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.

This new test is based on a very elegant CRISPR technology design described publicly by scientists from MIT, the McGovern Institute, and the Broad Institute back in early May. (They released a preliminary version even earlier, back in 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.

The first at-home coronavirus test is out, and it's useless

The FDA and a major laboratory testing company, LabCorp, just announced the first FDA-approved at-home test for COVID-19.

The problem is, it's almost useless. Here's why.

1. It's far too expensive, at $119 per test. Only wealthy people will be able to take advantage of this.
2. The kit itself (called the Pixel) is little more than a long Q-tip and saline solution. As the FDA describes it:
"LabCorp’s molecular test permits testing of a sample collected from the patient’s nose using a designated self-collection kit that contains nasal swabs and saline."
Your $119 pays for FedEx shipping both ways and for the actual test, which is done at LabCorp's facility.
3. It's far too slow. You have to apply for the kit, get it authorized by a physician, wait for the kit to arrive, ship it back, and only then will LabCorp run the test. You find out the results online. This sounds like it will take at least 5 days, probably a week. Much faster tests are available already for those who can drive to a testing site.
4. LabCorp doesn't have many of the kits available yet. Their own website, citing "limited quantities," says they will only sell the kits to healthcare workers and first responders for now.
5. For unexplained reasons, the company states that the kits aren't available at all in New York, New Jersey, Maryland, and Rhode Island. As everyone knows by now, New York has more cases than any other state in the country.

I was briefly excited when I saw this announcement. It turns out to describe a low-volume, overpriced test that will likely have little or no impact on the pandemic. We need millions of tests, freely available to everyone, not a small number of expensive tests only available to a few.

A possible treatment for COVID-19?

Amidst all of the unproven and ineffective treatments being promoted for coronavirus treatment, a new possibility has just emerged.

Scientists around the globe are devoting enormous resources to trying to develop new treatments for COVID-19, the pandemic that is sweeping across the world. So far, though, we don't have any effective therapies or vaccines.

That might be about to change. What's particularly exciting is that this new treatment uses a widely-available drug that has already been shown to be safe in humans.

In a new preprint, a team of my colleagues at Johns Hopkins University School of Medicine, led by Maximilian Konig, Bert Vogelstein, Joshua Vogelstein, Susan Athey, Shibin Zhou, and Chetan Bettegowda, describe the potential of prazosin to slow down and possibly prevent one of the worst effects of COVID-19: the cytokine storm.

[Some background: a cytokine storm is an extreme immune response of your own body. When coronavirus (SARS-CoV-2) enters the lungs, your immune system responds with virus-fighting cells that release small proteins called cytokines. In some cases, the immune system just keeps amplifying its response, sending more and more cytokines even though the infection might be under control. If it gets too bad, the cytokine storm itself may be fatal. Cytokine storms have been implicated in other viral diseases, including influenza and SARS.]

Let me start with a caveat: if prazosin works, it isn't a cure. However, it might prevent the need to go on a ventilator, which would be a huge benefit in a country (and a world) that has a severe shortage of ventilators right now. Even more important, it might save patients with severe COVID-19 from dying.

Several of the scientists involved in this new study have shown previously that drugs like prazosin (which are known technically as alpha-1AR antagonists) can prevent a cytokine storm–in mice. They realized that results in mice often fail to translate to humans, but in the current pandemic, how could they find time to do a new study?

They didn't: instead, they looked at a medical database and collected records from 13,125 men who had acute respiratory distress (ARD) from a variety of causes in the years 2007-2015. ARD is not the same as COVID-19, but it's similar; and if a cytokine storm occurs in ARD, patients are more likely to require a ventilator and/or die. Because prazosin is widely used by men (most commonly for enlarged prostates), they were able to compare the outcomes of men who had incidentally been taking prazosin to men who hadn't.

The results: men who had been taking prazosin had a 22% lower risk of either needing a ventilator or dying. That's not a huge effect, but it could be a game changer for our overwhelmed hospitals in the midst of this pandemic. Even a modest reduction in the number of patients needing ventilators–or dying–would be a huge win for public health. Also, the patients in this retrospective study weren't taking prazosin to treat their respiratory distress, and it's possible that higher doses might have a larger effect.

There are many more caveats here. First, the study I'm describing is a medRxiv preprint, meaning that it has not been peer-reviewed. In addition, the data are from a retrospective study of men who had a different disease, not COVID-19. So maybe prazosin won't work to prevent cytokine storms caused by the coronavirus.

