The four-alarm fire

I present to you three recent articles with a linked theme.

The first is about a study at the Walter and Eliza Hall Institute for Medical Research in Australia, and describes an mRNA vaccine that appears to be capable of stopping malaria in its tracks.  The impact of malaria is astonishing, a fact that often escapes the notice of those of us who live in temperate parts of the world where it doesn't occur.  I still remember my shock, when one of my biology professors asked what species of animal has caused more human deaths than any other -- in fact, more than all the other animals combined.

Turns out, of course, it's the mosquito.  Between malaria, yellow fever, and dengue, and a host of other less-common diseases like chikungunya, eastern equine encephalitis, and West Nile virus, mosquitoes (actually several species, but lumping them together for the sake of simplicity) have by far outstripped all other animals in their negative impact on humans.  And of the diseases they carry, malaria is the worst, infecting an estimated three hundred million people per year, and causing six hundred thousand annual fatalities.

The new vaccine is, like the COVID-19 vaccine, an activated piece of messenger RNA.  In this case, it targets a gene in the malaria microorganism that is essential to the pathogen's reproduction within the mosquito.

[Image licensed under the Creative Commons Supyyyy, Double-stranded RNA, CC BY-SA 4.0]

In preclinical trials, the vaccine caused a 99.7% drop in transmission rates.  The potential impact of a therapy with this efficacy is astronomical, especially given that post-infection medical treatment for malaria is of limited benefit -- and has to be administered for the remainder of the patient's life.  A vaccine that could stop malaria transmission almost completely would have as great a positive effect on life in equatorial regions of the world as the smallpox and polio vaccines did globally in the twentieth century.

The second is a series of studies having to do with the use of mRNA vaccines to target cancer.  The difficulty with conventional chemotherapy is that it's hard to find chemicals that kill tumor cells without damaging your own tissues; as I'm sure many of you know all too well, chemotherapy drugs often come along with miserable and long-lasting side effects.  The effectiveness of mRNA cancer treatments is that the strand of mRNA can be designed to target tumor-specific antigens, turning them into what amount to "smart bombs" that destroy cancerous tissues without harming the rest of the body.  The therapy has been demonstrated to be useful against a variety of types of cancer, including the deadly and extremely hard to treat pancreatic cancer.  There has even been dramatic work done that has raised the possibility of a universal cancer vaccine -- something about which University of Florida researcher Duane Mitchell said, "What we found is by using a vaccine designed not to target cancer specifically but rather to stimulate a strong immunologic response, we could elicit a very strong anticancer reaction.  And so this has significant potential to be broadly used across cancer patients — even possibly leading us to an off-the-shelf cancer vaccine."

The third is that the Secretary of Health and Human Services, Robert F. Kennedy Jr., just announced that he's canceling five hundred million dollars in funding for the development of mRNA vaccines.

Let me be blunt, here.

This action will kill people.

Not that RFK cares.  His dangerous lies were directly responsible for the vaccine avoidance that caused a devastating outbreak of measles in Samoa that killed eighty people, mostly children -- an action for which he has yet to take responsibility.  (This, of course, is hardly surprising; "It's someone else's fault" should be the new motto of the GOP.)

RFK has built his entire stance on lies.  He called the COVID-19 vaccine "the deadliest vaccine ever made," despite the CDC finding that vaccination saved more than two hundred thousand lives during the peak of the pandemic.  He has claimed without any scientific basis that all mRNA vaccines are dangerous, and in fact has talked about it in such a way as to lead people to believe that mRNA itself is a dangerous chemical, despite the fact that anyone who passed high school biology should recognize how ridiculous this is.  (I actually saw someone post, apparently seriously, that they would "never allow mRNA in their body," to which I responded, "good luck with that.")

I know there's some stiff competition, but I think RFK would top the list of the Most Dangerous Trump Appointees.  His fear-based, anti-science policies are going to directly result in deaths -- if we're lucky, it'll only be in the thousands, but if we have another pandemic, it could well be in the millions.  The scariest part is that I have no idea what we can do about it.  Besides not taking responsibility, the other thing the Republicans seem to be awfully good at is not bowing to pressure from knowledgeable experts.  In fact, being countered makes them double down and hang on even harder.

