Well, just a couple of them. Just I been reading and writing about a number of things not just SARS-CoV-2. Then again, it's my Renaissance man persona and curious nature. I do enjoy those creative posts!
Terrific round-up, and thank you! How you find time to do things like this, I can’t imagine, but I am grateful.
On your second point, oh I am so with you—right down to your powerful, damning last paragraph. I would add that Linsey Marr should be canonized. Like you, I sought out people on social media whom I felt knew what they were talking about and I could trust to speak the truth. That kept my spouse and I Covid free for a very long time, so at least we had the added protection of every vaccine on offer when, despite all our precautions, we got hit with it at a small gathering of friends last New Year’s Day. We will never put our KN95s away. Indeed, on our recent 11-hour saga at the ER, that mask was all that stood between us and a place packed with people, many likely with Covid, mostly not wearing masks. A friend who had to take a trip to the ER recently was not so lucky, and contracted Covid from exposure to it in the ER.
On Paxlovid “rebound,” well I can only say I have seen it, and while I take your point that “rebound” is not what it really is—and it would not stop the one of us who can swallow the pills from taking it—I must also say that it was really, really scary when it occurred. What you point to suggests the need for our public health system and health systems to better explain what is going on when this happens and when and whether it’s a cause for worry and some sort of treatment is required. As it was, we just sat helplessly with the worry for several more days that one of us was headed for long covid. Thankfully, that didn’t happen, but it was a terrifying experience.
Finally, I think this is critically important and very little understood: “The immune system takes a hit with each Covid infection.” I’m particularly glad you summarized the study on this one. Even though I am an over-educated layperson with a health care-related background, I found the study itself incomprehensible and would never have been able to draw your point out of it.
So, thank you for all, and may the rest of your week be good!
Hi Susan - so many good points here this could be its own post.
I enjoy writing these, and I figure I'll try another round up maybe in 1-2 months... probably should have gone home earlier last night as I admit I'm dragging today.
Saint Linsey Marr for president, no doubt. She saved many lives, and stubbornly advanced the awareness of ventilation and particulate/droplet physics from the dark closet where these things existed outside mainstream awareness. Especially among many clinicians who are still dichotomous droplet/airborne thinkers. There was a lot of legal and liability exposure related to finally acknowledging that this thing is airborne, and federal/CDC heel dragging was likely in part due to the consequent enormous paradigm shift that would need to occur to keep people safe... with very limited resources, PPE, and will to change, but with lots of blame to go around.
I remain a little skeptical about CDC dismissing antiviral rebound, too. Especially when someone goes from RAAT negative with symptom resolution, to RAAT positive with symptom recurrence. I'll follow the leaders, but I can't square that 100% of the time with the post-infectious inflammatory stage they say is always to blame. Nothing in life is ever 100%, so I work with people in the gray areas and try not to be too dogmatic.
You are over-educated only to the point of being a fantastic resource and voice, here and in the real world! Hope you have a good week, too!
This should be in a T-shirt: front: “Nothing in life is ever 100%”; “Back” “so I work with people in the gray areas and try not to be too dogmatic.” (PS: the RAAT description you offer as exception to the rule is exactly what my spouse experienced.) You are the best, and also, the conversation you’ve engendered here is terrific.
Thanks for the summary of good articles. I’m giving a small talk about pandemic preparedness, for an adult education course, reading the Covid Wars book and was chided by a classmate-- retired public health-- that due to pandemic fatigue, people may not be interested. So frustrating. These are older but educated adults. Some of them have recently been quite ill with COVID.
Jan - I hear you completely. If I were attending your talk I would be sitting on the edge of my seat and taking notes!
I think as primary care doctors we are used to people's eyes glazing over when we keep going to the well about diet, exercise, and prevention... so keep fighting all the good fights, shining light on the cobwebs, and don't forget that audience participation wins more attention and engagement in the end!
This is terrific! I will be saving to dust off whenever the trolls come out of the woodwork crowing WhErEs ThE EViDeNcE fOr VaCciNeS. Thank you for all the time you put into this newsletter 🙏
I love that Jonathan Howard calls out the bad faith double standards the "Sensible Medicine" crew plays by: "They always overstate risks of the vaccine and minimize the impact of the virus...[Dr. Cifu] knows his audience demands “robust data” only for vaccine benefits."
