Despite robust efforts to fight it, malaria remains one of the most significant infectious diseases affecting humans. According to UNICEF – ” In 2021, there were 247 million malaria cases globally that led to 619,000 deaths in total. Of these deaths, 77 per cent were children under 5 years of age.” Efforts to minimize malaria cost about $7 billion per year, through vaccination, drug therapy, and spraying pesticides to kill the mosquitos that carry the disease. Mosquito populations are developing resistance to the pesticides, however, which could raise the costs of control, while available funds can fluctuate.

One potential solution is using genetic engineering to fight malaria, and there are several approaches being developed that are close to being ready for deployment. They all use an approach known as a gene drive, which causes a desired trait to spread more quickly through a population than regular Mendelian genetics would allow. This idea is actually 60 years old, but newer techniques, such as CRISPR, are making it much easier and more powerful.

With sexual reproduction, each offspring has two sets of chromosomes, one from each parent. So organisms have two copies of each gene (each copy is called an allele). They then pass one of their two copies onto each offspring. Mendelian genetics assumes that there is a 50% chance for each allele to be inherited, and this is mostly true. The gene drive phenomenon refers to situations in which one allele has an advantage over the other, so it is more likely to be inherited. There are naturally occurring gene drives, but we’re going to focus on the latest synthetic gene drive, which involves CRISPR.

Continue Reading »

RFK Jr., who is now running for the Democratic presidential nomination, is anti-vaccine. He will vehemently deny this, but I don’t buy it for a second. He is simply playing the, “I’m not anti-vaccine, I am pro-safe vaccine” gambit, which is disingenuous and always has been. We have been covering this topic for years, and David Gorski did a recent excellent review of this at SBM. You can’t claim not to be anti-vaccine, and then defend a long list of anti-vaccine tropes.

RFK has apparently been avoiding his views on vaccines on the campaign trail, but it always seems to come up. On the Joe Rogan podcast RFK found what he must have thought was a friendly environment, and felt free to repeat is claim that vaccine cause autism. This is a topic I have been covering for two decades – vaccines do not cause autism. But let’s do a quick review of this harmful claim.

This first appeared in the 1990, when the anti-vaccine movement hit upon the increase in autism diagnoses as a new tactic. They start with the assumption that all bad things that happen to children are caused by vaccines, so obviously they must also be causing the rise in autism. When Andrew Wakefield came out with his fraudulent and now retracted study claiming an association between the MMR vaccine and autism, he became an instant celebrity of the anti-vaccine movement. Trouble is – the MMR vaccine does not cause autism. Wakefield, it turns out, had a patent on an alternative vaccine and was trying to torpedo the competition. But the anti-vaccine movement does not let science, evidence, or basic logic get in their way. So they simply moved over to a vaccine ingredient, thimerosal, which is a mercury-based preservative.

Continue Reading »

In my last post I noted that even mentioning general vague support for the LGBTQ community was enough to trigger very specific feedback, often making erroneous scientific claims. Each claim requires a deep dive and article-length discussion. Even though the discussion that followed in the comments was better than I thought it would be, it still filled with additional dubious claims. I suspect there are two main reasons for this. The first is that the topic of gender identity is complex and not intuitive. It may feel intuitive, as if your immediate gut reaction is all that is necessary to deal adequately with the topic, but it really isn’t. Ultimate this topic deals with how our brains construct our own sense of self, identity, and reality. These are always tricky concepts to deal with – and as I have pointed out before in other contexts, our brain constructs are counterintuitive by their very nature. In other words, our brains evolved for these constructs to feel real and automatic, and for the subconscious processes that create them to be invisible to us.

Second, the issue of gender identity has been highly politicized. This has resulted in any discussion of the topic being flooded with biased and deliberate misinformation. The usual FUD (fear, uncertainty doubt) strategies apply. And of course – science is hard. Even seemingly straightforward questions are actually quite complex. This makes it easy to create confusion by “just asking questions” or selectively applying skepticism.

One question at the heart of the trans issue is this – what is the rate of regret or even detransitioning after medical transition? One narrative is that adolescents (often conflated with “children”) are being prematurely herded down a road to transition, which they later regret. The other narrative is that, generally speaking, making the decision to transition is taken very seriously, with very low levels of later regret. Which is true?

Continue Reading »

Yesterday’s post was the first in an exchange about the effects of climate change on public health. Today’s post is my response.

Part II

Climate change is a critically important topic for society today, and it’s important that the public have a working knowledge of the facts, causes, effects, and potential interventions regarding climate change, so I am always happy to discuss the topic. Unfortunately, it’s a very complex topic that has been highly politicized and polarized. The science often becomes wrapped up in ideology – the best indication of this is that one’s political affiliation is the strongest predictor of the public’s opinions regarding climate change. The media, as they do in general, is happy to sensationalize the topic and often does not provide good context or background. Scientists have gotten better communicating about climate change, but not enough to override political affiliation.

