Categories
Antivaccine nonsense Bad science Medicine Pseudoscience Skepticism/critical thinking

Is Dr. Hooman Noorchashm’s #ScreenB4Vaccine being used by RFK Jr. to spread fear of COVID-19 vaccines?

Dr. Hooman Noorchashm has raised a concern about vaccinating people who’ve had COVID-19 before. Unfortunately, he is allowing antivaxxers to co-opt his concern to spread fear of COVID-19 vaccines. [Note: There is an addendum to this post. Please read it.]

(Orac note 1/31/2021: Please see the Addendum to this post, with Dr. Noorchashm’s response to my post and some updates. In brief, Dr. Noorchashm states that he did not give Robert F. Kennedy, Jr. permission to republish his post and open letter to the FDA, which should be kept in mind as you read this post.)

On Monday, I discussed some of the efforts by antivaxxers to try to undermine confidence in COVID-19 vaccines, noting how they were continuing apace. As I put it at the time, every pre-pandemic antivaccine trope in the book had already been picked up, dusted off, and recycled for use with COVID-19, including lies claiming that the vaccine renders females infertile, permanently alters your DNA, causes autoimmune disease, or even kills. Even though it occurs to me that, given the torrent of disinformation about vaccines being spread by the antivaccine movement about not just the Pfizer/BioNTech or Moderna COVID-19 vaccines, but all COVID-19 vaccines being developed and tested, I could easily turn this blog into nothing but posted entitled Antivaxxers’ efforts to undermine confidence in COVID-19 vaccines continue apace, parts 1 through infinity, I thought it worthwhile to followup on Monday’s post with a new example that I’ve come across. Besides, I have a long-running series entitled The annals of “I’m not antivaccine” that’s already up to part 27, but part 1 dates back to 2010. I fear I could get up to part 27 of this new series before summer if I’m not cars. But first, let’s meet Dr. Hooman Noorchashm, who is, inadvertently providing the antivaccine movement with a major new talking point.

Dr. Hooman Noorchashm: Duped by RFK Jr.?

I begin, as is often the case, with antivax leader Robert F. Kennedy, Jr., his own wretched hive of scum and antivaccine quackery, Children’s Health Defense, and its antivaccine publication The Defender. Here, RFK Jr. pulls the appeal to authority play, entitling his article, Cardiothoracic Surgeon Warns FDA, Pfizer on Immunological Danger of COVID Vaccines in Recently Convalescent and Asymptomatic Carriers. I must admit that I had never before heard of the cardiothoracic surgeon who wrote the article, Dr. Hooman Noorchashm. The Children’s Health Defense website describes him thusly:

Hooman Noorchashm MD, Ph.D. is a physician-scientist. He is an advocate for ethics, patient safety and women’s health. He and his 6 children live in Pennsylvania.

It turns out that this is the only article by him published on the Children’s Health Defense’s The Defender. This led me to ask: Is Dr. Noorchashm an antivaxxer, or is he someone with some potentially legitimate concerns about COVID-19 vaccines who’s been duped into publishing on The Defender? In other words, is he antivax himself, or has he been duped by the antivaccine movement? An alternative explanation is that RFK Jr. republished his post without his permission, but given that there is now a section on the Children’s Health Defense website with his name and a brief bio I rather suspect that he gave RFK Jr. permission to republish. [Note that in the addendum, Dr. Noorchashm states that he did not give RFK Jr. permission to republish his post, which makes RFK Jr.’s creation of an author page for Dr. Noorchashm appear even more dishonest. Mea culpa for being too quick to assume that Dr. Noorchashm had given him permission.]

Whatever the case, Dr. Noorchashm’s Twitter feed is worrisome. On the one hand, I find this:

But then I found this as well:

I wrote about Hank Aaron and his death 16 days after receiving the COVID-19 vaccine a few days ago. His tragic death at age 86 was almost certainly an example of the sorts of coincidental events that I had warned about, the ones that I predicted antivaxxers would weaponize, as they did the deaths of nursing home patients in Norway. Seeing Dr. Noorchashm using Hank Aaron’s death in exactly the same way that antivaxxers have been using it, to blame a COVID-19 vaccine in the absence of evidence of causation, for the death of an elderly man, is not a good look for someone who is “not antivaccine.” At the very least, he is doing the same thing with this anecdote that antivaxxers have done, used it to support causation when it is not at all clear that there is causation.

Going back to read his article linked to in the first Tweet, I see that it’s basically the same argument he makes in his Defender article. In fact, his Medium article is the very same article and open letter as the one published on The Defender. Oops! Reading Dr. Noorchashm’s background, publication record, and posts on social media, I’m leaning towards his having been duped, based on this statement:

I want to be very clear that I am an ardent supporter of President Biden’s plan to vaccinate 150 Million Americans in 100 days. And that my letter is not to be abused by political, uninformed or conspiratorial forces attempting to dissuade the American public from being vaccinated. I do believe that it is the patriotic duty of every American who can reasonably and safely be vaccinated, to do so — in order that we save our nation from this pandemic peril that is threatening our very existence.

Funny how Dr. Noorchashm included a disclaimer in the introduction to his open letter stating that he doesn’t want his concerns expressed in his letter to be “abused by political, uninformed or conspiratorial forces attempting to dissuade the American public from being vaccinated” but has done nothing about one of the most prominent antivaxxers of all, RFK Jr., having done exactly that. Dr. Noorchashm has just earned the not-so-coveted Godzilla facepalm:

Godzilla facepalm

Let’s move on to look at Dr. Noorchashm’s concerns. Is there anything behind them? If there is, he hasn’t made a good case.

Is it dangerous to vaccinate those who have antibodies to SARS-CoV-2?

Dr. Noorchashm’s main concern seems to be that those who have previously been exposed to COVID-19 (and have pre-existing antibodies), who’ve had COVID-19, or who might have asymptomatic COVID-19 at the time of vaccination will have particularly severe reactions to COVID-19 vaccination. It’s not an entirely unreasonable fear, but it’s a fear for which even he admits there is no evidence, instead referring to his concern as a “prognostication”:

I want to be clear to be clear that my warning here is based on a near definitive scientific Immunological prognostication. It is a “prognostication” in that I have put it forth in the absence of clear “evidence” of it being a material risk.This is because we are dealing with an evolving 11-month old national health emergency with many unknowns, and a vaccine that is only several weeks old — and was approved for massive scale use on the Emergency basis. And, in a setting where it is critical to quickly vaccinate as many citizens as possible to achieve herd immunity against SARS-CoV-2.

What’s with the scare quotes around “prognostication” and “evidence”? It’s almost as though Dr. Noorchashm is being sarcastic about the terms, as though he doesn’t accept the current very persuasive evidence for the safety and efficacy of the Moderna and Pfizer/BioNTech vaccines against COVID-19, even in patients who have pre-existing antibodies.

My puzzlement at Dr. Noorchashm’s strange phrasing aside, I would argue that existing data from the 70,000+ people in the Moderna and Pfizer clinical trials, plus the data regarding the millions vaccinated with these two vaccines thus far strongly support the safety and efficacy of these two vaccines and have not as yet raised any major red flags regarding Dr. Noorchashm’s concerns. Don’t get me wrong. I don’t have a problem with him bringing up such concerns—but in the appropriate forum, such as the peer-reviewed scientific literature. Unfortunately, by letting his name and reputation be cited in such a wretched hive of scum and antivaccine villainy as Robert F. Kennedy’s Children’s Health Defense, he is (most likely inadvertently) contributing to spreading fear about COVID-19 vaccines in the middle of a pandemic that’s killed well north of 400,000 people thus far in the US alone. In case Dr. Noorchashm ever sees this post, I will conclude this article with a description of RFK Jr.’s long history of antivaccine propaganda.

Before I get to that, let’s look at Dr. Noorchashm’s article. First, let’s see how RFK Jr. chooses to introduce it:

In a letter to the U.S. Food and Drug Administration (FDA), Pfizer and the press, Dr. Hooman Noorchashm warns of an “almost certain immunological prognotication that if viral antigens are present in the tissues of subjects who undergo vaccination, the antigen specific immune response triggered by the vaccine will target those tissues and cause tissue inflammation and damage.”

Noorchashm, M.D., Ph.D., is a physician-scientist and advocate for ethics, patient safety and women’s health. He specializes in cardiothoracic surgery and has taught and practiced medicine for nearly two decades.

“Dr. Noorchashm’s prognostications of harm in elderly individuals with cardiovascular disease coincides with the numerous reports of unexplained  cardiovascular deaths following COVID-19 vaccination in NorwayGermanythe UKGibraltar and the U.S.,” said Lyn Redwood, RN, MSN, director and president emerita of Children’s Health Defense.

Redwood noted that J. Patrick Whelan, M.D., Ph.D., sent similar concerns to the FDA on Dec. 8, 2020. 

Note that Lyn Redwood is every bit as antivaccine as RFK Jr. and I’ve been mentioning her antivaccine activism dating back to at least 2007, when she was associated with the antivaccine group Safeminds. Note how RFK Jr. and she frame the open letter. This is clearly going to be a new antivaccine talking point about COVID-19 vaccines going forward, and Dr. Noorchashm has cluelessly given antivaxxers scientific cover for it, his disclaimer about not wanting to see his letter misused by ideologues notwithstanding.

