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Category: COVID-19

Dr. Topol’s comment on LongCOVID and the heart is misleading/lacking context

By ANISH KOKA

It’s been a while but Anish Koka, a one time regular writer on THCB and occasional THCB Gang member, is back publishing up a storm on his Substack channel. You may recall that his political and clinical views don’t always mesh with some of the wooly liberals we feature on THCB (cough, cough, me), but we are delighted to be back publishing some of his pieces–starting with a look at a tweet from one of America’s most prominent cardiologists.–Matthew Holt

Given Twitter’s commitment to the truth in Medicine, I thought I would try to give them a hand by analyzing a semi-viral tweet about COVID and the heart.

Earlier this year (April 2022), the most influential cardiologist in the world tweeted about a study on the long term cardiac effects of COVID (LongCOVID).

Medical trainees who trained in the early 2000s like I did know Dr. Topol as an absolute legend in the field of Cardiology. He was responsible for seminal work in Cardiology in the 1980’s on the use of clot busting drugs for patients having heart attacks, and became head of cardiology for the famed Cleveland Clinic at the age of 36! (I vaguely recall feeling like I was starting to understand Cardiology at the age of 36.) He’s since moved on to do many other things, and is a potent voice that may have been instrumental in the FDA delaying approval of the mrna vaccines until after the 2020 election.

Nonetheless, this paper that he is giving his significant stamp of approval to has significant issues. As far as I can tell individuals with LongCOVID were recruited by advertising in LongCOVID support groups. No independent assessment carried out as far as I can tell clinically. If you say you have it—> you’re in.

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The (sort of, partial) Father mRNA Vaccines Who Now Spreads Vaccine Misinformation (Part 2)

By DAVID WARMFLASH, MD

This is part 2 of David Warmlash’s takedown of Robert W. Malone’s appearance (transcript) on the Rogan podcast. Part 1 is here

Menstruation and Fertility

Much more than the line about reproductive damage in the Wisconsin News clip that we used to open the story, Malone used the Rogan interview to dive more deeply into the topic, starting with:

 …there’s a huge number of dysmenorrhea and menometrorrhagia…

By that, he meant excessive menstrual cramping and very heavy, often irregular, bleeding, which he followed up with:

…they DENY it…

Judging by other parts of the interview, ‘they’ means government health agencies, big pharma, mainstream media. Thus, it was quite an accusation, given that, months prior to Malone’s talk with Rogan, the National Institutes of Health (NIH) had announced a program to study COVID-19 vaccination effects in pregnant and postpartum women and then announced, very publicly, that it had awarded $1.67 million to five institutions (Boston University, Harvard Medical School, Johns Hopkins University, Michigan State University, and Oregon Health and Science University [OHSU]) to study vaccines and the menstrual cycle.

Rather than bringing up any of that NIH-funded research, however, Malone jumped into a description of haredi rabbis asking him to ‘testify’ at a rabbinical ‘court’ in Brooklyn:

..it turns out that the rabbis in the Hasidic jew community carefully monitor–we don’t need to go into how–the menstrual cycle of the fertile women in their congregations, closely monitor it because there is strict guidance about cleanliness and intercourse and they had a major problem because they these you know these are all 60 plus up to 80 long beards right here that had exquisite understanding about the menstrual cycle in all the women in their congregations and they all knew that these menstrual cycles were being disrupted all the time…

What a load of mishigas.

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The (sort of, partial) Father mRNA Vaccines Who Now Spreads Vaccine Misinformation (Part 1)

By DAVID WARMFLASH, MD

Robert W. Malone, MD MS, is a physician-scientist who will live in infamy, thanks to the Joe Rogan Experience Podcast boosting his visibility this past December regarding his criticism of COVID-19 vaccines, particularly the mRNA vaccines (Moderna and Pfizer-BioNTech). Subsequently, Malone was banned from Twitter, which further boosted his celebrity status. Describing himself as the inventor of mRNA vaccine technology, he has been reaching a growing number of people with a narrative that makes COVID-19 vaccination sound scary. We cannot embed clips from the Rogan interview, which lasted about three hours, because it is accessed only on Spotify. But we can pull quotes from the interview transcript and we can see how Malone addresses non-scientists in shorter appearances, like the following clip from Wisconsin Morning news aimed at parents:

