. This should be a felony, and it is in some places, but all too often that unwarranted “respect” for faith gets parents either off the hook or with a minimal sentence. And all too often those parents justify their behavior, even when, by withholding medical care, they’ve killed their own child. As I note in my book (p. 234):

It’s not just the parents who are at fault. Religious exemptions are written into law by the federal and state governments—that is, those who represent all Americans. In fact, 38 of the 50 states have religious exemptions for child abuse and neglect in their civil codes, 15 states have such exemptions for misdemeanors, 17 for felony crimes against children, and five (Idaho, Iowa, Ohio, West Virginia, and Arkansas) have exemptions for manslaughter, murder, or capital murder. Altogether, 43 of the 50 states confer some type of civil or criminal immunity on parents who injure their children by withholding medical care on religious grounds.

As for vaccinations, there should be no religious exemptions for getting them, regardless of the dictate of your faith. That’s because refusing a vaccine is not a decision with purely personal consequences, but can have widespread and deleterious effects on other people. And yet, as I note further in my book (pp. 235-236):

Religious exemptions for vaccinations, allowed in 48 of the 50 U.S. states (all except Mississippi and West Virginia) endanger not only the children who don’t get immunized, but the community in general:  not everyone gets vaccinated, and even those who are don’t always acquire immunity. To attend public schools and many colleges, like the one where I teach, students must show evidence of vaccination for diseases like hepatitis, measles, mumps, diphtheria, and tetanus. The only exemptions permitted are for medical reasons, like a compromised immune system—and religion.

Nor are Christians the only believers who oppose immunization. Islamic clerics in Afghanistan, Pakistan, and Nigeria urge their followers to oppose polio vaccination, declaring it a conspiracy to sterilize Muslims. These efforts may prevent the complete eradication of polio from the human species, something already been achieved for smallpox. Dr. A Majid Katme, spokesman and former head of the Islamic Medical Association of the UK, described by the Guardian as “a respected figure in the British Muslim community,” has come out against all childhood vaccination, claiming that “the case of vaccination is first an Islamic one, based on Islamic ethos regarding the perfection of the natural human body’s immune defense system, empowered by great and prophetic guidance to avoid most infections.”  Taking his advice would, of course, be disastrous.

In all states, immunizations are required for public school enrollment, except for medical, religious and philosophical exemptions. Here’s the latest map (2021) of exemptions, taken from The National Conference of State Legislatures. As you can see, since my book was published in 2015, it appears that four states—Maine, New York, Connecticut, and California—no longer grant religious exemptions for vaccination. That’s good news. Note as well that only 15 states allow philosophical exemptions (the striped ones are also blue, meaning that they allow religious exemptions too). This shows not only that religion gets precedence over philosophy, but also that this precedence makes no sense, since a philosophical exemption is presumably a “reasoned” one (misguided though it may be), while religious dictates come from scripture or authority. Every state in the map below should be white.

Now I’ll read the article, and you are free to at any time by clicking on the screenshot below.

Chang and I largely agree, but diverge in three important ways:

First, though, he notes that the religious exemption comes from Title VII of the Civil Rights acts, which “require American employers to accommodate employees’ religious beliefs.” And those are the grounds on which many people are claiming religious exemption from the Covid vaccination, though Chang believes that these religionists aren’t really doing it on religious grounds (which don’t exist anyway, see below), but are “nonreligious and rooted in deep-seated suspicion of government and vulnerability to misinformation.”

Further, and this is what made me realize originally that this topic deserves a post, how many religions really have dictates prompting their followers to refuse vaccination?  We know about Christian Science, of course, and there are dozens of evangelical Christian sects, largely in the American Northwest, that refuse medical care as part of their faith. But try to find a justification for that in scripture. As Chang notes:

. . . there is no actual religious basis for exemptions from vaccine mandates in any established stream of Christianity. Within both Catholicism and all the major Protestant denominations, no creed or Scripture in any way prohibits Christians from getting the vaccine. Even the sect of Christian Scientists, which historically has abstained from medical treatment, has expressed openness to vaccines for the sake of the wider community. The consensus of mainstream Christian leaders — from Pope Francis to Franklin Graham — is that vaccination is consistent with biblical Christian faith.