And can I point out here that almost half of the research funding RFK cut could be offset by canceling the plans for Trump's fucking Versailles-wannabe golden ballroom?

This is a four-alarm fire, and it seems like barely anyone is paying attention.  Certainly no one who can do anything about it.  This goes way beyond whether any of us will be able to get flu and COVID boosters this fall; this is about basic medical research that can save countless lives.  But ignorance and anti-science dogmatism are winning at the moment.

I just hope that we won't have to wait until a deadly global pandemic for people to wake up and start objecting -- and getting this ignorant, dramatically unqualified ideologue out of a position he never should have been appointed to in the first place.

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Expertise

The attitude of many laypeople toward medical science can be summed up as "all you have to do is."

Never mind those silly experts, who actually went to medical school and all.  All you have to do is (choose one or more):

• take vitamins (two favorites are C and D)
• spend more time outdoors
• get more exercise
• get more exposure to sunshine
• drink more water
• stop eating meat
• eat more probiotics
• eat more protein
• eat less protein
• eat less processed food
• eat less sugar
• eat less salt
• eat less, period

Now, mind you, I'm not saying these are bad ideas, with the exception of eating both more and less protein, which are hard to do at the same time.  Most of us could use more exercise and eating less sugar and salt, for example.  It's just that the "all you have to do is" attitude tries to boil down all medical conditions to some easily understandable, easily treated set of causes, and avoids the scary truth that human health is complicated.

Sometimes so complicated that even the experts are stumped.

One of the weirdest examples of that latter phenomenon is a ten-year-long epidemic that happened in the early twentieth century, which directly caused at least a half a million deaths worldwide, and that even so most people haven't heard of.  It's called encephalitis lethargica, but that's really only a description of its symptoms; encephalitis means "brain swelling," and lethargica -- well, that one's obvious.  The first cases in the epidemic (although as you'll see, perhaps not the first cases ever) happened in 1915, and just about all of the patients experienced the same, very odd progression of symptoms:

• first, sore throat, headache, and lethargy
• double vision and an uncontrollable upward motion of the eyes ("oculogyric crisis") 
• upper body weakness, spasms, and neck rigidity
• "sleep inversion" -- the drive to sleep during the day and be awake at night
• temper tantrums, psychosis, and hypersexuality
• "klazomania" -- compulsive screaming
• catatonia

The most commonly effected were males between the ages of five and eighteen, but people of all genders and ages could (and did) get the disease.  The mortality rate was high -- about half of the known victims died within a year of onset -- and of the ones who survived, a great many had neurological problems for the rest of their lives, with many of them exhibiting emotional disturbances and/or Parkinsonism.

The disease is sometimes called Economo's disease, after Austrian neurologist Constantin von Economo,  who along with French pathologist Jean-René Cruchet wrote several papers describing the pathology, symptoms, and treatments (the latter, mostly unsuccessful) for it.

Medical journal photographs from 1920, showing Constantin von Economo (upper left) along with four patients suffering from encephalitis lethargica [Image is in the Public Domain]

To cut to the punch line: we still have no idea what caused it.

Initially, it was thought to have something to do with the Spanish flu, which happened around the same time -- possibly an autoimmune reaction triggered by the flu virus -- but that hypothesis was ruled out because there seems to be no correlation between the disease and previous flu exposure.  Also, the Spanish flu pandemic ended in 1919, while the epidemic of encephalitis lethargica went on until 1926.  (This by itself doesn't eliminate a connection; odd immune reactions occurring long after exposure are relatively common, such as shingles turning up years after contracting, and recovering from, chicken pox.)  The brilliant writer Oliver Sacks, in his book Awakenings, stated that the most likely culprit was an enterovirus, a group that contains the causative pathogen of another multi-symptom disease -- polio -- as well as the Coxsackie viruses, thought to play a role in such autoimmune diseases as type 1 diabetes, myalgic encephalomyelitis, and Sjögren's syndrome.  This contention, however, is still considered speculative at best.