Now, on to Dr. Noorchashm’s concerns:

As you also know it appears that the ACE-2 receptor on endothelium is the portal for viral entry into endothelial cells — and it seems that endothelial injury from the virus or from the inflammatory reaction it incites, is the reason why many COVID-19 patients experience thromboembolic complications.

So it is a matter of certainty that viral antigens are present in the endothelial lining of blood vessels in all persons with active or recent SARS-CoV-2 infection — irrespective of whether they are symptomatic or convalescent.

I am writing to warn that it is an almost certain immunological prognotication that if viral antigens are present in the tissues of subjects who undergo vaccination, the antigen specific immune response triggered by the vaccine will target those tissues and cause tissue inflammation and damage.

Most pertinently, when viral antigens are present in the vascular endothelium, and especially in elderly and frail with cardiovascular disease, the antigen specific immune response incited by the vaccine is almost certain to do damage to the vascular endothelium. Such vaccine directed endothelial inflammation is certain to cause blood clot formation with the potential for major thromboembolic complications, at least in a subset of such patients. If a majority of younger more robust patients might tolerate such vascular injury from a vaccine immune response, many elderly and frail patients with cardiovascular disease will not.

Basically, Dr. Noorchashm is expressing concern about a simple observation. The SARS-CoV-2 viral spike protein is the protein used in the Moderna and Pfizer/BioNTech vaccines as the antigen to develop an immune response. This protein is also the viral protein that binds to the ACE-2 receptor on cells to allow the virus to gain entry to cells. The ACE-2 receptor is a very important protein that is located on the surface of the endothelial cells that line blood vessels; so naturally in the case of COVID-19 infection one would expect the spike protein to be found in vascular endothelial cells in patients with COVID-19.

What Dr. Noorchashm is describing is a theoretical issue. It’s not an entirely unreasonable concern, given that it is believed that part of the pathophysiology of severe, life-threatening COVID-19 disease is an immune response that attacks blood vessels, but how much of an issue is it really, and does Dr. Noorchashm really think that the FDA, the companies that developed the spike protein-based COVID-19 vaccines, and the regulators charged with issuing the emergency use approval (EUA) for the vaccines and for monitoring their safety haven’t thought of this issue before? (Indeed, the CDC Advisory Committee on Immunization Practices—ACIP—did explicitly consider this concern.) Moreover, before these vaccines were developed, one major concern was something called antibody-dependent enhancement (ADE) of disease, a condition when insufficient antibody titers trigger enhancement of disease. Basically, in ADE, vaccine-induced non-neutralizing or weakly neutralizing antibodies bind to newly infecting virus to promote enhanced virus uptake into host cells. Fortunately, this appears not to be an issue with COVID-19 vaccines.

Here’s the thing. As I’ve discussed before, it will take epidemiology to differentiate increases in various conditions after vaccination against COVID-19 from the baseline rate of such conditions in the populations studied. For example, the deaths of nursing home patients in Norway I discussed earlier this week were not associated with a detectable increase in the baseline rate of 400 deaths/week in that particular population, meaning that they were almost certainly coincidental to the vaccine, as elderly patients in nursing homes will, unfortunately, die at a fairly high frequency (certainly compared to that of young, healthy people). That’s why, out of an abundance of caution, health authorities in Norway tweaked, but did not radically alter their recommendations for vaccination of elderly nursing home patients against COVID-19.

Again, I don’t have a problem with Dr. Noorchashm writing a letter of concern to the FDA. I do have a problem with him continuing to allow his message to be weaponized by RFK Jr. I also have a problem with him pointing to anecdotes that do not show causation to support his concerns without adding this sort of nuance.

#ScreenB4Vaccine?

Dr. Noorchashm’s whole idea is that we should “screen” before vaccinating against COVID-19; specifically, that anyone to be vaccinated against COVID-19 should have a blood test to look for antibodies against SARS-CoV-2 that could indicate previous infection or ongoing asymptomatic infection. In another post, he suggests:

It is critical that the elderly, the infirm and any persons with cardiovascular disease be screened with at least one, preferably two (as described above), of these assays immediately prior to vaccination— in order to maximally mitigate against the possibility of activating a dangerous inflammatory response. Here is a step-by-step roadmap on how to safely proceed based on the obtained results:
  1. Antibody Test Negative, PCR/Rapid Test Negative: Viral antigens are unlikely to be present in your body. Proceed with Vaccination ASAP.
  2. Antibody Test Positive, PCR/Rapid Test Negative: It is highly likely that you were exposed to the virus and may have viral proteins present in your tissues. You may be immune to the virus already. Delay Vaccination by 6–8 months and repeat PCR/Rapid Test immediately prior to vaccination at that time.
  3. Antibody Test Negative, PCR/Rapid Test Positive: You are carrier of the SARS-CoV-2 virus. DO NOT PROCEED WITH VACCINATION. Delay vaccination by 6–8 months and repeat PCR/Rapid Test immediately prior to vaccination at that time.
  4. Antibody Test Positive, PCR/Rapid Test Positive: You are a carrier of the SARS-CoV-2 virus and have already mounted an immune response against it. DO NOT PROCEED WITH VACCINATION. Delay vaccination by 6–8 months and repeat PCR/Rapid Test immediately prior to vaccination at that time.
If you fall in Category 3 or 4, you may have symptomatic COVID-19 disease or be asymptomatic. Proceed as follows: A) If you are asymptomatic: Repeat your PCR/Rapid test in 6–8 months. If negative, proceed with vaccination. B) If you have symptomatic COVID-19 disease: Repeat your Antibody test following convalescence and if positive, you are highly likely to be immune. This is the expected finding in the vast majority of people who’ve had previous COVID-19 disease. In this case, you may either choose to forgo vaccination, or you may receive the vaccine. If you choose to be vaccinated, repeat the PCR/Rapid Test immediately prior to vaccination and proceed if negative. The overall concept is that if you are a carrier of the virus, either by PCR or the Rapid test, you are safest delaying your vaccination by 6–8 months — in such a case, if you developed symptomatic disease, and are Antibody positive, you may also consider forgoing vaccination, because you have natural immunity. With asymptomatic infection, even if the Antibody test turns positive, it is safest to consider getting the vaccine. The basic premise being that symptomatic natural infection, while not the preferable way to achieve immunity, is itself a very powerful way to develop immunity.

And then in his letter, he states:

Therefore, it is my respectful request that FDA, in collaboration with Pfizer and Moderna, immediately and at the very minimum, institute clear recommendations to clinicians that they delay immunization in any recently convalescent patients, as well as, any known symptomatic or asymptomatic carriers — and to actively screen as many patients with high cardiovascular risk as is reasonably possible, in order to detect the presence of SARS-CoV-2, prior to vaccinating them.

A potential reasonable solution, especially in the nursing home setting, would be to use antibody screening as a surrogate means of excluding/delaying vaccination in persons who might have been exposed to the virus and have viral antigens lingering in their tissues.

Dr. Noorchashm even concludes:

I ask that you carefully and wisely consider my immunological prognostication and warning here — FDA, Pfizer and Moderna ought not miss this risk of harm to what is a daily increasing proportion of the population during this ongoing pandemic. Vaccinating patients with occult SARS-CoV-2 infections or lingering viral antigens, is a clear and present potential danger to the health of these patients.

But is it? Is it really? Again, even Dr. Noorchashm admits that he currently has no evidence that people who’ve had COVID-19 before, either an asymptomatic case or a case from which they’ve recovered, are having serious adverse events (SAEs) up to and including death after COVID-19 vaccination above the expected baseline rate in the relevant populations for such health problems. Instead, he keeps referring to his prediction as an ““almost certain immunological prognostication” or a “near definitive scientific Immunological prognostication” (capital letter included) in order to make his prediction sound way more certain than it really is. Meanwhile, I’ve been looking and looking for indications in the adverse events data after the rollout of the Moderna and Pfizer/BioNTech COVID-19 vaccines for a hint of an association between vaccination and death or serious illness, and I haven’t been finding any.

Meanwhile, other immunologists have been stating repeatedly that people who have had COVID-19 before should be vaccinated against it. Among the reasons these experts give is the variability in the level of neutralizing antibodies produced by different people after infection, ranging from low levels that don’t prevent reinfection to high levels that do. In brief, the vaccine “levels out” the variability in people’s immune responses.

Moreover, what Dr. Noorchashm proposes is not simple or cheap:

Sette says it’s a “reasonable argument” to suggest that maybe people who have had Covid-19 shouldn’t be prioritized to get the vaccine, should the stock of it remain limited over the long term. But in practice, that argument could become problematic. 

For one: “It’s too difficult to operationalize pre-vaccination testing,” Peter Hotez, vaccine expert and the dean of the National School of Tropical Medicine at Baylor College, says in an email. It would be tedious work to determine who might be immune to SARS-CoV-2 before vaccination. It could be tedious work to determine who has been infected prior to vaccination as well. 

Plus, again, the information resulting from such tests may not be all that useful in determining a person’s lasting immunity.

In fairness, what Dr. Noorchashm is arguing is not that testing everyone (or at least the old and infirm) for COVID-19 virus and antibodies before vaccinating against COVID-19 will determine who is and isn’t immune beforehand but rather that it will somehow make vaccination safer by preventing horrendous immune reactions that destroy blood vessels and cause sudden cardiovascular death in people who have preexisting COVID-19 antibodies or an asymptomatic infection.

