Category: health

Recent pushback on “affirmative care” and hormone blockers

July 31, 2022 • 9:15 am

I’m guessing that some day historians will look back at the mishigass surrounding “affirmative care” and wonder what the deuce was going on in America in the 2020s.

Now let me say at the outset that I have no objection to people with “gender dysphoria” changing their gender using drugs and surgery. But I also think that transitioning should not be allowed until after puberty, and for two reasons. First, we don’t know eough about the safety of “puberty blockers” used to stop the process while adolescents figure out their sexual identity, and second, because children who are too young to make mature judgments should not be allowed to make irreversible decisions about their bodies. Eighteen seems to me to be an appropriate age to begin a medical process of transitioning.

My objection to “affirmative care” is not that we shouldn’t treat young people repectfully when they have with a sincere desire to transition, or fail to support them. But in the U.S., and previously in the UK, the default option was “affirmative care”, with no real psychological probing to dissect the roots of gender dysphoria and see if it was a form of distress that might resolve into a child becoming gay. “Affirmative care”, in its most extreme form, pronounces children who question their sexuality as transsexuals, deems them ready to change sex, and encourages them to go on puberty blockers and then hormone therapy. (There are few adolescents who, once on blockers, decide to stop them and “de-transition.”)

I’m cautious because the huge rise in the number of adolescents who declare themselves transsexual (particularly biological women who want to change gender) could have a number of causes: a relaxation of the stigma against transsexuality, an increase in the genetic propensity to change gender (that’s impossible given the rate of the rise), or—as Abigail Shrier argues in her book Irreversible Damage, a sort of social contagion—a sense among young people that it’s far more cool to be trans than to be gay, and because such people get a lot of props and attention. (Shrier doesn’t claim that transition is always prompted by social contagion.)

Only the first and second hypotheses are supportable, and I think both are at play, but to deny that social contagion hypothesis plays any role in the temporal changes shown below is to deny reality. There are simply too many cases of seeing “detransitioners” (“desisters”) discuss the social pressure they were under, and of others seeing it at play in real life.

Below is an article by writer Lisa Davis you should read (click the screenshot). It’s on Bari Weiss’s site (and I don’t want to hear that Weiss is “alt-right” so that you can ignore it), and explains how several European countries, including the UK, Sweden, France, and Finland, are changing course on affirmative care, replacing it not with a refusal to let people transition, but with a more compassionate and psychologically-oriented inquiry into the roots of gender dysphoria.

The change in Europe comes from a realization of the weakness of the evidence supporting two assertions of trans activists: that puberty blockers are completely harmless and can be completely reversed if someone changes their mind, and that allowing medical transitioning reduces the rate of mental illness and suicide among those with gender dysphoria. We now know that the evidence for the first claim is wrong, and for the second is plagued by methodological weaknesses. We simply need a lot more data, and the Europeans are being cautious while Americans ignore the counterevidence. That’s unwise given the drastic and irreversible nature of many transitions.

Here’s a graph from the article above showing the increase in referrals to the gender-affirming Tavistock clinic, and this is just between 2009 and 2017 (original source here). Both the proportion of and the increase in biological females (compared to males) referred to the clinic for affirmation have increased substantially. If your hypothesis is that the rise reflects purely the de-stigmatizing of transsexuality, this discrepancy between the sexes must be explained. Of course, it also has to be explained if you hold a “social contagion” hypothesis.


 

I completely agree with Andrew Sullivan in his Friday column section called “Yes, the trans madness is real” when he says this:

I recall a few years ago having a heated conversation with some well-meaning trans activists who appeared completely aghast when I voiced some worries about the treatment of kids with gender dysphoria. What if the kid is gay, I asked? How do we know for sure if a pre-pubescent child really is trans and not just experimenting with gender the way many gay kids do? And are these nine-year-old children really mature enough to make life-long decisions that could make them permanently sterile, keep them on drugs for the rest of their lives, or permanently remove their capacity to have an orgasm? How could pre-pubescent kids even know what an orgasm was?

My activist friends were shocked. It seemed to me as if they had never previously been asked these questions. They were all very-well intentioned, and not entirely wrong — in a few extreme cases, there might be a reason to permanently change a child’s sex. But they assured me that no such errors were ever made, that the process was entirely ethical, and that all medical authorities backed it. They insisted that puberty blockers were harmless and fully reversible. The bubble is real.