I wrote something similar to a commenter on my LinkedIn post promoting my article on spillover veterinary vaccine hesitancy:
"While we don't have nearly enough studies, the data available is either inconclusive or non-supportive of links to long term adverse effects like immune mediated disease. IMO its a bit “sus” that many of the same people claiming your Banfield vet is ripping you off for that $20 vaccine are pushing over priced bullshit w little to no evidence behind them 🤔
I also find it quite ironic that most of the people in the alternative/holistic or “we’re just asking questions” crowd don’t even ATTEMPT to provide hard data for their colonics and crystals and lasers and homeopathy and supplements (that are often adulterated due to being totally unregulated!) but the second the conversation turns to drugs/vaccines, suddenly they’re all PhD epidemiologists with expertise in evidence based medicine who work at the Cochrane institute 🙄"
Hey Eric - I thought you would appreciate this post, and I'm glad you too have found a kindred voice of sorts with Jonathan Howard. I always forget about the website Science Based Medicine even though I listen to Steve Novella, and used to blog on the same site called Scienceblogs with David Gorski back in the day when he wrote Respectful Insolence. The skeptics are important soldiers in the war for truth through scientific discourse and interpretation ...even if they get cranky about Substack. Think we can recruit them over here? (ha!)
Nice reply to said commenter. The contradictions a human mind is capable of holding at the same time are incredible... I'm sure I am guilty of this at times, so always feel free to call me out when my thinking is flawed!
I'm so glad I discovered Science Based Medicine through that post! I also used to read Dr. Gorski on Scienceblogs (along with PZMyers, although over time I found him a bit too militant for my mellowing tastes); it's great to find him on his new home at SBM.
I spent part of the morning catching up on a number of their articles and the two below really explained a LOT about Sensible Medicine and the deliberate misuse of evidence-based medicine concepts to "zhuzh" up and mask what is basically just old-school anti-vaxx nonsense. Wish I had some of these resources when my Substack got flooded with crazies last fall! I'm definitely going to start using the phrase "methodolatry" in the future.
"2023: the year that the EBM paradigm was weaponized against vaccines and public health" - David Gorski
I got to the horrible substack he references "Sensible Medicine" by a normally reasonable source and it took me a little while to realize how horrible it is--misinformation can be so easily cloaked.
I loved this article, too, and I'm going to buy his book right now. I also learned of him through Eric Topol.
I can't figure a way to get Science Based Medicine in my inbox... I forget to go over to that site spontaneously but it is full of top notch scientific minds.
I'm humbled by your vote of confidence, so thanks for that too!
The Great Barrington Proclamation would have been a complete disaster, like so many other divergent paths we could have taken save for some heroes keeping more steady hands on the wheel. I just hope they are still there next time.
Sorry to comment so much: I have never found the Cochrane collaborative helpful--when I joined academia 20+ years ago, I wrote a "Cochrane for Clinicians" article for American Family Medicine and was shocked at how they discarded the vast majority of studies on the topic (antibiotics for sinusitis) based on the requirement to only evaluate studies that included sinus aspirates (not common even then.) Analyzing the 3 studies (having discarded hundreds) that were left, they could draw no conclusion.
So true! I value your inside experience here, and it’s really enlightening how paring things down for the sinusitis review potentially warped it for the lost cause of sinus aspirates! Who does that?
I share your wariness with blind faith in evidence based medicine, just as I am wary of practicing medicine 100% by the book. I will look forward to reading that new yorker article, thank you!
What a wonderful and useful compilation of information. Thank you. I was particularly struck by one of your comments about how everyone should get the vaccine once a year, maybe twice for the elderly. I am "elderly" at 75 and one of my pet grievances is how we are treated in policy decisions. No differential at all. And there seems to be no intent to change that approach. Probably because the public health authorities don't want to "dilute" the simple message of "once a year". So thanks for mentioning it - so few do.
Hi and thanks! I think there is a clear difference between the risks a 65 yo faces against Covid and what a 95 yo faces, yet the blanket recommendations mirror our magic number of 65 which is a convenient age to start Medicare. You are correct about trying to simplify the message, but many thought leaders I follow on this really think a 6month booster for those at highest risk is the way to go for now, and among the most significant risk factors as you know is age!
