Why you should trust the coronavirus vaccine

Let me start by making one thing clear: at the time of this writing, we don't have a scientifically validated vaccine for COVID-19. But more than 150 vaccines are being developed around the world, and many of them are already in advanced stages of testing.

So we'll have a vaccine soon, likely in a matter of months. And everyone should take it. I know I will.

Today I’m going to try to de-mystify vaccines a bit, in the hope that this might help people feel more comfortable with them.

Before explaining what a vaccine actually is, let me point out that vaccines are probably the single greatest medical advance in the history of human civilization. Vaccines have saved hundreds of millions of lives: prior to vaccines, people lived in fear of diseases like smallpox, which killed 300 million people in the 20th century alone. Thanks to the vaccine, we eradicated smallpox from the entire world in 1980. Polio is another dreaded disease that killed or permanently injured millions, until the 1950s, when Hilary Koprowski, Jonas Salk, and Alfred Sabin invented vaccines that protected against it. Today, no one in the U.S. or Europe worries about polio, and it too has nearly been eradicated worldwide.

What exactly is a vaccine? It’s a pretty simple concept. Our immune system has the remarkable ability to “remember” pathogens that we’ve been exposed to. So once you’ve been infected with some viruses or bacteria, you acquire immunity to those diseases that may last the rest of your life. A vaccine is basically a way to teach the immune system to recognize a pathogen without actually making you sick.

The simplest way to do this (conceptually) is to take a batch of viruses or bacteria, kill them so they’re harmless, and then just inject them into a person. The immune system then “sees” the proteins in the dead pathogens (because the proteins are still floating around), and it learns all it needs to know from these. Later on, if a live virus infects that person, her immune system will say “aha, I know you!” and will quickly surround and destroy the invaders.

Simple as it sounds, there are many complications with this process. One is that it’s often very hard to isolate and grow enough of the virus (or bacteria) for large-scale production. The viruses then need to be isolated, killed, and purified, which can be complicated and costly. For COVID-19, though, any cost is worth it.

Another, much newer way to make vaccines uses modern molecular technology to make RNA. There’s no need to isolate or grow the virus at all! This is how Moderna’s new mRNA vaccine works (see their whitepaper here).

The mRNA vaccine relies on the fact that we already know which protein in the SARS-CoV-2 virus is the most important one. It’s called the spike protein, so I’ll just call it Spike. Spike is what attaches to human cells and lets the virus infect them. We also know the sequence of the Spike gene: the sequence of the entire SARS-CoV-2 virus was released in early January, and we’ve now sequenced thousands of these viruses.

An mRNA vaccine simply uses the RNA itself, rather than dead viruses. Today we can synthesize RNA in large quantities, so if you take some of this RNA and inject it into a person, what happens? Well, our own cells will translate this RNA to produce the Spike protein. All by itself, the protein cannot possibly cause an infection. It’s analogous to having a motor without a car: you can’t go anywhere without the whole package.

But here’s the good part: our immune system will recognize Spike anyway, even without the virus, and it will remember this invader. So the RNA vaccine is, in theory at least, even safer than traditional vaccines, because live pathogens are never used in the production process. (Before the anti-vaxxers jump on me here, let me emphasize that traditional vaccines are incredibly safe.)

This is just one example: there are 23 vaccines already in human trials, and over 150 in development, using mRNA, proteins, and other approaches.

There are other ingredients in vaccines too: preservatives and adjuvants. Anti-vaxxers like to read vaccine ingredients and then claim that all sorts of harmful stuff is in there, but their claims are mostly just gross ignorance. Preservatives are there to prevent the growth of things like bacteria, so they make vaccines safer. And adjuvants like aluminum salts (the most common adjuvant) are ingredients that enhance the effectiveness of vaccines, meaning you can use a lower dose. Aluminum salts have a very long safety record.