Biblically based arguments against vaccination have been rebutted. The project Christians and the Vaccine, which I helped to found, has created numerous explainer videos in an effort to refute attempts by anti-vax Christians to hijack pro-life values, to distort biblical references like the “mark of the beast” and to inflame fears about government control. Christians who request religious exemptions rarely even try to offer substantive biblical and theological reasoning. Rather, the drivers for evangelical resistance are nonreligious and are rooted in deep-seated suspicion of government and vulnerability to misinformation.
Chang is doing a good deed by pointing out the weakness of religious exemptions for vaccination, and by insisting that all employers should get rid of religious exemptions for coronavirus vaccines (he specifies “for Christians”, but I think no religious exemptions should be allowed).

That’s one way we differ. The other is that Chang appears to think that Christians have a “right” to refuse the vaccine in general, though not necessarily to be employed without it:

My plea to my fellow Christians: If you insist on refusing the vaccine, that is your right. But please do not bring God into it. Doing so is the very definition of violating the Third Commandment, “Thou shalt not take the name of the Lord thy God in vain.”

I don’t think there’s a “right” for Christians to refuse vaccines deemed essential by the state. They have no more right to do that than to refuse to pay taxes on religious grounds, nor to send their children to public schools without the required shots (except, of course, for those pesky exemptions).  And not paying taxes is far less harmful to society than walking around with a possibly infectious microbe.  Everyone should be vaccinated for diseases like Covid unless there are medical contraindications. I can see no reason not to. People may say that a few people may suffer serious side effects, but those are far less harmful than living through a pandemic.

Finally, many religious schools allow unvaccinated children to attend, and some parents are sending their children there, or homeschooling them, to get around the normal vaccine requirements (right now only older children must be vaccinated). For safe vaccines, as Covid-19 jabs will surely prove to be for younger children, all children everywhere must be vaccinated, just like adults. After all, even religious children mingle with the general public, and endanger them when they’re unvaccinated.

Of course given my view that religion is man-made and generally detrimental to society (this is of course demonstrated by the last chapter of my book), I would object to any favoritism based on religion that doesn’t apply to secular people. (This doesn’t mean, though, that I favor philosophical exemptions to vaccination!) But you don’t have to go that route when making the argument that nobody should be exempt from a Covid vaccination except on medical grounds. The public health argument is sufficient.

Perhaps you disagree, or have other views. By all means, use the comments to air your thoughts.

An academic paper: Which saint is best to pray to if you’ve got Covid?

August 28, 2021 • 10:45 am

Inquiring minds want to know, and three Europeans (perhaps in cahoots with the divine) have answered:

When a reader sent me this article, and I read the online condensed version (it takes two minutes), I thought it as a joke. But no, it’s for real. You can see the journal site here, and a response to the article is the first one listed on the contents page of the latest issue. I’d love to see the response, or the full original paper (you can see a precis by clicking on the screenshot below).  I’ve archived the article’s precis here in case that for some reason they ditch the article.

 

Okay, I’m going to show you the whole “snippet” of the paper as presented by the journal:

Short report

Which Saint to pray for fighting against a Covid infection? A short survey

Summary

Background

In the absence of a treatment still considered universally effective, and of a vaccine validated by the health authorities, we wanted to know which Catholic saint the European Christian community turned to in the event of infection with Covid-19 to request a miraculous healing.

Methodology

An online survey was carried out on a sample of 1158 adults using social media tools.

Results

All results are presented in this research, with a few saints in the majority, and some dictated by the symptomatology of the Covid-19 infection or the personalities of certain « doctor guru ».

Conclusion

This medico-anthropological study is revealing the psychology of Western patients vis-à-vis the magic-religious means used in the fight against diseases, particularly in the epidemic/pandemic context.

Section snippets

Background

The relationship between religion and medicine is well known in human communities since antiquity. Medieval medicine was based on Hippocratic and Galenic doctrines, but it was also characterized by spiritual and divine influences. So, in European countries, in Middle Ages, Saints’ invocation for the curing of diseases was an usual practice.

Despite, the spiritual and religious dimensions have deviated from medicine after the Renaissance and the Late Enlightenment, the intercession to the Saints. . .

Methodology

We conducted a survey on two of the most used social networks: Twitter and Facebook. The survey was conducted between August 21 and 25, 2020. Each author posted on his Twitter and Facebook page, the following question: “Which saint you would pray for fighting against a Covid infection?”. The total number of followers targeted by the question was 15,840 people (92% from Europe).

Results

A total of 1158 adult anonymous participants (mainly from France and Italy) answered to our question. For obvious ethical reason, no sex, age or cultural background are available. All results are summarized in Table 1.