While the 1915-1926 outbreak was the most serious, medical historians have identified other epidemics that may be encephalitis lethargica in Europe -- 1580, 1674, 1712, and 1890.  Because there's no certainty of the cause of the 1915 outbreak, it's hard to be sure these are the same disease, but from the symptoms they sound similar.

The reason I bring all this up today is more than just a chance to talk about a biological oddity.  It's to point out that human physiology, and all the things that can go wrong with it, are complex topics.  Emergent diseases like encephalitis lethargica are scary precisely because they strike suddenly and hard, then can vanish before we have much of a chance to study them (and potentially prevent subsequent outbreaks).

And -- the crucial point -- when they do, we need the best-trained minds in medical science to have every tool at their disposal.

Which, in the United States, we don't.  At the moment, the head of the Department of Health and Human Services is a loony anti-vaxxer who is still trying to connect vaccines to autism despite massive study after massive study showing there's no correlation, much less a causation.  His latest salvo was touting putting cane sugar back into Coke as a major victory in "Making America Healthy Again," despite the fact that it's hard for me to see how anything involving drinking Coke would foster better health.  There's a real concern that because of his policies we may have significant shortages of the flu and COVID-19 vaccines this fall, raising the specter of unchecked epidemics.  Research into cancer treatment -- including an mRNA vaccine that shows great promise in treating deadly pancreatic cancer -- have had their funding pulled.

Oh, but according to RFK Jr., that's not a problem.  "All you have to do" to remain healthy is spend more time outdoors and take vitamins.

This is the man in charge of our health policy today.

Look, I know all too well that there were serious problems with the American medical system even before RFK was appointed.  Overpresciption of antibiotics, opioids, antidepressants, and anxiolytics.  Necessary medical procedures being denied by avaricious insurance companies.  Getting the runaround from GP to specialist and back again, with the result that treatment can be delayed weeks to months.  My wife's a registered nurse; don't think I'm unaware of the issues.

But.  If I were to develop a serious medical condition, I'd still want trained experts working on it.  Why on earth would I not?  How does it make sense to doubt medical expertise, when we trust expertise of just about every other sort?  No one gets on an airplane and says, "To hell with training, I'm okay if the plane is piloted by a plumber who has never flown before."  When your house's wiring needs work, you don't say, "I'm fine hiring an accountant to do the job.  He'll do just as well as an actual electrician."  People of all professions work long and hard to acquire their skills and knowledge, and by and large, we trust that they know what they're doing within their given fields.

So why have we been told that medical researchers are somehow the only ones who are lying to us?  And why do so many believe it?

I wish I knew the answer to that.  Maybe it's just because with something as complex and potentially scary as our health, we tend to flail around for something, anything, to make it simpler and more reassuring.  And it's a sad truth of life that sometimes the answers evade even the experts.  The outbreak of encephalitis lethargica is just one of many examples.  But when the next mystery disease strikes -- or even some of the familiar ones -- we want the best shot we have to respond quickly and effectively.

And for that, we need trained doctors and researchers, not anti-science ideologues.

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Ministry of propaganda

Is it too much to ask that the Trump administration simply tells the damn truth?

That's all I ask.  Just stop lying.  I'm fine with having differences of opinion over policy.  For example, claiming that unhooking from fossil fuels and switching to renewable energy would be an unreasonable burden on our economy is not the same thing as saying climate change isn't occurring.

The first is a policy question we could discuss, and perhaps, come to consensus about.  The second is a lie.  And as long as you're simply lying about the facts, there is no discussion to be had.

Take, for example, the person who would have to be included in the top five most dangerous members of this regime; Health and Human Services Secretary Robert F. Kennedy Jr.  He is an anti-science ideologue of the worst sort, and because of him the CDC is now limiting access to COVID-19 vaccinations and canceling funding for this year's flu vaccine -- including the potentially pandemic bird flu.

