Category: medicine and health

Vaccinations in school; why shouldn’t they be the parent’s “choice”?

February 12, 2022 • 12:20 pm

I have floated this question before, but want to raise it today to see if I can understand a distinction. And that distinction is between many people’s argument that they cannot be forced to get a Covid vaccination to stay on the job, but at the same time they allow their children to be forcibly vaccinated to attend public school.

Now there is no law in the U.S. saying that you must be vaccinated, period, though of course there are mandates specifying that you can’t work unless you’re vaccinated. New York City’s mandate for municipal workers went into effect today, after the Supreme Court turned down an emergency request yesterday to stall it. Up to 3,000 people might have lost their jobs this morning.  And yet many people still refuse to get vaccinated even if it means the loss of their livelihood. I see them on the news every night, making loud protests about their “rights” being violated by vaccine mandates. Along with that goes the mantra “this is my body and therefore it’s my choice.” And so they get fired, and some of them die, while others infect their fellow citizens.

This mass protest has culminated in the Great Truckers’ Protest of last week, and I hope it’s over now. (Did Trudeau show some moxie?) It was an act of civil disobedience, and therefore warrants punishment, but I had little sympathy for them.

What I don’t understand is this: these same people who assert their rights and bodily autonomy—and I see no “right” to be able to endanger the public safety by infecting others—make not a peep when they get shots for their kids to go to public school.

Not everyone understands that in the U.S., and presumably other countries, any child wishing to attend public school has to get a series of immunizations,

Here, for instance, are the vaccinations required for a child in to attend public school in Illinois.  I count 14 jabs needed to stave off ten diseases. That’s a lot of shots!

Click charts to enlarge:

 

 

Now why aren’t the parents protesting this forcible vaccination? Isn’t that a violation of either the parents’ or the students’ “rights”? If you’re one of the many who talk about “rights” and “my decision”, and yet still want to walk around in public, yes, it’s certainly hypocritical to not bring up “rights” for your children as well. But, except for a few fringe anti-vaxxers, or believers who want religious exemptions for their kids (I’m not sure these are even allowed for school vaccination), we hear no talk of rights for school immunization.

Is this hypocrisy? Well, I can think of several reasons why you could say “no”:

a.) The school vaccines have been proven safe and effective over years of trial, while, of course COVID vaccines have been around just a bit more than a year. The parents could say, “These vaccines work and don’t have bad side effects, so I won’t speak of “rights” But then you could ask them how much safety must be proven before vaccination becomes mandatory. As I recall, when the polio vaccine came out, it became mandatory within just a few years, and people were begging to get it.

b.) You could say that you have the right to decide for your own body, but not for the bodies of your kids, and therefore they should get vaccinated. But this doesn’t work because parents make decisions about the medical treatment of their kids all the time, especially before the kid is sentient enough to make its own choice, which is at a pretty advanced age. For school vaccinations, the parents have to agree by the time the child is five or six.  (Note as well that parents feel that have the right to decide their children’s religious beliefs before the kids are old enough to choose!)

c.) The parents could say that they have the alternative of no employment if they’re not vaccinated, but there’s no alternative for their kids if they’re not vaccinated. That’s not entirely true: there is homeschooling, which is free, and private (often religious) schools that don’t require vaccination. But The latter are often pricey.

d.)_ They are willing to risk getting Covid, but the children are too young to afford that risk. But this reverts back to a) above: if the vaccine isn’t risky for your children, why is it risky for you? (In fact, it’s more dangerous for adults to get Covid than for kids).

There is more to discuss here, but I won’t get into it. I’m just curious why parents who obediently let their kids be vaccinated (even with COVID shots for college!) turn into enraged don’t-tread-on-me” types when it’s their own jabs at issue.

If there’s a rational answer, I would say that a)—proven safety and effectiveness—would be the one, but of course the Covid data so far shows that the risk is minor compared to the effectiveness. Certainly we know that the chance of illness, hospitalization, and death is greatly reduced for adults if they get the shot (we’re talking about resistance of adults to getting vaccinated). Vaccination for adults is, without doubt, a net good save for those who are medically compromised.

