Category: Medicine

Kaiser doctor: Cause, Effect, What’s the Difference?

A press release on the Kaiser Permanente web site showcases Doctor Robert Sallis, who conducted a study in which the data on 50,000 KP members diagnosed with COVID-19, finding that people who were less active were 20% more likely to be hospitalized and 30% more likely to die after diagnosis.

Yes, it’s just as nonsensical as you are quite likely thinking.

We know that various comorbidities, such as diabetes, asthma, old age, and kidney disease can result in worse outcomes when someone gets COVID-19. And we also know that these same conditions are associated with lower levels of physical activity.

So Dr. Sallis has found that … sicker people are less active.

But he interprets it as meaning that exercise can save you from dying if you get the disease. That might be true, but the press release comes nowhere near proving it.

Of course, it’s possible the actual paper in the British Journal of Sports Medicine has a more powerful analysis. So I found it.

Umm ….

The activity levels were self-reported. Red flag.

The authors mention confounders. That’s it. They make no effort to account for them, they just vaguely discount them: “There is also the potential issue of residual confounding due to unmeasured confounders or measurement error. However, many studies have demonstrated numerous strong benefits from PA, especially among those who suffer from a variety of chronic diseases.” Yes, but that doesn’t mean that exercise automatically has benefits in every case. It would in principle be possible to do a better analysis, in which you compared people in matched subgroups (groups matched by age and pre-existing conditions, where the only difference between members is level of physical activity). They didn’t bother to do that.

Let me be clear: if I had access to the data I could do that analysis. It isn’t mysterious. They just didn’t.

So … this paper is, let’s say, very far from convincing.

Conspiracy theorizing: killing people again

Wisconsin pharmacist who destroyed more than 500 vaccine doses believes Earth is flat, FBI says.

Pharmacist Steven Brandenberg deliberately ruined over 500 doses of COVID-19 vaccine, by leaving it out of the freezer so that it spoiled.

Why? Because he thought it would be harmful, cause infertility, and that it included some kind of microchip.

Why? Because he believes in conspiracy theories. Notably, he believes that the Earth is flat, and that the sky is fake, a physical dome put in place to prevent people from seeing God. Note that this last theory is not compatible with literally any religion I’ve ever heard of. He isn’t religious–he has fallen down the rabbit hole and is unable to properly reality-check. He’s measuring the value of a proposition, not by how well it comports with reality, but by how cool it would be if it was true.

And … if any of the incorrectly vaccinated or unvaccinated people he deprived of their shots die, he has killed them in the name of nonexistent harms and nonexistent microchips.

For more on conspiracy theorizing:

All science denial is a form of conspiracy theory by Steven Novella.

Terrifyingly transmissible variants?

So, we hear a lot about how the VOC 202012/01 variant (the “British variant”) and 501Y.V2 (the “South African variant”) are more transmissible than the baseline SARS-CoV-2 virus, and there is evidence that this is true.

However, something to keep in mind:

New Cases of SARS-CoV-2 InfectionUKSouth Africa
Jan 1641,34613,973
Jan 3023,2755,297

So, while these new variants are coming to dominate new infections in both nations, both countries have reduced their number of actual infections dramatically. That isn’t an inconsistency–it just indicates that common-sense public health measures like distancing and mask-wearing actually work fine against the new variants. (There are lots of other factors, like the “post-Christmas surge” in cases abating, of course.)

This is what evil looks like

A protest forced the temporary closure of a COVID-19 vaccination site in Los Angeles. They’re literally willing to kill people for the fiction that COVID-19 doesn’t exist.

They’re willing to kill for a lie. I literally can’t think of worse evil. Bigger evil, sure, but not worse.

To quote a post from one of the protestors, “… please refrain from wearing Trump/MAGA attire as we want our statement to resonate with the sheeple. No flags but informational signs only.” Naturally, they had to lie about who they were.

Retail Unmasked

I wrote this to a particular local store. I’m not going to name-and-shame them, so this is an open letter to many retailers:


I was in your store this morning.

Several of your staff were wearing their masks either around their necks, or not covering their noses.

This is another way to say, “Not really wearing masks.”

Or, “Not protecting your customers or each other from disease.”

I am deliberately not naming or describing them, because this is not a failure of the hourly employee. It is inevitably and inarguably the responsibility of the management to ensure that the staff follows proper health and safety practices.

If you need assistance, Suffolk County and the State of New York have many resources available to you.