So why not do this testing anyway, out of an abundance of caution? The answer is relatively simple. First, it would, as Dr. Hotez points out, it would be tedious. Just as importantly, it would be expensive and add an enormous cost and delay to an already very costly vaccination effort, all while slowing it down. Just think of how much longer it would take to get people vaccinated if all of them (or even just a substantial portion of them) had to be tested by nasal swab and blood test for COVID-19 and for SARS-CoV-2 antibodies, respectively, before receiving the vaccination. In the middle of a pandemic whose death count in the US alone has been predicted to hit a half a million people well before the end of February, slowing down the vaccination effort could kill who knows how many thousands of people who might not die if they can be vaccinated sooner. Such a strategy might be justifiable if we had good reason to suspect that not doing the testing would result in the deaths of as many or more people, but not even Dr. Noorchashm can present good evidence that simply vaccinating people without testing them for COVID-19 first would result in anywhere near that many deaths—or even any deaths or SAEs at all! He has a theoretical concern and anecdotes, and that’s it.

Moreover, I would be willing to bet that Dr. Noorchashm doesn’t realize that he’s echoing a very old antivaccine trope. Antivaxxers love to claim that we should “vaccinate selectively” based on pre-vaccination testing. For example, antivaxxers will often claim that we should test children for measles titers before administering the second and third MMR dose. Others come up with all sorts of fanciful tests not based in science, including genomic tests, to “predict” who will be most at risk for “vaccine injury.” I don’t expect Dr. Noorchashm to be aware of this history, but I am aware of it, which is why I noticed right away why antivaxxers are starting to notice his #ScreenB4Vaccine hashtag:

Although, in fairness, not all antivaxxers are on board with Dr. Noorchashm’s recommendations because of this:

Basically, whether he realizes it or not, Dr. Noorchashm is feeding the antivaccine movement a talking point.

Dr. Noorchashm should not let his name and message be co-opted by antivaxxers

Readers might think that I was harsh when I asked whether Dr. Noorchashm is antivax or is being used by the antivaccine movement. While I don’t doubt that Dr. Noorchashm really does believe in the importance of the COVID-19 vaccination program as a very important part of the pathway out of this pandemic, I do see him using his pet hypothesis and anecdotes like that of Hank Aaron to promote a “solution” to a “problem” for which there is as yet no compelling scientific evidence. (See? I can use scare quotes too.)

Dr. Noorchashm notes:

Additionally, if the immunological risk I am prognosticating herein is in reality material, over the next months as millions more Americans are immunized, it will become quite visible to the public.

Here’s a retort. According to statistics updated today, over 87 million COVID-19 vaccines have been administered in 60 countries. In the US, 27.3 million doses have been distributed thus far since December 14, 2020. Currently, around 1.26 million doses per day are being administered in the US alone. Worldwide, the number is almost 4.2 million doses per day. That’s a hell of a lot of vaccines. If Dr. Noorchashm’s concern about an immune reaction against the vasculature in people who’ve had (or who have) COVID-19 who are vaccinated were significant, particularly if it were as big a concern as he’s arguing, we’d very likely have seen a signal for this problem by now in the safety data. We have not. I predict that we most likely will not.

As for Dr. Noorchashm, I’d like to remind him that, if he were really as provaccine as he claims, he would never in any way let his name or message be used by an antivaxxer like RFK Jr., as being associated with someone like RFK Jr. is utter poison to the reputation of anyone who purports to be pro-science—and rightly so. While it is true that RFK Jr. loves to claim to be “fiercely pro-vaccine,” he has consistently demonstrated himself to be, in reality, anything but. Indeed, he is “fiercely” antivaccine, as demonstrated by his history of likening vaccination to the Holocaust, trying to persuade Samoan officials that the MMR vaccine was dangerous (in the middle of a deadly measles outbreak!), claiming that today’s generation of children is the “sickest generation” (due to vaccines, of course!), or toadying up to President-Elect Donald Trump during the transition period to be chair of a “vaccine safety commission.” Indeed, last year his own family called him out for his antivaccine activism, while, predictably, RFK Jr. has, as so many antivaxxers have done, gone all-in on COVID-19 pseudoscience and conspiracy theories and become antimask, “anti-lockdown,” and pro-quack treatments. Seriously, this is not the sort of person you want to associate with if you truly don’t want your message to be used by antivaxxers.

I hope that, should Dr. Noorchashm see this post, he will realize that he is unwittingly allowing his name, scientific reputation, and message to be used by one of the most prominent antivaxxers in the world to spread fear, uncertainty, and doubt about COVID-19 vaccines. The least he can do is to admit his mistake and publicly demand that RFK Jr. remove his open letter from The Defender‘s website. Dr. Noorchashm should think of it this way. RFK Jr. undoubtedly thought that using his concerns about COVID-19 vaccination in people who have (or have had) the disease was a propaganda victory for Children’s Health Defense. If Dr. Noorchashm were to publicly renounce that use of his open letter to the FDA, that would “flip the script” and turn it into a messaging victory for pro-vaccine advocates, as RFK Jr. would be revealed to have deceptively appropriated his post and name to spread his antivaccine message.

Isn’t that something someone who is provaccine would really, really, really relish doing?

Addendum 1/31/2021

There have been some…developments…since this post went live on Friday.

First, Dr. Noorchashm has posted a rebuttal on Medium, and in the interests of accuracy and fairness, I need to point that out. Here is the link. I encourage everyone to read it.

I have also received distressed and angry emails from Dr. Noorchashm describing my post as “defamatory” and arguing against my point, while demanding that I either remove the post or tone it way down. In particular, he seems to object most to my having wondered if he was a “useful idiot” for RFK Jr., a question whose answer I will suggest that my readers decide for themselves.

It was in these emails that Dr. Noorchashm stated explicitly that he had not given RFK Jr. permission to republish his post. Oddly enough, he also cc’ed a number of people, including Acting FDA Commissioner Janet Woodcock (why, I don’t know), other FDA officials, Dr. Paul Offit (why, I also have no idea), several Wall Street Journal journalists, and the chairman of the department of surgery where I am faculty, as well as one other surgery faculty member in my department who is not even based at my hospital and likely has no idea what the heck this is about and only a vague idea of who I am. (Come to think of it, my chairman likely had no idea what this was about either.)

Meanwhile:

Dr. “Hooman” sounds a bit…threatening, n’est-ce pas?

In response to Dr. Noorchashm’s protestations that he is very pro-vaccine, I suggested that, taking him at his word the that is the case, he really should publicly demand that RFK Jr. remove his article from The Defender‘s website. It’s what a pro-vaccine advocate would do. In response, Dr. Noorchashm more or less shrugged his shoulders and said that anyone can use his articles. In his response, he even wrote:

What Gorski is alleging is that Mr. Kennedy is using my letter to stoke vaccine hesitancy — and he is critiquing me for permitting this usage of my scientific opinion and public letter to the FDA . As if I have any control over Mr. Kennedy’s, or his own, choice to opine or adopt my opinion piece however they wish to.

“It’s called living in America, David.”

To be clear, had I uploaded my letter to FDA and Pfizer into the FDA’s public comment portal, Mr. Kennedy would have had free access to it also. So really, what Gorski is suggesting is that I either not publish such a letter of concern, or that I demand that Kennedy withdraw his reference to my letter.

I intend to do neither of what Gorski is erroneously suggesting I should. Because, I believe that Dr. Gorski’s opinion is not aimed at creating consensus. It is aimed at getting a cheer from his echo chamber of followers, who do not see that it may very well be possible to convince a large proportion of the American public that these vaccines are highly likely to be effective — AND that they can be administered rationally and safely by mitigating against all real and potential safety risks.

I’m sorry, but this is just…disingenuous. Sure, Dr. Noorchashm’s letter to the FDA is public, but his introduction to his letter on Medium falls under his copyright, and remember: RFK Jr. did more than just copy Dr. Noorchashm’s public letter. RFK Jr. took the whole letter and introduction and republished them in toto on his website as though Dr. Noorchashm had written them for him, even going so far as to create an author profile for Dr. Noorchashm! Again, how anyone who is so passionately pro-vaccine can allow such a deceptive co-opting of his work to go unanswered, I have no idea. Perhaps Dr. Noorchashm can explain. Through it all, he kept saying things like, “Always polite!” as if his main complaint was that I was not “polite” or “civil” enough for him.

Finally, this morning Dr. Noorchashm did two things. First, he Tweeted this:

In response to people pointing out that he’s using single anecdotes in much the same way that antivaxxers do, he retorted:

And then…

Invoking the trope about people having believed that the earth was flat? Seriously? Scientists have actually known that the earth is roughly spherical since the 5th century BCE. Be that as it may, Dr. Noorchashm is using anecdotes to promote his view that the COVID-19 vaccine might have caused this, even though the article he’s linking to explicitly states that the COVID-19 vaccine had been ruled out as a contributing factor.

Then, Dr. Noorchashm wrote an email to my chairman complaining to him and asking him to tell me to remove my post or tone it way down. I know this because my chairman forwarded it to me with an “FYI.” I was half-tempted to publish the email here, but then thought the better of it. I will, however, conclude this addendum by pointing out that trying to use my bosses to silence me is a favored tactic of antivaxxers and quacks, one that’s been used against me so many times that it barely registers any more, other than for them to forward the email to me to let me know that someone had complained.