But I suspect that more is at stake here—perhaps ideology.  People have largely lost control of their lives during the pandemic, and refusing shots is a way of getting control, and also of showing the government that they can’t control you. This is likely connected with a conservative or libertarian ideology that opposes government intervention. In the case of the truckers, it seems to me they’re pissed off about a lot of things, including  loss of jobs and rising prices, and protesting against vaccines is the nucleus around which these resentments coalesce.

But maybe I’m not asking a meaningful question. It’s just that when I see a bunch of angry people yelling about “rights” and “bodily autonomy” on television, it makes me wonder whey they go all quiet when the needle goes into the arms of their kids.

A reader’s Claptonesque vaccine rant

January 30, 2022 • 9:30 am

The politically charged topics I get the most pushback about, whether it be in personal emails or comments (not all of which I post) are two: transsexual issues and criticism of bogus remedies for Covid. I can’t tell you the rancor I’ve seen about my view that we should be very wary of letting biological men who have assumed the gender of women compete in women’s sports. For that I have of course been called a “transphobe”, but I brush off that invective for I have no fear or hatred of transsexuals; sports is an issue of fairness towards women, and you can’t ignore the evidence. And yes, there is evidence about the performance, physiology, and morphology of men who transition (with or without medical treatment), and it’s not favorable towards the idea that they should take part in in women’s sports.

And of course when I went after ivermectin, people tried to trounce me, even though there was no evidence that it worked to prevent or cure Covid-19 (and there still isn’t).(I got a long email, for example, from Heather Heying, who very politely tried to convince me of the error of my ways.) But most of the ivermectin-pushers have no sense of the scientific reality: even if ivermectin did work, it wouldn’t work nearly as well as vaccinations, for the latter have been tested thoroughly and if Ivermectin had equally profound effects, we’d know it already. Taking all the side effects into account, you’re way, way better getting the jab than taking ivermectin, a drug used in humans for non-covid purposes like parasitic lice and worms.

I just realized that one of the reasons I write here, and what gets me most fired up, is when people misuse science to promote their ideological ends. Both ivermectin and transsexual issues have involved that kind of misuse, as does the current flap in New Zealand, where a tsunami of Wokeness is getting the government and universities to promote Mātauranga Māori, or Māori “ways of knowing”, as a form of science that should be taught as coequal to science in the classroom. While MM contains kernels of empirical truth, the whole movement is little more than an ideology of valorizing the oppressed being turned into science. (This is also happening in the U.S. with nonsense like “sex in humans is not binary” being promulgated as sacred truths.)

Others can believe such nonsense if they want, but when they try to force it on others, or teach it as “science” or “fact” to others, it becomes something I can’t abide. As Hitchens said, more or less, “you can have your toys if you want, but you can’t make me play with them.” Nor can you make my children play with them—in this case “my children” being those who haven’t been exposed to (or who don’t know how to assess) scientific data.

But I digress. It was just a passing epiphany. At any rate, speaking of Covid-19, I got this rather unhinged comment trying to force its way onto my website this morning. I don’t know why reader “Alex” (this would have been his screen name) is so heated up about vaccinatoon, but he seems to be one of those Claptonesque people who cannot abide the idea of being forced to be vaccinated. These people apparently don’t realize that for children to attend public school in America, they need to get many vaccinations. Otherwise, “no school for you.”

I’ll leave it to readers to respond to the comment below. Say what you will to “Alex”, and I’ll send him a link to the comments here.  As always, try to be polite (granted, it’s hard with a hothead like this), and abide by the Roolz, even though Alex didn’t.