I will note that at least one staffer was apparently walking in to start a shift. You may want to remind them to wear a mask whenever they are in the store, not just when they are on the clock. The same rules that apply to your customers apply to your staff. Masks protect us all, but only if we all wear them.

Let me emphasize that I’m not angry at your staff, or you. I am trying to help protect them, and you, from a potentially deadly disease.

Thank you.

Resurrections in Spain!

According to the Worldometer, 1915 people returned from the dead today (May 25, 2020). Specifically, COVID-19 victims.

I thought this would be the result of a statistical correction, maybe Spain reclassifying a bunch of deaths as being caused by something else, but their News section says nothing about that. My Spanish is very rusty, but their source also doesn’t say such a thing.

I was never that great of a programmer, but surely someone at the Worldometer could have inserted sanity checks for things like the dead rising from the grave. Is Spain threatened by a zombie apocalypse, in addition to the pandemic?

On that same page, they also show that -372 new cases appeared today, and that no one in Spain has recovered from COVID-19 since March 18.

I emailed to let them know about that last anomaly a couple of days ago. No answer so far.

I like the Worldometer’s coronavirus pages and look at them regularly. I have no idea why this slipped through and never got corrected.

Covid-19 and your business: an open letter

In the past few days, I have received emails from hotel chains, supermarkets, convenience stores, travel brands, and a storage locker company explaining how they’re protecting my health from the Covid-19 outbreak. Almost all of them are stamped from the same template:

  • We are sanitizing frequently-touched surfaces more often
  • If you have reservations, we are giving you flexibility to change them, even if we don’t usually let you cancel without penalty
  • We’re following applicable recommendations from WHO and the CDC

Only one, 7-Eleven, has mentioned a critical one: asking sick people to not come in, and saying that they’re directing any employee to stay home if feeling ill. That last is obviously key, though. Here’s the thing: they don’t mention “And we’re giving them sick pay.”

People who work in restaurants and convenience stores are often part-timers with no benefits, and in particular no paid sick days. Telling a person who needs her pay from the night shift to feed her kids, “Just stay home if you run a fever,” is like saying “Just let your family starve if you run a fever.” They won’t and they can’t.

So: how seriously do you really take this outbreak? Are you ready to pay your staff to stay home when sick? Because if not … then people will inevitably die.

No, I don’t think the Thais have cured the Wuhan virus

Did you see that Thai doctors have cured the Novel Coronavirus? … and-812699

Don’t hold your breath. They claim to have used anti-HIV drugs. Those are almost all antiretrovirals. Coronavirii are not retroviruses. It seems very unlikely meds that work by inhibiting the enzyme reverse transcriptase would affect members of the Coronaviridae, since the RNA of a coronavirus is not reverse-transcribed into DNA.

Oseltamivir (trade name Tamiflu), their third drug, is specific to influenza and again would not be expected to work against a totally different type of virus. I actually found a Chinese study that tested it against the SARS virus (close relative of 2019-nCoV) and found no activity.

The whole media brouhaha is based on … one patient.

I can’t rule it out. I can and do doubt it a lot.

Parents torture child, nearly kill him. No mention of charges.

Warning: I am very, very angry.

In Oregon (in 2017), a child was diagnosed with tetanus. It was the first case in that state in over 3 decades.

The parent withheld the DTAP vaccine (which prevents Diphtheria, Tetanus, and Pertussis) despite medical recommendations. Their son got a cut while playing, they treated it themselves (with home suturing!) and didn’t seek medical attention until he developed the classic symptom of tetanus — involuntary muscle contractions. It reached the point where he could not breathe without both drugs and mechanical assistance. With devoted care from many practitioners over a period of two months, the team in Oregon managed to save him from his parents.

As part of treatment he got one dose of DTAP. Five are suggested for full protection. Even after he got a deadly disease that came very close to killing him and meant months of hospitalization and rehab, the parents said that they would refuse to give him the other four doses.

In a just world, they would be sentenced to daily injections of strychnine for two months. Enough to put their own muscles in spasm to the point that they needed mechanical help to breathe. In our world, there seems to be no mention of even a Child Protective Services investigation. I’m sort of glad I have no way to know the names of these hideous monsters, because I would feel some obligation to drive to Oregon and scream at them.

No, that is not hyperbole. They badwording tortured a helpless child. Monsters.

Gluten sensitivity: is it a thing?