In fact, trying to get someone in trouble at work by complaining to his boss about something he wrote on his blog is rarely a good look. In fact, it’s usually quite cowardly, and the intent to silence is almost always very obvious. Someone who is so pro-vaccine really should think twice about using this tactic, given how favored it is by science denialists and cranks. Again, I’ve had this technique wielded against me more times than I can remember, going back to April 2005. Dr. Noorchashm now knows that I react very negatively to it.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

142 replies on “Is Dr. Hooman Noorchashm’s #ScreenB4Vaccine being used by RFK Jr. to spread fear of COVID-19 vaccines?”

I agree with your points. I will point out that I saw no indication on the CHD article that they requested or received permission to reprint the letter. I, like you, would suspect they did, but the article didn’t say it, that I’ve seen. So maybe he didn’t. They are still using it, of course, and maybe that’s what he worried when he set out the introduction. But his tweets seem to suggest sympathy to the antivaccine views.

In addition to your points about experts addressing the call for testing, ACIP itself did discuss it too, with the same conclusions you set out. The question wasn’t ignored in the recommendation process. Dr. Noorchashm can still disagree, of course.

I note that RFK Jr. added a section for Dr. Noorchashm on The Defender. Moreover, the original post on Medium did not, as far as I can see, say that it’s open access and freely republishable. These two observations, plus RFK Jr. being a lawyer (and how rapidly Dr. Noorchashm’s article was republished on The Defender), suggest to me that he got Dr. Noorchashm’s permission before republishing. He wouldn’t be the first provaccine advocate to have been duped by antivaxxers.

I could be wrong, of course. (It wouldn’t be the first time RFK Jr. has done shady things.) However, if I am incorrect, then that would be even more of a reason for Dr. Noorchashm to demand that his article be removed from the Children’s Health Defense website.

I just know that if a crank republished one of my articles in its entirety with an introduction that tried to mischaracterize the article to support his position, I’d go ballistic demanding publicly and in private that they remove the post from their website immediately. If public shaming failed, I might even bring the lawyers.

The bio of Dr Noorchashm had an odd bit there at the end where it talks about his 6 kids, but not about any kind of partner. Probably nothing.

The bio of Dr Noorchashm had an odd bit there at the end where it talks about his 6 kids, but not about any kind of partner.

His wife Amy Reed died of uterine cancer in 2017.

This may have some bearing on his current feeling about COVID-19 vaccines. Noorchashm is also a proponent of cyclosporin A for treatment of COVID-19.

@Orac

“We have not. I PREDICT that we very likely will not.”

Or you could prognosticate!–a word Dr N seems to really, really enjoy using.

I wonder if he knows Dr Oz? Maybe they met at cardiothoracic surgery class.

I have noticed that cranks do try to get legitimate scientists/ experts/ authors to appear alongside them and then, they might later distort their work, using it to support their own drivel. They may misrepresent their outlets as “science” or ” progressive politics” ( CHD, PRN, respectively ) . Personally, I know that a former cabinet secretary and scholar appeared on PRN’s noontime woo-fest and allowed his writing to be reprinted there as well; later, the crank continued to insult the professor’s colleagues and party…
I took it upon myself to e-mail him ( I won’t name him because I have respect for his many contributions) describing the miscreant and his work, without actually saying, “You’ve been duped by a con artist” but I never saw his work or him there again.
I would hope that people would investigate where they or their work appear but con artists con people.

The “strange phrasing” of the statement “It is a “prognostication” in that I have put it forth in the absence of clear “evidence” of it being a material risk.” is this: translated, it’s “it is a guess that I have put forth in the absence of knowledge”.

SARS-CoV-2 is not the only pathogenic human virus to infect endothelial cells. For example, cytomegalovirus (CMV) and some influenza viruses do this.

I haven’t been able to find evidence that giving influenza vaccine to people who’ve already been infected causes grievous vascular damage. In the case of CMV, serious infections (i.e in transplant patients or other immunocompromised individuals) are often treated with immune globulin in addition to antiviral medications. If Dr. Noorchashm was correct, wouldn’t thrombotic events and other major consequences based on antibody-mediated endothelial damage have led to the abandonment of this therapy?

“I want to be clear to be clear that my warning here is based on a near definitive scientific Immunological prognostication” is wonderfully confident, but not what I’d expect to hear from a knowledgeable and reputable scientist.

Purely anecdotal, but I had COVID-19 starting mid Nov. Got Pfizer #1 end of December. Had two days of fever and achy including a sore arm after it, worse than typical for flu vaccine. Sore arm and achy following #2 for 1 day last week. I didn’t really give a crap about ADE given it’s all the Lying-Wailer’s been blathering about since October, just renamed as “pathogenic priming”.

I wrote the CDC after #1 to ask if they consider modifying their V-Safe adverse event tracking to ask (at time of sign up) if you’ve already had COVID-19 and when in order to track via V-
Safe if those who’ve had COVID-19 are having more immunogenic reactions to the vaccine. They replied they are looking at doing this but also tracking this via other ways.

The only contra-indication for COVID-19 vaccine if you’ve already had COVID-19 are (1)not to still be acutely ill from COVID-19, and, (2) if you received convalescent plasma or monoclonal antibodies (you’d have to at least have been in the ED for antibodies, inpatient for plasma) to wait 90 days before taking the vaccine.

As you noted, good luck with this silly idea of lab screening people ahead of the vaccine. The US is having enough problems as it is just getting the vaccine into arms right now.

Funny you should tell this story. I took part in a study in May screening healthcare workers for antibodies to SARS-CoV-2. To my surprise, I tested positive. Given the prevalence of COVID-19 in the Detroit area at the time and the false positive rate of the antibody test, I estimated its positive predictive value to be a little over 50%. So, did I have an asymptomatic case of COVID-19 or not? Who knows? It was roughly a 50-50 chance; so I didn’t change my behavior.

Then I got the Pfizer vaccine in late December. It kicked my ass. For a couple of days afterward I had severe muscle aches and fatigue. No fever, though. After the second dose, I had a similar, but less severe, reaction, this time with chills. Again, no fever. That made me wonder if I really had had an asymptomatic case of COVID-19 in the spring, or one that was so mildly symptomatic that it blended in with my usual spring allergies. So I was not unreceptive to the concept that someone who’s had COVID-19 might have a more severe reaction to the vaccine. Unfortunately, Dr. Noorchashm went off the deep end.

My dad just told me he got the first dose four and a half hours ago! No symptoms whatsoever. I tried to warn him that he might be in for a rough weekend but he wasn’t hearing it. 😀

I’m increasingly getting a strong impression that a lot of scientists, in spite of being aware of the existence antivaxxers and assorted denialists, just are not aware of how such types will pounce on the slightest thing that they think supports their position and how they are perfectly willing to stretch legitimate statements to the breaking point. Every word has to be carefully measured and its consequence considered. That’s damned hard in written work and almost beyond hope in interviews and the like.
As an example, Dr. Fauci said in an interview “So, I think if somebody does come in with [a Ct value of] 37, 38, even 36, you got to say, you know, it’s just dead nucleotides, period.” That was jumped upon by the “caseademic” denialists. Fauci failed to state that that is likely the case post-infection but the high threshold could also be due to failure to pick up viable virus if someone were tested very soon after an exposure, as might happen with contact tracing and referrals for testing. Someone might be very unlikely to be contagious at that point, but could well be in a few days.

Yeah, I think you’re right. So many doctors and scientists are utterly clueless about how science deniers work. In fact, if you want to see that in action, look at Dr. Noorchashm’s Twitter feed since he became aware of this post. He’s bristling at the suggestion that he might be a useful idiot for RFK, Jr., and expressing a desire to have a “reasonable dialogue” with him, all while showing an utter lack of concern that RFK Jr. is using his article as antivaccine propaganda and comparing me unfavorably to RFK Jr. in terms of being “reasonable.”

There’s a big clue about Dr N:
how could anyone expect to have a reasonable dialogue with RFKjr?

@ Christine Rose:

I’ve always wondered if RFKjr took up his quest against vaccines, protecting an ‘oppressed’ minority, after being essentially eliminated from seeking elected office
because of his somewhat suspect personal history ( drug problems, divorces, ex-wife’s suicide) so he became another type of crusader to fulfill his destiny or intrinsic demands of his lineage.
He mentions his uncle and father and trades on the family name a lot.

I always had fun when someone called him “Senator” Kennedy. I would ask them which state that was, or were they referring to the Senator John Kennedy from Louisiana. They were not amused.

How could anyone expect to have a reasonable dialogue with RFKjr?

The same way Joe Biden expects to have a reasonable dialogue with Repubicans.

That’s not (just) a joke. Their expectation is a statement about their principles, or should I say their projections of their principles. There’s a kind of denial in it that’s egotistical, in a way…

Skeptics are not immune from this, on some other questions, too…

@ sadmar

There’s a difference between expecting reasonable dialogue and forcing uncompromising dialogue. The first one is wishful thinking, even on behalf of skeptics. The second one is what skeptics can do, and in some sense what RI is (almost) all about.

People living in their informational bubble and echo chambers is starting to be a plague the whole world over.