So why don’t people trust vaccines? Largely because the anti-vaccine movement has spent years spreading misinformation and fear, and it is already pronouncing strong opposition to any coronavirus vaccine, regardless of the evidence. The New York Times reported this week that mistrust of future coronavirus vaccines could imperil public health, especially in the United States. Polls have shown that large proportions of Americans say they won't take a vaccine even when it's available, which is, frankly, kind of crazy. (It didn’t help when tennis player Novak Djokovic expressed doubts about whether he’d be willing to take any future coronavirus vaccine.) Last month, NIH’s Anthony Fauci said that the “general anti-science, anti-authority, anti-vaccine feeling” in the U.S. may seriously undermine the effectiveness of any future vaccine. Of course, this could change once we really do have a vaccine, and we should all hope it does. But the anti-vaxxers never let up.

It also doesn't help build trust when the Trump administration calls their vaccine program "Operation Warp Speed." This might have sounded exciting to some sci-fi fans in the White House, but to many people it sounds more like a devil-may-care approach that emphasizes speed over safety. 

So how do we establish trust in the new vaccines, which are probably coming just a few months from now? One way to reassure people is to publish all the numbers from the vaccine trials. A just-published study in NEJM on the Moderna vaccine (the RNA vaccine) provides exactly these numbers, and they look very good in terms of both safety and effectiveness. 

In that study, all 45 participants had a robust antibody response–a stronger response, in fact, than in many people who’d been infected with the virus itself. There were some side effects, including fever and chills, but all were graded as mild or moderate. The scientists looked at 3 different dosage levels, and the side effects were greatest in the highest dose–but the antibody response was perfectly adequate in the lower dosage levels. So the next phase of testing, already under way, is using the lower dosages.

This was a phase 1 study, but it's very encouraging. If these results hold up in a large group–a question that is being tested now, in a phase 3 study–we'll have a working vaccine. 

And if you want to know more about this trial, you can read about it at the public NIH site, ClinicalTrials.gov.

Many if not all of the vaccines being developed in Europe and the U.S. are going through the same kind of scrutiny, and we’ll be able to see the results of those tests too. This is how we generate trust in the results: share them openly. I’m very re-assured by what I’ve seen so far.

The bottom line: vaccines work, and our methods for testing them are rigorous and thorough. With a little luck, the world will have multiple COVID-19 vaccines by the end of 2020. Once we have enough people vaccinated, our long nightmare with the coronavirus pandemic will come to an end.

It's not okay to open universities without universal coronavirus testing

Paper strip COVID-19 test developed at MIT
and the Broad Institute

Over the past week, many universities, including my own Johns Hopkins University, announced plans for re-opening this fall. As expected, almost all of them will re-open.

Most of the plans for re-opening are entirely predictable, involving lots of social distancing rules, but in some cases they appear to reflect a mindset that seems more driven by fear of legal liability then genuine concern for everyone's health. If they really care, universities should offer testing to everyone on campus–students, faculty, and staff–and they should make the tests frequent and mandatory. So far, most are not doing this, with exceptions including Cornell University, Yale University, MIT, Dartmouth, and a few others. (Many schools, including Hopkins, haven’t announced a testing plan but yet implement one. Duke and Penn have announced that students will at least be tested initially upon their return.)

It's not really that hard, and it's not that expensive, to offer testing to all students. Let me explain.

Most universities (I've read a dozen or more re-opening plans, but I'll go out on a limb and say "most") plan to open with a mixture of in-person and online classes. In-person classes will be smaller, with students spaced apart in large rooms, and masks required. Larger lectures will be offered online, much as we did this past spring. Universities are also offering students the opportunity to opt out and take a temporary leave of absence if they're not comfortable returning.

Universities know that most students will opt to return. After all, what else can they do? In a normal world, students could take time off to travel, or pursue an internship, or study elsewhere; but in our COVID-infected world right now, there's simply nowhere to go.

So the students will return, and universities will require them to agree to practice social distancing, wear masks, blah blah blah. The students will agree to all these restrictions, and then they will behave like college students everywhere.

In other words, students will get together without masks, party late into the night, and generally share whatever infections any of them have. Luckily for students, the 18-24 year-old age group has very low risk of serious illness from COVID-19. Most of them will recover quickly.

The same is not true for faculty, staff, and the communities around our universities. Many of us (myself included) are far more vulnerable to serious complications if we get infected, and students will unintentionally be vectors for spreading the virus. Without testing in place so that we know who's infected, this is highly likely to happen.