…Before you inject your child – a decision that is irreversible – I wanted to let you know the scientific facts about this genetic vaccine, which is based on the mRNA vaccine technology I created…

There are three issues parents need to understand:

The first is that a viral gene will be injected into your childrens cells. This gene forces your childs body to make toxic spike proteins. These proteins often cause permanent damage in childrens critical organs, including

Their brain and nervous system

Their heart and blood vessels, including blood clots

Their reproductive system

And this vaccine can trigger fundamental changes to their immune system

The most alarming point about this is that once these damages have occurred, they are irreparable

You cant fix the lesions within their brain

You cant repair heart tissue scarring

You cant repair a genetically reset immune system, and

This vaccine can cause reproductive damage that could affect future generations of your family….

Along with the alarmist theme, there are some phrases in the excerpt that people with little knowledge of biology could take the wrong way. The ‘toxic’ spike protein terminology warrants unpacking later, because Malone’s more farfetched ideas rest upon his disagreement with experts who have worked on that very spike protein. This is a protein that SARS-CoV2 (the virus that causes COVID-19) makes and uses to enter body cells, and is the basis of most of the COVID-19 vaccines that are approved throughout the world. In the case of the genetic vaccines (the mRNA vaccines of Pfizer-BioNTech and Moderna and the viral vector vaccines of Johnson and Johnson and AstraZeneca), the vaccines do not actually contain spike protein. Instead, they contain a recipe for cells of a vaccinated person (not all the person’s cells, but just a small sampling) to make spike protein —in very small amounts and for a very limited time— and display it on the outer part of their cell membranes. This allows the immune system to use that vaccine-generated spike protein for target practice, so you can build immunity against the virus without the virus infecting you.

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Ecology and Technical Advance

By MIKE MAGEE

It is fair to say that the vast majority of Americans know more about viruses today than they did 24 months ago. The death and destruction in the wake of COVID-19 and its progeny have been a powerful motivator. Fear and worry tend to focus one’s attention.

Our collective learnings are evolving. We have already seen historic comparisons to other epidemics. Just search “The 10 worst epidemics” for confirmation. But one critical area which has been skimmed over, and only delicately probed (if at all) is the ecology or “the ecological point of view.”

For those interested, let me recommend “Natural History of Infectious Disease” published in 1972 by Nobel laureate and Australian biologist Sir Macfarlane Burnet and his colleague David O. White.

Chapter 1 begins: “In the final third of the twentieth century, we of the affluent West are confronted with no lack of environmental, social, and political problems, but one of the immemorial hazards of human existence is gone. Young people today have had almost no experience of serious infectious disease…For the first time in history deaths in infancy and childhood are not predominantly from infection.” But a few sentences on, they add this addendum, “Infectious diseases may be almost invisible, but it is still potentially as important as ever it was.”

Americans are all too familiar with the living biologic organism named COVID-19. By now, they know what it looks like, the role of its outer spikes, its nuclear makeup, and genetic alterations that allow the creation of derivative variants and vaccines. But in addition to its biological science, it also has an ecological life as well.

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Spotify, Joe Rogan, and Health Care

By KIM BELLARD

Here’s a sentence I never thought I’d have to write: the most interesting discussion in healthcare in the past week has been about Neil Young versus Spotify.  

For those of you who have not been following the controversy, Neil Young gave Spotify an ultimatum: it could have his music or Joe Rogan, but not both.  “I am doing this because Spotify is spreading fake information about vaccines – potentially causing death to those who believe the disinformation being spread by them.”  Spotify chose Rogan.

Mr. Young was not the first to express alarm at some of the Covid “information” promoted on Mr. Rogan’s podcast, The Joe Rogan Experience (JRE); in December, for example, several hundred scientists from around the world issued an open letter to Spotify specifically about JRE, warning:

By allowing the propagation of false and societally harmful assertions, Spotify is enabling its hosted media to damage public trust in scientific research and sow doubt in the credibility of data-driven guidance offered by medical professionals.