A non-biologist friend was just asking me about this last night, in the context of, if you just got infected with SARS-CoV-2, and then the same day you get your vaccination, is that likely to be a bad thing? He didn’t have any specific “bad thing” in mind, and based on my immunology background I didn’t think so. I know that there are some vaccines where getting exposed to the disease right after getting vaccinated can be really dangerous, but that’s the yellow fever vaccine, which among other things is a live virus.
So thanks for this timely article, I’ll send it along to my friend as he tries to get all the elderly members of his church vaccianted.

I talked to my employer today who had just gotten his first dose. Interestingly enough, they asked him only if he got two specific recent vaccines — hepatitis and shingles (if he, and I, remembered correctly).

The people on this site always talk about grifters and how they are taking advantage of people and their fears.

Well here is a real grifter who took 7 million in speaking fees in just 2 years from the big big banks and is now bailing those same banks out because she is treasury secretary. It was even too much for “real clear politics” to ignore. And this was just in the first week of her job.

“WH Ignores Question About Yellen Taking $800k In Speaking Fees From Firm That Bailed Out Loser Hedge Fund In Gamestop Affair”

https://www.realclearpolitics.com/video/2021/01/28/wh_wont_say_if_janet_yellen_should_recuse_herself_after_taking_800k_in_speaking_fees_from_key_figure_in_gamestoprobinhood_scandal_hft_firm_citadel.html#!

That’s OK, Tim, we’re old friends.

[I mean, yes, it was so obvious a line to use that it went beyond cliche and landed squarely in the precincts of actionable abuse of language. But sometimes you just have to give in to baser impulses.]

‘In brief, the vaccine “levels out” the variability in people’s immune responses.’ – Can you provide a published paper that shows the Covid vaccine will ‘level out’ the variability in people’s immune responses?

The text in the paragraph that is another color (for me it is red) goes to another page that has a fuller explanation. Go there, and ask them for the paper.

The link is to an advisory board briefing which doesn’t even contain any clinical trial data. If ORAC is going to copy and paste statements he should provide peer reviewed papers to back those statements up.

Furthermore, what is included in ORAC’s link (the advisory board briefing) is far from a definitive statement in regards to what ORAC wrote about vaccines ‘leveling’ out variabilities in immune responses.

‘it’s not yet known whether Covid-19 vaccines will boost a person’s natural immune response to the novel coronavirus after an initial infection.

Scientists are still working to definitively prove whether Covid-19 vaccines provide an immunological boost to people who’ve already been infected with the coronavirus’

Can you provide a published paper that shows the Covid vaccine will ‘level out’ the variability in people’s immune responses?

Well well well, here you are asking for a citation to support someone’s statement. Yet you get all pissy when we ask (sarcastically, I admit) for the same thing. Think carefully about that. Take your time.

I guess you are incapable of providing data or studies to back up ORAC’s statement as well so you are trying to pull a bait and switch. I provided names; you were just too lazy to look them up. ORAC provided nothing of worth; no authors; no names of studies; no trial data; NADA.

Only an advisory board briefing.

@ TBruce:

I didn’t immediately recognise who the guests were by name ( about the college).. OMFG it was one of the worst examples of Maher’s support for outre views ! His website, Real Time with Bill Maher, has the entire 9 minute interview. They were presented as experts and, the guy especially, spoke so authoritatively that I imagine viewers who were less informed took him very seriously. Orac and others illustrated why the lab genesis theory is not very likely to be accurate months ago and news outlets covered it in detail.
I was watching it, telling my SO how Orac and Co would react!

OK I know that this is supposed to be a comedy show but he does present serious topics so shouldn’t someone affiliated with him screen guests and say, ” Bonkers!” or advise presenting them as being “controversial” ?.

Yeah, I started watching Maher’s show Friday night. When I saw who his first guests were and saw the direction his questions were taking, particularly his portrayal of criticism of having a “reasonable, adult conversation about COVID-19 vaccines,” I knew that I’d risk blowing an aneurysm if I continued to watch and changed channels.

That Daily Beast article is incorrect, though. The idea that SARS-CoV-2 originated in a Wuhan lab was not come from Steve Bannon. It showed up very early on in the pandemic, and Steve Bannon latched on to it.

Over here it is recommended that if you had a positive PCR result, you should wait a month before getting a vaccine. And two weeks, if you had symptoms associated with Covid but no positive test results. Which is probably reasonable.

For one: “It’s too difficult to operationalize pre-vaccination testing,” Peter Hotez – WOW! Dr. Hotez should talk to Prof. Dr. Ralf Hoffmann from the Institute of Bioanalytical Chemistry, Leipzig University and Prof. Dr. Jörg Gabert about that as well as the Helmholtz Centre for Infection Research.

So we’re supposed to “talk to” Profs Hoffman and Gabert as well as the Helmholtz Institute before we can find out what your point is?
Forget it, your comment is worthless.

Do you know how to use search engines?

If you were capable you would realize how worthless it was for ORAC to copy and paste Dr. Hotez’s comments. All is well though; there is hardly any traffic seeking to access the low-level information provided here.

So it’s up to me to do a search to make your argument for you.
Anything else I can do for you? Cup of tea? A nice foot rub?\
In other words, put up or shut up.

The number and frequency of his comments are starting to reach what I call “flood stage”; i.e., the level at which he’s flooding a comment thread and thereby annoy my longtime regular readers and commenters.

“and thereby annoy my longtime regular readers and commenters.”

Not anymore than ‘Greg’ or ‘Tim’. At least, Dobson raises some challenging… challenges.

And on that note, where is ‘scott’? Did he knock himself into a coma with his Big Bertha after slicing on the second hole?

sadmar: ““Dobby” is the name of a nice elf*, not an annoying troll.”

Okay, I will call him “Dooby.” He is silly.

I am not making an argument. I pointing out that ORAC’s information is woefully inadequate and you are misinformed. Educate yourself. If you want me to do so; you are going to have to pay me.

You are being terribly unclear. We are not obligated to Google your gibberish. If you think we are misinformed, then you need to edjumacate us. Provide us the information with the links you think are suitable.

Otherwise, stop grifting. We are not going to pay you for more gibberish. Especially since you cannot click on a link in the article that answered one of your questions.

It was so incredibly hard to copy and paste the two names provided to you into the Google search engine to come up with this link. It looks like ORAC’s followers are morons. Too pitiful to accept money from on second thought. If you can’t put two and two together regarding this link and ORAC’s Hotez copy and paste you are beyond hope. A lengthier explanation will certainly be lost on you. As well; ORAC is clearly in the dark if he is not familiar with the study undertaken by the Helmholz Centre for Infection Research. This of course is in relation to the inane Hotez comment ORAC included in his lengthy diatribe. https://innovationorigins.com/german-researchers-develop-new-corona-antibody-test-for-home-use/

Here is the product page for the AProof COVID antibody test developed by Gabert & Hoffman at Uni Leipzig: https://www.aproof-corona.de/en/

It’s a home fingerprick test, the blood is collected on a card and sent to Aproof’s labs, where it is analysed and the results are made available online after 1-2 working days. Postage for sending the sample to the lab is free within Germany.

The test costs €49 (price only shown on the German language version of the page), which is not far off the cost of two doses of the Pfizer vaccine, and probably more than two doses of other vaccines, so using the test to avoid vaccinating people who are already antibody-positive is unlikely to save any money (since you’d need to test everyone to avoid vaccinating only those who are COVID positive). Even in the US, only about 8% of people have had COVID, so it’s not going to reduce the number of vaccinations by a large amount, either.

More of a question is whether they are set up to do the millions of tests a day that would be needed if they were to be routinely used to test people before vaccination.

Who is prl and why is there no option to respond to their commentary?

*There is not a reply tab underneath their post

Who is prl

Rude. We didn’t ask who is Dobson. Maybe we should.

and why is there no option to respond to their commentary?

I dunno what you are talking about. I just did.
Is your search engine broken?

@Dobson:

[W]hy is there no option to respond to [prl’s] commentary?

Comments here are nested, but only to two levels. So you can comment, reply to a comment, and reply to a reply, but not reply to a reply to a reply. That’s why you had to go up one level to respond to prl.

prl – There are scores of antibody tests that are already available in the US and it can be quite easy to get a test. I had my doctor send a referral and went to a walk in lab not needing an appointment on the same day. Look at all of the tests listed by the FDA. You will be scrolling a long-time. https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance

PRL- your numbers are way off concerning the percentage of people who have contracted Covid in the US according to the CDC.

52.9 million total infections may have occurred in the U.S. population from February 27–September 30, 2020.

Please note; this is only through September 2020;

These researchers who work for the CDC say around 16% of the U.S. population was infected through September 2020 using their modeling estimate.

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1780/6000389

@Dobson: I took the infection rate from worldometer’s cases per million for the US. Even if the actual number of cases is double that (you cite the CDC as saying “may be”), you still need to test everyone to avoid vaccinating 16%.

I gave the information about the AProof test because it was the one that you cited as being the go-to test.

IMO, the US could probably speed up their vaccination rollout far more by fixing their logistical problems than by testing everyone before vaccination.

“pay me”

Yea, no. I’mma pretty shur this asshat can get it right all on his own for pretty much ‘free’.