We could greatly reduce the risk of viral transmission if we had universal testing of everyone on campus. This would have to be followed by contact tracing, which we can do with a smartphone app, and isolation of infected individuals. There are now several ways to offer coronavirus testing, and perhaps the most promising is a simple, saliva-based test that only costs a few dollars.

These new tests are based on very elegant CRISPR technology designs; one was described publicly by scientists from MIT, the McGovern Institute, and the Broad Institute in early May (with a preliminary version in February), and another was described publicly by scientists from UC San Francisco and Mammoth Biosciences in mid-February. At least 3 companies–E25Bio, Mammoth Biosciences, and Sherlock Biosciences–are now gearing up to manufacturer these tests, and the cost will be just one to five dollars.

The new paper-strip test couldn't be much simpler: you simply spit into a tube, and then place a specially-treated paper strip into the saliva. (Several other variants on this process are in development.) After some simple processing using inexpensive, widely available equipment, the strip then changes color if the coronavirus is present. The whole process takes under an hour

An alternative to the paper strips is a home-grown virus detection process using modern DNA and RNA sequencing technology. Most major universities (including my own) have this expertise on campus. Working with colleagues at Hopkins, we estimated that we could "roll our own" large-scale testing technology for about $10 per test, with 12-hour turnaround time, and that we could test everyone at least once a week. Not as good as the paper strips, but far better than doing nothing.

Meanwhile, the only FDA-approved tests, based on RT-PCR technology, use nasal swabs, which are far more invasive and difficult to use (you have to stick those swaps deep into the nasal cavity), and cost $50-$100 per test. Either of these reasons suffice to make nasal swab testing impractical as a universal testing method. 

I've already heard objections to these newer tests. The most common refrains are (1) they sometimes have false negatives, meaning that an infection is not detected, and (2) they're not FDA approved. To both of these I have the same response: so what? Is it better to bring back thousands of students, to mix and mingle with hundreds (or thousands) of faculty and staff, and not provide any testing at all? No.

Without a cheap, FDA-approved test, universities have an excuse to take the easy way out: bring everyone back, make them promise to socially distance, and don't offer any testing. Under this scheme, we won't have any way to know who's infected. Many professors and university employees have expressed alarm, and some have signed petitions asking for the right to teach remotely

I agree that universities should re-open this fall–indeed, I think it's imperative to do so, in order to start bringing the world back to normalcy. But universities can't keep pretending that a set of social distancing rules, combined with a mix of online and in-person classes, is enough. 

Many of us don't care if the coronavirus test is FDA approved, and we know it's not perfect. The tests are already quite good, as peer-reviewed papers have shown, and they'll get better. Universities can offer these tests or others to everyone on campus. Cornell University has announced that it will do so, as have Yale, MIT, and Dartmouth. I hope every other college and university, including my own, will do the same.

Three promising treatments for COVID-19: not a cure, but progress

We still don't have a cure, but each of these treatments could save your life.

Among the thousands of scientific studies already published about coronavirus and COVID-19, a few rays of hope have appeared. We don't have a cure yet, but at least three treatments seem to slow the virus down and save some people from the worst effects. Until we get a vaccine, these might be the best we can hope for.

Here are the three treatments that have shown the most promise, from what I've read.

1. Dexamethasone. The latest news is about dexamethasone, a widely available steroid that has been used safely in people for many years. Just a week ago, Oxford University announced results from a large study in which they gave dexamethasone to 2104 patients and compared those patients to 4321 others who received standard care. The results were striking: dexamethasone reduced deaths by 35% in patients on ventilators, and by 20% in patients who needed supplemental oxygen. 

In the announcement from Oxford, Prof. Peter Horby, one of the lead investigators of the new study, said
"the survival benefit is clear and large in those patients who are sick enough to require oxygen... Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide."
This was the best news we've had since the pandemic started. We finally have a drug that is cheap, easy to administer, and actually reduces mortality in very sick patients. 

2. Famotidine is a common, inexpensive heartburn medicine sold over-the-counter as Pepcid AC. In a very preliminary study examining the outcome of patients who took famotidine around the time of hospital admission, released in early May, doctors at Columbia University, in collaboration with New York's Northwell Health and Cold Spring Harbor Lab, compared patients on famotidine to other patients who were all very ill. The study was small and not well-controlled, so we have to be very cautious about jumping to conclusions on this one. Nonetheless, the results were promising: the number of patients in this study who either died or needed a ventilator dropped from 22% to 10% with famotidine. 