Here’s what I got:

A new comment on the post “Bret Weinstein and Heather Heying go unvaccinated for Covid, take and promote Ivermectin instead” is waiting for your approval

Author: Alex

Comment:It’s January 2022. Do you still want to keep banging the “pandemic of the unvaccinated” drum? Because, despite all of your willingness to smear and deride the unvaccinated, I believe those authoritarians who want to continuously ramp up punitive measures against the unvaccinated in the face of the facts before us are the true, anti-scientific deplorables..It’s appalling to me that people want to coerce others into getting this vaccine through loss of livelihood, stripping of freedoms, and even criminal penalties, especially given that we don’t have legal recourse against these companies. That fact alone to me excuses anyone for turning down the vaccine. It’s fine if you personally want to take that risk (I did myself), but to want punitive measures or even to just endlessly ridicule those who decide not to take those odds is reprehensible to me, given the more dubious efficacy of these vaccines than promised and the other repeated breaches of trust from our institutions through this entire pandemic.And I say this as someone who got two shots of Moderna, so you can’t hurl unoriginal “anti-vaxx” insults my way. Seriously, you all need to realize that the tone and comments expressed on this page are totally unconvincing and alienate those like me from your positions. Do what you will with that information.

What I did with this information is given Alex an entire post to rant about the vaccination. That’s better than just ditching his comment as medically uninformed and potentially dangerous, which was my first inclination.

How “indigenous medicine” differs from “medicine”

January 25, 2022 • 11:15 am

I seem to be spending a lot of time reading about Mātauranga Māori (the indigenous “way of knowing” of the Māori of New Zealand, henceforth called MM), for there’s a battle over whether it’s to be considered “coequal to science” in New Zealand science classes, and whether MM should be taught with as much intensity, truth value, and classroom time as “modern science”— which is simply what we call “science”.  Yesterday I did a two-hour video podcast with a New Zealander on the subject, and it should be posted soon.

In the meantime, I’m looking for specific claims about MM and how it can tell us stuff that modern science can’t, or can somehow supplement modern science.

If you try to run down the claims of the “science” in MM, it invariably comes down to one of three examples.

First, Polynesians learned to navigate by the stars and other signs (this is a form of cultural selection, as those who couldn’t do it didn’t survive), which is indeed a form of knowledge, but doesn’t deserve as much classroom time as, say, the theory and mechanisms of biological evolution.

Second, the Māori teach us proper stewardship of the land. This claim is at best dubious given their historical destruction of the land and its fauna), as well as the value of scientific conservationists, who are using modern methods, for example, to save the kakapo: the world’s only flightless parrot.

Third, we have the recurrent claim that the Māori idea of a water demon in a river taught people that when the demon twitched its tail, the river would overflow, supposedly prompting road builders to circumvent the stream. I can’t tell you how many times I’ve heard the water-demon claim adumbrated as exemplifying the true value of MM. But hydrodynamics, which is what the builders really relied on, tells you much more than mythological tales or metaphors about where to put your roads. If MM is so valuable, why do its advocate always go back to the “water demon example”?

The same goes for medicine. Many Māori practice traditional medicine, often involving medicinal plants but also prayer and the numinous. Does it work? It could in practice, because, after all, we’ve gotten clues to modern medicines from observing indigenous practices. The ingestion of cinchona bark, which contains quinine, was a folk remedy for malaria, and 25% of modern pharmceuticals are said to have been derived from plants. But finding out what about the bark was the active substance, and how well it worked, required more than indigenous knowledge.

These examples can constitute knowledge gained from experience, but the gold standard for testing drugs these days is not a trial-and-error process, but the vastly more efficient method of double-blind testing.  Below is a paper from Frontiers in Immunology that’s been represented to me as an example of how MM can help science find new drugs. Sadly, the paper doesn’t even come close to doing that. Click on the screenshot to read; you can download a pdf there, too.

I’m not going to go through it. It simply describes how the Māori suffer excessively from type 2 diabetes (this is largely blamed on colonialism, which apparently gave them no healthy sources of food), and that there are traditional plants that they ingest to relieve the symptoms and damage of the condition. They then list all the possible plants, describe the chemicals in them, and say which ones might improve diabetes because rat studies have shown them to effect the insulin/glucose storage pathways. (Many of the plants lack even that minimal evidence.)