But maybe it will. My colleagues shared their preprint with me because they are convinced that, if nothing else, their hypothesis needs to be examined by as many scientists and doctors as possible. They are starting their own clinical trial, but they hope that these preliminary findings "will inspire immediate clinical trials in countries now desperate for new ways to reduce hospital admissions, ventilator needs, sickness, and death."

Prazosin has been in medical use since 1974 and is widely available and inexpensive. It's one of the most promising treatments I've heard of, far more promising than hydroxychloroquine. Even if it only slightly reduces the need for ventilators, it may have a huge impact on this pandemic. We need to start investigating it right away.

(Note: I've made it a rule not to write columns about my own or my colleagues' scientific accomplishments. Many rules are being broken in this pandemic, and I decided the urgency of this potential treatment was more than sufficient to break my usual rule.)

No, megadoses of vitamin C won't cure a coronavirus infection

The world is awash in treatments for COVID-19, the illness caused by coronavirus. Or at least that's what you might think if you just searched the internet.

The truth is, we don't yet have any effective treatments for COVID-19, although thousands of scientists are working furiously to try to create them.

Today we'll look at just one of the supposed treatments, which is being actively promoted on social media and many websites: vitamin C.

For those who don't want to read further, I'll start with the conclusion: vitamin C won't help to prevent or to treat coronavirus infection. I wish we had such a simple solution, but we don't.

Now let's back up a bit. Why would anyone think that vitamin C might be effective in treating this terrible virus? Vitamin C is an essential nutrient, and we all need it, but most people get plenty of vitamin C in their normal diet. As I've written before, taking vitamin C supplements is unnecessary but probably harmless, although megadoses carry the risk of kidney stones.

The modern craze with vitamin C started with Linus Pauling, a brilliant chemist and a Nobel Prize winner. Late in his career, he wrote a book promoting vitamin C as a miracle cure for many illnesses, including the common cold (which is caused by a virus). He had very little good evidence for this belief, but his promotion of vitamin C led to hundreds of studies testing his hypothesis. The bottom line: vitamin C doesn't work at preventing or curing the common cold. (See Paul Offit's book if you want more details on this and many other "miracle" cures.)

But wait, someone might object: haven't some of those vitamin C studies (as in this review paper) shown a benefit against the common cold? Well yes, but when you run hundreds of studies of a treatment that doesn't work, this is what happens: negative studies are hard to get published, but positive studies are easier. Run enough studies, and a few of them, merely by chance, will show a small positive effect. That's what we've seen with vitamin C.

Today, though, everyone is looking for a cure for COVID-19, and not surprisingly, many people (even some doctors) are claiming vitamin C is the answer. I've seen Twitter users explain, very confidently, that you just need to take 12,000 mg of vitamin C and you'll get better. This website comes right out and states that high-dose vitamin C will cure coronavirus, based on a widely-shared video from a doctor in China. (I won't provide the link because it has already done enough damage.)

It's almost impossible to disprove a claim that a treatment works. For example, I could claim that ginger snap cookies helps to prevent coronavirus infection. That's right! Ginger snaps, made with real ginger, which seems to have magical curative properties. If you object, I could demand that you prove me wrong–but the onus is on me, as the one making the claim, to first provide some genuine evidence. We haven't seen anything like that for vitamin C.

We need well-controlled experiments to know with any confidence that a treatment works. Some doctors at Wuhan University have started a trial of vitamin C to see if it has any benefits for COVID-19, but results won't be available for many months. I'm skeptical, but at least they're approaching the question the right way.

Dozens of studies of new treatments for COVID19 are being launched right now, with remarkable speed due to the urgency of the pandemic.The WHO has just launched trials of the 4 most promising existing drugs (which don't include vitamin C, I should add). To obtain a believable, positive result, we need to see evidence that a carefully administered treatment provides a significant benefit over what we're doing now–which is little more than supportive care, unfortunately.

Meanwhile, we'll have to wait and hope that one of the plausible efforts currently under way will yield an effective treatment. We've been down this road too many times with vitamin C, though, and the chances that it will have any effect are, based on past experience, close to zero.

FDA to coronavirus scammers: watch out!

The coronavirus pandemic has the whole world's attention. For now, there's no treatment and definitely no cure for COVID-19, the disease caused by the virus.

