May 2024 News in Review – More COVID and More Bits and Pieces

I wish it wasn’t so, but COVID keeps popping into the news. This was a multipage piece in the NY Times headlined “Could Covid Vaccines Have Caused Some People Harm?”

This is certainly an important question. The Times article has some specific data on that matter, but, in keeping with the journalistic imperative to keep the focus on the human interest aspect of the news, most of the article is about five individuals who had some form of adverse reactions after having received a dose of the COVID vaccine.

(This is probably irrelevant, but I note that the Times has morphed COVID from an abbreviation denoting the coronavirus disease to a proper noun.)

The specific data cited by the Times can be summarized briefly. In the US, 270 million people have been vaccinated, and 677 million doses of the different iterations of COVID vaccines have been administered. As of this April, just over 13,000 vaccine injury compensation claims have been filed with the federal government. Of these claims, only 19% have been reviewed. Of the claims reviewed, only 47 claims (= approximately 1.9%) were deemed eligible for compensation, and only 12 claims have actually been paid out. The average compensation paid in relation to those 12 claims was about $3,600.

The 47 claims considered eligible for compensation to date come to less than 0.0002% of the 270 million individuals that were vaccinated.

Why was it that so few of the 13,000 vaccine injury compensation claims were deemed eligible for compensation? Probably because many of the claims were for symptoms that may have affected the vaccinated individuals very briefly, or for symptoms that are not considered to be “injuries” in the medical sense. Dr Janet Woodcock, former FDA commissioner, pointed out that brain fog – which is one of the symptoms most frequently mentioned by vaccinated persons – is not acknowledged as a side effect by federal officials, mostly because it doesn’t have a research-based medical definition.

Surprisingly, most of the specific cases of individuals who reported experiencing some form of harm after a COVID vaccine were health professionals, including Dr Gregory Poland, editor in chief of the journal Vaccine; Dr Buddy Creech, who led several COVID vaccine trials at Vanderbilt University; Shaun Barcavage, a nurse practitioner; Renée France, a physical therapist; and Dr Michelle Zimmerman, a neuroscientist. The symptoms reported included Bell’s palsy, tinnitus and whooshing sounds in the ears, Guillain-Barré syndrome (which is a known side effect of other vaccines including the flu shot), a blood-clotting disorder, and stinging pain in the eyes, mouth, and genitals.

Tinnitus is described as a hearing disorder, where we “hear” some kind of sound in our ears when no sound is actually happening. The Vaccine Adverse Events Reporting System (VAERS, part of the CDC) has records of 17,000 cases of tinnitus following a COVID vaccine. However, about one in four adults in the US have some form of tinnitus, so a cause-and-effect relationship is difficult to establish.

VAERS also reports that myocarditis (inflammation of the middle layer of the heart wall) affected about 1,200 individuals, mostly young people between the ages of 12 and 17, after a second dose of the COVID vaccine.

The Times article was surprisingly short of suggested causes of the post-vaccine effects. Dr Zimmerman specifically mentioned that the vaccine dose she had received was probably contaminated. Speaking now for myself, my guess would be that in the cases where there really was a cause-and-effect relationship between the vaccine and the symptom, contamination was the likely source of the problem.

There is certainly reason to suspect that some adverse effects might follow vaccination, whether with the COVID vaccine or other vaccines. The person is having a foreign substance injected into his/her body. The substance is intended to trigger a reaction in the recipient’s immune system, causing changes both in the immediate immune reaction and the cellular immune reaction. This is a big deal, no question about it. But clearly, in the overwhelming majority of persons who have received one or multiple COVID vaccine doses, those “big deal” changes in the immune system caused only the mildest of adverse effects.

By far the likeliest cause of adverse side effects is contamination, either of the vaccine itself, or of the process of administering the vaccine – the hypodermic syringe or needle, or other factors connected with the administration of the vaccine.

And then there is the post hoc propter hoc fallacy. An individual got the COVID vaccine, following which he/she felt sick in some way, therefore it must have been the COVID vaccine that made him/her feel those symptoms.