What is lacking in the study is this:

a.) Any evidence that these remedies actually work (there are, of course, no double blind studies). The whole paper is full of statements like, “Traditional reports describe compound X as having good effect for diabetes” and “Māori practitioners are known to use the leaves of Y to help alleviate symptoms.” This is assertion based on tradition, not evidence, though it could be evidence were the plants or their extracts tested under proper clinical conditions.

b.) Any evidence that the chemicals in the long list of plants help alleviate diabetes in humans.

c.) Any evidence that the plant “medicines” are better than the drugs currently used to treat type 2 diabetes.

In other words, the studies show a lot of “this is possible” and “that is possible” but give no substantive evidence for the efficacy of the Māori treatment for diabetes. This lack of evidence for efficacy is of course not unique to Māori medicine, but is characteristic of much “alternative” medicine throughout the world, as well as other traditional cures like reiki, faith-healing, and so on. In fact, faith is an integral part of Māori medicine, as the authors note (my emphasis)

Given the uniqueness and diversity of New Zealand indigenous flora, it is likely that new anti-diabetic treatments will be discovered from these sources. [JAC: I am not sure this is at all true. There may be more efficacious plants elsewhere in the world!] The plant vegetation foods, seeds, roots, nuts, and fruits that formed the basis of traditional Māori diet and rongoā would seem worthwhile targets in a systematic search for anti-diabetic agents. It is also important to understand that Māori believe the beneficial effects of rākau rongoā are not due to the plant alone, but are more importantly due to other traditional influences such as faith in Te Atua God, personal mauri (connection) with Papatūānuku (mother earth), a good sense of oneself as Māori, and a good sense of whakapapa (family history). In Māori communities, natural health and traditional medicinal practices are increasingly widely supported (Williams, 2001).

This means that Māori culture plays some ineffable role in the cures. And the need for “faith” to make the medicine works is a blatant way of insulating the potential treatments from falsification.

One such statement:

There has been growing recognition that “health” is more than an individualistic, biomedical concept; health is also determined by social circumstances and contexts (Lines et al., 2019). These social determinants of health involve the conditions under which people live and work, and include diverse factors such as language, culture, and identity. Indigenous culture is a dynamic and adaptive system of meaning that is learned, shared, and transmitted from one generation to the next and is reflected in the values, norms, practices, symbols, ways of life, and other social interactions of a given culture (Kreuter and McClure, 2004). Relationships, interconnectivity, and community are fundamental to these dynamics (Lines et al., 2019).

Language and identity? But wait; there’s more:

For Māori, the indigenous peoples of New Zealand, there is an intrinsic connection between the health of the people and the health of their land (McGowan, 2017). Māori developed mātauranga of their whenua over centuries, which was passed down from their ancestors who originated from Hawaiiki (Smith, 1898). As such, mātauranga Māori is about connection to Papatūānuku or whenua land (McGowan, 2017). Once those connections are broken, mātauranga Māori becomes less of a living knowledge. A disconnection of mātauranga Māori commonly occurs when it is taken out of context in which it originated.

That makes no sense at all to me.

So we see how MM can be rendered immune to falsification, which is a way to say that it’s “not science”.  Anything that can’t be falsified shouldn’t be taught in science class.

Futher, you can say, as advocates of paranormal stuff like ESP often do, that “it won’t work if taken out of context”.  An example (don’t ask me to translate). Emphasis is mine:

Many Māori support the use of animal testing to understand the effects of rongoā at the physiological and molecular level, if that knowledge is unknown. Many Māori support animal testing of rākau rongoā if the research is conducted under the guidance and protection of a Māori kaumatua (elder), kairongoā (rongoā Māori practitioner), and Māori kairangahau (researcher). As mentioned earlier, Māori have strong interests in kaitiakitanga and rangatiratanga, and support animal testing of rākau rongoā if it is preserved and governed under their guidance.

Māori view the intake of rongoā by animals as a very natural process, which can help guide laboratory research if conducted in a culturally humane and safe environment for the animal and rākau rongoā under investigation. Furthermore, it is important that a karakia (prayer) is given by a Māori kaumatua before the research commences and ends, including when the animal is euthanized humanely.