Discussion

Analyzing the results in more detail, from the survey it emerges that the majority saint is St. Rita (Fig. 1). From a young age, Rita of Cascia (Italy, 1381-1457) dreamed of consecrating herself to God, but she was destined to marry a violent man. Rita’s patience and love changed her husband’s character. After the violent death of her husband and two children from illness, Rita decided to follow the youthful desire by entering the monastery of the Order of Sant’Agostino in Cascia (Italy) [4].

Conclusions

This short medico-anthropological study is revealing the psychology of Western patients vis-à-vis the magic-religious means used in the fight against diseases, particularly in an epidemic/pandemic context. The survey confirms that Catholic people continue to entrust their sorrows, their anxieties and their hopes to the divinity, especially in time of global stress, mainly if it is a suddenly-presented difficulty that have changed the people’s lifestyle. Moreover, the choice of the Saints to. . .

Authors’ contributions

AP had the initial idea of the search and contributed to the survey. AC contributed to the survey. PC wrote the first draft of the manuscript, with significant critical input from all other coauthors. All authors have read and approve the final article. PC is the manuscript guarantor.

Disclosure of interest

The authors declare that they have no competing interest.

So if you don’t get vaccinated, you better start praying to Saint Rita.

This is unbelievably stupid. And their research used subjects garnered from Twitter and Facebook!

Note that this isn’t just a survey of opinion, but is somewhat prescriptive: “In the absence of a treatment still considered universally effective, and of a vaccine validated by the health authorities, we wanted to know which Catholic saint the European Christian community turned to in the event of infection with Covid-19 to request a miraculous healing.”

Elsevier should be ashamed of itself. If anybody has access to the letter of response, I’d love to see it.

h/t: Ginger K

JAMA and race

August 23, 2021 • 10:45 am

The Journal of the American Medical Association has published a 6-page article about how to incorporate race and ethnicity into medical reporting. It’s not bad as far as it goes; in fact there’s only one thing wrong with it, but to me it seems like a big thing. Read by clicking on the screenshot below; you can also download a pdf file at the site.

They first define “race” and “ethnicity” by using the Oxford English Dictionary, which is the way I’d go about it. Here are their definitions:

The Oxford English Dictionary currently defines race as “a group of people connected by common descent or origin” or “any of the (putative) major groupings of mankind, usually defined in terms of distinct physical features or shared ethnicity” and ethnicity as “membership of a group regarded as ultimately of common descent, or having a common national or cultural tradition.” For example, in the US, ethnicity has referred to Hispanic or Latino, Latina, or Latinx people.

Although these definitions are overlapping, since they both incorporate people of “common descent”, one (or at least I) tend to think of “race” as the assertion, now known to be wrong, that humanity is divided up into a finite number of physically and genetically well-demarcated groups. (This claim historically went along with the assertion that there’s more genetic variation between “racial” groups than within those groups, we now know that that is absolutely wrong; within-group variation hugely predominates). Nevertheless, one can show by using data from many genes and gene sites, and clustering algorithms, that humanity can be shown to form genetic clusters that correspond to geography, which of course corresponds to evolutionary history.

But the issue is that there are clusters within clusters within clusters, and where you draw the line and say “this cluster” is a “race” is purely subjective. That’s why I don’t like the term “race”, as it’s too freighted with biological misconceptions as well as social assumptions and, of course, the use of “race” as a way to divide and rank people. .

“Ethnicity” is a different matter, as it’s not freighted, and although the definition above conflates ancestry with “cultural tradition”, they’re often connected. But for biological purposes I’d stick with ancestry, which of course refers to shared genes.

What I object to in the JAMA article is this sentence (I’ve put it in bold):

Race and ethnicity are social constructs, without scientific or biological meaning.

This is not so much flat wrong as grossly misleading. For example, I just cited the paper of Rosenberg et al., which shows that the genetic endowment of human groups correlates significantly to their geographical location (for example, if you choose to partition human genetic variation into five groups (how many groups you choose is arbitrary), you get a pretty clear demarcation between people from Africa, from Europe, from East Asia, from Oceania, and from the Americas. (To show further grouping, if you choose six groups, the Kalash people of Asia pop up). This is one reason why companies like 23 And Me stay in business.

This association of location with genetic clustering (and these geographic clusters do correspond to old “classical” notions of race) is not without scientific meaning, because the groupings represent the history of human migration and genetic isolation. That’s why these groups form in the first place. Now you can call these groups “ethnic groups” instead of “races”, or just “geographic groups” (frankly, you could call them almost anything, though, as I said, I avoid “race), but they show something profound about human history. The statement in bold above could be used to dismiss that meaning, which is why I consider that statement misleading.