That hasn't stopped charlatans and scammers to claim that they have treatments, and to offer them for sale. I often wonder (sometimes in this column) whether people selling bogus cures truly believe their own statements, or whether they are just liars who know they're selling nonsense. In the former case, they are merely misinformed or ignorant. In the latter case, they are con artists who deserve our scorn. In either case, though, we shouldn't be buying their products.

Let's look at a few marketers who have gotten the attention of regulators just this past week. In the U.S., the FTC and the FDA announced that they just took the following action:
"The FTC and FDA have jointly issued warning letters to seven sellers of unapproved and misbranded products, claiming they can treat or prevent the Coronavirus. The companies’ products include teas, essential oils, and colloidal silver."
That's right, scammers: you better clean up your acts, or else we're going to ... write you a letter!

To be fair, it's not the fault of the FTC or the FDA that their enforcement powers are so weak. Congress has severely limited the ability of the FDA to regulate businesses who sell supplements and other scams, as I've written before. The supplement industry is big business, and they've lobbied Congress–very successfully–to prevent any truly effective regulation.

So here are the seven scammers whose claims were so outrageous that the FDA and the FTC have already (in just a few weeks, record time for these agencies) notified them that they must stop their false advertising:

The products offered by these dishonest marketers include essential oils, teas, and colloidal silver. None of them work at all against coronavirus. The FTC warning letters point to their websites, Twitter, and Facebook.

I checked them out to see if the claims are still there, and here's what I found.

Twitter suspended the Quinessence account for violating its rules, but the N-ergetics Twitter account is still live, and it features a claim that "Colloidal Silver Benefits against Antibiotic resistant ZIKA, Viruses, Superbugs, Flu." (That claim is false.)

Vivify Holistic was using Facebook to promote false claims (according to the FDA letter), and Facebook has apparently shut down that page. GuruNanda's FB and Twitter accounts are both active, but they seem to have removed their claims about coronavirus.

Vital Silver's FB page has a posting from March 9, apparently prompted by the FDA letter, stating that "These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease." This is the standard disclaimer that all supplement makers use. But then they added this "The content of this page are based on my religious beliefs as protected by the First Amendment." That's a new one to me. Nonetheless, their product still can't cure coronavirus.

Herbal Amy promotes her products through Facebook and a website: the FDA told her to take down her "Coronavirus protocol" products (she had many of them), which she seems to have done. Her FB page is still active, and she explains there that "we have had a Coronavirus protocol for sale for the last 2.5 YEARS. This is not a new herbal formula or a new virus." Huh? So her argument is that she has been making a false claim for a long time now?

Jim Bakker is another story. For those too young to remember, Bakker was a popular televangelist in the 1970s and 1980s who was convicted of 24 counts of financial fraud. He served five years in prison and resumed his television preaching in 2003. One of the ways he makes money is selling colloidal silver (tiny silver particles suspended in liquid), which he recently claimed could cure coronavirus. This led the FDA, the FTC, and the NY Attorney General to order Bakker to stop his false advertising.

The state of Missouri has gone further than the feeble FDA: they are suing Jim Bakker to stop him from harming people. The Missouri attorney general charged that Bakker is
"falsely promising to consumers that Silver Solution can cure, eliminate, kill or deactivate coronavirus and/or boost elderly consumers' immune system and help keep them healthy when there is, in fact, no vaccine, pill, potion or other product available to treat or cure coronavirus disease 2019."
Good for the Missouri AG. Time will tell if all of these demands will change Bakker's behavior.

I should add that colloidal silver doesn't treat anything, and in fact it can be truly harmful. A JAMA Dermatology article a few years ago described it as "dangerous and readily available." Stay away from this stuff.

This article wouldn't be complete if I didn't add one more scam artist: the far-right conspiracy theorist Alex Jones has claimed, ridiculously, that he has a toothpaste that can “kills the whole SARS-corona family at point-blank range.” No such toothpaste exists, and the New York attorney general has ordered Jones to stop.

As I wrote at the beginning, I can't know for certain which of the people selling these products truly believe they have a treatment for COVID-19 and which of them are knowingly lying. But consumers should beware: false claims will continue to appear as long as there's money to be made.

No one has a treatment for coronavirus infection. The WHO has a site up now, which I recommend, that dispels many of the myths. I'll close with a quote from that site:
"To date, there is no specific medicine recommended to prevent or treat the new coronavirus (2019-nCoV)."

Coronavirus: time to panic?