I think it’s better to give kids with gender dysphoria extensive psychological counseling—NOT affirmative from the outset, i.e., not “affirming” that children who say they’re of another gender must be right—before giving them irreversible medical treatment, treatment that we now know can render people sterile, unable to enjoy sex, and, in the case of puberty blockers, cause other medical damage. Sullivan, who experienced dysphoria himself, says that many adolescents go through a period of confused sexuality, and perhaps would become gay were it not more fashionable to change gender.

Both articles detail some big changes in Europe about how to treat gender dysphoria. I’ll summarize what most of us know already (the first article above gives links):

  • Sweden has revised its guidelines for treating gender dysphoria in adolescents, arguing that gender-affirming treatment may be more harmful than good, and claiming that affirmative treatment “should be offered only in exceptional cases.”
  • Finland, using an evidence-based approach showing that many young people seeking transitioning had severe psychiatric problems, that there were risks to using puberty blockers (see below), both physically in in terms of sexuality, changed its protocol for treating gender dysphoria:

(From Davis’s piece): In Finland, for patients who fit the profile of participants in the Dutch study, after a prolonged period of evaluation, and with a multidisciplinary team including a psychiatrist, psychologist, social worker and nurse, puberty blockers may be started near the onset of puberty, and cross-sex hormones may be possible starting at age 16. Assessments take place at two gender identity clinics; gender surgeries are offered only at one center. Both Finland and Sweden now stress gathering data and extensive follow-up.

My own view is that giving puberty blockers “near the onset of puberty”, or at age 16, is too young.

  • The National Academy of Medicine in France has urged caution in proceeding with drugs and surgery in cases of gender dysphoria since some of it may be due to social contagion. It recommends more extensive psychological counseling of those with gender dysphoria.
  • The Tavistock clinic in London (a notorious place for affirmative therapy) is to be closed, replaced by a number of regional clinics practicing a different brand of care. This is the result of a critical review headed by Dr. Hillary Cass, commissioned to review Tavistock and its practices. Their recommendations, which the government accepted, was to de-centralize the clinics, adopt more “holistic care”, and ratchet back on the use of puberty blockers, which now appear to have possibly severe medical consequences.
  • The medical consequences of puberty-blocking drugs like Lupron, which according to Sullivan have been known for a while, include brain swelling and loss of vision, possible bone damage, and other irreversible effects. In fact, these blockers are used for other conditions, and I understand are always prescribed by doctors treating gender dysphoria “off label”, i.e., they’re not specifically recommended by the FDA for stalling puberty while a child ponders its gender.

This month the FDA added brain swelling to the warning labels of puberty blockers. The sample size is small, and these problems appear only in biological females (the most common sex experiencing gender dysphoria), but an FDA warning is nothing to take lightly. Here’s a tweet about the dichotomy between the American use of blockers willy-nilly in American “affirmative care”, and the warnings on drug labels. Clearly, more research needs to be done (that’s what Sweden and Finland concluded) before blockers are used so readily. But, in contrast to the caution about other new remedies, like Covid-19 vaccines, the standards for usage are very lax in the U.S., and were in the UK as well:

Nevertheless, as both Sullivan and Davis point out, the U.S., urged on by the Biden Administration, is going full steam ahead with affirmative care.

Sullivan:

In the US, however, as many states move in the European direction, the left is pushing harder. California has a bill offering sanctuary for any child seeking a sex change. The Biden administration still insists that “every major medical association agrees: gender-affirming care is life-saving, medically necessary, age-appropriate and a critical tool for health care providers.” The absolute certainty, compared with the second thoughts in Europe, is striking.

Davis, referring to Finland and Sweden’s revised guidelines in comparison to America’s (my emphasis):

Both guidelines starkly contrast with those proffered by the Illinois-based World Professional Association of Transgender Health, an advocacy group made up of activists, academics, lawyers, and healthcare providers, which has set the standard when it comes to transgender care in the United States. WPATH will soon issue new standards that lower recommended ages for blockers, hormones and surgeries. (WPATH did not respond to a request for comment.)

WPATH’s position is in keeping with an array of U.S. medical associations and activist groups across the country that insist gender-affirming care is “life-saving.” Assistant Secretary of Health Rachel Levine, who is herself a transgender woman, recently asserted that there is a medical consensus as to its benefits. Some activists and gender clinicians in the U.S. feel that WPATH doesn’t go far enough, asserting that any child who wants puberty blockers should get them, for instance, or claiming that a teenager who later regrets having her breasts removed can just get new ones.