I have seen web stuff stating with assurance that everyone who gets the COVID vaccine will die. My response is, “Sure – eventually.” And everyone who ever drinks a glass of water will also die – eventually – but not because they drank a glass of water.

I do not mean to minimize the actual risks of receiving a vaccine, whether for COVID or the flu or smallpox or polio. But the risk of harm from a vaccine is super-miniscule compared with the risks of the diseases the vaccines protect us from. For example, the incidence of side effects following the polio vaccine was 1 in 1.4 to 3.4 million. Flu vaccine side effects are more common, but mild – injection site reactions, fatigue, headaches.

I think the NY Times erred in giving front-page space to an article about the potential harms caused by the COVID vaccine. The article will bolster the stance of the antivaxxers, which is does not in the least contribute to the general welfare…

And now for some brief bulletins about other health-related matters.

Including olive oil in our regular diet is associated with reduce risk of dementia

This was based on a study in 93,383 adults in the US which enrolled participants from two pre-existing long-term association studies – the Nurses’ Health Study and the Health Professionals Follow-Up Study. Data for the study was collated over a 33-year-long period between 1990 and 2023 and consisted of biennial assessments of participants’ lifestyle habits and medical histories.

The study reported that consuming seven or more grams of olive oil per day was associated with a 28% reduction in dementia-related death compared to participants devoid of olive oil consumption. This study suggests that olive oil intake may present an efficient strategy to combat dementia mortality risk among Americans. (JAMA Network Open ;7, 5, e2410021)

In case you’re wondering, seven grams of olive oil is not a lot. It comes to just a bit more than one-and-a-half teaspoonsful, which is considerably less than I use in salad dressing, or in cooking when I sauté an onion.

Here’s a direct quote from the study: “Participants were asked how frequently they consumed specific foods, including types of fats and oils used for cooking or added to meals in the past 12 months. Total olive oil intake was determined by summing up answers to 3 questions related to olive oil consumption (i.e., olive oil used for salad dressings, olive oil added to food or bread, and olive oil used for baking and frying at home).”

The study did not specifically say so, but my assumption is that increased olive oil consumption is linked with decreased consumption of other lipids and fats, which are more likely to be specifically unhealthy. Sautéing your onion in olive oil is probably healthier that doing it in butter (don’t get me wrong, I am a staunch defender of butter, but it has its limits) – and as for margarine, let’s not go there.
The study participants were asked about their overall diet, and it was noted that olive oil consumption was linked with the Mediterranean diet, which, as we have discussed, emphasizes vegetables, fish, whole grains, and wine. However, the benefits associated with olive oil were also found in participants who did not stay within the Mediterranean diet guidelines. The olive oil benefits were more pronounced in the women than the men in the study cohort.

Updated recommendations for breast cancer screening from USPSTF

The US Preventive Services Task Force updated its recommendations for breast cancer screening just a few weeks ago, in a statement published in JAMA on April 30 (doi:10.1001/jama.2024.5534).

The updated USPSTF recommendations lower the age at which biennial screenings should start, from age 50 to age 40. This is a very significant change, evidently in response to increases in the rate of breast cancer in women in the 40 to 49 age range – about 2% per year from 2015 to 2019.

The task force’s new guidelines do not apply to women with a history of breast cancer; those who’ve had an abnormality on a previous biopsy; or those with a genetic marker for breast cancer, such as the BRCA1 or BRCA2 genes. Those groups may need to be screened earlier and more frequently. The recommendation cuts off after women reach the age of 74.

The American Cancer Society recommends annual screenings, rather than every other year, for women ages 45 to 54, with the option to switch to biennial screenings once they turn 55. It does not recommend that women stop screenings at any particular age, as long as they are expected to live at least 10 more years.

“We are disappointed that the updated USPSTF screening recommendations do not include women over the age of 74,” the ACS said in a statement. “Millions of women over age 75 are in very good health and are expected to live many more years during which their risk of breast cancer remains high.”