The mechanism by which famotidine might work isn't yet understood, but at least it is plausible, as Derek Lowe explains here. Northwell Health is conducting a larger, controlled study, and we should know soon if the results hold up., and we should know soon if the results hold up.

3. Alpha blockers. I wrote about these in early April: alpha blockers are another common, widely available drug (one version is called Prazosin) that has been used safely by millions of men to treat enlarged prostates. A preliminary, retrospective study showed that alpha blockers can slow down the "cytokine storm" that many patients suffer in severe coronavirus cases. 

To be more specific, patients who were already taking alpha blockers seemed to have a 22% lower risk of dying from infections that caused acute respiratory distress (ARD). This is not COVID, but the investigators used a large database with over 13,000 patients who had ARD in the past. A group of my colleagues at Johns Hopkins Medicine, led by Maximilian Konig and Bert Vogelstein, are now conducting a clinical trial to see if alpha blockers work equally well in COVID-19 patients.

All three of these treatments seem to have something in common: they slow down the body's hyper-stimulated immune response to the virus. None of them actually kill the virus, as a true anti-viral would do, but many people who are dying are suffering from their own immune system's too-aggressive attack on the virus.

Notice that I'm not including two drugs that have received a huge amount of press lately: remdesivir and hydroxychloroquine. Remdesivir has shown some promising results, but even in the results announced by its own manufacturer, Gilead, the benefits were very modest. A study published a month ago in NEJM showed that patients on remdesivir recovered from COVID-19 four days sooner (11 days rather than 15), and had slightly lower mortality, but those results were described as preliminary. Unlike the other drugs I'm excited about, remdesivir is very new, expensive, and not widely available. 

Hydroxychloroquine, by contrast, has been a total failure, as I described just a month ago. The primary reason it has gotten so much attention was, first, that it was heavily promoted by a French scientist, Didier Raoult, based on a small, very poorly-run study that he published in March; and second, that it was latched onto and promoted by Donald Trump. Since then, several larger, much better run studies have shown either that hydroxychloroquine has no benefit or, worse, that it causes harm, in the form of heart arrhythmias, which can be fatal. 

Nonetheless, we now have 3 drugs that seem to reduce mortality in the sickest patients. If anyone I know gets sick with COVID-19, I will tell them to ask their doctors for dexamethasone, if the doctors have offered it right away.

Despite this progress, the world desperately needs a vaccine. Over 100 vaccine candidates are currently being pursued, and let's all hope that some of them succeed. It can't happen soon enough.

The Environmental Protection Agency's new rule will protect polluters, not the environment

Here's a neat political trick: if you want to introduce a new law, but you know people will hate it, give it a misleading, nice-sounding name. It's surprising how well this works. Let me explain.

The U.S. Environmental Protection Agency (EPA) was founded in 1970 under Republican President Richard Nixon, and since that time it has helped the country clean up our air, water, and soil at thousands of locations. For many years, the agency was a bipartisan success.

Now, though, the EPA is run by a former coal industry lobbyist, Andrew Wheeler, and it seems more concerned with protecting polluters than with the environment. The latest example is a newly proposed rule that will allow the EPA to ignore a vast swath of scientific research that demonstrates the harmful effects of pollution on people's health. This includes research on the damage caused by burning coal and other fossil fuels.

(I should note that this new proposal was first introduced by the previous EPA administrator, Scott Pruitt, another friend of the fossil fuel industry who sued the EPA 14 times while serving as attorney general for Oklahoma.)

If the EPA were being honest, it would call this new proposal something like "Ignoring the Science on the Harmful Effects of Pollution." Of course, Congress would never go near a proposal like that, so instead the EPA calls it "Strengthening Transparency in Regulatory Science."

Huh? How can they do that?

Well, there's nothing to prevent the EPA from calling this proposal "Motherhood and Apple Pie," but they like to pretend the title has something to do with the content of the new regulation. And it does.