The requirement that you must have specific Māori elders around to do the research properly, and to recite a specific prayer, is another way of immunizing this kind of MM against falsification.

Finally, the authors disparage modern medicine simply because it’s “colonial”. I found the statement below amusing—but also infuriating (remember, this is a peer-reviewed paper in an immunology journal):

Mainstream health systems are constantly charging Māori to validate the efficacy of their rongoā Māori practice based on mainstream health systems, without recognizing that Māori have their own body of knowledge and practice systems based on mātauranga Māori and tikanga Māori (traditional kaupapa Māori protocol) (Koia, 2016). This is viewed as institutional racism and Crown inaction on health equity in New Zealand (Came et al., 2019). Furthermore, this also supports historical practices of colonization and forced assimilation enacted by the Crown as profoundly racist (Smith, 2012). Furthermore, colonial policies informed by superior Pākehā people, institutions, and systems, have allowed entitlement of Pākehā to resources and power, including those related to traditional rongoā Māori practices. As such, the New Zealand Crown are thought to be in breach of Treaty of Waitangi obligations in terms of inequity between mainstream health systems and traditional rongoā Māori healing practices.

In other words, “We don’t need no stinking tests because that’s just racist colonialism.”

As I said, there may be value in investigating “traditional” plants used in indigenous treatment of diabetes. But you can’t just assert that or say “traditionally, plant X has been used and seen to be helpful.” Further, new remedies have to be at least as useful (taking into account side effects) as the ones already in use. There may be no plant as effective as insulin in some severe cases of type 2 diabetes. I find it ironic that the authors note this at the end of their paper:

Based on traditional reports and knowledge, karamu, kūmarahou, and kawakawa each display anti-diabetic potential. Remarkably, no molecular or biomedical research has been conducted to confirm the anti-diabetic efficacy of these rākau rongoā and to understand the mechanisms by which these effects are achieved. Although early phytochemical studies confirm known constituents, research is yet to be performed to validate anti-diabetic agents of the given rākau rongoā. 2D cell culture and animal model systems provide ways to study the effectiveness of anti-diabetic agents sourced from rākau rongoā.

Translation: those plants have chemicals in them, but we’re not sure whether they work.

That’s an admission that they have no idea whether any of the plants they suggest are of even potential value (the “potential” here is defined very thinly). Finally, the efficacy of the plants is said to defend on the need for a specific Māori harvesting protocol that comes close to religious practice (my emphasis):

The preparation of rongoā from these should be performed following certain principles and Figure 2 illustrates a kaupapa Māori molecular research scheme to undertake pre-clinical and clinical studies to test efficacy of karamu, kūmarahou, and kawakawa rākau rongoā in T2DM “mate huka.” Harvesting and aqueous extraction of rākau rongoā ought to be performed under the direction of a kairongoā or Māori kaumātua. In line with traditional Māori protocol, karakia is essential to acknowledge and thank the gift of Tane Mahuta prior to harvesting any rākau rongoā plant material. Harvesting rākau rongoā involves considering the needs of others, ensuring sustainability in the forest, being gentle with footprints in the forest, harvesting the eastside of the plant by hand, never harvest in the rain and to harvest leaves during growing season (Kerridge, 2014

The east side of the plant?  Harvesting during the growing season alone? I can think of reasons why one might do the opposite—and at least you should try a variety of protocols, like harvesting on the west side of the plant!

I found little of value in this paper, but was astounded to see how infused the medicine is with prayer, proper Māori elders, and unjustified harvesting practices, as well as having some unspecified but necessary connection to the land.  There are ways to do double-blind tests on the plants even without a clinical study, but none of that has been done in this case.

I will continue to read defenses of MM as being scientific or supplementing science, but I tell you, it’s a mental beating. And imagine what’s in store for New Zealand medical schools if MM is required to be taught, as it may well be, as an alternative and equally valuable way of treating disease or injury!

Bari Weiss: anti-vaxer?

