COVID19 vaccines and the resistance

When these new mRNA vaccines were coming out, I was very hesitant. As a medical practitioner, I was eligible to get them right away, but as of today, I still have not gotten a vaccination for COVID19.
The vaccines are using a new technology and have been rushed out the door to get them to market and who knows what kind of corners were cut to get them out quickly. Every time a new medication comes out, there are all kinds of side effects that didn’t show up in the initial studies because the companies select the participants in the studies to be those at lower risk for the side effects. It isn’t until it’s actually out in the real world and all kinds of people with different genetic and environmental loads are taking it that we see the real spectrum of side effects.
I’m not against vaccines. I am against the inappropriate use of vaccines and on my website you can see a few articles I wrote about the inappropriately broad recommendations for
flu vaccines that are not based on science. Frankly, having a vaccine to get us out of this COVID19 mess would be a nice thing.
So, I waited. Once the vaccines have been out in the real world for a while, we’ll see the reality of what they do.
It’s been a few months and I’ve been seeing data from places like Israel where they’ve already vaccinated a good chunk of the population and they are
seeing a roughly 95% protection against symptoms, pretty close to what Moderna and Pfizer were reporting. Not bad!
One concern is that people who are vaccinated can still acquire the virus and won’t know it (95% reduction in showing symptoms, remember) and become asymptomatic carriers. We finally got some data on it with these mRNA vaccines and it looks like they reduce transmission of the virus by
80%, too.
In terms of allergies, these mRNA vaccines are remarkably clean with only
a few ingredients and none of the adjuvants we see in the other vaccines.
What about those side effects?
What I’ve seen from talking to people who had the vaccines is that a little under half of the people have no side effects from the first shot and a little less than that from the second shot. The side effects that have occurred seem to go mostly away within 48 hours of the vaccination. As we all know, there are a host of people who had COVID19 and continue to have symptoms long after the infection is over (though it seems that vaccinating them will help about 1/3 of the time).
How about some data for the rarer and more severe side effects?
As of yesterday, there are 1,913 reports of death (0.0018%) among the 109 million COVID-19 vaccine doses administered to people in the US. Any death during the reporting period gets reported and then they look into whether it was vaccine related and so far none in the US have seemed to be related to the vaccine itself. Here’s the article:
Selected Adverse Events Reported after COVID-19 Vaccination | CDC.
Even if 100% of those deaths were related to the vaccine, it’s still a much lower death rate than from the virus itself (which seems to have a death rate between 0.1% and 4.1%, and it is 1.8% among confirmed cases in the US).
As far as anaphylaxis goes, in the U.S. – according to the Centers for Disease Control and Prevention, as of Jan. 19 there have been 15 cases of anaphylaxis with the Moderna shot and 45 with the Pfizer shot. That translates to 2.1 cases per million doses and 6.2 cases per million doses, respectively. Again, much lower rates than complications from COVID-19.
As far as the autoimmune potential goes, however, there’s little data on it and it’s hard to connect it to a particular event. I think a case can certainly be made that if your own cells are making the spike protein, you could develop autoimmunity. However, it doesn’t seem to actually happen in practice, at least right away. Also the mRNA doesn’t stick around and make you continue making the protein for a long time, so if it doesn’t develop fairly quickly it probably isn’t going to. Of course it’s impossible _prove_ it doesn’t so it’s not wrong to say there’s a possibility. There’s also a possibility that you could win the lottery after getting the vaccine.
We always need to weigh risk versus benefit, or risk of treatment versus risk of no treatment. The risk of treatment doesn’t seem very impressive and the risk of not treating is clearly greater, not only in the risk of death, but also in the risk of long-term consequences.
So, with all the data pouring in showing the safety and efficacy of the mRNA vaccines, I have to say that my resistance to getting it is crumbling. I may actually get vaccinated in the next couple weeks.

Oops! Vitamin C beats hydroxychloroquin for preventing SARS-CoV-2!