Here's what the new regulations do: they will allow the EPA to ignore any science where the public doesn't have access to all of the underlying data–including private, individually identifiable health data. The EPA is pretending that this rule all about openness and transparency (who could object to that?), but actually it's not that at all. It's really about protecting the fossil fuel industry.

As The New York Times reported two years ago
"the proposed new policy has its roots in the fossil fuel industry’s opposition to a groundbreaking 1993 Harvard University study that definitively linked polluted air to premature deaths.... In that study, which began in the mid-1970s, scientists signed confidentiality agreements so they could track the private medical and occupational histories of more than 22,000 individuals in six cities around the country."
So apparently the fossil fuel industry thought: hmm, how do we prevent the EPA from regulating us when this high-quality study shows that pollution kills? They couldn't successfully attack the study, so they concocted the strategy of demanding all the confidential data on the participants. When they were told that the data would have to remain secret, they saw their opening: "transparency" would be their mode of attack, aided by their lobbyists Scott Pruitt and Andrew Wheeler.

The Harvard study and hundreds of others like it, which have shown time and time again that air pollution kills people, will be ignored if the proposed new EPA regulation goes into effect.

Not surprisingly, public health scientists and medical experts have spoken out strongly against the EPA's proposed new rules. The American Association for the Advancement of Science said, in a statement last month, that the rules would allow the EPA "to exclude the best available science from informing EPA regulations, making it difficult for the agency to fulfill its mission to protect environmental and human health." Writing in The Hill, biostatisticians Roger Peng (a colleague of mine) and Steve Pierson wrote that the new rule 
"weakens EPA’s scientific process and undermines its mission to protect the environment and the health of the U.S. population." 
So that's how it's done. The EPA wants to enable more pollution for its friends in the fossil fuel industry, but they can't say that out loud. The only beneficiaries of this newly proposed rule will be industries that don't want to pay for the cost of cleaning up their pollution. Meanwhile, everyone who breathes air–which, the last time I checked, included every human being on the planet–will suffer from dirtier air, water, and soil.

But don't tell that to the EPA. They are still claiming that this is just about "transparency."

Does the human placenta have a microbiome?

A few years ago, the medical community was in a bit of a tizzy over a scientific report that the human placenta has its own microbiome–a complex mixture of bacteria that maybe, just maybe, affected the health of newborn babies.

According to the New York Times' rather breathless reporting at the time
"the placenta ... harbors a world of bacteria that may influence the course of pregnancy and help shape an infant’s health and the bacterial makeup of its gut."
This news was very surprising to many scientists, who had long assumed that the placenta was sterile. The 2014 study, titled "The placenta harbors a unique microbiome," found hundreds of bacterial species in the placentas of 320 women. The Times report suggested that the "wrong mix" of bacteria might cause premature births, and it further suggested that the placental microbiome might seed the intestinal microbiome that babies develop later.

Turns out it was all wrong.

Many scientists were skeptical at the time. Those of us working in the microbiome field know that bacterial contamination is everywhere, and it's all too easy to "discover" microbes that came from other sources besides the tissue you thought you were studying. My colleague Jonathan Eisen (at UC Davis) called the 2014 paper and the accompanying discussion "serious overselling of the microbiome."

One good thing about science is that it corrects itself, although sometimes it takes a while. In this case, it took about 5 years. Two studies, both published in mid-2019, looked at hundreds more samples, and carefully screened out contaminants, and found: nothing.

In the first of the newer studies, a group of scientists led by Marcus de Goffau and Gordon Smith at the Sanger Institute in the UK looked at placentas from over 500 newborns. The looked very hard for any evidence of bacteria, but–unlike the scientists in the 2014 study–they took a much more rigorous view of contamination. Like the first study, they found hundreds of species of bacteria, but unlike the first study, the recognized that all of them (with one interesting exception, likely an infection) were contamination. As they explained: 
"samples of placental tissue become contaminated during labor and delivery, even when they were dissected from within the placenta."
In the second study, published just a few weeks after the UK study, a group at Bar Ilan University in Israel looked at 28 human placentas using 5 different techniques, including the techniques from the 2014 study. They found no evidence for bacteria in any of the placentas. Their conclusion was simple and stark: 
"the fetal environment in the womb is sterile."
Unfortunately, the leader of the original study, Kjersti Aagard from Baylor College of Medicine, refuses to admit that her original results were wrong. She claimed, in an interview with The Atlantic's Ed Yong last year, that the UK group were "too strict" about removing bacteria as contaminants, and that they "are not recognizing, or are naive to, other evidence for colonization" by bacteria.