January 22, 2022 • 11:30 am

In this segment of Bill Maher’s show last night, Democratic Congressman Ritchie Torres from New York, Bari Weiss, and Maher discuss Covid-19, with the topic being “whether it’s time to move past Covid restrictions and get back to normal.” Weiss and Maher seem to say “yes,” while Torres urges caution. 

Bari Weiss declares that she’s “had it” with Covid, that masks don’t work, that you can be vaccinated and still get infected with omicron, that lockdowns cause suicide, that few children have died from Covid and that “it’s time to end it”, apparently meaning we no longer need to take precautions against Covid, including getting rid of masks, lockdowns, and vaccinations. She’s arguing, as Torres characterizes her view, that “the response to the disease has been worse than the disease itself.” But have 800,000 Americans committed suicide from Covid-induced depression? No: look at the data from StatNews:

Those of us who posited that suicide rates may actually decline during the pandemic were either dismissed or criticized. But we were right: Provisional data released by the U.S. Centers for Disease Control and Prevention suggests that for the entire year of 2020 — when most lockdown procedures were put in place, many communities saw their highest rates of Covid-related deaths, and economic uncertainty was at its peak — suicide rates dropped by 3%.

For verification of this, see here and here (the latter is the Suicide Prevention Resource Center, which says that more data should be analyzed when it comes in later).

As for the efficacy of masks, the data summarizing their value can be seen at the CDC website, which actually gives data and doesn’t just say “wear masks”.

The gist of what she says here is that we shouldn’t have done anything about the pandemic. Maybe we would have had 2 millions deaths, but that’s just collateral damage.

Torres makes the point that nearly 100% the people in the hospital with Covid now are unvaccinated. They’re still dying, so how can you claim that vaccines don’t work? (The original clinical trials, of course, confirmed the efficacy of the vaccine.). As reader Paul wrote,

At least on COVID, Bari Weiss seems to have joined the other side. She and Bill seem to believe that the vaccine only protects the recipient against hospitalization and death and doesn’t help them avoid catching and passing on the disease. In general, Weiss seems to be positioning herself as a “media personality” rather than a writer, at least that’s my take.

Not only that, but she’s not even hewing to the data.  She’s come perilously close to being an anti-vaxer, if she isn’t one already.

In Weiss’s case, she hasn’t stayed in her ideological position while the left moved further left. No, she appears to be shifting to the right. I wouldn’t be surprised if eventually she become a never-Trumper Republican. I hope not, but what she had to say in this short segment greatly disheartened me.  And so did Maher’s response.

Weiss, at least, owes America a clarification of what she means when she says, “it’s time to end it.” End WHAT?

 

You can order your free Covid test kits now

January 18, 2022 • 11:30 am

Although American households were supposed to order their 4 free Covid test kits beginning tomorrow, reader Paul, quick to the mark, found out that you can order them NOW.

Just go to this site (or click on the screenshot below), and enter your name and address after pressing the blue button. Check out (no charge), and you’ll immediately get a confirmation email from the USPS.

The details (remember, rapid antigen tests aren’t usually accepted for international travel):

  • Limit of one order per residential address
  • One order includes 4 individual rapid antigen COVID-19 tests
  • Orders will ship free starting in late January

DO IT NOW!  Thanks, Paul.

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!

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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).

The New York Times might have used Bayes’ Theorem

January 4, 2022 • 10:00 am

by Greg Mayer

The New York Times has a data analysis division which they call The Upshot; I think they created it to compensate for the loss of Nate Silver’s 538, which was once hosted by the Times. The Upshot reporters and analysts tend to be policy wonks with some statistical savvy, so I took note of a big story they had on page 1 of Sunday’s (2 January) paper on why many prenatal tests “are usually wrong.”

The upshot, if you will, of the story is that many prenatal tests for rare chromosomal disorders unnecessarily alarm prospective parents because, even if the test result is positive, it is unlikely that the fetus actually has the disease. This is because when a disease is rare most positives are false positives, even when the test is quite accurate. For the five syndromes analyzed by the Times, the proportion of false positives (i.e. “wrong” results) ranged from 80% to 93%!

