Quacks misuse Koch’s postulates to deny that SARS-CoV-2 causes COVID-19

Quacks often deny germ theory. I realize that it’s hard for a lot of physicians to believe that, in 2020, germ theory denial is a thing, but it is. (I’ve written about it many times before.) There are a variety of forms of denial of germ theory, too, ranging from “soft” denial to harder forms of denial. One example occurred in 2008, when Bill Maher engaged in “soft” germ theory denial in which, although he didn’t deny that the influenza virus causes the flu, he denied the effectiveness and safety of flu vaccines while simultaneously claiming that he “wouldn’t get the flu on a plane” because his “terrain” was so hostile to germs because of his healthy lifestyle and diet. (I couldn’t help but wonder all the weed he brags about smoking is part of that claim.) Bob Costas, of all people, responded with the perfect retort, “Oh, come on, Superman!” Indeed, amusingly, in response to criticism Maher fervently denied that he had denied germ theory, even though he had also quoted a common germ theory denialist lie about the “deathbed conversion” of Louis Pasteur, the father of germ theory, it’s a myth frequently spread by quacks who claim that Pasteur “recanted” on his deathbed (note the choice of word) and “confessed” that it was the “terrain,” not the microbes. (This never happened.) Another form of “soft” germ theory denial is the the co-opting and abuse of of Koch’s postulates to cast doubt on whether various microbes actually cause disease.

Yes, in the middle of a pandemic, quacks are misusing Koch’s postulates to try to deny germ theory.

I came across an example of this the other day posted to a chiropractor’s website in which Koch’s postulates were misrepresented, misunderstood, and abused to cast doubt on whether SARS-CoV-2, the coronavirus that causes COVID-19 and has resulted in so much suffering and death this year, is really the cause of the disease. It came in the form a video featuring Sayer Ji interviewing a “natural healing consultant” (i.e., quack) named Dr. Andrew Kaufman.

Regular readers will likely be familiar with Sayer Ji, as he’s been featured a number of times on the blog to deconstruct the quackery and antivaccine disinformation that he regularly spreads. Examples abound, including his teaming up with his wife, the equally quacky psychiatrist turned Goop icon, Kelly Brogan to deny public health science and science-based interventions to slow the spread of COVID-19. Before that, Ji regularly peddled antivaccine disinformation (I found it particularly amusing when he complained about attempts to clamp down on antivaccine disinformation on social media), willfully misunderstood the concept of overdiagnosis in order to attack screening tests, and even denied the importance of genetics in causing cancer. And, yes, he’s denied germ theory before, once using what I like to call in reference to the quack view of it the “mystical, magical microbiome” (or was it the “magical mystical microbiome“?) as a pretext to deny germ theory.

As for Dr. Andrew Kaufman, sadly, he does have an MD, and, oddly enough, has not been featured on this blog, a failure that I plan to remedy now. Unsurprisingly, he features a quack Miranda warning prominently on his website, where he describes himself thusly:

I am a natural healing consultant, inventor, public speaker, forensic psychiatrist, and expert witness. I completed my psychiatric training at Duke University Medical Center after graduating from the Medical University of South Carolina, and I have a B.S. from M.I.T. in Molecular Biology. I have conducted and published original research and lectured, supervised, and mentored medical students, residents, and fellows in all psychiatric specialties. I have been qualified as an expert witness in local, state, and federal courts. I have held leadership positions in academic medicine and professional organizations. I ran a start-up company to develop a medical device I invented and patented.

So, like Kelly Brogan, he’s a psychiatrist. He also sends up a lot of red flags, for example:

Medicamentum Authentica means “authentic medicine” in Latin. This is the standard I ascribe to when I present health information and work with clients. Since word meanings are frequently changed, even inverted, by official dictionaries, Latin provides sanctuary. Since Latin is no longer spoken, it is considered a ‘dead language.’ Thus, its meanings will never be compromised.