To someone who works in the field, this kind of denial is all too familiar. Microbes are invisible, which means we never actually see the contamination happening–but it does happen, all the time, and many scientific results have evaporated upon closer scrutiny. Even the most careful processing of samples cannot get rid of all the bacterial DNA, because the laboratory kits that we use for sequencing themselves have bacterial DNA in them (as has been shown in several studies). 

So no, there's no placental microbiome, and that's likely a good thing.

One final note: in just the past two months, two major studies (here and here) have appeared that each claimed to find hundreds of bacterial species associated with many types of cancer. Sound familiar? Both studies tried hard to control for contamination, and both involved a massive amount of work. Despite their efforts to exclude contamination, though, I suspect we'll eventually find that these results, which are biologically quite implausible, will evaporate. It might just take a while. 


What do Trump and Yale Medical School have in common? Both were duped about hydroxychloroquine

Hydroxychloroquine, promoted just a few short weeks ago as a cure for COVID-19, is useless.

Actually, it's worse than that. Hydroxychloroquine causes heart arrythmias, which can be fatal. Data from early trials of hydroxychloroquine show that it is killing people, not saving them.

Why, then, are so many people talking about hydroxychloroquine? The answer is a tale of scientific hubris and incompetence bordering on fraud. It's also a tale of how Yale Medical School and the Trump administration both fell for it.

Part 1: the hubris of a French "science star."
Last week, the New York Times ran a lengthy profile of Didier Raoult, a French microbiologist who the Times lauded as a "science star." Raoult vaulted into the public eye in March, when he published a very small study claiming that a combination of hydroxychloroquine, an anti-malarial drug, and the antibiotic azithromycin could cure COVID-19. Claimed Raoult:
"We know how to cure the disease" (Didier Raoult, quoted in the NY Times)
Actually, Raoult's proclamations began earlier, on February 25, when he posted a video on YouTube called "Coronavirus, game over." Not surprisingly, the world took notice. (Note that as the evidence for his so-called treatment evaporated, he re-titled the video "Coronavirus, towards a way out of the crisis.")

Raoult's study was deeply flawed, and it has been taken apart by multiple scientists, so I won't repeat all their points here. A good summary of many of the flaws was written by Elisabeth Bik, first on Twitter and then in a blog article, back in late March. Among other flaws, the study dropped 6 of the 26 patients who were given hydroxychloroquine without explaining why. One of those patients died. “My results always look amazing if I leave out the patients who died,” Bik commented.

Raoult is not happy with Dr. Bik. He recently called her a "witch hunter" on Twitter. This apparently is not unusual for Raoult; the NY Times compares his psychology to that of Napoleon. I wonder what he'll call me after this article appears.

In addition to its serious flaws, the paper was published in a journal whose editor-in-chief, Jean-Marc Rolain, was also a co-author on the paper. Even worse is the fact that, as the journal itself notes, the paper was accepted just one day after being submitted. Clearly, this paper did not undergo careful peer review, and it reeks of extremely sloppy science.

Since then, several larger, better-run studies have either found no benefit for hydroxychloroquine, or found actual harm. To be specific, a study of 368 patients in US Veterans Administration hospitals found that the mortality rate in patients given hydroxychloroquine was 27.8%. Patients who received both hydroxychloroquine and the antibiotic azythromycin had a mortality rate of 22.1%. But patients who did received neither one had a mortality rate of 11.4%.

In other words, giving patients hydroxychloroquine doubled their risk of dying.

One final note about Didier Raoult: he has a truly unbelievable number of scientific publications, over 2,800 according to PubMed. From 2012-2019, he averaged 176 papers per year, or about one paper every two days. Speaking as a scientist, it simply isn't possible that he made any real contribution to the vast majority of these papers. The NY Times explained that Raoult puts his name on every paper published by his institute, which employs hundreds of scientists. Again, speaking as a scientist, this is grossly unethical. No scientist should put his/her name on a paper unless they made a genuine scientific contribution to it. At many universities, Raoult's behavior would be grounds for dismissal.