And the American College of Radiology (ACR) expressed disappointment that the USPSTF did not suggest yearly, rather than biennial screenings, starting at age 40, as the college recommends. Their recommendation is that all women, especially black and Jewish women, discuss their breast cancer risk with their doctors before their 25th birthday. Black women are 40% more likely than white women to die from breast cancer, and Jewish women of Eastern European descent have a higher-than-average risk of breast cancer.

The UPSTF brought up the risks associated with getting scans every year, namely that annual scans can yield more false positive results, which can lead to unnecessary biopsies or women receiving treatment for lesions that do not necessarily pose a health risk.

In our previous discussions of USPSTF recommendations, I have suggested that these recommendations are not exclusively based on medical evidence. The USPSTF is not an official federal agency, but a volunteer organization that evaluates medical evidence and also weighs economic and social considerations. Regarding the risks of annual versus biennial breast scans, both the ACS and the ACR strongly suggest that those risks are minor, particular when compared with the benefit of detecting cancer in earlier stages.

And what are these risks? An unnecessary biopsy is a risk, but a very small risk. The biopsy would be considered unnecessary if the result turned out to be something like a non-cancerous lesion. But the biopsy could not be deemed “unnecessary” in advance. The scan detected something. It makes sense to find out what it is.

Mostly, the risk is just being called back for more imaging, and perhaps an ultrasound. The likelihood is that many women, perhaps most women, would prefer annual screening in spite of these minimally increased risks.

Is it possible that we can specifically harness our senses to improve our memory?

Absolutely so, says Andrew Budson, MD, a professor of neurology at the Boston University Chobanian & Avedisian School of Medicine. This section is based on an interview with Budson in Harvard Health Letter.

Budson observes that as long as we’re awake and alert, we have information always coming in through our senses. There are parts of the brain — the hippocampus and some structures related to it — that are taking this information in and potentially getting ready to store it.
We form a memory for only the parts that we pay attention to. If we pay attention to sensory information, then the hippocampus records that information and we’re able to remember it for the next, say, couple of days. And if it’s something important to us, it can be tagged as important while the memory is being created over the next week or so, which can generate a long-lasting memory that can be stored and retrieved over weeks, months, or years.

The way this works is that our senses generate electrochemical activity — brain cells firing, typically in the cerebral cortex. And there are links from the cerebral cortex to the hippocampus, which takes separate sights, sounds, smells, thoughts, and feelings and binds them together into something coherent. Another part of the hippocampus gives this information an index of sorts so it can be found later.
Anytime you are forming memories that you want to stay with you, you want them to be as multisensory as possible. Budson’s own research has looked at the difference between being able to remember things as a word or remember things as a picture. His findings suggested that you’ll remember things better if you use as many different sensory modalities as possible.

So, if you are trying to remember a list of grocery items, for example, but you can’t write them down, you’re much more likely to remember the items if you picture them in your mind: picture an apple, a loaf of bread, a bottle of olive oil, and so on. If you say the names of the items out loud, and you hear yourself saying them, that will help too, as will thinking about the taste of the items, like the taste of the apple as you bite into it. We can use our senses to remember things better. And when we’re retrieving memories, we can try to latch on to any one part of a multisensory experience, and that’s going to allow us to be able to retrieve the memory more easily, faster, and, potentially, in a richer and more detailed manner.

The interviewer asked Budson whether the linking of our senses might explain why sometimes smells or songs can jog memories in people with Alzheimer’s and other conditions causing memory loss.

Budson suggested that there may be different answers. In terms of smells, odor detection is probably the oldest sense that we have, and the hippocampus, which is key in storing memories, is right next to the part of the brain that’s doing all this odor-sensing. Smell can engender some of the strongest retrievals of memories in anyone of any age, including people with Alzheimer’s.

One of the complicating factors is that smell is often impaired in Alzheimer’s, and we often need to use stronger tastes and smells to elicit the same response.

Music can elicit memories for a couple of different reasons. One reason is that we tend to hear a song, especially a song we like, multiple times. If it’s a book or a poem, maybe we’ll read it once or twice, but with a song, people can hear it hundreds of times over a couple of years.