In Sweden and Finland, this issue has been primarily a question of health and medicine. Here in the U.S. it is a political football.

Why the ignoring of evidence and lack of caution in the U.S. as opposed to Europe? Why are we not following the examples of countries that take an evidence-based approach to medical policy about gender dysphoria? Surely one of the reasons is “wokeness”: the idea that changing gender is to be admired as an act of courage, and that transgender people, or those who wish to become so, should be valorized as members of stigmatized minorities. And, sadly, the Biden administration has bought into the pronouncements of the extreme Left, which include unquestioning approbation for “affirmative care.”

Yes, there’s some stigma about transgender people, and yes, we should help those who, after intensive medical and psychological examination, are deemed to be serious about their gender misindentification rather than confused about their sexuality. And yes, we should treat transgender people in nearly all respects as equals to members of the biological sex they assume.  But what we should not do is, in the interests of seeming virtuous, rush children and adolescents into very serious and irreversible medical procedures without proper vetting.

How to get your free covid-19 home tests from the U.S. government

July 25, 2022 • 9:00 am

Just a note that all Americans are now entitled to their third free set of rapid antigen test kits for covid-19.  Most of you are familiar with these: you swab your nostrils, swirl the swab in a special liquid, and then squeeze the liquid into a depression on a small plastic device (first picture below) In 15 minutes you get a simple readout that says whether or not the kit has detected antigens: the spike proteins presented by the SARS-CoV-2 virus that is responsible for COVID-19. (The vaccine is designed to prompt your body to produce antibodies to these antigens.)

The devices look like this; you also get a swab, a vial of liquid, and detailed instructions with diagrams.

And the results look like this after 15 minutes. If you have the one on the left with a “C”, no antigen was seen; you’re negative. (That does not mean for certain that you’re free from infection; these tests do give false negatives.) If you have two lines, at both site “C” and site “T”, you have antigen and are infected (again, there can be false positives).  A faint line a “T” still indicates infection.

These are not as good as PCR tests, which remain the gold standard for testing for covid, but they’re useful to have around, and when I was feeling stuffy the other day, I gave myself two tests a day apart (I was fine.)

I think they’re expensive if you buy them, but the U.S. government is sending Americans two free kits in a third round of distribution. Each kit has FOUR tests, so you can test yourself eight times. (It’s easy to do!).

To get yours, and you should get them now, go here to the government website, which explains the kits and allows you to order by phone, or go here to order them by email, as I did, by clicking on the blue button the first website. All you do is fill in your name and address, and the Postal Service will ship you two packages of four kits. There is no charge for anything, but be sure to push the green checkout button.

Two points. I’m not a doctor, so ask your physician for help in interpreting the results or finding out when to test and what to do if you are positive. Also, this is for American citizens only, provided as a service by the gubmint.

Once again: Ivermectin doesn’t work

February 20, 2022 • 10:00 am

The paper at issue today reports the most thorough and well controlled study of the effect of ivermectin on Covid-19 around, and it was just published in JAMA Internal Medicine. What it supports, contra the claims of Joe Rogan, Bret and Heather Weinstein, and a whole slew of Republican loons, is that the drug ivermectin—as already asserted by the FDA—neither prevents nor cures covid-19. Or rather, this study shows that once adults over 50 who get the virus and are hospitalized with comorbidities, Ivermectin doesn’t help them get better. (An earlier study published in BMC Infectious Diseases, both randomized and double-blinded, and including a placebo, showed that taking ivermectin had no significant effect on keeping people out of the hospital.)

The upshot is that every well controlled study shows that ivermectin is useless in helping you once you get the virus. Another meta-analysis of reasonably well done studies that included prevention concluded that there was no good evidence that the drug even prevented infection.  The only studies that may show value of ivermectin are those in which many participants have high loads of worms as comorbidities. In such studies (which don’t apply in the US or UK), the drug may, by helping you get rid of worms (see below), make recovery from covid more likely. But even in that case there’s no excuse not to get vaccinated.  And of course you wouldn’t take ivermectin unless there was evidence you had worms.

Ivermectin is used in humans to cure parasitic worms and head lice, but can be dangerous if taken in doses high enough to kill viruses in vitro. Nevertheless, in this age of conspiracy theories and general lunacy, even credentialed scientists like the Weinsteins have recommended ivermectin and criticized vaccines, even though it’s beyond doubt that the vaccines prevent severe illness and hospitalization. You’d have to be crazy or paranoid to pass up vaccination in favor of ivermectin But thousands do it, so there you are.