Part 2: Trump and Yale Medical School fall for it.
As the NY Times reported, and as most of the U.S. knows, Trump began touting the benefits of hydroxychloroquine at a news conference on March 19:
“I think it’s going to be very exciting. I think it could be a game changer and maybe not. And maybe not," Trump said.
Right. Soon after that, the FDA, "under what appears to have been strong pressure from the Trump administration," issued an emergency use authorization for hydroxychloroquine.

Medical experts, including NIAID director Anthony Fauci, quickly injected a note of caution, pointing out that the evidence was very preliminary, and that we needed better studies. Nonetheless, Trump and his political allies ran with the news that a "cure" was available. They were wrong.

Perhaps most disturbing, though, was the behavior of some highly regarded doctors, who also fell for Didier Raoult's hype. One might excuse politicians for being fooled–they don't have the training–but the same excuse doesn't work for a medical expert.

And yet on March 26, Yale Medical School boldly tweeted out its "Treatment algorithm for COVID19," promoted with two megaphone icons:
Attached to the tweet was a graphic of a flowchart, showing that the first steps in their treatment algorithm were hydroxychloroquine and atazanavir. At the time, I replied to their tweet and warned them that there was no good evidence for their recommendations. Their response:
"While there are no FDA approved treatments for COVID19, this protocol is based on available knowledge, personal observations & communications from other institutions. In the absence of firm evidence for best treatments, this is intended as a working document & subject to change."
Well, at least they responded. But in their response, they admit that their protocol is based on anecdotal evidence and little else. This is seriously disappointing, coming as it does from one of the nation's top medical schools. It also displays hubris not that dissimilar from Didier Raoult's.

Now that more evidence has emerged, and we know that hydroxychloroquine doesn't help and probably harms COVID19 patients, has Yale updated its treatment protocol? Well yes: they tweeted out a new algorithm on May 15. Now it says:
"Consider hydroxychloroquine x 5 days with close cardiac monitoring."
This is truly appalling. The only evidence of efficacy was the small, badly-run study promoted by Didier Raoult, which has now been contradicted by much larger, better run studies. We now know that hydroxychloroquine is harmful. Others on Twitter quickly questioned the new Yale recommendation, but it's still there as of this writing.

So there you have it. As of this writing, many so-called experts are still pushing the use of an ineffective, dangerous drug that doesn't help, and may harm, people infected with the SARS-CoV-2 coronavirus. A bogus claim promoted by a self-important, egotistical scientist who published a sloppy study in a journal run by one of his co-authors turned into millions of doses of medication wrongfully prescribed.

And for now, Yale Medical School still hasn't admitted any error. I'm waiting.

[Note: I am an alumnus of Yale University, and I have long been one of its biggest fans. I did not attend medical school there, but their unscientific behavior is nonetheless especially disappointing to me as an alum.]

The WHO's endorsement of TCM may have helped cause the coronavirus pandemic

About a year and a half ago, I wrote an article titled "WHO endorses Traditional Chinese Medicine. Expect deaths to rise." It went somewhat viral, with over 100,000 views, and then went quiet until last week, when it was revived on Twitter, which has driven thousands of new views to it. Multiple people asked me to re-visit it, in light of the coronavirus and its possible origin in a live animal market in China.

The deaths I was referring to in that title were the deaths of animals (as I'll explain below), not people. What I didn't write about–and what Twitter is buzzing about now–is the possibility that live animal markets in China, such as the one where the Covid-19 virus may have first infected humans, include bats sold for their use in traditional Chinese medicine, or TCM. We now know that the coronavirus almost certainly originated in bats. It's entirely possible–indeed, it seems very likely–that TCM is responsible for the emergence of the Covid-19 coronavirus.

The title of my article might have been more prescient than I guessed at the time.