All part of his "Make America Healthy Again" campaign.  Because horrible policies are just fine as long as you give them a snappy name, right?

Of course right.

[Image is in the Public Domain courtesy of the U. S. Air Force]

It doesn't end with anti-vaxx nonsense, either.  Just this week, RFK stated that gender-affirming care for individuals with gender dysphoria should be discontinued -- once again, flying in the face of scientific study after scientific study.  Ignore the science, he says; instead, listen to the directives from the government.

And what is the government suggesting instead?

Why, "conversion therapy."

Yep, the same thing that was touted to "cure homosexuality," and which (once again) study after study has shown to be (1) ineffective, and (2) psychologically damaging.  RFK's letter to healthcare providers states that they should uphold their oaths to "do no harm" by following a strategy that has been conclusively shown to do harm.

Then there's his report on "gold-standard" scientific research that allegedly supports his viewpoints on holistic health and the sins of Big Pharma -- which contains (1) dozens of citations that were identified as mischaracterized by the actual authors themselves, and (2) at least seven citations for studies that appear to be nonexistent.  In other words, RFK pulled the middle-school bibliography-boosting stunt of making up plausible-looking sources, taking others and claiming they said things they didn't actually say, and hoping like hell no one notices.

Well, someone noticed.  But did he retract the report and apologize?

Ha.  Of course he didn't.  This administration never apologizes for anything.  Confronted by their own blatant lies, they just double down, stamping their feet and saying "it is so true!", and rely on the fact that their supporters have no scientific training and very short memories.

Oh, and also this week, he promised a ban on federally-funded medical researchers from publishing in top-flight journals like Lancet, The New England Journal of Medicine, and Journal of the American Medical Association.  Why?  Because they're "corrupt."  Instead, he wants them to publish in a journal he's going to run, after vetting researchers as "good, legitimate scientists" -- meaning, of course, that they agree with him.

Look, it's not (as I've said many times before) that I'm unaware of the problems inherent in the American medical system.  My wife is a nurse, so I hear about a lot of it from her, and I've witnessed the misery that friends and family members have gone through trying to navigate their way through predatory insurance companies, inefficient and understaffed medical care providers, and ridiculously overpriced pharmaceuticals.  I have one friend who's had a ton of chronic health problems, and has gone through the wringer with misprescribed medications and unmanaged side effects.

But RFK is making a bad situation much, much worse.  His outright lies and barrage of unapologetic misinformation are going to kill people, pure and simple.  But my guess is that no one is going to pull on the reins, because we can't stop a program called "Make America Healthy Again," right?  What, do you want to Make America Unhealthy Again?

Honestly, I put the lion's share of the blame here on the members of Congress who voted to approve his appointment to the Cabinet.  It's not like his views were some kind of a secret; we knew about incidents like his lies about the measles vaccine resulting in an epidemic in Samoa that killed eighty people.  The man goes way past "unqualified," into the territory of "outright dangerous."  He should never have been appointed, much less confirmed.

So this is episode #352,981 of "We Tried To Warn You."  And now we're seeing the results of that dreadful lapse of civic responsibility on the part of our elected officials.

All I can say is that insofar as you can, take care of your health.  Take precautions, get the vaccines that are available, and educate yourself using actual scientific research and not Ministry of Propaganda doublespeak.  Even so, my suspicion is that it's going to be a rough few years.

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The ideologue

I told myself that I wasn't going to do another political post so soon after Tuesday's, but dammit, my good intentions got blasted to smithereens by Robert F. Kennedy, Jr.