As I said, there are groups within groups. Even within Europe, a paper by Novembre et al. reported, using half a million DNA sites, 50% of individuals could be placed within 310 km of their reported origin and 90% within 700 km of their origin.. And that’s just within Europe (read the paper for more details). Again, this reflects a history of limited movement of Europeans between generations.  Finally, in terms of “self identification”,  Tang et al., using just 326 markers, performed a genetic cluster analysis and identified four groups that matched nearly perfectly with the “racial” self-identification of people given four choices (white, African-American, East Asian, and Hispanic). Here’s what they found:

Of 3,636 subjects of varying race/ ethnicity, only 5 (0.14%) showed genetic cluster membership different from their self-identified race/ethnicity. On the other hand, we detected only modest genetic differentiation between different current geographic locales within each race/ethnicity group. Thus, ancient geographic ancestry, which is highly correlated with self-identified race/ ethnicity—as opposed to current residence—is the major determinant of genetic structure in the U.S. population.

That is, there is almost perfect correspondence between what “race” (or ethnic group)  Americans consider themselves to be and the identification of groups using observed genetic differences. Because these are Americans, and move around more, the genetics reflect ancestry more closely than geography, though in Europe geographic origin is also important.

I needn’t point out that the morphological traits that we use to distinguish people from different areas also reflect genetic differences, including facial characteristics, hair color and texture, eye shape, and, of course, pigmentation. These are based on genetic differences. Of course this doesn’t mean there is a “Caucasian race” distinguishable by morphology, but simply that the way we have divided up humanity is not without biological meaning. (What these differences mean, and how they evolved, is of course, obscure.) Again, there is biological meaning in ethnicity, if you see ethnicity as reflecting groups having common evolutionary descent.

Finally, as we all know, different ethnic groups have different incidence of genetic diseases, and these reflect genetic differences among groups. West African blacks and their descendants in the U.S. are, for example, more prone to sickle-cell disease than those of other groups. Ditto for Tay-Sachs disease and Ashkenazi Jews. Of course these diseases are not found only within the ethnic groups, but there are significant difference in the incidence of diseases, and thus in the gene forms causing those diseases, among these groups. If you consider West African or Ashkenazi Jews as “ethnic groups”, which they are according to the definition above, then yes, ethnicity has a biological meaning, which reflects evolutionary history and common ancestry (if you don’t know the sickle-cell story, you should look it up).

The article goes into all kinds of nuances about how to report race (self-report seems to be the best way), and I don’t have much of a beef with their classification or how it’s to be used. EXCEPT that they recommend recording race not as a way to aid in diagnoses and genetic counseling (if two Ashkenazi Jews came to an obstetrician, she’d probably recommend they be tested to see if they were Tay-Sachs carriers, but she wouldn’t recommend the same for blacks) but as a way to ensure “equity” of treatment and accurate reporting of the incidence of diseases.

The article’s underlying rationale for recording race at all is that although (as they claim) race or ethnicity has nothing to do with biology, it does have to do with socioeconomic factors like racism, “disparities and inequities” and “intersectionality”, and those factors may play a role in disease.  Note that class is not even mentioned, even though that surely plays a big role as well. But to ignore ethnicity except insofar as it (supposedly) closely correlates with health-related socioeconomic conditions is to not only overlook genetic data correlated with disease, but also to make unwarranted assumptions—that all members of an ethnic group are likely to share socioeconomic factors causal in disease.

I guess what bothers me the most about this article, besides the ignoring of genetic factors in favor of socioeconomic ones, is the claim that there is no biological significance of “race” or “ethnicity”. Depending on how you define these terms, that’s misleading. And if you use a “common ancestry” definition of either word, it’s just wrong. The claims that race and ethnicity are social constructs having nothing to do with biology overlooks a whole world of genetics, evolution, and demographics. It’s a phrase that hides what interests many of us about variation among groups in the human population. (For another take on genetic differences between groups that reflect evolution via different local adaptations, see this short note by Sarah Tishkoff, which shows that many interesting and important adaptations vary among ethnic groups.)

In other words, what bothers me is the idea, reflected in the statement in bold above, that all humanity is genetically the same. This is a mantra of much of the Left, reflecting a repugnance towards biological determinism and a sense that humans are almost infinitely malleable. But humans are genetically not the same, whether you’re talking about differences between ethnic groups or between men and women. It’s time that we face the data and admit this, and also realize that recognizing group differences is not at all the same as admitting that some groups are “better” than others. The assumption that the recognition of differences will automatically lead to ranking and then to bigotry is the mistaken conflation that produces articles like the one in JAMA.