Indeed, a just-published scientific paper pins the blame for Covid-19 squarely on TCM. The paper argues that
"a live or recently deceased infected bat species was handled by traders because of its value in TCM, and that such an infected individual, or the still infective bat or bat products, may have been the route by which the virus entered the exotic meat market in Wuhan."
Let's back up a bit and review the World Health Organization's involvement in this debacle. Just one year ago, the WHO added a chapter on TCM to its official International Classification of Diseases (ICD-11) for the first time. It apparently took this action after strong lobbying pressure from China: as a 2018 story in Nature pointed out:
"Over the past few years, [China] has been aggressively promoting TCM on the international stage both for expanding its global influence and for a share of the estimated US$50-billion global market."
This action by the WHO was the result of a long effort by its previous director (she left in 2017), Margaret Chan, who "worked closely with China" to get the WHO to endorse TCM.

Many scientists decried this action. The editors of Scientific American called it a "bad idea." Nature warned that it could "backfire," writing that it
"risks legitimizing an unfounded underlying philosophy and some unscientific practice.... Whatever its aims, the WHO’s chapter [on TCM] is unlikely to do anything other than fuel the expanding sales of largely unproven treatments."
TCM is not medicine. It's little more than a set of traditional beliefs (or a philosophy, as Nature called it) about various concoctions and their effect on one's health. Most of these beliefs have no evidence whatsoever that they provide any health benefits. Many of them derive from a pre-scientific view (which is not at all unique to China) that eating an animal gives one some of the properties of that animal. This is utter nonsense, of course.

Unfortunately, TCM is far from harmless, as I pointed out in my 2018 article. TCM has led to the horrific slaughter of the last remaining rhinoceroses in Africa in order to hack off their horns, which are sold to become part of elixirs that some people mistakenly think confer strength, virility, or other health benefits. Two years ago, National Geographic ran a heart-wrenching photo essay showing some of the awful results of rhinoceros poaching in Africa; take a look at these photos here (warning: these are very graphic).

TCM is behind the slaughter of the last remaining wild tigers, which are virtually extinct now in Asia, so that men can foolishly eat their bones, claws, and genitals in the mistaken belief that tiger parts will make them virile. Here too, National Geographic has details and photographs of cruel "tiger farms" that are almost too painful to look at.

TCM has also nearly wiped out pangolins, a completely harmless, gentle animal that has been killed in vast numbers because TCM practioners believe, wrongly, that its scale have some medicinal value. (They don't.) For more about this harmful practice, see this article I wrote in 2017.

And donkeys too: the Independent reported last November that "half the global population of donkeys could be wiped out in just five years, due to a surge in demand for their hides, which are used in traditional Chinese medicine." The world's donkey population is now in a state of crisis, according to the article, because of soaring demand in China for donkey hides, which are used to make eijao (donkey hide glue), a popular TCM product with no evidence that it has any medical benefits. Literally millions of donkeys are being slaughtered for nothing.

Before people accuse me of cultural insensitivity, let me add that there's no legitimate reason to use terms such as "Chinese" medicine, or American, Italian, Spanish, Indian, or [insert your favorite nationality] medicine. There's just medicine–if a treatment works, then it's medicine. If something doesn't work, then it's not medicine and we shouldn't sell it to people with false claims.

TCM has been a scam for decades: it was revived and heavily promoted in China by former dictator Mao Zedong, who didn't believe in it himself, but pushed it as a cheap alternative to real medicine. I won't go over that again here, but see these stories from Alan Levinovitz in Slate and David Gorski at Science-based Medicine.

The WHO is under new leadership now, but I see no sign that it's revising its endorsement of TCM, which is still lauded on the WHO website. Now we see that, in addition to the pointless slaughter of thousands of animals, some of which are likely to go extinct as a result, TCM might also create conditions that lead to new human pandemic diseases.

The new scientific paper that I mentioned above–the one that explains why trading in bat species for TCM may have caused the current pandemic, concludes that "a change in these practices is highly recommended."

That would be the understatement of the year.

It's sadly ironic that the WHO, which has in many ways been leading the fight against the Covid-19 virus, may have contributed to the conditions (live animal markets trading in wild animals) that allowed the virus to jump into the human population. It's too late to prevent that, but it's not too late for the WHO to take steps to prevent the next pandemic: they can and should remove TCM from their official guidelines.

As for China, they should recognize that the profits they make from the sales of animal parts for TCM are vastly outweighed by the harm these practices cause. China should stop promoting TCM, and it should ban the killing of wild animals for spurious medical reasons.