Yes, be very careful whenever you see a physician or other health practitioner using words like “true” and “authentic” with respect to medicine. These words bespeak a rather concrete worldview, in which only what they promote is “true” and “authentic.” The reference to Latin as a “dead language’ whose meanings will “never be compromised” is only a cherry on the top of the sundae of woo-speak. In any event, Dr. Kaufman appears to have been a psychiatrist at SUNY Upstate Medical University before he turned to woo. With the appearance of COVID-19, his woo was turbocharged, and he’s definitely been denying germ theory with respect to SARS-CoV-2 causing COVID-19, which leads me to kicking myself for not having written about him before. Fortunately, Jonathan Jarry in a fantastic article entitled The Psychiatrist Who Calmly Denies Reality:

Sounding composed and knowledgeable, Kaufman repeatedly tells his viewers that viruses are not a cause of human diseases. Through watching hours and hours of video, I have seen him deny the existence of the viruses behind the common cold, polio, HIV-AIDS, viral hepatitis, chickenpox, COVID-19, and measles.

And:

Dr. Andrew Kaufman rose to fame in the early days of the pandemic by claiming that what scientists were actually seeing with their electron microscopes was not a new coronavirus but rather exosomes. This story is quite interesting as it reveals a common tactic Kaufman uses. In building a bridge between an observation and a conclusion he likes, he will often use valid science to lay down a number of planks. When that bridge is almost complete, he runs out of planks and takes a leap of faith, but that leap may only be noticeable by an expert. Going back to exosomes, most of what Kaufman says is true. Our body is made of cells, and you can imagine a cell like a soap bubble. An exosome is a tiny bubble that buds off from that soap bubble and starts floating around, maybe eventually fusing with another soap bubble.

These exosomes can carry payloads, like genetic material, and act as transporters inside our body, and they do look an awful lot like many viruses. In fact, sometimes a virus will infect a cell and an exosome containing the virus’ genetic material will bud off and go on to infect another cell, just like a viral particle would! But here we reach the end of our bridge. Two scientific experts discussed this issue in a YouTube video and concluded that “clearly, there are similarities between exosomes and the coronavirus but they are absolutely different in many aspects.” Kaufman takes a leap and claims the virus does not exist. It’s all exosomes.

Imagine a whole hour of video with this sort of nonsense, and that’s what you get. I’m further amazed that I don’t recall ever having come across this video before, given that it was posted to the chiroquack website in September, but here it is, still on YouTube:

https://youtu.be/sSBQUIEUbQ8

The video’s introduction states:

In this interview, Dr. Kaufman explores a new study published in NATURE which claims to establish COVID-19 related pathogenicity in an animal model, but which does not fulfill Koch’s postulates for germ theory, and may overtly misrepresent the truth. This, in fact, is not new, as many publications have claimed to isolate COVID-19 or prove its role in causing animal and human deaths, yet none of them are actually capable of demonstrating this conclusively. Sayer Ji asks hard hitting questions and together they explore the implications of this and other research to the ongoing weaponization of germ theory as a political weapon for mass control and surveillance in violation of basic human, civil, constitutional and medical rights.

Note how the language gives away the game: “Weaponization of germ theory as a political weapon for mass control and surveillance.” Ji even introduces Kaufman with statements about how he is a “leader” in questioning how the “dominant narrative around COVID being this lethal invisible particle” that “sprung up in Wuhan in some kind of wet market” or was a “bioweapon” led to the “complete cessation” of social and economic activity, all based on what Ji characterizes as this “invisible particle” that’s been identified and is being tested everywhere. Particularly amusing is how Ji claims that Kaufman has been “telling the truth from the perspective of science itself.”