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The Tests were a Test

By KIM BELLARD

Raise your hand if you’ve gone out shopping for home COVID tests, only to find empty shelves and signs apologizing for the lack of availability.  Raise your hand if you’ve been able to obtain one, but were surprised at its cost.  Raise your hand if you took one and weren’t quite sure you did it right, or wondered who, if anyone, would be getting the results.

Vox says that the COVID home test reimbursement process “is a microcosm of US health care,” and I think they’ve understated the situation.  Testing has been a microcosm for the US health care system generally.  It was a test, and our healthcare system failed.

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The Covid Vaccine’s PR Crisis: Health Innovation vs the Take-Down Power of Disinformation

By JESSICA DaMASSA

Misinformation and disinformation (intentionally wrong information) have plagued the storyline of the Covid19 vaccine since the early days of its development, creating a healthcare communications crisis that has not only stalled U.S. vaccination rates, but has also raised questions about how medical and scientific experts will ever again win trust across audiences and communications platforms that are becoming increasingly fragmented, and sometimes hostile.

Yesterday, on the two-year anniversary of the first Covid case in the U.S., I sat down with Dr. Carlos del Rio, Professor of Infectious Diseases & Epidemiology at Emory University, and Jon Reiner, Editorial Director at 120/80 MKTG, to check-in on the vaccine conversation and, more generally, what we in the health innovation community can learn from this situation as we attempt to introduce other new medicines, breakthrough technologies, and scientific advances to the world.

Dr. del Rio served as a vaccine expert in a public service campaign that 120/80 MKTG put together called “Just the Facts on Vax,” which sought to combat vaccine disinformation early-on with a series of bite-sized, social-media-ready videos that put infectious disease experts front-and-center to answer common questions about the vaccine. The full campaign can be viewed on 120over80 MKTG’s YouTube channel, but can it still have an impact? And, in the grand scheme of things, when it comes to people’s personal health, evolving medical or scientific information, and a litany of communication platforms that can position nearly anyone as an expert, how do real experts build trust? An interesting – and timely – chat about the power of information and the “trusted expert” archetype in the context of one of the most unique healthcare stories of our lifetime.

The Vaccine Brawl – A Legal Battle in Process

By MIKE MAGEE

The power to mandate vaccines was litigated and resolved over a century ago. Justice John Marshall Harlin, a favorite of current Chief Justice Roberts, penned the 7 to 2 majority opinion in 1905’s Jacobson v. Massachusetts. Its impact was epic.

In 1905, Massachusetts was one of 11 states that required compulsory vaccinations. The Rev. Henning Jacobson, a Lutheran minister, challenged the city of Cambridge, MA, which had passed a local law requiring citizens to undergo smallpox vaccination or pay a $5 fine. Jacobson and his son claimed they had previously had bad reactions to the vaccine and refused to pay the fine believing the government was denying them their due process XIV Amendment rights.

In deciding against them, Harlan wrote, “liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own [liberty]…” 

Of course, a state’s right to legislate compulsory public health measures does not require them to do so. In fact, as we have seen in Texas and Florida among others, they may decide to do just the opposite – declare life-saving mandates (for masks or vaccines) to be unlawful. At least 14 states have passed laws barring employer and school vaccine mandates and imposing penalties in Republican-controlled states already.  

So state powers are clearly a double-edged sword when it comes to health care. 

Questions anyone?

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Does Our Healthcare System Work for the Most Vulnerable Americans?

By DEBORAH AFEZOLLI, CARL-PHILIPPE ROUSSEAU, HELEN FERNANDEZ, ELIZABETH LINDENBERGER

“Why did you choose this field?” Most physicians are asked this question at some point in their early careers. We are geriatrics and palliative medicine physicians, so when that question is posed to us, it is invariably followed by another: “Isn’t your job depressing?”

No, our job is not depressing. We are trained in the care of older adults and those with serious illness, and we find this work very rewarding.  What truly depresses us is how many vulnerable patients died during the pandemic, and how the scourge of COVID-19 revealed the cracks in our health system. Never before in modern times have so many people been affected by serious illness at the same time, nor have so many suffered from the challenges of our dysfunctional health system. Our nation has now witnessed the medical system’s failure to take comprehensive care of its sickest patients.  This is something those in our own field observed long before the pandemic and have been striving to improve.