We anticipate guidance about Spring boosters with the XBB shots 20% of adults received already this year. They worked about 54% of the time against infection, which ain't bad. I would take that again, knowing it drops off each month:
“Thought leaders” you follow are convinced, influential and persuasive. I am less confident that we’ll see that guidance this Spring. We’re only 2-3 months away and there’s been not a peep/hint on the idea. All we hear is the “annual” - just like the flu shot. ( And, believe me, we’re listening and reading all we can get our hands on). I don’t worry as much anymore about our children in their mid to late 30s, but we are in our mid to later 70s and are still very concerned. We’d appreciate it if you’d use your platform to advocate for two doses a year for us. I consider you a “thought leader” too.
I will definitely post when there is a recommendation or not this spring! I also follow Dr. Daniel Griffin, who does a great weekly podcast called this week in virology clinical update. He hinted that there is probably nothing stopping people from getting a six month booster if they really want one from the pharmacy, recommendation or not. I’m going to wait for the official word on this, but just FYI.
I love the peeks you give us into your dad-daughter relationship. This one brings back fond memories of my daughter enjoying the snow with her daddy, too.
Burning the midnight oil again? Nice synopsis! Don't forget we have a few other respiratory diseases out there. ;-)
Don’t tempt me!
I’m guessing you have heard of the studies above and read most of them, as I know you follow the trail better than most.
Feeling a creative post for a break next time perhaps!
Well, just a couple of them. Just I been reading and writing about a number of things not just SARS-CoV-2. Then again, it's my Renaissance man persona and curious nature. I do enjoy those creative posts!
Very useful info. Thank you!!!!
Terrific round-up, and thank you! How you find time to do things like this, I can’t imagine, but I am grateful.
On your second point, oh I am so with you—right down to your powerful, damning last paragraph. I would add that Linsey Marr should be canonized. Like you, I sought out people on social media whom I felt knew what they were talking about and I could trust to speak the truth. That kept my spouse and I Covid free for a very long time, so at least we had the added protection of every vaccine on offer when, despite all our precautions, we got hit with it at a small gathering of friends last New Year’s Day. We will never put our KN95s away. Indeed, on our recent 11-hour saga at the ER, that mask was all that stood between us and a place packed with people, many likely with Covid, mostly not wearing masks. A friend who had to take a trip to the ER recently was not so lucky, and contracted Covid from exposure to it in the ER.
On Paxlovid “rebound,” well I can only say I have seen it, and while I take your point that “rebound” is not what it really is—and it would not stop the one of us who can swallow the pills from taking it—I must also say that it was really, really scary when it occurred. What you point to suggests the need for our public health system and health systems to better explain what is going on when this happens and when and whether it’s a cause for worry and some sort of treatment is required. As it was, we just sat helplessly with the worry for several more days that one of us was headed for long covid. Thankfully, that didn’t happen, but it was a terrifying experience.
Finally, I think this is critically important and very little understood: “The immune system takes a hit with each Covid infection.” I’m particularly glad you summarized the study on this one. Even though I am an over-educated layperson with a health care-related background, I found the study itself incomprehensible and would never have been able to draw your point out of it.
So, thank you for all, and may the rest of your week be good!
Hi Susan - so many good points here this could be its own post.
I enjoy writing these, and I figure I'll try another round up maybe in 1-2 months... probably should have gone home earlier last night as I admit I'm dragging today.
Saint Linsey Marr for president, no doubt. She saved many lives, and stubbornly advanced the awareness of ventilation and particulate/droplet physics from the dark closet where these things existed outside mainstream awareness. Especially among many clinicians who are still dichotomous droplet/airborne thinkers. There was a lot of legal and liability exposure related to finally acknowledging that this thing is airborne, and federal/CDC heel dragging was likely in part due to the consequent enormous paradigm shift that would need to occur to keep people safe... with very limited resources, PPE, and will to change, but with lots of blame to go around.
I remain a little skeptical about CDC dismissing antiviral rebound, too. Especially when someone goes from RAAT negative with symptom resolution, to RAAT positive with symptom recurrence. I'll follow the leaders, but I can't square that 100% of the time with the post-infectious inflammatory stage they say is always to blame. Nothing in life is ever 100%, so I work with people in the gray areas and try not to be too dogmatic.