The Times does not go into detail of how they got those figures, but from links in their footnotes, I think they are empirical estimates, based on studies which did more conclusive followup testing of individuals who tested positive. My first thought, when looking at Sunday’s paper itself (which of course doesn’t have links!), was that they had used Bayes’ Theorem, the manufacturers’ stated sensitivity and specificity for their tests (the two components of a test’s accuracy), and the known prevalence of the condition to calculate the false positive rate.

Bayes’ Theorem is an important result in probability theory, first derived by the Rev. Thomas Bayes, and published posthumously in 1763. There is controversy over the school of statistical inference known as Bayesian statistics; the controversy concerns how one can form a “prior probability distribution”, but in this case we have an empirically derived prior probability distribution, the prevalence, which can be thought of as the probability of an individual drawn at random from the population in which the prevalence is known (or well-estimated) having the condition. There is thus no controversy over the application of Bayes’ Theorem to cases of disease diagnosis when there is a known prevalence of the condition, such as in the cases at hand.

Here’s how it works. (Remember, though, that I think the Times used empirical estimates of the rate, not this type of calculation.)

Using Bayes’ Theorem, we can say that the probability of having a disease (D) given a positive test result (+) depends on the sensitivity of the test (= the probability of a positive result given an individual has the disease, P(+∣D)), the specificity of the test (= the probability of a negative result given an individual does not have the disease, P(-∣ not D)), and the prevalence of the disease (= the probability that a random individual has the disease, P(D)). Formally,

P(D∣+) = P(+∣D)⋅P(D)/P(+)

where the terms are as defined above, and P(+) is the probability of a random individual testing positive. This is given by the sensitivity times the prevalence plus the specificity times (1- the prevalence), or

P(+) = P(+∣D)⋅P(D) + P(+∣ not D)⋅(1-P(D))

The whole thing in words can be put as

probability you are ill given a positive test =

sensitivity⋅prevalence/[sensitivity⋅prevalence + (1-specificity)⋅(1-prevalence)]

Let’s suppose we have a sensitive test, say P(+∣D)=.95, which is also quite specific, say P(-∣ not D)=.95 (sensitivity and specificity need not be equal; this is only a hypothetical), and a low prevalence, say P(D)=.01. Then

probability you are ill given a positive test =

= (.95)(.01)/[(.95)(.01)+(.05)(.99)]

= .16.

Thus, if you had a positive test, 84% of the time it would be “wrong”! This is right in the neighborhood of the rates found by the Times for the five conditions they examined. Notice that in this example, both sensitivity and specificity are high (which is good– you want both of these to be near the maximum of 1.0 if possible), but because prevalence is low (.01), the test is still usually “wrong”.

In an earlier discussion of Bayes’ Theorem, Jerry noted:

This [tests for rare conditions being usually wrong] is a common and counterintuitive result that could be of practical use to those of you who get a positive test. Such tests almost always mandate re-testing!

He’s absolutely right. A test with these properties is useful for screening, but not for diagnosis– you’d usually want to get a more definitive test before making any irreversible medical decisions. (For COVID 19, for example, PCR tests are more definitive than the quicker antigen tests.) The Times also discusses some of the unsavory aspects of the marketing of these tests, and the tragedy of the truly life and death decisions that can ensue, all of which flow from the results of the tests being misunderstood.

(Note: an alert reader spotted a mistake in the verbal equation, and in checking on it I spotted another in one of the symbolic equations. Both corrections have now been made, which are in bold above. The numerical result was not affected, as I’d used the correct numbers for the calculation, even though my verbal expression of them was wrong!)

For a nice but brief discussion, with some mathematical details, of the application of Bayes’ theorem to diagnosis, see sections 1.1-1.3 of Richard M. Royall’s Statistical Evidence: A Likelihood Paradigm (Chapman &Hall, London, 1996). Royall is not a Bayesian, which demonstrates the uncontroversial nature of the application of Bayes’ Theorem to diagnosis.