Tim; your comment makes it very clear that ORAC has highly intelligent articulate people following him.

“ORAC has highly intelligent articulate people following him.”

WTF, Dobson? Are yu moking my autist retardednist status? Have yu cheched your short posistion lately? I heard yur wife left you over it.

Also; cool story, bro.

What do your irrelevant conclusions have to do with ORAC’s link?

Again, ORAC’s link does not support his speculation.

What is included in ORAC’s link (the advisory board briefing) is far from a definitive statement in regards to what ORAC wrote about vaccines ‘leveling’ out variabilities in immune responses.

‘it’s not yet known whether Covid-19 vaccines will boost a person’s natural immune response to the novel coronavirus after an initial infection.

Scientists are still working to definitively prove whether Covid-19 vaccines provide an immunological boost to people who’ve already been infected with the coronavirus’

Anti-vaccine jerks protested at the mass-immunization site at Dodger Stadium today, causing the authorities to close the gates for a while. I suspect that this will not be permitted to repeat itself, and we will soon enough see some arrests being made if they try to do it again.

Fuck those people up their fucking assholes. Sideways. With old-school, swamp cypress ribbed roots. That being said, it’s not like they can ship the aging vaccines to Alabama where most are like “wats a covid vaccine, precious”.

…Saw that last night. I guess there wasn’t an immediately available police presence that could deal with them hence the gates closing until police could chase them off (honestly, should have arrested them). That’s rotten to think that extra security may be required just to deal with these AVers.

As to whom I was respondng to got pilfererd with my tiny key board, I’ll just drop this here at the bottom; The thought has left me now… It happens when I drink alot. Sorry. Here is some cat-breading to fill the gap: https://youtu.be/D8ZBNnpvGl8?t=1

Please don’t do this IRL but, if you do, party on,dude!

@ Dobson:

Let me fill you in concerning…
The Rules of the Game

Amongst scientists, there are generally accepted consensus positions:
memory is associative, tectonic plates, vaccines don’t cause autism, viruses mutate, gravity exists

Should a person wish to dispute any of these, they can do research, write books or argue on the internet but
because the standard is already based upon decades of research and is well known, it doesn’t even have to be stated explicitly, re-iterated ad infinitum or “proven”.. Orac, unlike many science communicators, is usually kind enough to provide links to his previous writing or important material upon which he bases his position because he knows that not all of his readers know every little detail about a topic.

If you argue with the consensus, you have to illustrate why you do. Do you have research, a unique philosophical viewpoint or real world evidence upon which you base your ideas?
How is what you hold different from what is generally recognised as veridical?

ORAC is throwing up schlock for which there is no established research such as vaccines ‘leveling out’ variabilities in immune responses. There is no way to argue against a consensus; because there is no consensus! ORAC even posted a link which says there is no consensus. ORAC should remove that speculative schlock. He is talking out of his arse.

@ Dobson

“ORAC even posted a link which says there is no consensus.”

Oh? That’s news! Where is that link?

“He is talking out of his arse.”

Seems like projection to me.

F68.10 – ‘Meanwhile, other immunologists have been STATING REPEATEDLY that people who have had COVID-19 before should be vaccinated against it. Among the reasons these experts give is the variability in the level of neutralizing antibodies produced by different people after infection, ranging from low levels that don’t prevent reinfection to high levels that do. In brief, the vaccine “levels out” the variability in people’s immune responses.’

ORAC’s ‘STATING REPEATEDLY’ link to an advisory board briefing is in red.

The speculative schlock is ORAC’s last sentence.

@ Dobson

“ORAC’s ‘STATING REPEATEDLY’ link to an advisory board briefing is in red.”

OK. I’m starting to see your point. You should phrase it in a much more agreeable manner if you expect courteous answers.

“The speculative schlock is ORAC’s last sentence.”

That sentence was summing up the link he gave. That’s it. Then there is the issue of the hierarchy of evidence. And Orac has given his take on it, and he likely does expect the scientific community to hierarchise evidence this way. Which is what consensus is all about.

Scientific consensus if not about a putative democracy of medical practitioners, but about the state of the literature and standard ways science has agreed to hierarchise evidence.

It’s not a Landsgemeinde.

https://www.youtube.com/watch?v=oj165uv3ZS4

F68.10 – The data is not there concerning the Covid19 mRNA vaccines. ORAC is emoting speculative schlock. If you have the data; I would love to see it!

F68.10 – The data is not there (for mRNA Covid19 vaccines) to support ORAC’s speculative schlock.

If you have it; I would love to see it!

@Denice: “Amongst scientists, there are generally accepted consensus positions: memory is associative, tectonic plates, vaccines don’t cause autism, viruses mutate, gravity exists”

Better yet, tell them what gravity is actually made of. And be sure to stand well back as all the wackjobs lose their shit in absolute fury. ’Cos all they care about is dragging hard reality down to their sub-infantile level of not-even-understanding and beating it to death with their swolled egos. Which you’re only making harder for them, what with all your annoying sciencing and “it’s a bit more complicated than that”s.

I don’t like the whole ‘loop quanum gravity’ thing and other variants. “emergent”??, Go fuck yourselves.

Why should I embrace the idea that mass/energy warps spacetime needs to be ‘moderated’ by some kind of particle? “made of” hurmmmff.

@ Dobson

You write: “it’s not yet known whether Covid-19 vaccines will boost a person’s natural immune response to the novel coronavirus after an initial infection.”

Yep; but we do know that a few cases have been reinfected AND we know about both natural boosters and vaccine boosters. Natural boosters are historically when kids who had some childhood infection, prior to vaccines, experienced additional infections that their already alerted immune systems dealt with sub-clinically and, at the same time, revved up a bit. Booster vaccines work the same. Given what we know about both types of boosters, while awaiting definitive research results, given the extremely low risk from the current COVID vaccines, giving a booster, especially to those who on follow-up, show lower antibody levels, is a smart thing to do.

Your comments are really over-the-hill, extreme and against what science knows about boosters, which is certainly NOT “speculative schlock.”

Those were not my words; they were taken from ORAC’s link. Again; please show the trial data or peer reviewed papers that show Covid vaccines ‘level out’ immune variabilities.

Yes boosters work the vast majority of the time; but sometimes they are not very effective. Take the Zostavax vaccine for an example. You would have to turn this CDC chart upside down to show it was having an impact on boosting immunity. Fortunately it has been discontinued.

The CDC estimates that each year about one million Americans develop shingles and the rate is rising. In 1945 through 1949, the incidence of shingles was 0.76 cases per 1000 person-years, and from 2000 through 2007 the rate was 3.15 per 1000, a four-fold increase.

Among a group of 21 million adults, occurrences of herpes zoster ophthalmicus (HZO), when shingles gets in the eyes, tripled during a 12-year-period, according to Kellogg Eye Center research presented at the 2019 Association for Research in Vision and Ophthalmology annual meeting in Vancouver. – May 2, 2019

This has occurred steadily after the introduction of the varicella vaccine in 1995.

I hesitate to use this example as I will automatically be pegged as ‘anti-vax’ which will shut down all meaningful conversation and dialogue.

And again; unless there is firm data; ORAC’s speculations fall into the realm of pseudoscience.

https://www.cdc.gov/shingles/images/shingles-rates-years.jpg

Gee, as I recall there was a huge event that ended in 1945, can you remember what it was? It was also the second so named.

Now something else happened after those years. Shingles is something that most often happens to people over a certain age, and right now those who are getting it have special name. Okay, Boomer, can you guess it? And why does it have that name?

Neither sustained mortality throughout both World Wars nor Boisterous Fecundity has any bearing on rates.

So larger numbers of vulnerable populations mean nothing? By the way those born in the peak years of 1956-1958 are now in their early 60s, and before the pandemic caused a shortage of Shingrix.

Your logic circuits seem are flawed with history and demographics.

And obviously the change of average life span in more than 75 years also has nothing to do with the size of the vulnerable population between the 1940s and this year? You know we can just ignore the latter twentieth century with the introduction of antibiotics, respirators, blood pressure meds, etc.

Further to Chris’ comment (so rudely dismissed by Dawson), the over 65 population in the USA has more than doubled as a percentage of the population between1950 and 2020. S0, that would account for a doubling of the rate of shingles in the general population.
Also in 2020 is a significant group of people who would simply not be represented in 1950. I refer to people with immune deficiency, such as cancer survivors on chemotherapy, transplant recipients, renal dialysis patients, recipients of other immunosuppressive agents for lupus and other systemic autoimmune disease, to mention a few. They are all much more susceptible to episodes of shingles and would add to the percentage rate pf incidence. This group would not be represented in the population in 1950 because they would mostly be dead.
But, hey, they didn’t get shingles!

While the graph you provided was normalized at cases per 1000 population it started in 1998… So where is the data from before 1950? Perhaps you need a lesson on how to read a graph.

Along with lessons that folks in those days had damaged heart valves from scarlet fever, actually died from cancer, and suffocated to death due to pneumonia because ventilators did not exist. Or that there was no way to truly diagnose shingles other than saying “that is a weird painful rash.”

Just a question: what does shingles have to do with the SARS-CoV-2 virus?

I am interested in this question because my youngest kid got chicken pox when they were a six month old baby in 1994. That was a year before the varicella was available: https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/varicella.pdf

@ ORAC

Sorry to hear about your reaction to the Pfizer vaccine, though compared to actual COVID-19, mild to say the least.