You are over-educated only to the point of being a fantastic resource and voice, here and in the real world! Hope you have a good week, too!
This should be in a T-shirt: front: “Nothing in life is ever 100%”; “Back” “so I work with people in the gray areas and try not to be too dogmatic.” (PS: the RAAT description you offer as exception to the rule is exactly what my spouse experienced.) You are the best, and also, the conversation you’ve engendered here is terrific.
Thanks for the summary of good articles. I’m giving a small talk about pandemic preparedness, for an adult education course, reading the Covid Wars book and was chided by a classmate-- retired public health-- that due to pandemic fatigue, people may not be interested. So frustrating. These are older but educated adults. Some of them have recently been quite ill with COVID.
Jan - I hear you completely. If I were attending your talk I would be sitting on the edge of my seat and taking notes!
I think as primary care doctors we are used to people's eyes glazing over when we keep going to the well about diet, exercise, and prevention... so keep fighting all the good fights, shining light on the cobwebs, and don't forget that audience participation wins more attention and engagement in the end!
It is great you are doing this, and as an alte kaker who just turned 75, I would be one of those sitting on the edge of my seat.
This is terrific! I will be saving to dust off whenever the trolls come out of the woodwork crowing WhErEs ThE EViDeNcE fOr VaCciNeS. Thank you for all the time you put into this newsletter 🙏
I love that Jonathan Howard calls out the bad faith double standards the "Sensible Medicine" crew plays by: "They always overstate risks of the vaccine and minimize the impact of the virus...[Dr. Cifu] knows his audience demands “robust data” only for vaccine benefits."
I wrote something similar to a commenter on my LinkedIn post promoting my article on spillover veterinary vaccine hesitancy:
"While we don't have nearly enough studies, the data available is either inconclusive or non-supportive of links to long term adverse effects like immune mediated disease. IMO its a bit “sus” that many of the same people claiming your Banfield vet is ripping you off for that $20 vaccine are pushing over priced bullshit w little to no evidence behind them 🤔
I also find it quite ironic that most of the people in the alternative/holistic or “we’re just asking questions” crowd don’t even ATTEMPT to provide hard data for their colonics and crystals and lasers and homeopathy and supplements (that are often adulterated due to being totally unregulated!) but the second the conversation turns to drugs/vaccines, suddenly they’re all PhD epidemiologists with expertise in evidence based medicine who work at the Cochrane institute 🙄"
Hey Eric - I thought you would appreciate this post, and I'm glad you too have found a kindred voice of sorts with Jonathan Howard. I always forget about the website Science Based Medicine even though I listen to Steve Novella, and used to blog on the same site called Scienceblogs with David Gorski back in the day when he wrote Respectful Insolence. The skeptics are important soldiers in the war for truth through scientific discourse and interpretation ...even if they get cranky about Substack. Think we can recruit them over here? (ha!)
Nice reply to said commenter. The contradictions a human mind is capable of holding at the same time are incredible... I'm sure I am guilty of this at times, so always feel free to call me out when my thinking is flawed!
I'm so glad I discovered Science Based Medicine through that post! I also used to read Dr. Gorski on Scienceblogs (along with PZMyers, although over time I found him a bit too militant for my mellowing tastes); it's great to find him on his new home at SBM.
I spent part of the morning catching up on a number of their articles and the two below really explained a LOT about Sensible Medicine and the deliberate misuse of evidence-based medicine concepts to "zhuzh" up and mask what is basically just old-school anti-vaxx nonsense. Wish I had some of these resources when my Substack got flooded with crazies last fall! I'm definitely going to start using the phrase "methodolatry" in the future.
"2023: the year that the EBM paradigm was weaponized against vaccines and public health" - David Gorski
https://sciencebasedmedicine.org/2023-the-year-that-the-evidence-based-medicine-ebm-paradigm-was-weaponized-against-vaccines-and-public-health/
"Methodolatry and COVID" - Jonathan Howard
https://sciencebasedmedicine.org/methodolatry-and-covid/
Thank you for linking the amazing Johnathan Howard piece on Science-Based Medicine--it's a long read but so good: https://sciencebasedmedicine.org/dr-adam-cifu-we-now-need-to-accept-that-this-is-here-to-get-infected-with-again-and-again/?utm_source=substack&utm_medium=email
Johnathan Howard wrote "We want them all infected" --the concept behind the Great Barrington Proclamation
I heard Eric Topol interview him: https://erictopol.substack.com/p/jonathan-howard-author-of-we-want
I got to the horrible substack he references "Sensible Medicine" by a normally reasonable source and it took me a little while to realize how horrible it is--misinformation can be so easily cloaked.