The world is starting to panic over the 2019 coronavirus outbreak. Are we over-reacting?

Here are 3 reasons why we should panic, followed by 4 reasons why we shouldn't.
  1. The virus, 2019-nCoV, is completely new to humans, and we don't know exactly how bad it will get. As of 29 February, it has already killed nearly 3,000 people, over 2,700 of them in China. 
  2. It appears to be very infectious. Cases are now appearing in people who didn't travel to China, and who didn't have any contact with known cases. Coronavirus illness (newl named COVID-19) has now been reported in over 60 countries, on every continent except Antarctica. No matter where you are, it is probably coming your way.
  3. The mortality rate has been reported to be as high as 2%.  The Johns Hopkins University tracking site makes it appear even higher, with 2,933 deaths out of 85,688 cases, which is over 3%. By comparison, the 1918 Influenza pandemic had a mortality rate of around 2-3%, and in that epidemic, the worst in modern history, 30–50 million people died, which was 1.7% of the world's population at the time.  Extrapolating to today's population of 7.7 billion people, a virus that deadly would kill 130 million people.
This seems really bad. So perhaps we are not overreacting.

On the other hand, there are several very good reasons why we should stay calm.
  1. The mortality rate is probably much, much less than 2%. The rapid spread of COVID-19 suggests that many more people are infected than those who have confirmed cases. The number of people who have no symptoms or very mild symptoms is likely to be ten times as high as the number of reported cases. (This is only a guess.) That would mean the mortality rate might be only 0.2%, or even lower. We still don't know. (The cruise ship that was quarantined in the Japan had just over 700 cases, and 6 people have died, suggesting a mortality rate of 1%.)
  2. The reported mortality rate is dramatically lower in young people. If you are under 30, you can probably relax a bit. However, if you are over 70, the mortality rate is frighteningly high, 8-15%
  3. 2,933 deaths is a tragedy, but it's a tiny number compared to the annual deaths from the influenza virus, which we have learned to live with. In the U.S. alone, the CDC estimates that 12,000–61,000 people die each year from the flu (the number varies a lot because the virus itself changes from year to year), and 9-45 million people get sick. The worldwide totals are far higher. So in terms of numbers, the world is definitely over-reacting to the new coronavirus.
  4. Infectious viruses tended to become milder over time. At least 4 other coronaviruses already circulate among humans, causing little more than mild cold symptoms. It is quite possible that the virus causing COVID-19, nCoV-19, may mutate to become a milder disease as well. RNA viruses mutate extremely rapidly, and from an evolutionary perspective, viruses adapt to their hosts by becoming milder. (My perspective is based in part on my past research on the influenza virus.) From the virus's point of view, it can't spread itself around if the host is too sick.
What can we do? A few things:
  1. Panic isn't helpful. Don't panic.
  2. In the short term, the best response will be to develop a vaccine. (Dr. Peter Hotez and colleagues at Baylor College of Medicine are already working on one.) We need to dramatically increase government investment in vaccine development. It seems that the U.S. is doing that, although not quickly enough.
  3. If you feel sick, stay home.
  4. It's probably best to avoid travel to a location where COVID-19 is known to be circulating widely. Right now this list includes China and Iran, but it could grow in the coming weeks.
  5. In the longer term, we need to increase rather than cut biomedical research funding. Even if we get a vaccine, we still need actual treatments, not only for COVID-19 but for other viruses. (Most viruses are incurable with current technology.) The recent proposal out of the White House aims to cut NIH funding by 7% and CDC funding by 16%. As anyone following the coronavirus news now realizes, the CDC is responsible for tracking the virus in the U.S. and for coordinating our public health measures to respond to the outbreak.
Finally, I should add a note of caution about the bogus treatments already being hawked by peddlers of pseudoscience. There are multiple websites and Facebook pages, including some anti-vaccine sites, already claiming they know how to treat coronavirus illness. (I won't link to any of them, as I don't want to give them the traffic.) These are complete scams. No one has any treatment that will prevent or cure COVID-19, but if we make the investment, we'll get a treatment one day.

(Note: the WHO has renamed the virus SARS-CoV-2, but The Lancet article that first described its genome calls it nCoV-19.)

Would you trust your kids with this man? No? I didn't think so.

Today I want to shine a bit of light on the conspiracy theorist behind the film "Vaxxed" and its recent sequel, "Vaxxed II." I'm not going to provide any links to the movie, or to describe it, except to say that it's a slickly-produced conspiracy theory masquerading as a documentary. Don't watch it.