My sense is the core issue is that the complexity of climate change allows everyone to cherry pick those details that fit their narrative. You can find examples to support whatever narrative you want to believe. You don’t even have to be factually incorrect (although many people certainly are), you just have to be selective in your details and interpretation. Climate change is a Rorschach test of subjective validation and confirmation bias.

I say this all because I think Scott’s narrative comes through very clearly. He contacted me asking fervently for a debate on this specific topic, the health effects of climate change. I thought this was a little odd since I have never written or expressed an opinion about this topic before. It seems he assumed what my position was based on other things I have written about climate change – that I think it’s real, it is primarily being caused by humans, and the effects are likely to be bad for the environment and human civilization. This brings up another aspect of the climate change debate, that people generally take sides and think that everyone fits relatively cleanly into the “for or against” side. Once someone thinks they have detected what side you are on, they then ascribe the entire package of views to you.

Continue Reading »

This is the first entry in an exchange between me and Scott Hastings, who requested the exchange. This is his opening arguments. My response will be tomorrow’s post.

Part I:

Hi Steven, first of all, I am tremendously grateful to you for taking time to engage with me on this very important topic. Thank you.

I’d like to start by sharing just a few media articles I found that are now over 3 years old:

New York Times: November 13, 2019 “Climate Change Poses Threats to Children’s Health Worldwide”

ABC News Australia: November 5, 2019 “11,000 scientists declare climate emergency warning world faces catastrophic threat”

CNN: November 12, 2019 “The climate crisis will profoundly affect the health of every child alive today,”

Wired: November 13, 2019 “How the Climate Crisis Is Killing Us, in 9 Alarming Charts, A new report from over 100 experts paints a devastating picture of how climate change is already imperiling human health.”

We are both physicians, so I don’t want to leave out the American Medical Association statement on climate change.

I think you get the point…We are daily inundated with a “climate emergency” just around the corner.  It also seems that all the experts (at least 97% anyway) are in some general agreement about the “devastating catastrophe” lurking somewhere out there. However, the official IPCC-5 report seems to be a whole lot less confident than the headlines mentioned above.

My aim is to take exact verbiage from IPCC-5, then apply the most up to date scientific literature available to cross-check their stated claims. Since I’m a physician, I am specifically interested in health outcomes as a result of climate change. I am looking at global health trends (since this is a global phenomena), as well as trends in global natural events like floods, fires, and hurricanes as these obviously contribute to health outcomes.  It’s simple really, in our world of experts, nobody needs to be an expert at opening the newspaper the morning after the superbowl to see who won the game. In this case, the “newspaper” is going to be scientific research literature based on global observational trends from generally that was published in the past 6 years. What I will not include is modeling studies. That’s like trying to predict who is going to win the superbowl. I’m not interested in that.  Just real-world objective observations found on google scholar or pubmed. I’m only interested in who won the superbowl, not in some supposed “superbowl prediction expert”.

Are you ready? Continue Reading »

Some ideas never seem to die. There is something compelling about the narrative, perhaps because it fills some explanatory need. One of those narratives is that “they” have “the cure” to cancer but are keeping it hidden from the public in order to protect the profits that result from cancer treatment. I recently received the following e-mail (partly redacted):

“I read many articles by physicians like yourself that claim secrets cannot be kept about cancer cures.  I beg to differ.

Pharmaceutical firms require their associates to sign confidentiality agreements as a condition of employment.  If they breach it, it’s safe to assume that they risk grave consequences for doing so.

These companies could care less about sick people.  They only care about the health of their bottom line.  They make far more profit on lifetime treatments rather than one-shot cures.  After the patent expiration on a cure, the steady stream of revenue comes to a halt.

A cure eliminates the need for any new drug development unless the side effects are unpalatable.  I was even told as much by a retired employee of a pharmaceutical company.  She saw the private memos from their lobbyists.

In any case, the confidentiality contracts are why secrets are kept in the pharmaceutical industry.  It’s also why cancer cures can be kept hidden as it would be treated as a trade secret.  No one wants to be brought up on a felony charge of industrial espionage.  Nor do they wish to be sued for it by their former employer.

Ask yourself the following question: would you risk your family’s future under those circumstances?  No way!  If you signed one of those legal instruments, you would never divulge such information if you came across it.”

The notion that a pharmaceutical company could hide a cancer cure is, in my opinion, and from the perspective of an academic physician who has participated in clinical research for pharmaceutical companies, hopelessly naive. The belief comes partly from looking into a complex system from the outside, without any real idea how it actually works.  First let’s talk about the science and then we’ll turn to the logistics of the conspiracy itself.

Continue Reading »

As many experts predicted, the COVID-19 pandemic is slowly sliding into an endemic infection. A pandemic is essentially when an epidemic goes worldwide. Endemic means that an infection is here to stay. It is no longer considered an “outbreak” but is constantly spreading around a population without having to be introduced. The flu, for example, is endemic, although it is also seasonal. Measles was endemic in the US, but then was eliminated through vaccination and was reduced to isolated outbreaks. However, it is transitioning to being endemic again because of vaccine hesitancy.