As Richard Feynman said in another context (the Challenger disaster), “For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.” .

h/t: Bill

_______________

Flanagin A, Frey T, Christiansen SL, AMA Manual of Style Committee. Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA. 2021;326(7):621–627. doi:10.1001/jama.2021.13304

More evidence that COVID-19 had a zoonotic (animal) origin and didn’t come from a lab

August 19, 2021 • 10:30 am

“Zoonotic,” in case you didn’t know, refers to an infectious disease transmitted between animals. And, in a post a few days ago, I highlighted a paper in Science suggesting that the coronavirus did originate as a zoonotic disease: it came from horseshoe bats and was transferred by bats to another mammal (one likely candidate is the palm civet or “civet cat”, a viverrid, not a felid), and then from this mammalian carrier to humans in Wuhan “wet markets.” The authors emphasized that there was no evidence that the virus came out of the local lab.

A new paper in press in Cell comes to the same conclusion, though they summarize all the evidence, not just the phylogenetic evidence (family tree of viruses). The new paper, however, is not as certain about the species of mammal that transferred the virus from bat to human. But they are pretty sure that the virus was not cultured in the Wuhan Institute of Virology (WIV), and then either escaped or was somehow released to cause disease. This paper, which Matthew called to my attention, has an international team of distinguished disease experts as authors, and they summarize all the evidence that COVID-19 is a purely zoonotic disease and escaped from a Wuhan wet market, not from the WIV. The paper is really only 11 pages long, and you can download the pdf by clicking on the screenshot below.

I’ll just summarize the lines of evidence (there’s more in the paper, too, but the first 11 pages of double-spaced text is all you need to read.

1.) All previous coronavirus infections of humans (viruses other than SARS-CoV2, or what I’ll call COVID-19) have a zoonotic origin, several of which had their origin in “wet markets” selling animals like civet cats and raccoon dogs. Workers in these markets have high concentrations of antibodies against various coronaviruses.

2.) The sequence of COVID-19 is similar to that of other coronaviruses in humans known to have zoonotic origins.

3.) Epidemiologically, the spread of the virus strongly implicates the wet market in Wuhan as the source, not the WIV.  As the authors note:

Based on epidemiological data, the Huanan market in Wuhan was an early and major epicenter of SARS-CoV-2 infection. Two of the three earliest documented COVID-19 cases were directly linked to this market selling wild animals, as were 28% of all cases reported in December 2019 (WHO, 2021). Overall, 55% of cases during December 2019 had an exposure to either the Huanan or other markets in Wuhan, with these cases more prevalent in the first half of that month (WHO, 2021). Examination of the locations of early cases shows that most cluster around the Huanan market, located north of the Yangtze river (Figure 1B-E), although case reporting may be subject to sampling biases reflecting the density and age structure of the population in central Wuhan, and exact location of some early cases is uncertain. These districts were also the first to exhibit excess pneumonia deaths in January 2020 (Figure 1F-H), a metric that is less susceptible to the potential biases associated with case reporting. There is no epidemiological link to any other locality in Wuhan, including the Wuhan Institute of Virology (WIV) located south of the Yangtze and the subject of considerable speculation. Although some early cases do not have a direct epidemiological link to a market (WHO, 2021), this is expected given high rates of asymptomatic transmission and undocumented secondary transmission events, and was similarly observed in early SARS-CoV cases in Foshan (Xu et al., 2004).

If you’re a conspiracy theorist that the virus was released from the lab by mistake, you’d have to say that it somehow got itself over to the wet market before it started infecting people. The wet market, not the WIV, was the epicenter of the infection.

4.) The COVID-19 virus was actually detected in “environmental samples” taken in the Hunan wet market, especially in the part of the market that sold animals and animal parts.

5.) As I showed in my post two days ago, the viruses closest in sequence to the human COVID-19 virus are three bat viruses from Yunnan. (It’s still not clear how they or their relatives found their way to the Yunnan wet market). But the telling part is, as the authors say, “None of these three closer viruses were collected by the WIV and all were sequenced after the pandemic had begun.”

6.) The absence of the known intermediate animal host for COVID-19 does not suggest that the virus was clearly engineered by humans in the lab, for the animal source of many human pathogens of zoonotic origin, including Hepatitis-C, polio, and Ebola, have not been identified.

7.) Although there have been isolated incidents in labs in which people got infected with viruses, there’s been only one documented example of a pandemic coming from human origin: “the 1977 A/H1N1 flu epidemic, that most likely originated from a large-scale vaccine challenge trial.” There are no epidemics known caused by the escape of a novel virus. (You might respond that, “Well, this could be the first one,” but the other evidence I adduce tells against this.)