With luck, you should be able to get the new study by clicking on the screenshot below, especially if you have the legal Unpaywall app. There’s also a link to the pdf, and if all else fails, make a judicious inquiry.

First, the background: the authors summarize what’s know about Ivermectin in studies to date. As I and others have mentioned before

Although some early clinical studies suggested the potential efficacy of ivermectin in the treatment and prevention of COVID-19, these studies had methodologic weaknesses. In 2021, 2 randomized clinical trials from Colombia and Argentina found no significant effect of ivermectin on symptom resolution and hospitalization rates for patients with COVID-19. A Cochrane meta-analysis also found insufficient evidence to support the use of ivermectin for the treatment or prevention of COVID-19. [JAC: The meta-analysis is linked above.]

The new study was done in Malaysia (other studies are ongoing, I believe), and iswasrandomized with respect to patient condition and age, but there was no placebo control. That is, half the infected patients were given “standard of care” (none were vaccinated) and the other half were given “standard of care” plus Ivermectin. The outcomes were followed over time.  The result: not only did Ivermectin not work, but there was a slightly higher, though nonsignificant, risk of the ivermectin treated patients progressing to the phase that required supplemental oxygen. That is exactly the opposite of what you would expect if some patients were taking placebos, for you might expect that if there’s a placebo effect, then placebo-ingesting patients would do better than those not taking placebos (i.e., the patients in this study). But despite the absence of placebos, there was still no effect of ivermectin in this study using any measure of “disease progression”.

I’m not going to summarize the results in detail, because the authors do a good job of that themselves.

There are three summaries of the results. First, the “TL/DR” version:

Note below that the 490 patients observed were all over 50 and had documented comorbidities—factors that make them more susceptible to complications and death.  Here is the protocol (indented, bolding is mine except in headers).

The Ivermectin Treatment Efficacy in COVID-19 High-Risk Patients (I-TECH) study was an open-label randomized clinical trial conducted at 20 public hospitals and a COVID-19 quarantine center in Malaysia between May 31 and October 25, 2021. Within the first week of patients’ symptom onset, the study enrolled patients 50 years and older with laboratory-confirmed COVID-19, comorbidities, and mild to moderate disease.

Interventions  Patients were randomized in a 1:1 ratio to receive either oral ivermectin, 0.4 mg/kg body weight daily for 5 days, plus standard of care (n = 241) or standard of care alone (n = 249). The standard of care consisted of symptomatic therapy and monitoring for signs of early deterioration based on clinical findings, laboratory test results, and chest imaging.

Note again: no placebo pills were given. And here’s how they measured outcome:

Main Outcomes and Measures  The primary outcome was the proportion of patients who progressed to severe disease, defined as the hypoxic stage requiring supplemental oxygen to maintain pulse oximetry oxygen saturation of 95% or higher. Secondary outcomes of the trial included the rates of mechanical ventilation, intensive care unit admission, 28-day in-hospital mortality, and adverse events.

The results are below. Note that slightly more patients in the ivermectin-dosed group (4% more) progressed to severe disease (i.e., requiring supplemental oxygen than those in the group treated the same but without ivermectin. Incorporating still other measures of “progression to severe disease,” there was again no significant difference, although there was slightly more deaths (nonsignificantly more) in the ivermectin versus control group. Finally, the most common side effect, diarrhea, was found more often in the ivermectin versus control group,but I can’t find the statistics for that difference.

Results  Among 490 patients included in the primary analysis (mean [SD] age, 62.5 [8.7] years; 267 women [54.5%]), 52 of 241 patients (21.6%) in the ivermectin group and 43 of 249 patients (17.3%) in the control group progressed to severe disease (relative risk [RR], 1.25; 95% CI, 0.87-1.80; P = .25). For all prespecified secondary outcomes, there were no significant differences between groups. Mechanical ventilation occurred in 4 (1.7%) vs 10 (4.0%) (RR, 0.41; 95% CI, 0.13-1.30; P = .17), intensive care unit admission in 6 (2.4%) vs 8 (3.2%) (RR, 0.78; 95% CI, 0.27-2.20; P = .79), and 28-day in-hospital death in 3 (1.2%) vs 10 (4.0%) (RR, 0.31; 95% CI, 0.09-1.11; P = .09). The most common adverse event reported was diarrhea (14 [5.8%] in the ivermectin group and 4 [1.6%] in the control group).