In a paper released yesterday in the Annals of Internal Medicine, “Hydroxychloroquine as Postexposure Prophylaxis to Prevent Severe Acute Respiratory Syndrome Coronavirus 2 Infection”, vitamin C performed better then hydroxychloroquine in preventing exposed people from developing SARS-CoV-2, with about 20% fewer people progressing to COVID-19 disease in the vitamin C group.
The authors intended the vitamin C as a placebo to compare against the medicine, but they did use a dose that was a good start (500mg for 3 days and then 250mg daily) since the body will burn through vitamin C when fighting infections. Their references for the claim that vitamin C is a placebo and ineffective dose for this were based on 2 articles that do not support their contention:
one article on using a multivitamin with only 60mg of C to prevent respiratory infections that didn’t show any benefit, and a second article that gave 1.5g of C IV 4x/day to patients who were already in the ICU with sceptic shock. Clearly the first article used a dose that 1/4 to 1/8 of the “placebo” dose so we could expect a larger effect (which did, after all, show a non-significant 5% reduction in infections, so maybe we could expect a 4x greater benefit from 4x the dose, like the 20% we saw if we assume the medicine had no effect). On the other hand, the second trial had patients that were infinitely sicker (the current trial subjects weren’t sick) with a greater vitamin C requirement and already on death’s doorstep (15% of the patients died in the first week), and also is in contrast to other trials that showed benefit from similar doses.
In any event, the contention that this study shows that hydroxychloroquine doesn’t work but actually causes harm may actually just be showing that vitamin C even at modest doses is more beneficial than the medicine. Since they haven’t actually done a trial with a real inactive placebo, the outcome is still not clear, but at a minimum vitamin C isn’t going to hurt and might help. There have been
other case reports showing benefit to large doses of vitamin C in people with active COVID-19 disease, but the response from the medical establishment has largely been silence.

Scary supplements

I just came across an article with the provocative headline “Use of dietary supplements lead to 23,000 emergency visits each year” based on a 2015 NEJM study. This article seems to be suggesting that supplements are hazardous and should be avoided or at least more heavily regulated. Actually, they explicitly quote a physician who talks about the untested-ness and unregulated-ness of dietary supplements.
It also said that of this estimated 23,000 ER visits each year, there are “more then 2,100 hospitalizations”annually from supplements (
average hospital admission from ER visits is 11.9%, a little more frequent than the 9.1% admission rate we see here). That sounds like a lot of visits and hospital stays. Are supplements really that dangerous?
Conveniently, the same page also had links to some other ER statistics:
  • Annual ER visits related to schizophrenia in young adults is 382,000 (over 16 times more common that from supplements), of which about half are hospitalized as a result (nearly 90 times more common than supplement-related admissions)
  • Nearly 100,000 seniors are admitted to the hospital annually because of emergencies caused by adverse drug events. That’s over 47 times the number from supplements and that’s just in seniors.
  • 1.1 million annual ER visits from drug poisoning (once again, over 47 times the number from supplements), of which 24.5% are hospitalized (over 128 times more hospitalizations than from supplements)
  • The are around 24,000 ER visits for treadmill-related injuries annually, making treadmills more dangerous to the country than supplements
  • Apparently, even mirrors are more dangerous than supplements with 24,943 mirror-related injuries in 2014. There are even more injuries from sound recording equipment (44,278) and television sets and monitors (61,136). Interestingly, protection devices (12,829) injuries seem to be a bit safer than supplements, but do remember that ER visits for supplements are often just that someone took a lot or an unknown number of a supplement and are going to be sure it’s safe, so in many of these cases, there is no actual injury - just worry.
So, certainly, it’s worth paying attention to what you are taking and not throwing caution to the wind, but supplements are hardly the public health hazard that articles like this are trying to imply.

Interview in Crazy Wisdom Journal

Last fall, I was interviewed in the Crazy Wisdom Journal (CW is a local bookstore and hub for local healing arts), and the interview was recently published. Like all written materials, things have changed slightly since it was written, but it’s mostly up to date. It’s pretty in-depth and long, but I don’t think it’s too boring to finish.
For people who want to get a better idea of my philosophy of health care, this is a good read.
Also, for people who like to nitpick, there is a small error on page 44 (don’t worry, it starts on page 42: it’s not
that long) where I said “disease sensitivities” instead of “food sensitivities”.
In any event, it is a decent read and the PDF can be found by clicking here (the article starts on page 42):
The Crazy Wisdom Interview with Malcolm Sickels MD, or if you’d like to read it in your browser, click here for the flip book.

How effective is the Shingles vaccine?