8.) There is no evidence that the WIV or any other lab was working on the SARS-CoV-2 virus or any related virus before the pandemic.

9.) Despite extensive attempts to find the virus in workers at the WIV, there are no reports of COVID-19 infections in that institute.

10.) Previous experimental work on coronaviruses at the WIV have involved inserting a “genetic backbone” and other genetic markers that we do not see in the human COVID-19 virus that’s causing the pandemic.

11.) To culture the virus in the lab, workers would have to infect wild-type mice, but were unable to do so with SARS-CoV-2.  The virus has since been engineered to be culture-able in mice, but that occurred after the pandemic had already begun.

12.) Adaptive mutations that enhanced the infectivity of the virus arose after the pandemic started, ergo were not engineered in the lab.

13.) Sequences that “lab-contaminant” advocates say could only have been engineered into the virus by humans have in fact been found naturally in other coronaviruses. That they’re missing in close relatives of the coronavirus could reflect only our pretty profound ignorance of what strains SARS-CoV-2 evolved from from.  And there is no evidence that that kind of genetic engineering was ever going on at WIV.

The “conclusions” on pp. 10-11 are pretty clear:

“the most parsimonious explanation for the origin of SARS-CoV-2 is a zoonotic event” involving transfer from an intermediate host in a Wuhan wet market.

“There is currently no evidence that SARS-CoV-2 has a laboratory origin.”

And the last paragraph:

We contend that although the animal reservoir for SARS-CoV-2 has not been identified and the key species may not have been tested, in contrast to other scenarios there is substantial body of scientific evidence supporting a zoonotic origin. While the possibility of a laboratory accident cannot be entirely dismissed, and may be near impossible to falsify, this conduit for emergence is highly unlikely relative to the numerous and repeated human-animal contacts that occur routinely in the wildlife trade. Failure to comprehensively investigate the zoonotic origin through collaborative and carefully coordinated studies would leave the world vulnerable to future pandemics arising from the same human activities that have repeatedly put us on a collision course with novel viruses.

This paper is of course tentative, like all such conclusions, but the data add up to a “normal” zoonotic event and not escape from the lab. It’s clear the virus was not engineered to kill humans as a bioweapon, as there’s no evidence that the WIV worked on it. And even if it did, why would it happen to escape to a wet market—places where these viruses are known to exist naturally.  Nor is there evidence that the WIV was simply studying the virus and it escaped as an accident that caused the pandemic.

In other words, conspiracy theories about the virus seem to be untenable, but, humans being human and prone to conspiracies, they’ll persist.

UPDATE: in the thread after this tweet, third author Rasmussen goes through the evidence that people think supports a lab origin, and then dispels it:

h/t: Matthew

The origin of the coronavirus

August 17, 2021 • 1:00 pm

A new paper in Science (click on screenshot below, pdf here, reference at bottom) suggests that Covid-19—referred to in this study as SARS-CoV-2—likely originated in horseshoe bats that were collected in Yunnan in southern China, were not contaminations from the Wuhan Institute of Viriology (WIV), but were transferred to humans via an intermediate animal vector (probably a civet cat) in a wet market. Note that two of the authors are Chinese, and one might think that they have an interest in exculpating the WIV, but that opens up a whole can of worms that I’d prefer to avoid.

Click:

Here’s a phylogeny (family tree) of the “sarbecoviruses” that are evolutionarily closest to the Covid-19 virus, with the caption from the Science paper. Click on photo twice to make it really big.

Note that the three viruses closet to human coronavirus in sequence are all from areas close together in Yunnan, and all in species of horseshoe bats ( genus Rhinolophus, variants RpYN06, RmYN02, and PRC31). Viruses in pangolins (Manis javanica), also presumably derived from bats, are much less closely related, and thus unlikely as a source of human infection. The virus RaTG13, sequenced and kept at WIV, seems too distant from the human coronavirus to have been the source, and horseshoe bats are found not just in Yunnan, but are widely dispersed throughout China.

The authors posit that, since bats were not sold in Wuhan markets, another animal—they think the civet cat—is the likely transmitter of the virus to humans in a wet market, and this happened in about December of 2019. The bat virus may have gotten into a civet (or a raccoon dog, or a fox, or a mink) on one of the many farms where these animals are raised for sale as meat, and then transported to wet markets in other places in China.