[Image licensed under the Creative Commons Gage Skidmore from Surprise, AZ, United States of America, Robert F. Kennedy, Jr. (53427511876) (cropped), CC BY-SA 2.0]

Let me open by stating my bias up front.  My considered opinion, as a 32-year veteran science teacher with fifteen years of experience writing on science-related topics, is that RFK is a certifiable lunatic.  He combines the worst of the alt-med nonsense -- the kinds of things promoted by Mike "The Health Ranger" Adams and Vani "Food Babe" Hari -- with outlandish and debunked conspiracy theories, then dishes it all up as if it was peer-reviewed science.  Here are the three stories that destroyed my resolve to stay away from politics for at least a few days:

• In a town hall moderated by "Dr. Phil," he was asked by an audience member what he was planning on doing about "chemtrails."  You probably know that "chemtrails" are a completely discredited conspiracy theory claiming that The Bad Guys are putting stuff into jet fuel -- the "stuff" varies from heavy metals to radioactive isotopes to pathogens like anthrax -- so that when the exhaust is released into the upper atmosphere, it settles down on all of us and poisons us.  Notwithstanding that this has to be the absolute stupidest idea for a poison-delivery method I've ever heard of, it's been studied (I can only imagine the eye-rolling done by the scientists assigned to the research), and... nothing.  Contrails are almost entirely water vapor, with small amounts of soot from incomplete burning of jet fuel.  That's it.  But did RFK say that?  Of course not.  He's all in on chemtrails.  "It’s done, we think, by DARPA [the Defense Advance Research Projects Agency]," he said.  "And a lot of it now is coming out of the jet fuel -- so those materials are put in jet fuel.  I’m going to do everything in my power to stop it.  We’re bringing on somebody who’s going to think only about that, find out who’s doing it, and holding them accountable."

• An article in Ars Technica provides evidence -- in the form of RFK's own words -- that he doubts the basis of the medical science of infectious disease, the "Germ Theory of Disease."  Which claims that many diseases are (1) caused by pathogenic viruses, bacteria, fungi, or protists, and are therefore (2) communicable.  You'd think this'd be beyond question by this point, right?  Wrong.  RFK believes that any disease involving a pathogen is caused by having a weakened immune system -- i.e., all pathogens are opportunistic.  Get enough clean water, food, air, and sunlight, and you'll never get sick.  This is the basis of his anti-vaxx stance; if you live right, you shouldn't need 'em.  If this was a rational stance -- which it is not -- I'd ask him why, then, did childhood death rates go down so dramatically during the 1950s and 1960s, when mandatory vaccination programs against diseases like measles, mumps, rubella, diphtheria, tetanus, pertussis, and polio were instituted?  Did all the kids suddenly start eating right, or something?

• He stated outright that it was reasonable that religious people would shun the MMR vaccine, because it contains "aborted fetus debris."  Needless to say, this is untrue.  Vaccines against viral diseases are cultured in cell lines grown in labs, not in aborted fetuses.  If this were true, it'd be kind of funny that some of the most anti-abortion people around -- the leaders of the Catholic Church -- have no problem with vaccines, and in fact, strongly recommend that children get all of the critical childhood vaccines on the schedule recommended by most doctors.

Look, it's not that I'm against the idea that we need good food and clean air and water.  I'm also well aware that Big Pharma has a lot to answer for in how it produces, vets, and prices drugs.  But going from there to something I saw posted on social media a couple of days ago -- a 32-point-font banner saying, "BIG PHARMA HAS NEVER CURED A SINGLE ILLNESS!" is blatant idiocy.  To give just one example, a friend of mine, who was diagnosed with leukemia at age eighteen and is now a happy and healthy young woman in her late twenties, would not be alive today without the chemotherapy developed and produced by "Big Pharma."  

But under RFK, cancer research -- and also research into Alzheimer's, multiple sclerosis, ALS, Parkinson's, and most recently, Ebola fever -- has been defunded in favor of spurious projects to "stop chemtrails" and "look into the connection between vaccines and autism."  (tl;dr: There isn't one.)

In short, RFK is a dangerous ideologue who shouldn't be allowed within hailing distance of our national health policy.  His continued occupation of the position of Secretary of Health and Human Services is going to result in irreparable damage to the American health care system.

But a man like him is never going to step down, because he can't conceive of the possibility that he could be wrong.  An attitude which, of course, is endemic in our government right now.

I wonder how many people will have to die before anyone will step in and fire him?