I volunteered last September for the Moderna COVID-19 phase 3 study, received first injection Sept 2 and second Oct 2. At each visit received physical, nasal pharyngeal swab, and blood test, though NOT told results. Prior to volunteering, I reviewed mRNA in several Genetics textbooks I have, then did search of both PubMed and Google Scholar for any reports of vaccines using mRNA and thought it could be a game changer with little risk.

Since I had literally NO reaction to the two shots, I was disappointed, fairly certain I received a placebo, though reports of Phase 1 and 2 found around 10% who got shot didn’t have any noticeable adverse events. On January 16 went to lab, nasal pharyngeal and blood, then asked if thought received placebo. I said “yep”; but small chance actually received vaccine. Well, I was right, so received first vaccine shot. Afterwards felt NOTHING until about 5 hours later when left deltoid became quite sore, so took my temperature, nope, just nice sore arm, took temperature several times, nope; but sore arm lasted around 36 hours. I was SO HAPPY as I knew vaccine was being reacted to by my immune system. I donated blood three times last year and two weeks after I get the second shot (which according to studies may have a bit more kick to it) I intend to start donating plasma and volunteer at a FOOD BANK, though, of course, will still wear mask and do my best to practice physical distancing. In my mid 70s, hesitant to be among people; but vaccine and mask worth feeling I can contribute.

Peter Doshi is Associate Editor of BMJ. He has written several antivax pieces on COVID vaccine, including “disease” based on one sign, e.g., fever and studies not designed to capture serious disease. BULL SHIT! First, if we had one of list of symptoms were asked to contact study, would be called in, and if two of symptoms AND nasal pharyngeal swap or blood tests found COVID, then considered infected. However, we supplied study with Primary Care Physicians office and FAX number AND gave permission to access our medical records. As part of the study, we answered a short weekly questionnaire and received phone calls. If they couldn’t reach us, they could then contact our PCP. The article in NEJM: Baden et al (2020 Dec 30). Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. New England Journal of Medicine:
Available at: https://www.nejm.org/doi/full/10.1056/NEJMoa2035389

Makes it quite clear; but I’ve also read the entire Protocol, available on FDA website, which Doshi claimed he read. Around 1 1/2 years ago I posted a number of RAPID RESPONSES to BMJ (their comments blog). Several times they posted my RRs days, even a week after submitted; but posted on date submitted, so, only if someone scrolled down several pages would they see them. Then they didn’t post 8 or 9 of my comments, so I gave up. I sent them to several colleagues who found nothing untoward in them, no name calling, just including numerous references, which they allow. At the same time, I’ve continued to monitor them and they have posted literally 100s of antivax RRs, including a number jumping at what Doshi writes.

BMJ’s editor, Fiona Godlee invited Brian Deer, the journalist who uncovered Andrew Wakefield’s fraudulent research, to write a series in 2010. So I really don’t understand how a premier medical journal could hire and retain as an Associate Editor an antivaxxer like Peter Doshi, block or delay my RRs, and publish some of the most irrational comments I have seen.

For any reading this too lazy to access the article above, it states:”Covid-19 cases were defined as occurring in participants who had at least two of the following symptoms. . .and at least one nasopharyngeal swab, nasal swab, or saliva sample (or respiratory sample, if the participant was hospitalized) that was positive for SARS-CoV-2 by reverse-transcriptase–polymerase-chain-reaction (RT-PCR) test. Participants were assessed for the presence of SARS-CoV-2–binding antibodies specific to the SARS-CoV-2 nucleocapsid protein. . . A secondary end point was the efficacy of mRNA-1273 in the prevention of severe Covid-19 as defined by one of the following criteria: respiratory rate of 30 or more breaths per minute; heart rate at or exceeding 125 beats per minute; oxygen saturation at 93% or less while the participant was breathing ambient air at sea level or a ratio of the partial pressure of oxygen to the fraction of inspired oxygen below 300 mm Hg; respiratory failure; acute respiratory distress syndrome; evidence of shock (systolic blood pressure <90 mm Hg, diastolic blood pressure <60 mm Hg, or a need for vasopressors); clinically significant acute renal, hepatic, or neurologic dysfunction; admission to an intensive care unit; or death.”

Anyone hesitating to get the vaccine, I would HIGHLY recommend reading carefully the paper AND ignoring Peter Doshi and his ilk. And, no, the vaccine doesn’t guarantee complete protection; but, as with flu vaccine, it reduces chance of symptomatic infection, reduces probability of serious infection, reduces risk of hospitalization, and reduces risk of death. AND reduces risk of spreading disease. Quite simply, if your immune system is keep you from being symptomatic, then reduces significantly viral load, and viral shedding, either to low levels or even to close to zero. This is IMMUNOLOGY 101.

Based on the L.A. “scamdemic” protest which temporarily shut down a Covid-19 vaccine site, it looks like antivaxers have gone well beyond their previous insistence that people who want vaccines can have them, just don’t make them mandatory for anyone. Trying to thwart people who want the vaccine is denying them free will. Just a wee bit hypocritical.

https://slate.com/news-and-politics/2021/01/anti-vaccine-mob-dodger-stadium-covid-coronavirus.html

Note to those who think that they can’t get their point across without shouting in ALL CAPS or capitalizing poster names, there’s a simple italics technique. Just put an underline immediately before and after the word(s) or phrase you want to emphasize. Usually works fine.

The protest is now being covered by many newspapers and news outlets ( see Bing news): according to them, it’s a collaboration between right wing and anti-vax groups.

As the virus spreads, mutating over time, rendering presently used vaccines less effective, anti-vaxxers’ performance art wastes even more time.
Thanks, disease promoters!

@ ORAC

I totally agree that his use of anecdotes and his e-mail to your boss are typical antivax strategies and antiscience. However, though I agree that if he really has any integrity he should STRONGLY request RFK to take down his paper, as far as I know, there is NO law that could compel this. Quite simply his paper is not copyrighted. And so, I highly doubt RFK would remove it, though he should still try.

Besides that the ACIP and others have reviewed the potential problems brought up by Noorchashm, there is a long history of kids being often re-exposed to childhood infections, e.g., measles, mumps, etc. and I am reasonably certain that some viral fragments remained in them, so why, when confronted with full-blown, full strength viruses, have we not seen serious reactions explainable as an immune response to viral fragments???

A final word, his use of phrase such as “intellectually childish” say more about him, especially given he made it absolutely clear he has no intention of contacting RFK. As for “intellectually childish,” he obviously has no understanding of how anti vaccinations weaponize, exaggerate, take out of context anything and everything. He simply doesn’t seem to live in the real world which makes clear that if you write something it is fair game for both valid (yours) and invalid responses (RFK).

@Joel: “Quite simply his paper is not copyrighted.”

If Noorchashm wrote the paper then the copyright is his by default; unless he’s explicitly transferred that ownership to somebody else or placed it in the public domain.

Medium teens of service are clear that the owner maintains copyright.

He could tell them to take it down, even if they don’t and he lacks the ability or inclination to enforce it legally after. It’s a choice not to.

Noorchashm: “We do NOT vaccinate people who are infected or recently convalescent for a reason!”

Dr. N. appears unaware that we do routinely vaccinate children and adults with mild illnesses per CDC guidelines. Even moderate to severe illness is not an absolute contraindication to vaccination; physicians determine suitability for vaccination on a case-by-case basis.

http://healthline.com/health/flu/flu-shot-while-sick#side-effects

It’s disappointing to see Dr. N. lashing out at critics using tactics similar to those employed by antivaxers – fanning suspicion of government as “big brother”, use of anecdotes and name-calling, referring to critics as “science deniers” and comparing them to Trump supporters. All that’s missing is a reference to evidence-based vaccination practice as a “religion”. And of course there’s complaining to Dr. G.’s boss.

It’s understandable that having one’s open letter picked up and gleefully rebroadcast by a notorious antivaxer who’s played footsie with the far right could be embarrassing. But why attack people who support your stated views on the value of immunization, whose sin is pointing out that your concerns are being exploited by someone who’s compared vaccination to the Holocaust?

@Dobson

When I got to specifically, that anyone to be vaccinated against COVID-19 should have a blood test to look for antibodies against SARS-CoV-2 that could indicate previous infection or ongoing asymptomatic infection. in the post, I had a little morbid chuckle thinking of Monty Python’s ‘Architect Sketch’:

==

— Quite frankly, I think the central pillar system may need strenghthening a bit

— Isn’t that going to put the cost up?

— It might.

— Well, I don’t know whether I’d worry about “strengthening” that much; Afterall, they’re not meant to be luxury flats…

==

The tests aren’t immediate either so doing that will put the cost up in both lives (due to lost timeliness of vaccination) and $$. But right now some 1 of 900 people in the US are dead from the virus and few (or none?) from the vaccine out of millions of doses given. If testing, contact tracing, and isolating were done here early on in the first place we wouldn’t be in this mess now.

Perhaps, in the future, when luxury can be afforded then testing first might be an option. Afterall, Orac noted that he suspects exposure late last spring and that the vaccine “kicked his ass”. And I’ve heard anecdotally that a reinfection is much worse the second time around (Though I take it that notion is far from settled over perhaps a false test for the ‘first’ infection — There doesn’t seem to be much doubt that the new variant in Brazil is reinfecting people.).