As an interesting sidelight, the authors suggest that the spread of the coronavirus was promoted by a shortage of pork in China in 2019, which itself was due to swine flu that led to 150 million pigs being killed. They posit that other animals, like civet, could have replaced pork in the diet, and those animals would be intermediate vectors that led to the interspecies leap in late 2019. (Our own species is now considered the main vector for Covid-19!).  They suggest, alternatively, that the virus could have survived in frozen wild meat rather than in live animals sold in wet markets.

Finally, now that we’re the main host of the virus, the authors worry that we ourselves could infect other wildlife, which would then become reservoirs for evolution and re-infection (this is called “reverse zoonoisis”)

There are several questions that are unanswered in this short paper, but may be common knowledge. How do the authors manage to discount a lab strain as a source of the human infection? Were the closest Yunnan viruses not kept in the Wuhan Institute? Did anybody sample civets or other animals sold in the Wuhan market for coronavirus? (The market, of course, is closed, so this may be impossible.) Why do the authors consider the civet cat (palm civet) the most likely intermediate host of the virus? They cite this paper, showing a near-identity of the human and palm civet virus, but do they have similar data from other mammals?

I am not an expert on the various theories of transmission of cornavirus from bats (the most likely origin) to humans, but offer this for your delectation.

___________

Lytras, S., W. Xia, J. Hughes, X. Jiang, and D. L. Robertson. 2021. The animal origin of SARS-CoV-2. Science: DOI: 10.1126/science.abh0117

The woke termites burrow their way into therapists’ offices

August 14, 2021 • 10:30 am

You’d think that the last places one would start treating individuals as embodying characteristics of their “tribe” are the offices of therapists.  After all, both psychologists and psychiatrists are expected to deal with their patientS as people with unique problems, and not impute to the patient “group” characteristics based on stereotypes or political ideology. Nor should they impose their own political views on their patients, which is a real no-no for therapists. (They do, of course have ideas on how to treat patients, and make suggestions, but not of the genre, “hey, maybe you’d feel better if you wore a MAGA hat.”)

Well, the idea that therapy is ideology-free is, of course, dead wrong, especially now when there is no tent in the Universe where the Woke Camel won’t stick its nose. And so the nose goes onto the couch, as recounted in this Persuasion article by Sally Satel. Click on the screenshot to read:

Now activist therapists aren’t new; for years we’ve had specimens who impose their own views on patients rather than sussing out a patient’s problems from their own words. These activists include “recovered memory therapists”, who, it seems, already know what memories are supposed to be recovered, and try to convince the patient about the truth of things that might never have happened.

You’ve heard of the McMartin preschool case, in which recovered memory therapists dug up instances of sexual and even Satanic abuse of children that never happened. The accused people spent several years in jail, but were eventually acquitted. Right now Jerry Sandusky is sitting in prison for sexual abuse of young boys, with a lot of the testimony that put him there “recovered” by therapists digging around in the minds of young people. (Some said they weren’t abused but, after some bouts with the therapists, suddenly remembered that Sandusky committed sexual acts on them).

These therapists are clearly activists, and one would, based on their activities and the political leanings of therapists, expect them to often be on the Left.

Sally Satel, a psychiatrist who wrote this piece, is against activism, though she is affiliated with the Right-Wing American Enterprise Institute. Wikipedia says she’s a “political conservative” and has also written several books about the incursion of Left-wing doctrine into medicine, like this one (click to go to Amazon site):

Satel’s also identified as working at a methadone clinic in Washington D.C. and as a visiting professor at Columbia University’s Vagelos College of Physicians and Surgeons. If you’re one of those, you can ignore her views simply because she’s a conservative, but you might be missing some truths. And her claimed truth in this piece, which can be at least partly checked by following the links she gives, is that therapy is increasingly turning into the instillation of woke attitudes into patients as the world because woker. I doubt that, in these times, you’ll find that thesis inherently unlikely! But here’s what she says:

Until roughly five years ago, people seeking mental health care could expect their therapists to keep politics out of the office. But as counselor education programs and professional organizations across the country embrace a radical social justice agenda, that bedrock principle of neutrality is crumbling. Mental health professionals—mainly counselors and therapists—are increasingly replacing evidence-driven therapeutics with ideologically motivated practice and activism.

The Graduate Counseling Program at the University of Vermont, for example, intends to “structurally align” itself with the Black Lives Matter movement and begin “the work of undoing systemic white supremacy.” After George Floyd’s death, the Johns Hopkins University Counseling Center advised would-be students to “consider us one of many resources in the difficult but necessary work of engaging with internalized bias, recognizing privilege, and aligning values of anti-racism and allyship with embodied and sustained practice.”