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Deadly pseudoscience

In 2012, a 19-month-old boy named Ezekiel Stephan spiked a fever and was obviously in distress.  His parents, a British Columbian couple named David and Collet Stephan, decided not to seek medical attention for their child, instead treating him with "natural" and "alternative" treatments such as extracts of hot pepper, garlic, onion, and horseradish.

The little boy had bacterial meningitis.  By the time they decided to get the boy to the emergency room, he had lapsed into a coma, and hours later he died.

The Stephans were arrested and tried for "failing to provide necessities of life for their child."  David Stephan was said to be "completely unremorseful" and was sentenced to four months in jail.  Collet was put under house arrest for three months.  Both were ordered to perform 240 hours of community service.

And now, the Stephans have gone to Prince George, British Columbia to promote "natural remedies" for Truehope Nutritional Support, Inc., a company founded by his father.  Truehope's EMPowerPlus is one of the "remedies" that "assists with brain function" that they gave to their child shortly before he died.

[image courtesy of the Wikimedia Commons]

Dave Fuller, owner of Ave Maria Specialties, a "holistic health" store that carries Truehope products, seems to give nothing but a shoulder shrug with respect to the Stephans' actions.  "Who am I to say that just because something happened that was an accident the guy regrets — his son died — that he shouldn't have a job?" Fuller said.

Let's be clear here.  This was not an accident.  Bacterial meningitis is a horrible disease, but caught early enough, is treatable.  This couple deliberately ignored their little boy's increasingly severe symptoms in favor of quack "remedies," rejecting modern medicine for alt-med bullshit.  And as a result, their child died.

Unfortunately, this abandonment of science in favor of pseudoscience is becoming increasingly common.  The medical researchers are labeled as shills for "Big Pharma," and their data is rejected as inaccurate or outright fabrication, designed to "keep us buying drugs" or "keep us sick," and any information about low efficacy or side effects is allegedly covered up.

In fact, we're one of the healthiest societies the world has ever seen.  Most of the diseases that killed our great-grandparents' generation are now unheard of (how many people do you know have had diphtheria?).  And yet there are people who want to reject everything that modern medical research has given us in favor of the same kinds of remedies our ancestors used -- that didn't work very well back then, and still don't work now.

It's this same idea that is driving Donald Trump's links to the anti-vaxx movement, most recently his request of a meeting with Robert F. Kennedy, Jr., an anti-vaxxer who hides behind the "we just want safe vaccines" half-truth -- and Kennedy is now apparently going to head up a "vaccine safety board" to further investigate such nonsense as the link between vaccines and autism, which has been studied every which way from Sunday and always results in no correlation whatsoever.

All of this gives the impression that we need oversight because at the moment vaccines and other medications are simply thrown out willy-nilly by the medical researchers with no vetting at all, and that now we'll finally have someone making sure we're protected from the evils of Big Pharma.  Of course, nothing could be further from the truth; there is already the Advisory Committee for Immunization Practices (which has been around for fifty years) which oversees the testing and evaluation of vaccines and provides data to the CDC regarding efficacy and potential side effects.  The same is true for other medications; there is a rigorous set of tests each drug has to undergo, first on animal models and then (if they look promising) on human volunteers, before they are approved by the FDA.

That doesn't mean the process is foolproof.  Humans are fallible, data can be misinterpreted, experiments can fall prey to unintended sample bias.  There's no doubt that the profit motive in the pharmaceuticals and health insurance industries has led to price inflation for medications.  But the drugs themselves are, by and large, safe and effective, and sure as hell are better than horseradish extract for treating meningitis.

But the step from "the system has some flaws and could use reform" to "reject all modern medicine in favor of roots and berries" is all too easy a step for some people, and in the case of the Stephans, it resulted in their son's death.  And, more appallingly, they're still hawking the same stuff despite a very real test case establishing that it's worthless.

The bottom line: science isn't perfect, but as a means of determining the truth, it's the best thing on the market.  And also, the trenchant comment from Tim Minchin's performance piece "Storm:"  "There's a name for alternative medicine that works.  It's called... medicine."