And the upshot:

Conclusions and Relevance  In this randomized clinical trial of high-risk patients with mild to moderate COVID-19, ivermectin treatment during early illness did not prevent progression to severe disease. The study findings do not support the use of ivermectin for patients with COVID-19.

Here’s the entirety of the discussion (bolding mine); note that the authors, as is proper, point out the limitations of the work.

Discussion

In this randomized clinical trial of early ivermectin treatment for adults with mild to moderate COVID-19 and comorbidities, we found no evidence that ivermectin was efficacious in reducing the risk of severe disease. Our findings are consistent with the results of the IVERCOR-COVID19 trial,17 which found that ivermectin was ineffective in reducing the risk of hospitalization.

Prior randomized clinical trials of ivermectin treatment for patients with COVID-19 and with 400 or more patients enrolled focused on outpatients.16,17 In contrast, the patients in our trial were hospitalized, which permitted the observed administration of ivermectin with a high adherence rate. Furthermore, we used clearly defined criteria for ascertaining progression to severe disease.

The pharmacokinetics of ivermectin for treating COVID-19 has been a contentious issue. The plasma inhibitory concentrations of ivermectin for SARS-CoV-2 are high; thus, establishing an effective ivermectin dose regimen without causing toxic effects in patients is difficult.27,28 The dose regimens that produced favorable results against COVID-19 ranged from a 0.2-mg/kg single dose to 0.6 mg/kg/d for 5 days29–32; a concentration-dependent antiviral effect was demonstrated by Krolewiecki et al.29 Pharmacokinetic studies have suggested that a single dose of up to 120 mg of ivermectin can be safe and well tolerated.33 Considering the peak of SARS-CoV-2 viral load during the first week of illness and its prolongation in severe disease,34 our trial used an ivermectin dose of 0.4 mg/kg of body weight daily for 5 days. The notably higher incidence of AEs  [“adverse effects”] in the ivermectin group raises concerns about the use of this drug outside of trial settings and without medical supervision.

Limitations

Our study has limitations. First, the open-label trial design might contribute to the underreporting of adverse events in the control group while overestimating the drug effects of ivermectin. Second, our study was not designed to assess the effects of ivermectin on mortality from COVID-19. Finally, the generalizability of our findings may be limited by the older study population, although younger and healthier individuals with low risk of severe disease are less likely to benefit from specific COVID-19 treatments.

Note as well the “limitatation” that placebos were not given. Another limitation is that this study didn’t assess the chance of getting infected in the first place when you take ivermectin, or of being hospitalized if you get infected, though other work (see above) has suggested no effect of ivermectin on either of these measures.

I was prepared to admit that my criticism of ivermectin was wrong had these properly-designed studies shown an effect, but of course because ivermectin is usually suggested as a substitute for getting vaccinated, the real thing you want to know is whether, compared to getting the jabs, you’re better off swallowing ivermectin.  Given the efficacy of the vaccines, which has now been conclusively demonstrated (and yes, the effects wane over time, so we may need a yearly booster), I was already pretty sure that those who touted ivermectin as a better substitute for vaccination were wrong.  But this study does nothing to convince me that I was wrong.

More studies will come out, and eventually we’ll have a pretty solid conclusion. And I’ll bet any reader $100 that it will show that ivermectin is no substitute for vaccination or the other new drugs that are being used to relieve symptoms and combat the virus.

The question now is whether people like Joe Rogan or, especially, Bret and Heather Weinstein will admit that ivermectin—at least in this study—has no effect. Ideally, scientists will admit when they’re wrong, and, as Richard Dawkins has emphasized, that is an admirable trait. Such admissions move science along faster than waiting for a generation wedded to an idea to die off and be replaced by those who have different ideas. Now I haven’t been wrong about ivermectin yet, but when I see a study showing it’s more efficacious than vaccines in keeping you out of the hospital, or alive, I’d like to think I’d say whose three words. Will the Weinsteins say them?

I predict no. We will see a lot of hemming and hawing frothe Quacksters, and perhaps qualifications like “well, the study showed X but didn’t show the real prediction, which is Y.” In fact, I don’t remember hearing anybody pushing quack remedies admit that they were wrong.

The reason I’m so dogged about this is because people who tout quack remedies when there are good ones can do harm. And it’s far worse if they push the quackery while wearing the mantle of science.

But listen up: STAY AWAY FROM THE DAMN IVERMECTIN!