Such sentiments are not limited to mission statements—they are playing out in the real world of clinical training. Some counseling programs encourage students to engage in social justice activism. Most troubling of all, trainees are being taught to see patients not as individuals with unique needs, but as avatars of their gender, race, and ethnic groups. Accordingly, more and more counselors encourage their patients to understand their problems as a consequence of an oppressive society. White patients, for instance, are told that their distress stems from their subjugation of others, while black and minority patients are told that their problems stem from being oppressed.

The stakes for patients are high. When therapists use patients as receptacles for their worldview, patients are not led to introspection, nor are they emboldened to experiment with new attitudes, perspectives, and actions. Patients labeled by their therapists as oppressors can feel alienated and confused; those branded as oppressed learn to see themselves as feeble victims. It is difficult to imagine how a healthy therapeutic alliance between counselor and patient—a core bond nurtured through a clinician’s posture of caring neutrality and compassionate detachment—could thrive under these conditions.

Is it hard to imagine that therapists might engage in this form of indoctrination when secondary-school and college teacher do it all the time? Satel goes on:

The American Counseling Association, “the world’s largest association exclusively representing professional counselors,” has a Code of Ethics that explicitly cautions against such boundary violations: “Counselors are [to be] aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors.” Yet the association has said nothing about the overt ideological stance of some programs, or blatant instances of imposition.

It’s hard to argue with that paragraph’s advice. Nor is it hard to believe that any form of propagandizing patients will be aimed at moving them toward the left because, at least according to Five Thirty Eight, social and personality psychologists are about as liberal as college professors:

When New York University psychologist Jonathan Haidt asked about a thousand attendees at the annual meeting of the Society for Personality and Social Psychology in 2011 to identify their political views with a show of hands, only three hands went up for “conservative or on the right.” Separately, a survey of more than 500 social and personality psychologists published in 2012 found that only 6 percent identified as conservative overall, though there was more diversity on economic and foreign policy issues.1 The survey also found that 37.5 percent of respondents expressed a willingness to discriminate against conservative colleagues when making hiring decisions. Psychologists, it appears, tend to fall on the liberal end of the political spectrum.

I expect therapists will line up pretty much the same way.

Now it’s okay if a patient’s problems involve politics. Perhaps he was driven to fury by Trump, and it’s upsetting his life. Or he can’t live in a world in which race seems to be the main driver of everything. Then the therapist can draw out the patients and suggest ways to improve their lives. But I don’t think it’s ever valid to impose your own politics on a patient, nor to treat them as a member of a political or ethnic group rather than an individual, like trying to urge them to be “more black or Hispanic” or “less white”.  Satel has a couple of anecdotes about this, but remember, they are anecdotes.

Central to the ideology that’s creeping into the field of mental health care is a growing aversion to recognizing personal responsibility and agency. One colleague of mine who works in a prominent psychiatry department told me that during a group discussion of the growing problem of stress and suicide in black youth, her colleagues were unwilling to discuss explanations that pointed to factors coming from within beleaguered communities. Thus, participants who pointed to fear of police aggression and societal discrimination were greeted with nods, but when she suggested they also consider bullying by classmates, chaos in the home, or neighborhood violence, she was ignored.

I have had my own encounter with this growing illiberal strain. Following a lecture I gave earlier this year to a group of psychiatrists and trainees, I was castigated by several attendees for drawing attention to personal agency in overcoming drug addiction. My transgression, as they saw it, was to “blame the victim” and take focus away from factors such as racism, poor education, and poverty—which, as I had noted in my presentation, also predispose people to heavy drug use. But I was not “blaming the victim,” I explained in an icy Q-and-A; rather, I was drawing attention to the patients’ capacities to improve their lives and, therefore, to hope.

As a palliative, she touts an organization, The International Association of Psychology and Counseling, dedicated to promoting “critical thinking over indoctrination” and to an organization called FAIR in Medicine, a group designed to combat the incursion of ideology into medicine as a whole.  As Satel says at the end (her emphasis):

Though I am worried for my profession, for colleagues who feel pressure to conform, and for the patients who depend on them, I take heart from these flares of resistance. I am confident that there is a silenced majority of clinicians who see the need to resist the ideological encroachment into the field of mental health care and the health sector more broadly. These new organizations are in their early stages but have the potential to attract the critical mass needed to rebuff politicized narratives and re-assert the primacy of individual patients in all their complexity.

Dr. Sally Satel