Again, this video is a little over an hour long, and I couldn’t stand to watch the whole thing. I’m not even going to go into the weeds that much, because there’s so much misinformation, bad science, pseudoscience, and disinformation in the video that it would take a series of posts to deal with it, although I can point out that Jarry was very much right about Kaufman’s techniques of science denial and disinformation in terms of how he cherry picks papers and takes germs of reasonable science and concerns and twists them into weapons against germ theory that he uses to deny that SARS-CoV-2 has definitively been shown to be the cause of the COVID-19 pandemic. Central to this is his central claim, which I’m going to zero in on and not get so much into the numerous weeds, that SARS-CoV-2 does not meet Koch’s postulates for causation of COVID-19.

First, let’s review Koch’s postulates, using the quote from Robert Koch from 1890 repeated on the chiropractor’s website:

However, if it can be proved: first that the parasite occurs in every case of the disease in question, and under circumstances which can account for the pathological changes and clinical course of the disease; secondly, that it occurs in no other disease as a fortuitous and non­ pathogenic parasite; and thirdly, that it, after being fully isolated from the body and repeatedly grown in pure culture, can induce the disease anew…

Or, to boil Koch’s postulates down to a 1937 version by Thomas Rivers and colleagues:

1. The parasite (virus) is present in every case of the disease.
2. The parasite should be fully isolated from the body and all products of disease (i.e. purified)
3. The parasite should be grown in a pure culture (not possible for viruses)
4. The isolated parasite produces the same disease, with all of its characteristics, in a normal host

I love to note how germ theory denying quacks just love to cite 19th century understandings of infectious disease as the be-all and end-all of the science of infectious disease, as if science hasn’t advanced in 120 years! Ji and Kaufmann even cite a quote that Koch’s postulates have not been satisfied in viral diseases, leading to this quote about modification of Koch’s postulates for viruses:

… the spirit of his [Koch’s] rules of proof still holds in that a worker must demonstrate that a virus is not only associated with a disease but that is actually the cause… this is accomplished by the production with a degree of regularity of a transmissible infection in susceptible experimental hosts by means of inoculation of material, free from ordinary microbes or ricketssiae, obtained from patients with the natural disease…

Again, Koch’s postulates arose from 19th century science and were proposed when germ theory was still in its infancy. We’ve learned since then that things are a lot more complicated, and, of course, quacks have been trying to point to examples of that complexity to cast doubt on the whole edifice of germ theory as the explanation for infectious diseases. The funny thing is that even in the 19th century Koch soon realized that there existed infectious diseases that did not fulfill his postulates:

Koch’s postulates were developed in the 19th century as general guidelines to identify pathogens that could be isolated with the techniques of the day. Even in Koch’s time, it was recognized that some infectious agents were clearly responsible for disease, even though they did not fulfill all of the postulates. Currently, a number of infectious agents are accepted as the cause of diseases despite their not fulfilling all of Koch’s postulates.

And Thomas Rivers, viewed as the “father of modern virology” even wrote:

It is unfortunate that so many workers blindly followed the rules, because Koch himself quickly realized that in certain instances all the conditions could not be met. . . . Thus, in regard to certain diseases, particularly those caused by viruses, the blind adherence to Koch’s postulates may act as a hindrance instead of an aid.’

Today scientists recognize Koch’s postulates mainly for their historical importance rather than as hard-and-fast rules to demonstrate disease causation. As mentioned by Thomas Rivers above, even Koch started to loosen the requirements of some of his own postulates, for example:

Koch abandoned the requirement of the first postulate altogether when he discovered asymptomatic carriers of cholera and, later, of typhoid fever. Asymptomatic or subclinical infection carriers are now known to be a common feature of many infectious diseases, especially viruses such as polio, herpes simplex, HIV, and hepatitis C. Specifically, all doctors and virologists agree that the poliovirus causes paralysis in just a few infected subjects, and the success of the polio vaccine in preventing disease supports the conviction that the poliovirus is the causative agent.