Anti-vax activists often use conspiracy theory tactics, which work like this: they simply make up a claim, out of thin air, that a secret cabal of doctors (or government scientists, or pharma companies) is out to harm patients by giving them vaccines, and is hiding the "truth" about the risks of vaccination. Never mind how irrational this is, and never mind that there's not a shred of evidence behind it: if you try to argue with the anti-vaxxer, you're part of the conspiracy.

So rather than try to disprove something that was never proven in the first place, let's look instead at the source of the anti-vax propaganda film, "Vaxxed." The source is one man: Andrew Wakefield. Who is this guy, and why is he so obsessed with vaccines?

Wakefield was once a doctor, before he had his license revoked a decade ago. In his former life, he was a gastroenterologist, with no special training in vaccines or infectious diseases. He first gained fame–a lot of fame–for a 1998 paper in a medical journal, The Lancet, in which he claimed to have discovered a link between the MMR vaccine (that's the one that covers measles, mumps, and rubella) and autism.

Here are some things you need to know about Wakefield before watching his movie:

  1. Wakefield's 1998 paper, it eventually turned out, was "an elaborate fraud." Wakefield defrauded the public, his patients, and even his own co-authors on the paper, most of whom were unaware of his elaborate conflicts of interests.
  2. Before he published his 1998 study, Wakefield was hired by a lawyer, Richard Barr, who was trying to build a lawsuit against vaccine makers. Barr paid Wakefield £435,000 (equal to $750,000 US dollars at the time) to help him build his case. Wakefield's co-authors were unaware of this contract.
  3. The study claimed that 8 out of 12 children had been diagnosed with autism soon after getting the MMR vaccine. It described these children as "a consecutive series" of admissions to the hospital where Wakefield worked. That was a lie. It turned out, as investigative journalist Brian Deer revealed, that all 12 children and their parents were referred to Wakefield by Barr–the lawyer who was paying Wakefield to conduct the study, and who was trying to sue vaccine makers.
  4. Wakefield also falsified data on all 12 of the children in his original study.
  5. Wakefield conducted "invasive and distressing procedures" on the children without approval from his hospital's ethics board.
  6. After learning some of the back story, 10 of his 12 co-authors tried to retract the paper in 2004. Wakefield refused to join them, so they published a partial retraction, signed by the 10 co-authors. The Lancet itself later fully retracted the paper (over Wakefield's objections), but it took until 2010 for them to act. By then, the anti-vax movement had spread widely.
  7. Prior to publishing his paper, Wakefield filed a patent claim for a "safer" vaccine for measles, one that would have profited him greatly once he discredited the (perfectly safe) MMR vaccine.
  8. After losing his license in the UK, Wakefield moved to Austin, Texas where he ran an organization called Thoughtful House, through which he paid himself a salary of $280,000. (Perhaps coincidentally, Austin is now a hotbed of anti-vaccination activism.)

For more than 20 years, Andrew Wakefield has made money off false claims that vaccines cause autism, first put forth in his discredited 1998 paper. He gives talks, writes books, conducts seminars, and now makes movies, of which make him money. Since the publication of his paper, dozens of studies involving literally millions of children have shown, time and again, that vaccines do not cause autism. Wakefield has denied every one of those studies, and continues to push his bogus claims.

(Why, you might ask, have scientists conducted studies looking for a link between autism and vaccines, if there was never any evidence for such a link? The answer is simple: anti-vaxxers have been so successful at scaring people about a nonexistent threat that scientists and public health experts felt it necessary to conduct those studies, in order to reassure people. Literally millions of dollars have been spent to prove something we already knew.)

Meanwhile, measles outbreaks have appeared with increasing frequency in the U.S., the UK, other European countries, and around the world, including the deadly outbreak in Samoa late last year, which caused 5,700 infections and 83 deaths in a population of just 200,000. Wakefield's new movie was released in the middle of that outbreak.

So to anyone who watched the movie Vaxxed and is now having doubts about vaccines, I ask: would you trust your children with this man? I wouldn't.

Are you "vaccine hesitant"? You may be in a cult

Edward Jenner, who pioneered vaccination, and two colleagues
 (right) seeing off three anti-vaccination opponents, with the dead
lying at their feet (1808). 
I Cruikshank/Wellcome Images/Wikimedia
The World Health Organization recently declared that "vaccine hesitancy," as they called it, was one of the top 10 threats to global health. That's right: it was up there with air pollution, climate change, influenza, Ebola, and other threats.