He's a hero, but so are you.
I loved this article, too, and I'm going to buy his book right now. I also learned of him through Eric Topol.
I can't figure a way to get Science Based Medicine in my inbox... I forget to go over to that site spontaneously but it is full of top notch scientific minds.
I'm humbled by your vote of confidence, so thanks for that too!
The Great Barrington Proclamation would have been a complete disaster, like so many other divergent paths we could have taken save for some heroes keeping more steady hands on the wheel. I just hope they are still there next time.
I keep trying to “ subscribe “ to Science Based Medicine but it doesn’t take: guess I should bookmark the site
Sorry to comment so much: I have never found the Cochrane collaborative helpful--when I joined academia 20+ years ago, I wrote a "Cochrane for Clinicians" article for American Family Medicine and was shocked at how they discarded the vast majority of studies on the topic (antibiotics for sinusitis) based on the requirement to only evaluate studies that included sinus aspirates (not common even then.) Analyzing the 3 studies (having discarded hundreds) that were left, they could draw no conclusion.
I'm old enough to remember when EBM started and it's better than pure anecdote but not perfect. I loved this old New Yorker article about the inability to replicate studies: https://www.newyorker.com/magazine/2010/12/13/the-truth-wears-off
So true! I value your inside experience here, and it’s really enlightening how paring things down for the sinusitis review potentially warped it for the lost cause of sinus aspirates! Who does that?
I share your wariness with blind faith in evidence based medicine, just as I am wary of practicing medicine 100% by the book. I will look forward to reading that new yorker article, thank you!
What a wonderful and useful compilation of information. Thank you. I was particularly struck by one of your comments about how everyone should get the vaccine once a year, maybe twice for the elderly. I am "elderly" at 75 and one of my pet grievances is how we are treated in policy decisions. No differential at all. And there seems to be no intent to change that approach. Probably because the public health authorities don't want to "dilute" the simple message of "once a year". So thanks for mentioning it - so few do.
Hi and thanks! I think there is a clear difference between the risks a 65 yo faces against Covid and what a 95 yo faces, yet the blanket recommendations mirror our magic number of 65 which is a convenient age to start Medicare. You are correct about trying to simplify the message, but many thought leaders I follow on this really think a 6month booster for those at highest risk is the way to go for now, and among the most significant risk factors as you know is age!
We anticipate guidance about Spring boosters with the XBB shots 20% of adults received already this year. They worked about 54% of the time against infection, which ain't bad. I would take that again, knowing it drops off each month:
https://www.statnews.com/2024/02/01/updated-covid-vaccine-effectiveness/
Hi and thanks for responding. I hope the
“Thought leaders” you follow are convinced, influential and persuasive. I am less confident that we’ll see that guidance this Spring. We’re only 2-3 months away and there’s been not a peep/hint on the idea. All we hear is the “annual” - just like the flu shot. ( And, believe me, we’re listening and reading all we can get our hands on). I don’t worry as much anymore about our children in their mid to late 30s, but we are in our mid to later 70s and are still very concerned. We’d appreciate it if you’d use your platform to advocate for two doses a year for us. I consider you a “thought leader” too.
I will definitely post when there is a recommendation or not this spring! I also follow Dr. Daniel Griffin, who does a great weekly podcast called this week in virology clinical update. He hinted that there is probably nothing stopping people from getting a six month booster if they really want one from the pharmacy, recommendation or not. I’m going to wait for the official word on this, but just FYI.
I love the peeks you give us into your dad-daughter relationship. This one brings back fond memories of my daughter enjoying the snow with her daddy, too.
Awww 🥰 … it goes so fast as they say. I could write a whole blog about being a dad but that wouldn’t leave time to fold laundry and make bad jokes.
Thx. We may just grab one in any event. But hope we don’t have to break any rules.🙃