Sound familiar? It is now known that SARS-CoV-2 can cause asymptomatic infections in a relatively high proportion of patients and that these asymptomatic people can transmit the virus. How large a driver of the pandemic asymptomatic spread is has been heatedly debated, but there is no doubt that you can have COVID-19 and have few or no symptoms. It is true that, early in the pandemic, the World Health Organization appeared to have stated that asymptomatic spread of COVID-19 was rare (it didn’t exactly say that), and it was soon forced it to walk even that claim back rapidly.

Even the second of Koch’s postulates doesn’t always apply:

The second postulate may also be suspended for certain microorganisms or entities that cannot (at the present time) be grown in pure culture, such as prions responsible for Creutzfeldt–Jakob disease.

Ditto the third of Koch’s postulates:

The third postulate specifies “should”, not “must”, because as Koch himself proved in regard to both tuberculosis and cholera, that not all organisms exposed to an infectious agent will acquire the infection. Noninfection may be due to such factors as general health and proper immune functioning; acquired immunity from previous exposure or vaccination; or genetic immunity, as with the resistance to malaria conferred by possessing at least one sickle cell allele.

Again, does this sound familiar? Asymptomatic infection with SARS-CoV-2 occurs. A lot. Moreover, the virus can be grown in culture, just as many coronaviruses have been. It’s related to SARS, a coronavirus (hence its name), the coronavirus that was so feared in 2002-2003.

Another thing that Kaufman does in the video is to cherry pick studies to try to cast doubt on. For instance, he looks at the New England Journal of Medicine study published in January that first described the novel coronavirus isolated from patients with a mysterious new pneumonia in China in late 2019 that isolated virus from three patients in Wuhan. He harps on a statement in the conclusion of the paper:

Although our study does not fulfill Koch’s postulates, our analyses provide evidence implicating 2019-nCoV in the Wuhan outbreak. Additional evidence to confirm the etiologic significance of 2019-nCoV in the Wuhan outbreak include identification of a 2019-nCoV antigen in the lung tissue of patients by immunohistochemical analysis, detection of IgM and IgG antiviral antibodies in the serum samples from a patient at two time points to demonstrate seroconversion, and animal (monkey) experiments to provide evidence of pathogenicity.

Well, duh! It was January. The outbreak in Wuhan had only been going on a couple of months. In fact, that paper was quite impressive for what the scientists could accomplish in that they isolated a new virus, sequenced its genome and related it to existing coronaviruses, and published highly suggestive evidence that this new coronavirus was the cause of the pneumonia observed, with the authors noting:

We report a novel CoV (2019-nCoV) that was identified in hospitalized patients in Wuhan, China, in December 2019 and January 2020. Evidence for the presence of this virus includes identification in bronchoalveolar-lavage fluid in three patients by whole-genome sequencing, direct PCR, and culture. The illness likely to have been caused by this CoV was named “novel coronavirus-infected pneumonia” (NCIP). Complete genomes were submitted to GISAID. Phylogenetic analysis revealed that 2019-nCoV falls into the genus betacoronavirus, which includes coronaviruses (SARS-CoV, bat SARS-like CoV, and others) discovered in humans, bats, and other wild animals.15 We report isolation of the virus and the initial description of its specific cytopathic effects and morphology.

Which is exactly what the authors did. Kaufman tries to cast doubt on it by pointing to the small sample size. Again, this study was preliminary evidence, not absolutely confirmatory, and there have been many, many studies since then confirming that this then-novel coronavirus is the cause of COVID-19. He also claims that there was “no virus particle directly from patient demonstrated or identified,” Note the word “directly.” The authors actually did culture the virus in human airway epithelial cells and Vero E6 and Huh-7 cell lines. Hilariously, Kaufman also claims that “short RNA sequences of unknown origin from BAL sample” were “not conclusive.” This is a misrepresentation of PCR methods used to amplify RNA from the virus isolated from human respiratory isolates. He even dismisses, in essence, the computational biology behind next generation sequencing that has been used to sequence the virus as a “theoretical model of a theoretical virus.” He says he’s working on a white paper to claim this. He also dismisses next gen sequencing as being only good if you know the sequence is already, which is utter nonsense. Of course, knowledge of existing coronavirus sequences was used to guide the sequencing of SARS-CoV-2, but that doesn’t mean that scientists didn’t correctly identify the virus. (I suspect that molecular biologists who deal with next gen sequencing would be face palming furiously, if they ever listened to this part.)