For the WHO, "vaccine hesitancy" is a polite phrase designed to engage the public and highlight how serious the problem is, without angering those who are guilty of it. I'm not going to be quite so polite here: "vaccine hesitant" means anti-vax. The anti-vax movement, which aggressively spreads fear and misinformation about vaccines, has become a major, worldwide threat.

It also resembles a cult, as I'll explain.

The most recent anti-vax nonsense centers on the new coronavirus that originated in China, and that has led the Chinese government to impose a massive quarantine affecting millions of people. This is a genuine public health crisis, and it has nothing to do with vaccines. Nonetheless, some anti-vaxxers are claiming, without evidence, that the new virus originated from a failed effort to create a coronavirus vaccine. I don't have time to get into that here, but Orac has a lengthy, detailed takedown of that bogus claim.

"Vaccine hesitancy" sometimes refers to parents who are just learning about vaccines for the first time, and who rely on the Internet to search for information. Unfortunately, these new parents are likely to be flooded with anti-vax messages, especially on Facebook. (In recent years, Google has taken steps to lower the priority of anti-vax sites, which has improved things considerably. Sites such as now appear near the top of searches for "vaccine safety.") It's entirely reasonable to ask your doctor about the benefits and risks of vaccines.

But the answers that parents hear should be clear: vaccines work. As physician ZDoggMD (a pseudonym, obviously) explains in this video:

"Anti-vaccine sentiment is a poisonous scourge.... There's no debate about vaccines. Let's get over that nonsense that the media and celebrities have created, okay? There is nobody in the medical community of any actual reputation who believes that there are two sides to this."
The problem is that anti-vaxxers are continuously creating new websites, Facebook groups, and even movies to spread misinformation about vaccines, particularly the long-debunked claim that vaccines cause autism.

Why do I suggest that anti-vaxxers resemble a cult? Because they have several of the key features of cults, such as:

  1. Members of the cult have special insights that outsiders cannot comprehend. With anti-vaxxers, this means they are completely convinced that they know that vaccines cause harm, despite mountains of evidence to the contrary.
  2. The group and its leaders are the exclusive means of knowing "truth" or receiving validation, and no other process of discovery is credible. The anti-vax movement has had several prominent leaders, whose followers flock to their speeches and events. These include Andrew Wakefield, the disgraced former doctor who lost his medical license after it was revealed that he had committed fraud. His followers, though, either don't know or ignore his fraudulent past, and regard him as a hero. He makes a living from his books, a movie, and speaking fees, all based on spreading fear about vaccines. An even more prominent anti-vax leader is Robert Kennedy, Jr., who also sells books and gives speeches proclaiming the harms of vaccines. Thanks to his famous name, and despite the fact that he has no medical or scientific training, some people believe him.
  3. Unreasonable fear about the outside world, such as impending catastrophe, evil conspiracies and persecutions. Conspiracy theories are the core of many anti-vax arguments. The most common version holds that the "medical establishment" (whoever that is) are hiding the dangers of vaccines so that they can make money. This is utter nonsense. All of doctors I know in the infectious disease community are motivated by a wish to cure disease. In any case, most doctors make little or no money from the vaccines they administer.
  4. No meaningful financial disclosure regarding budget or expenses. Some anti-vaxxers profit handsomely by selling bogus, ineffective supplements as alternatives to vaccines. (I'm looking at you, Joe Mercola.) Because supplements are largely unregulated, they get away with it. They'd prefer you to think they're "just in it for the children."

I've no doubt that anti-vaxxers like Wakefield, Kennedy, and others would deny that they are conspiracy theorists, because that's how conspiracy theorists operate. If you question them (they argue), you must be part of the conspiracy. By their own reasoning, they can never be wrong.

So if you encounter someone, either on the sidelines at your kid's soccer game, on Facebook, or elsewhere, who is spreading claims that vaccines are harmful, pause for a minute and ask: what is the source of this information? Is it coming from someone who is profiting from this fear-mongering? There's a good chance the answer is yes.