 

h/t: Alex, Leslie

Eric Clapton argues that pharmaceutical advertising hypnotized him into getting the covid jab that did him in

January 25, 2022 • 9:00 am

The more Eric Clapton opens his gob about vaccination, the dumber he looks. He would be well advised to shut up and play his axe.  While there is a minute possibility that Clapton did indeed get sick from his injection, I suspect that if he is now chronically ill, it may well be due to something else. But even if it was the jab that did him in, he has no business trying to persuade the world to avoid vaccination against Covid.There are enough data on immediate side effects to show that he is a real outlier and not the norm.  And the idea that he was hypnotized into getting the jab. . . . well, I have no words.

See the tweet at the bottom for what is also my reaction.

Below is the first part of a two-part interview of Clapton by “The real music observer”, David Spuria. (A second part is promised.) This one is eighteen minutes long, and prompted the NY Post article below it.

The most bizarre part of this video is Clapton’s claim that he was manipulated by Big Pharma advertising into getting a covid jab. The notes below, which are from the interview, were reprinted in the Post.

Eric Clapton’s career “had almost gone anyway” until his campaign against conventional medicine took off.

The 76-year-old musician went on the Real Music Observer YouTube channel to discuss how his life has changed since reluctantly taking AstraZeneca’s therapy in 2021. Clapton has since become outspoken about his anti-vaccination stance.

He claimed that he’d been duped into getting the COVID-19 jab by subliminal messaging in pharmaceutical advertising — and urged others not to fall for it.

“Whatever the memo was, it hadn’t reached me,” he said, referring to the “mass formation hypnosis” conspiracy theory, which gained traction in 2021 as part of anti-vaccine propaganda. (In related circles, it’s also been called “mass formation psychosis.”)

Credited to Belgian psychologist Mattias Desmet, the theory essentially points to a sort of mind control that has taken over society, allowing for unscrupulous leaders to easily manipulate populations into, for example, accepting vaccines or wearing face masks.

“Then I started to realize there was really a memo, and a guy, Mattias Desmet [professor of clinical psychology at Ghent University in Belgium], talked about it,” Clapton continued. “And it’s great. The theory of mass formation hypnosis. And I could see it then. Once I kind of started to look for it, I saw it everywhere.”

JAC: That is known in the trade as “confirmation bias.”

Clapton recalled “seeing little things on YouTube which were like subliminal advertising,” he said.

His “preexisting condition”, which he claims caused him to get really sick after the jab, seems to be a bad back caused by a nerve inflammation. Well, perhaps. But to blame your taking the jab on subliminal manipulation—hypnosis, for crying out loud!—is risible.

:. 

More from The Post and the video, including his collaboration on anti-vax music with Van Morrison:

The former Cream guitarist also talked about his efforts with fellow British songwriter Van Morrison to speak up on behalf of other artists against vaccine requirements.

“My career had almost gone anyway. At the point where I spoke out, it had been almost 18 months since I’d kind of been forcibly retired,” he said, as pandemic restrictions shut down live events for months.

“I joined forces with Van and I got the tip Van was standing up to the measures and I thought, ‘Why is nobody else doing this?’ … so I contacted him.”

He said Morrison, 76, complained that he wasn’t “allowed” to freely object to vaccine requirements.

“I was mystified, I seemed to be the only person that found it exciting or even appropriate. I’m cut from a cloth where if you tell me I can’t do something, I really want to know why,” the “Cocaine” singer said.

He sounds calm and rational (the British accent helps), but what’s coming out of his mouth is nonsense. Now of course he has the right to say anything he wants, including his theory of “mass hypnosis”, but we can fault Clapton for trying to persuade others to avoid a preventive that has been shown to work. As he says, “I had a tool [his music], and I could do something about that” [i.e., promulgating his crazy views].

Click on the screenshot to read the Post article, though if you watch the 18-minute video above, you don’t really need to. 

I think this tweet is appropriate.

h/t: Barry

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

January 14, 2022 • 9:15 am

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

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

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

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

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

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

It has spikes, like Covid-19:

Source

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

________________________

Reference:

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

Guest post: Censorship at a Canadian Medical Journal

January 2, 2022 • 11:15 am

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

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

And here’s his contribution:

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

by Leslie MacMillan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CTVnews reported further on 24 Dec:

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

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

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

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

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

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

Action

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

Contacts for responding:

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

At this site you can contact the Canadian Medical Association.

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

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

Travails of the aged

January 1, 2022 • 6:17 pm

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

1.) What did you have for Christmas dinner?

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

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

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

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

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

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

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

I do not think that they will sing to me.