These days, the shingles vaccine (for herpes zoster) can be found at just about any pharmacy. However it’s been hard to find real numbers on the benefit of this vaccine and so once again scare tactics come into play to get people to get the vaccine. How effective is it really? (Please note all these studies were done on healthy seniors, whose incidence of shingles is higher than younger populations.)
A
new study came out which adds to a previous study showing that the vaccine reduces the burden of illness by 50% and the incidence of post-herpetic neuralgia (where the pain of shingles never goes away) by 60%. In the new study, it looks like the benefit of the vaccine drops dramatically after the fourth year, so people would need to get a new shot every 5 years or so.
So, the cumulative risk reduction is about 50% for getting shingles and 60% for getting post-herpetic neuralgia, which sounds great, but what does that really mean for the person getting the shot. After all, if you wore a metal helmet around all the time, it might reduce your risk of getting killed by a meteorite by 50%, but the risk of getting hit my a meteorite is so small in the first place (less than 1 in 5 billion/year) that it’s not worth the trouble to wear the helmet.
In the study, the annual risk of getting shingles in seniors was 1.1% without a vaccine and 0.54% with the shot, meaning 0.57% of the people who get the vaccine will avoid shingles because of it. Put another way, if 175 people got the vaccine 1 person wouldn’t get shingles because of it. Usually, shingles is a temporary annoyance (about 1 in 8 seniors getting shingles will get post-herpetic neuralgia), so 175 shots and $38,500 (around $220/shot) seems like a lot to prevent 1 case of shingles. But wait! The shot gives similar protection for about 5 years, so we have to amortize that cost over 5 years: 35 shots and $7,700 to prevent 1 case of shingles.
However, post-herpetic neuralgia can be quite devastating, so what does it cost to prevent that? The risk in seniors is about 0.14% per year and goes down to 0.046% with the shot, so 0.09% of those who get the shot will avoid post-herpetic neuralgia each year. That’s 1087 shots, but spread over 5 years it’s only 217 shots to prevent 1 case of post-herpetic neuralgia at a cost of around $48,000. Compare that to the risk if avoiding a second heart attack by taking a statin: 50 people taking it for 5 years to prevent 1 heart attack at a cost of (say $20/month on the cheap end: $1200/person x50 people) $60,000.
What does all this mean to you? If you are a senior and get a shingles shot (for about $220), you have a 1 in 35 chance it will prevent you from getting shingles over the next 5 years and a 1 in 217 chance it will prevent you from getting post-herpetic neuralgia in the next 5 years. Better odds than wearing a meteor-protecting helmet (everyone on the planet would have to wear one for a few years to prevent 1 death from meteor), but still something to think about.
Also, note that having shingles is at least as effective at preventing future episodes of shingles as the vaccine is, so no need to get the vaccine if you’ve had shingles within the past five years.
Finally, understand that this is only looking at the simplest to measure outcome of the vaccine and monetary costs associated with it. Costs from side effects haven’t been discussed. Whatever immune dysregulation may occur from this vaccine is not only difficult to measure (it isn’t going to happen right away so would be hard to connect with the event of being vaccinated), but actively hidden (any reaction severe enough do trigger a lawsuit and prompt enough to implicate a vaccine bypasses the normal court system and goes to a special vaccine court, where all outcomes are kept secret, so there is no record of how much of a problem there is from any vaccine).

Time will tell.

Recently, I had a new patient who had been inappropriately placed on Fosamax (a bisphosphonate) for a bone density that just barely edged into the osteopenia range. She didn’t like being on it and persuaded her doctor to take her off it after 5 years. Recently, another doctor put her back on it (after 8 years off) because her bone density was about the same (i.e. still osteopenia).
Now, I know that 15 years ago, Fosamax was new and the
drug reps were pushing it hard and everyone thought it was the bee’s knees, so it’s understandable (but not justifiable) for her doctor to have placed her on Fosamax then. Now, however, it’s generic so there’s no drug rep pushing the medication, so why would a physician be prescribing it inappropriately?
Well, despite my
pointing out that this is poor practice by the evidence five years ago, an article on the current evidence of these medications’ lack of benefit with long term use only came out today after FDA presentations about the lack of efficacy.
The risks have been continually underplayed: osteonecrosis of the jaw and atypical fractures. Both of these, like most side effects, are dramatically under-reported. An oral surgeon isn’t going to want it getting out that a patient got osteonecrosis of the jaw, so is going to avoid working on people with risk and downplay what does happen. Meanwhile, atypical fractures aren’t going to get reported simply because the people seeing them (mostly ER docs) are too busy and are just trying to get the patient better. So, the true incidence of these risks is probably dramatically higher than what is reported in the literature.
It’s unfortunate that the real data on risks and lack of benefit of these medications only comes out once the medication goes off patent. We see the same with the PPIs (Prilosec, Nexium, etc): nutritional docs have been pointing out the risks for years, but now that they are off patent, the risks of pneumonia, bone loss, and small intestine bacterial overgrowth are starting to trickle out into the mainstream press.
Could it be that media corporations are hesitant to bite the hand that feeds them? Ever since direct-to-consumer drug advertising started, those advertising dollars have bought silence from the news outlets in addition to interest from patients. Perhaps the for-profit media is only willing to speak ill of a drug once it’s gone generic and the profits have already dried up.

HBOT for Horses

Last monday there was an article in the New York Times on using alternative therapies for treating racehorses. Among the treatments discussed was hyperbaric oxygen for healing up muscles better and faster.
10horses_CA1-popup

It’s nice that the benefits of
HBOT are getting some recognition. By delivering more oxygen to the tissues, it can speed wound healing and help bring damaged tissues back from the brink.
There’s more and more data on the benefits of using it and we’re finally starting to see
some research on the benefits of mild hyperbaric therapy (1.5 atmospheres pressure or less).