Chills without fever is interesting to me. It has been a long time since I had a high fever and chills but I remember thinking that the ‘chill’ part was probably some stimulus to cover up and conserve energy during the bakeoff.

I don’t know from “leveling out”. Perhaps Orac meant “topping off” as in a fuel tank — to whatever capacity “tank” any one individual has??

https://youtu.be/QfArEGCm7yM?t=247

The multitudes of people currently waiting to be vaccinated could easily get antibody tests in the meantime. HMO’s, PPO’s, employers, colleges and universities are currently covering these tests.

Hmm. Around here, it is still a 250 mile round trip to get one without an appointment.

I heard they have a home test coming out with an included, sure to be rapey, cellphone app. But I would think such pre-screening would need to show levels of antibodies and not just ‘presence’. Otherwise, false positives may frighten some away or give false confidence of existing protection.

And who is paying for that in the end? What is the availability of these tests on the market? Is the market ready to supply a million of these tests per day.

US is rich enough, but Ukraine, for instance, could not afford it for its population of 39M (on controlled territories). Do think not only in First World categories.

If a test costs 10$ on wholesale (it’s $15+ on retail), that’s $390M on the whole population (provided we use it only once and none are wasted), with their availability a great question (we still have to test people who are getting COVID now, and antibody tests may be a cheaper alternative). That’s not what Ukraine is able to afford (or any other country of comparable wealth). Of course giving out huge sums of money for testing for which there is little need proven so far will spark reasonable anger of the taxpayers and the first thought of such a taxpayer (even a doctor) will be that the guy has a relative who wants go get rich quickly. Which is what usually happens.

And again, you haven’t made the case dr Noorchashm’s concerns are actually real, because the strongest evidence for refuting his concerns is that we’ve vaccinated millions and yet there was no increased incidence of adverse reactions among those who were infected with COVID before and received vaccines.

@ Dangerous Bacon

You write: “Dr. N. appears unaware that we do routinely vaccinate children and adults with mild illnesses per CDC guidelines. Even moderate to severe illness is not an absolute contraindication to vaccination; physicians determine suitability for vaccination on a case-by-case basis.”

Dr N’s worry is that the vaccine will elicit antibodies specific for COVID and, thus, attack COVID viral particles. CDC guidelines are to vaccinate when mild illness; but they wouldn’t vaccinate a kid in the middle of, say, measles with measles vaccine. So, not the same thing. Good try! 😀 However, as clearly explained in article ORAC links to, antibody-dependent enhancement when weak antibody response and when T-cells not involved. The mRNA vaccines elicit extremely high antibody responses and t-cells with cross-immunity and follow-ups have NOT found a problem.

Um, Joel? I was responding to the assertion that sick people in general are not/should not be vaccinated. To quote Dr. N. again:

“Do U know why we don’t vaccinate people who are ill or convalescing?”

Read for context.

Again, illness (especially of a mild nature) is not a contraindication to vaccination.

@ Tim

You write: “And I’ve heard anecdotally that a reinfection is much worse the second time around (Though I take it that notion is far from settled over perhaps a false test for the ‘first’ infection — There doesn’t seem to be much doubt that the new variant in Brazil is reinfecting people.”

Well, I have downloaded several articles and almost all the secondary infections were milder; but a very few died; however, with such a small number impossible to be sure what caused their deaths, e.g., Post Hoc Ergo Prompter Hoc. As for Brazil new variant, still no clear indication that re-infection still not milder in most cases. I think you should avoid using “anecdotes.” Go to PubMed and Google Scholar.

” I think you should avoid using “anecdotes.” Go to PubMed and Google Scholar.”

Thx, Joel A. Harrison, PhD, MPH

That’s probably sound advice. But the truth is that I don’t really have much aptidude for digging through all that stuff. I’ve spent too much time listening to talk radio (I think it made me get alzheimers and am on my anxious tippy toes just awaiting the first symptoms) and various other sites this past year and ‘it’ is ping-ponging between “the virus is not real/dangerous” and “OMG if you get it a second time you’re gonna die in a New Yurk minute.” If mental whiplash is a thing then ‘outlets’ probably should be held outright culpable.

Of course, “blowing [off] chunks*” has an interesting connotation around these parts and is not usually mentioned in polite conversation within the local drinking establishments afterwards.

But, hey; It’s Gooble. They gotta keep up appearances as They do They.

*chunks==Chads for the rest of the english speaking world outside my own particular deep red hell.

I had kinda been intending to employ my Advanced Judgement of Motive via Rhetoric and Behavior skills [ ;- ) ] to opine on the query in the headline. I’m now bummed I didn’t get around to doing so, since — believe it or not — the updates in the addendum basically confirm everything I was going to say. To wit, Dr. N.’s assertion that his is not a useful idiot essentially confirms that he is, in fact a useful idiot. By which, I mean he really is pro-vax, but his ego has opened him up to being used by RFKJ. I was going to guess that : 1) He’s overly invested in his “screen before vaxing” idee fixe, leading him first to put it out on Medium without thinking about the practicality issue Dr. Hotez raised and blind to how it might be misused. 2) a) RFKJ’s people probably swiped it without asking, and either also swiped the author ID material or made it up from publicly available info OR b) They misrepresented their identity and purpose and Dr. N. said “Sure, you can use it” without further deliberation or investigation as he was happy to get any further circulation for his idee fixe.

Now, of course, he’s too prideful [he is a surgeon after all ;- ) ] to admit any error, and is all defensive…

ON A RELATED MANNER
Minions may want to read, and perhaps Orac may want to comment on, a piece in the NYT titled “The Science of Reasoning With Unreasonable People” which uses antivaxers as an example.
https://www.nytimes.com/2021/01/31/opinion/change-someones-mind.html
Methinks it’s not without merit, but also not without… uhh… some “issues”…

I was simply too “polite” to say what you’ve said. To be honest, I got a bit of an inkling about him just from reading his blog post and Twitter feed that should have told me: Stay away. This guy is trouble. This guy is likely to harass you at work. Sadly, I ignored that little prickly feeling on the back of my neck

I also think there’s some projection going on. I think his accusation that I’m attention seeking (which he’s made on Twitter and by email) comes from him actually enjoying the attention that my post brought him, especially on Twitter, and likes that RFK Jr.’s stealing of his post got his idea out to more people. (He’ll never admit this, I suspect.) To be honest, I get all the attention I can handle; extra attention from one of my posts above and beyond what I usually get is usually not something I seek out or enjoy. And, as much as I joke about cranks emailing my chairman and how my bosses don’t really care about their complaints, it nonetheless is not pleasant to have to explain what’s going on to them when this happens. Of course, people like Dr. Noorchashm know that. It’s why they do it.

In any event, I think you’re right. Dr. Noorchashm has his idée fixe that he passionately believes in, the criticism of which he simply cannot abide, so much so that he tries to recruit more powerful people to shut up critics, such as their bosses.

Oh you stepped on some sensitive toes.

Dr. Noorchashm’s comparing those here to Trump’s cult following is so amusingly valid. Just like Trumpers consider his obvious wrongdoings as defensible for the greater good; you can’t admit that precautions in mass vaccine administration should be followed; also for the greater good (because; HESITANCY). The Cult of Trump is very similar to the Cult of Vaccines; facts (including science) don’t matter.

Hi Joel, glad to see you are back.

Actually it’s even worse. You would have approached Dr. Noorchashm’s article critically & analytically … except that now you can’t because RFK jr used it. Now you must be anti-Whatever Dr. Noorchashm Said. Even if the science is good. Doesn’t matter because RFK jr used it.

Actually reading this post would show you that Orac addressed the substance of Dr. Noorchashm’s article, acknowledged where it’s plausible and pointed out issues.

In other words, the article shows you mistaken.

Also, now, a few days later, I’ve done some more research and reading and concluded that Dr. Noorchashm’s hypothesis is not very plausible at all. I might write a followup to explain why.

Also, Dr Daniel Griffin got into this issue about 20 minutes into his latest clinical update on TWiV.
https://www.microbe.tv/twiv/twiv-713/

We’ve now vaccinated millions of people with the Pfizer and Moderna vaccines in the U.S. alone and haven’t found a hint of a problem signal related to prior Covid-19 infection. And hundreds of thousands of them undoubtedly had such an infection.

the vaccines create a consistent level of antibodies, and eventually memory B-cells.

The CDC has no recommended minimum interval between an infection and vaccination. (Not that CK respects their recommendations.)

2 of his rules:
…never miss an opportunity to vaccinate
…don’t waste a vaccine.

@ Orac,

Are you saying that if you had high cardiovascular risk & a past history of Covid +; that you would not elect to be screened to detect the presence of SARS-CoV-2, prior to vaccinating?

You really should listen to Dr Griffin’s TWiV interview. He describes the case of one of his patients who had severe Covid-19 and was on a ventilator for 55 days. Obviously no need for screening!!!

When he received his second dose of the vaccine and knew he would protected against a repeat of that, he cried for joy.

Want to respond to Orac? Here's your chance. Leave a reply! Just make sure that you've read the Comment Policy (link located in the main menu in the upper right hand corner of the page) first if you're new here!

This site uses Akismet to reduce spam. Learn how your comment data is processed.