All of us practicing geriatrics and palliative care have had a loved one who has been challenged by aging, by serious illness, or indeed by the very healthcare system that is supposed to help them. As medical students and residents, we personally confronted these systemic deficiencies and wondered about alternatives for those patients with the most complex needs. We chose fellowships in geriatrics and palliative medicine because we wanted to try and make a difference in the healthcare that is offered to our most vulnerable patients.

During the New York City surge in the spring of 2020, we were front line workers at a major academic medical center. While the global pandemic took us all by surprise, our clinical training and passion for treating vulnerable populations left us feeling capable and ready to serve. Due to the urgent needs of overwhelming numbers of extremely sick patients, our Department was charged with rapidly expanding access to geriatrics and palliative care across our seven hospitals. We were embedded in Emergency Departments (EDs), hospitalist services, and critical care units.  We roamed the hospitals with electronic tablets and held the hands of dying patients, while urgently contacting families to clarify goals of care.  For those who wanted to receive care in the community, we scrambled to set up telehealth visits and coordinate the necessary support. Way too often we could not meet their needs with adequate services, forcing them to visit overwhelmed Emergency Rooms.

While we helped individual patients and eased some of the strain on our hospitals, our system was overwhelmed and mortality numbers continued to steadily rise. Within our hospitals, staff were redeployed to care for the most critically ill in the emergency departments and intensive care units.  In this frantic time, we were fortunate that our hospitals had sufficient medical resources to care for the sickest patients and for the staff.  However, the sub-acute nursing facilities (SNF) and long-term care facilities strained to protect their residents and their employees. Shortages of PPE, staff, space, testing supplies, and funding all contributed to the high mortality numbers we saw in many NYC facilities and across the nation. There were also limited resources allocated to delivering outpatient care in our patients living in the community.  The rapid shift to telehealth was not feasible for many of our older patients, and even when it was possible, the delivery of diagnostic and therapeutic care was limited and suboptimal.

Data now shows that older adults and those with underlying chronic illnesses were disproportionately affected by the COVID-19 pandemic, experiencing higher hospitalization rates as well as higher death rates. Although adults 65 and older account for only 16% of the US population, they represent 80% of COVID-19 deaths. Residents of nursing homes, the frail homebound, and older people of color were the hit the hardest. Thirty-five percent of the deaths in the US from March-May 2020 occurred among nursing home residents and employees. Nationally, over 600,000 nursing home residents were infected with COVID-19 and over 100,000 died from the disease. These data are underestimates and the death toll is likely higher. We cannot explain why older Black Americans were 1.2 times more likely to die than white Americans nor why the odds of dying from COVID were nearly two times higher for persons living in South Dakota as compared to Wyoming or Nebraska. Often, the paid caregivers for these vulnerable patients were themselves vulnerable underpaid women of color who were at higher risk of contracting COVID.

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Sleepless Nights For Evolutionary Biologists: A Greek Tragedy in The Making

By MIKE MAGEE

In my Jesuit high school, we were offered only one science course – chemistry. I took it in my Senior year and did pretty well. In contrast, I took four years of Latin, and three years of Greek, as part of the school’s Greek Honors tract.

Little did I know that Covid would create a pathologic convergence of sorts six decades later. Let’s review the Covid mutants:

Alpha – A variant first detected in Kent, UK with 50% more transmissibility than the original and has spread widely.

Beta – Originating in South Africa and the first to show a mutation that partially provided evasion of the human immune system, but may have also made it less infectious.

Gamma – First detected in Brazil with rapid spread throughout South America.

Delta – First seen in India with 50% more transmissibility than the Alpha variant, and now the dominant variant in America and around the world.

Our ability to track and identify mutating viruses in real time is now extraordinary. Over 2 million Covid genomes have been cataloged and published. But describing the “anatomy” of the virus is miles away from understanding the functional significance of their codes, or the various biochemical instructions they may instruct.

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