Settling for treatment

I was talking to some of my neighbors today about IPT (Insulin Potentiated Therapy), and how it uses lower doses of chemotherapy with fewer side effects than conventional chemotherapy and may even produce better outcomes (though there’s not much research on it). One of them asked why more doctors aren’t learning how to do this. To me, the reason seems straightforward in our current medical system: there’s no economic incentive to do it.
In order to learn to do IPT, a doctor needs to take time off work to learn to do it. That means no income for that time (actually, losing money since overhead costs remains when the doctor isn’t working) without much potential for increased revenue after learning the treatment. Hospitals and offices make money from delivering chemotherapy by marking up the drugs they are giving in addition to charging for services. More chemo and higher priced chemo (recent cancer drugs cost 20-200 times more than older drugs and may not give any more substantial benefit) means more money to keep the offices open and funds to cover fancy new cancer clinics and free art therapy classes. So, using less drug (IPT typically uses 10% of the usual dose) or older drugs (a vial of an old medication can be as little as $15 where a vial of a newer drug like Topotecan costs nearly $2000 per vial and others cost more... remember that chemo may use multiple vials and costs to administer the drugs will add substantially to the price) would substantially reduce the revenues of these offices and hospitals.
With big organizations, money drives everything they do and a potential loss of income (switching from larger margin chemos to smaller amount of cheaper drugs) isn’t going to contribute to a healthy bottom line.
It is an unfortunate reality that in this country there’s more interest in doing more expensive procedures than a less expensive procedure that may perform better.

Gluten in hemp milk

I’ve heard a case report of hemp milk having gluten in it. After noticing a reaction that correlated with hemp milk drinking, one person sampled every brand and flavor she could find and they all tested positive for gluten with an in-home kit. She had a conversation with one of the companies who told her that the farmers who grow hemp also grow barley, so cross-contamination is probably the issue.
Yes, the hemp milk was labeled gluten-free, but in the US right now there is no legal definition of gluten-free. So, if there’s any lesson in this, it’s that we should push the FDA to hurry up and settle on a definition of what “gluten-free” means.

I'm not crazy: aspirin for everyone?

I sometimes start to wonder if I’m crazy when conventional docs continually and persistently do things that I’m sure are a bad idea. Are they all practicing bad medicine or am I crazy? It’s nice when I’m reassured that I was right all along.
This time, it’s about aspirin. Whenever anyone over the age of 35 goes into a doctor’s office, it seems like the doctors routinely put them on an aspirin a day. The dose of aspirin depends on the doctor’s specialty: primary care docs recommend 81mg and cardiologists want people on 325mg or more.
Ostensibly, the aspirin is to reduce the risk of heart attacks. It reduces the stickiness of platelets (which make blood clot), making them less likely to clump and clog up arteries and cause heart attacks and ischemic strokes (caused by a clot).
However, aspirin is (like most drugs) not an entirely benign substance. It can cause bleeds in the stomach and intestine, which can be worsened by the anti-clotting actions of it. In addition, it can increase the risk of any type of bleeding, particularly hemorrhagic strokes (caused by a bleed rather than a clot: less common but worse).
Recent research has demonstrated that while aspirin does reduce the risk of another heart attack in people who have had one, it isn’t so impressive in people who have never had a heart attack. In particular, the only people who haven’t had a heart attack yet who should be candidates for daily aspirin use are people over 45 (men) or 55 (women) who are already at high risk of a heart attack and don’t have risk of bleeding (BP is close to normal and not at risk for falls).
Now the big question: if some should get aspirin, what dose should they get? Once again, the
primary care docs provide better care than specialists: 81mg provides better risk reduction and less increase in risk than 325mg. In fact, it appears that higher doses of aspirin might blunt the anti-platelet effects in addition to increasing the risks of adverse events (however it appears that cardiologists might not be reading their own journals like Chest).
So, how effective is it? Well, 119 high-risk men under 60 would need to take aspirin for 5 years to prevent one heart attack. Over those 5 years, there is a little more than a 1 in 3 chance that someone in that group will have a major intestinal bleed because of the aspirin. Put another way, if we took 1000 men with a 6% 10-year risk of hart attack and gave them aspirin for 10 years, we will have prevented 19 heart attacks (dropping the number from 60 to 41), caused 8 major bleeds and 1 hemorrhagic stroke. Men can
look up their risk/benefit ratio here.
In women, the benefit is less impressive: the chance of preventing a stroke is less and isn’t that different from the chance of causing a bleed. Women can
look up the specific risk/benefit ratios here.
However, if you are
having a heart attack, one of the best things you can do (in addition to calling 9-1-1) is chew up and swallow an aspirin. I’d still make the phone call first, though.