While we are all anxious for the COVID-19 pandemic to be over, I don’t remember any expert claiming that the virus would go away, or be eliminated to any significant degree. Rather, it would simply become like the flu, an endemic simmering infection that becomes part of the background. The only question has been – what is the best path to transition from pandemic to endemic? Some argued that perhaps the best path was to simply let the pandemic run its course, and create immunity through natural infection. This has always been an unscientific and dangerous suggestion, because that path leads through a maximum of disease and death.

The evidence clearly shows that the best path to minimizing COVID while ending its pandemic status was through a combination of vaccination and infection. We have no choice about the infection part because there is no plausible way to reduce it to zero (as China discovered). But we do want to reduce the spread of COVID, especially to vulnerable populations, while reducing the risk of serious illness, hospitalization and death through vaccination. Pandemics always eventually burn themselves out, even in the pre-vaccination era, but we don’t want that to happen from a plague-level decimation.

Evidence has been building that the best immunity from COVID is through hybrid immunity – a combination of vaccination and breakthrough infection. I managed to go two years without getting COVID, for example, but eventually succumbed once mask-wearing no longer became commonplace. However, by that time I had been fully vaccinated and boosted, so when I did get COVID it was indistinguishable from a fairly mild cold. If there weren’t a pandemic (and I didn’t test positive) I would have just thought I had a summer cold. Hybrid immunity works either way, whether you were infected then vaccinated, or vaccinated and then contracted COVID (the preferred order).  Continue Reading »

SBM will be hosting a viewing of a new documentary – Virulent: The Vaccine War. This will be followed by a Q&A with me, David Gorski, and the film producers. This is a virtual screening so you can watch it anytime between now and January 29th. The Q&A will start on Sunday, 1/29, at 7 pm.

Here is a link to the event page. We are asking for a donation of $12.50. This is an “early bird” rate, as on Tuesday, January 24, the price will increase to $15. Your donation will support grassroots screenings like this one to build awareness and demonstrate to public TV & educational distributors that there is an audience for the film.

For more more information, you can read the announcement on SBM.

As a science communicator with a skeptical brand, I often have to walk a fine line. New scientific and technological developments can be amazing, but they are often surrounded by hype. I want to encourage enthusiasm for science, and I want to share the amazement and joy I experience following the latest discoveries. But it is very important to separate hype from reality, to temper our enthusiasm with realism, and to not get ahead of the science. It can be a very narrowly calibrated sweet-spot, one I have to consciously pay attention to.

I have found it particularly challenging to hit this sweet spot with artificial intelligence (AI), especially recently. The past few years in particular have seen some amazing advances in AI applications, and in 2022, applications like DALLE-2, Midjourney, and ChatGPT showcased the power and disruptive potential of AI to the public. It’s hard to oversell how powerful these narrow AI applications can be, but at the same time it is easy to overhype them in other ways. I think it often comes down to this – people generally (even experts, historically) underestimate the potential of narrow AI (AI applications that have a specific function and are not conscious or have general intelligence). At the same time they tend to overestimate how soon we will see general AI, or they extrapolate linearly current AI advances into the future.

For example, with applications like Midjourney and ChatGPT, how far will applications like these go with extrapolations of current technology? They certainly will be better in 5 and 10 years, but will they transform into something truly creative? And does that even matter? Will these applications run into limits, or will they advance to be indistinguishable from human creators?

Meanwhile, programmers continue to show off the power and potential of current narrow AI technology, fueled by massive data sets and ever more powerful computers. Perhaps the most transformational applications are those running in the background of public consciousness, working to accelerate research and technological development. One area where AI is becoming particularly powerful is drug development.

Continue Reading »

We are living in the future, at least the future I imagined 30 years ago when I was beginning my medical career. At the time I learned about a lot of new technologies that were only in the proof-of-concept or research phase, but there was a lot of enthusiasm about their potential. As often happens, translating those technologies into therapeutics took longer than we hoped, but now that they are hitting they are more powerful than we dreamed.

We now live in a world where there are monoclonal antibody therapeutics for many diseases, changing almost every field of medicine. We are starting to do real gene therapy to cure or mitigate genetic diseases. We have harnessed immune cells in order to target them against cancers. We are also at the beginning of hacking the brain with electrical and magnetic interventions to treat pain, seizures, movement disorders, and other conditions. These are all powerful approaches that are transforming medicine. They are not just incremental advances, such as developing a new drug, but entirely new methods of treatment that open up new possibilities.

I now read news items on a regular basis about such new treatments. One that caught my eye recently was just published in Science: Translational Medicine – Bifunctional cancer cell–based vaccine concomitantly drives direct tumor killing and antitumor immunity. This is a study in mice, so there are years of research before this approach hits the clinic, but it shows the potential of our existing technology.

Continue Reading »