It's ironic that when the world is faced with a true health emergency, such as the Ebola virus or the Wuhan coronavirus, the first thing that public health experts start to work on is a new vaccine. That's because vaccines provide our best protection against infections. We now have effective vaccines for 16 diseases that used to harm and even kill children in large numbers around the world. We've eliminated smallpox worldwide, and we've nearly eliminated polio, thanks to vaccines. Their very effectiveness is what has allowed the anti-vax message to take hold: many people are no longer frightened of dying from infectious diseases.

We're still a long way from conquering infections, but there's no reason for the world to slip back in time to an era when large numbers of people died from preventable infections. Vaccines work, if we'll let them.

Surprise! Many organic foods are GMOs, and they are transgenic

A new study finds that many common foods, including beer and tea, turn out to be "natural" GMOs. What's a health-food purist to do?

Even though no one has found any evidence that genetically modified organisms (GMOs) are harmful, anti-GMO activists have campaigned against them for years, with considerable success. As of this writing, 19 out of 28 countries in the European Union have voted to ban or severely restrict genetically modified plants, and many other countries impose similar bans.

But all of these restrictions may be in vain, because nature got there first. It turns out that many common foods have already been genetically modified, by a bacterium called Agrobacterium. (Read on to see the list.) And, in news that should be even more frightening to the anti-GMO crowd, these foods are transgenic: they contain genetic material from completely different species. Frankenfoods!

First, as I've argued before, genetic modification technology is just a tool, and a very precise one at that. Scientifically, claiming that GMOs are bad for you is nonsensical–it depends entirely on what the genetic modification is. Whether a food scientist modifies a tomato to taste better by traditional breeding or by using GM technology, you still end up with a tomato that has different genetic content. The only difference is that with traditional breeding, you have no idea what exactly you changed in the plant's DNA. And humans have already consumed billions of servings of GM foods with no ill effects. The GM foods we eat today are perfectly safe.

So back to my first point. What are all these natural Frankenfoods, and how did they get that way?

I'll start with the common sweet potato, or yam. Humans eat hundreds of varieties of sweet potatoes, and you can buy them in markets on every continent. Back in 2015, a group of scientists from Belgium, Peru, China, and the US (Tina Kyndt and colleagues) discovered that every cultivated variety of sweet potato has "foreign" DNA integrated into its genome, from a bacterium called (appropriately) Agrobacterium. They tested 291 different varieties, and found the bacterium 100% of the time. They also tested wild relatives of sweet potato, and found that the wild varieties (which humans don't eat) are missing the bacterial DNA.

Agrobacterium is a bacterium with special properties: it has evolved to be able to insert its DNA directly into the genomes of a wide variety of plants. (Don't worry, it doesn't infect humans.) In sweet potatoes, this happened naturally, centuries or millenia ago, long before humans were cultivating it. But then we came along, and (apparently) we liked the taste of these naturally transgenic sweet potatoes, so those are the ones that we chose to cultivate. As a result, all the sweet potatoes we eat are GMOs, although it happened naturally.

That was five years ago. But in a newly published study, scientists Tatiana Matveeva from Russia and Léon Otten from France discovered that Agrobacterium has made its way into dozens of other plants, including some of our favorite foods and drinks. Matveeva and Otten searched through the genomes (the DNA) of hundreds of plants, and found 39 natural GMOs, as they called them.

So without further ado, here are the natural GMO foods, all of them transgenic, with the common name followed by the formal species name in italics:

  • bananas (Musa acuminata)
  • beer (hops) (Humulus lupulus)
  • cranberries (Vaccinium macrocarpon)
  • date-plum (Diospyros lotus)
  • guava (Psidium guajava)
  • peanuts (Arachis hypogaea)
  • pomelo fruit (Citrus maxima)
  • Suriname cherry (Eugenia uniflora)
  • sweet potatoes (Ipomoea species)
  • tea (Camellia sinensis, which is used for most teas)
  • walnuts (Juglans species)
  • yams (Dioscorea alata)

That's right, beer and tea are GMOs–even if they are labelled as "organic." Keep in mind that this list is undoubtedly incomplete: the new study relied on current genome databases, which are still missing many common foods. 

If you're reading this, you've probably already consumed countless servings of transgenic, GMO foods. As I wrote above, there's no reason to believe that GMO foods are harmful in any way. Plenty of plants are naturally poisonous, of course (think hemlock), but widely-consumed foods got that way for a reason: people like to eat them, and they help sustain us.

If you believe the alarmist claims of the anti-GMO movement, then you're going to have to start avoiding many more foods, including everything on the list above. And yes, that includes beer.