In fact, an update to Koch’s postulates based on advances over the prior 100 years in science, microbiology, virology, and nucleic acid sequencing was proposed in 1996 by Fredricks and Relman and were summarized thusly:

1. A nucleic acid sequence belonging to a putative pathogen should be present in most cases of an infectious disease. Microbial nucleic acids should be found preferentially in those organs or gross anatomic sites known to be diseased, and not in those organs that lack pathology.
2. Fewer, or no, copy numbers of pathogen-associated nucleic acid sequences should occur in hosts or tissues without disease.
3. With resolution of disease, the copy number of pathogen-associated nucleic acid sequences should decrease or become undetectable. With clinical relapse, the opposite should occur.
4. When sequence detection predates disease, or sequence copy number correlates with severity of disease or pathology, the sequence-disease association is more likely to be a causal relationship.
5. The nature of the microorganism inferred from the available sequence should be consistent with the known biological characteristics of that group of organisms.
6. Tissue-sequence correlates should be sought at the cellular level: efforts should be made to demonstrate specific in situ hybridization of microbial sequence to areas of tissue pathology and to visible microorganisms or to areas where microorganisms are presumed to be located.
7. These sequence-based forms of evidence for microbial causation should be reproducible.

SARS-CoV-2 fulfills Koch’s postulates easily, as can be demonstrated by looking at the totality of evidence and not misrepresenting it, all while recognizing what PCR and next generation sequencing really are, rather than the simplistic, distorted view that Kaufman provides. In fact, I don’t even need to list all the examples myself here. In October Virology Down Under published an exhaustive list of studies showing that this coronavirus does, in fact, fulfill Koch’s postulates.

Whenever I point out that a very common thread of “thought”—if you can call it “thought”—in alternative medicine is nothing more than germ theory denial, the usual reaction from my fellow physicians is incredulity. Newbies who haven’t encountered quacks before invariably do a double take when I inform them that germ theory denialism is a thing, particularly among antivaccine activists. (After all, vaccines don’t make sense if microorganisms don’t cause disease.) Yet, time and time again I find examples of quacks who deny that disease is a consequence of infection. In fact, some go so far as to try to argue in the other direction, that microorganisms are good for us. Of course, there is a grain of truth in this. We’ve known for a long time that one of the pernicious effects of antibiotics is that they kill the beneficial bacteria along with the pathogenic bacteria, leading to syndromes like antibiotic-associated diarrhea and C. difficilecolitis, just to name an example. The problem is not so much that quacks claim that our microbiome, for example, can be beneficial, it’s that they basically deny that there are pathogenic bacteria, their usual spin on this claim being that these viruses and bacteria can’t cause disease if you’re truly healthy and your immune system is intact. Unfortunately, the subtext of this is that, if you aren’t “healthy,” it’s your fault. If you don’t believe me, just look at the rant by antivaxxer Del Bigtree, in which he urges his listeners to “catch this cold” while blaming the victims of COVID-19 for having made themselves chronically ill and therefore susceptible to COVID-19.

Most physicians (and most people in general) have a hard time believing that there are actual physicians out there who deny germ theory in the middle of a pandemic that’s already killed nearly 1.7 million people worldwide, including over 310,000 Americans, with the actual numbers likely being much higher, but there are. Andrew Kaufman’s attempt to twist Koch’s postulates to deny that SARS-CoV-2 has been identified as the coronavirus responsible for COVID-19 is but one example, unfortunately. Indeed, he’s such a font of disinformation that I’m likely going to have to delve more deeply into his claims.