First off, there is most certainly a real medical condition called celiac disease. It involves a measurable immune reaction to foods that contain gluten. Gluten is a protein-starch complex (but often described in non-technical and medical writing as just protein) found in some grass seeds, such as wheat, rye, and barley, but not others like rice and corn. It is not found in any foods other than those made from these specific grains.

Celiac is apparently found in about 1% of the population.

Some medical authorities and lay people also assert the existence of “Non-Celiac Gluten Sensitivity” (NGCS). As you might expect, this describes people who are sensitive to gluten in some way, but not through the (partially) known mechanism of celiac disease. To quote a BBC article by “Doctor Chris” van Tulleken, “Although many people who do not have coeliac disease claim to suffer gut symptoms like bloating and nausea when they eat gluten – and even other things like “brain fog” and tiredness – these have not been linked to any physiological changes that can be measured and hence used to make a clinical description and diagnosis.”

Someone with my background wonders if a claimed syndrome that has such a wide variety of symptoms which correlate to nothing measurable might be a result of pareidolia, the tendency of the human brain to find patterns in noisy data, even when no such pattern is real. Examples of what I have just named “pareidolic diseases” include Morgellon’s Syndrome, chronic Lyme disease, and Candidiasis/Yeast Allergy. They share having relatively common, non-specific symptoms (e. g. fatigue, stomach upset) and not being detectable by any lab tests, even when (as with Lyme disease) there is a well-known, effective test available.

Dr. van Tulleken’s “Trust Me, I’m a Doctor” team conducted a study to test the reality of NCGS. The found 60 people, some of whom claimed to experience NGCS, and put them on a gluten-free diet including (experimenter-supplied) gluten-free pasta, but for two weeks (randomly selected?) of the study period, each was given pasta containing gluten instead. The team then analyzed the subjects’ reported symptoms, and also performed lab tests to show inflammation and IgE (antibody) levels. The study was double-blinded, in that neither researchers nor subjects knew in which two week period the subjects were eating gluten until after the study concluded. The subjects acted as their own controls by experiencing both with- and without-gluten diets.

The results: subjects did in fact report feeling fewer gut-related symptoms like bloating during the gluten-free weeks. Variation in other symptoms (e.g. tiredness) was not statistically significant. There was also no significant correlation between gluten-free diet and the lab values being measured.

Dr. van Tulleken does state in the linked BBC article that it’s likely at least some subjects knew which weeks they were eating gluten-containing pasta. And as he concedes, this can easily explain the slight variation in the digestive symptoms.

A weakness he apparently did not realize in his analysis: the two pastas are very clearly made with different recipes. It’s perfectly possible that the gluten-containing pasta that was used has some other difference from the gluten-free one that explains the gut symptomology, perhaps an herb or a preservative that some people are really slightly sensitive to. It’s  possible that the gluten-containing pasta just has less fiber (for one possible example), and that the additional fiber in the gluten-free food aided the subjects’ digestion. Dr. van Tulleken doesn’t provide the recipes/brands for the two foods, making it hard to speculate beyond that guess.

Also, the subjects were eating food they selected and purchased themselves, aside from the pasta. Since as far as one can tell from the BBC article they weren’t asked to record their consumption, it wouldn’t be difficult for this dietary variation to randomly cause one group to score higher on some symptoms.

I’m surprised that Dr. van Tulleken did not report whether the self-diagnosed NGCS sufferers showed greater incidence of gut symptoms than the non-diagnosed. If NGCS is real (and not universal in the population) then a difference between NGCS patients and the rest of the subjects would certainly exist.

It is not stated in the article, but I suspect Dr. van Tulleken’s group does not plan to publish these results in a peer-reviewed journal, which seems to me to be disappointing. I’d love to read in more detail about the protocol and results.

As published, the results seem completely compatible with NGCS being a pareidolic disease. They are also consistent with NGCS being a real syndrome, but with only a small effect (at least in the experimental circumstances). Note that with its weak protocol and small sample size (n=60) it isn’t strong evidence for anything.

I suggest that Dr. van Tulleken’s group or someone else repeat the experiment but with the subjects eating identical diets (entirely supplied by the experimenters, ideally, not just gluten-free with the subjects buying their own food). However, each subject would be required to swallow 10 identical capsules per day. For the “control” period the capsules would contain a non-gluten protein. For the “experimental” period, the capsules would contain gluten proteins. That would make it impossible for the subjects to detect which weeks include gluten from the flavor/texture of their food, and also eliminate the possible effect of other ingredients in the two different pasta recipes.