Another reason is that music isn’t just causing the brain’s auditory cortex to fire.  Music also triggers the emotional centers in the brain, and it also triggers all of the rhythm centers in the brain. These are directly linked to motor centers in the brain, which is why it’s easy to tap your feet or clap your hands to the musical rhythms. So when we hear music, it is almost as if we’re getting a multisensory experience just from the music, and so it ends up being encoded as a rich experience.

The interviewer asked Budson about the experience of having a bit of music stuck in our heads, so that we “hear” it over and over, whether we like it or not. Budson’s response was, “Well, you’ve just said a very important pearl, which is that although we can influence what we remember and what we forget, for the most part, we don’t have a lot of control. We don’t have nearly as much control as we would like. If you think of what that means about how memory evolved and how our conscious abilities evolved, it is very, very interesting.”

A personal note here. My wife has spotted a phenomenon that confirms what Budson says about the linking of our senses, and I have definitely experienced the same phenomenon. When I close my eyes, my other senses dial up in intensity. The taste of food is more pronounced. I hear music more clearly – not just the melody, but the harmonies and the counterpoint. The scent of a flower seems to pervade my senses. And my wife has noticed that if she is searching for a tiny item in her purse, she is much better able to do it with her eyes closed.

So it seems that dialing down one sense – eyesight – prompts the hippocampus to dial up the other senses. Our senses are certainly linked, and they affect one another in ways that are somewhat counterintuitive.

Not good news: Lyme disease prevalence is getting worse

The condition is named for Lyme, Connecticut, where a cluster of cases was first described in 1977. Despite its name, Lyme disease has been reported in every U.S. state except Hawaii. Once thought of as a “woods of New England” problem, persons who spend time outdoors need to understand Lyme disease.

Lyme disease continues to be the most common illness transmitted by ticks. It continues to spread in endemic areas such as the upper Midwest and the Northeast, but it has also spread down into the mid-Atlantic region and upward into the upper Northeast. With climate change and warmer temperatures, Lyme disease is now spreading up into Vermont, New Hampshire, and Maine.

The reported increase in prevalence may be in part due to increased general awareness and reporting. The CDC is now reporting both confirmed and probable Lyme disease cases, for example.

The areas where people are most likely to get Lyme disease are those that are wooded or have dense foliage, whether suburban or rural. Ticks live in wooded areas and brush, so people aren’t likely to get it in an urban area, for example, where there’s little greenery. But golf courses can be risky. When golfers hit the ball into the brush, they leave the highly manicured fairways and go into the rough, which could be an area where there are a lot of ticks. The presence of whitetail deer, or small mammals such as white-footed mice, which can be carriers, is another indicator that there might be Lyme disease.

Lyme disease is transmitted by the deer tick, also known as the blacklegged tick. Other ticks, such as dog ticks, can transmit other illnesses, but not Lyme disease. If not caught early, Lyme disease can progress to facial paralysis, arthritis, meningitis, or carditis, which is inflammation of the heart that can cause serious rhythm abnormalities.

Children aged 5 to 9 are the most highly affected by Lyme disease. Also, men more frequently contract Lyme disease than women, probably because they tend to venture into wooded areas more frequently than women. The incidence rate ratios of males over females in most age groups were 39% to 89% percent higher for the time period of 1992 to 2016.

Pets can also bring ticks into the house. For example, if a dog is out running in the woods, comes inside and sits on the furniture or sleeps in the bed with you, it does increase your likelihood of getting a tick bite. And a dog can contract Lyme disease, although they have certain protections that we don’t have yet, like vaccination. Dogs can be vaccinated, and many dogs take a tick and flea treatment that prevents them from getting tick bites

For humans, a vaccine against Lyme disease is in a Phase 3 trial right now. The optimistic expectation is that the vaccine (from Pfizer and Valneva) will be ready in 2025. Another potential therapy to prevent Lyme, developed by the U Mass Chan Medical School, is in clinical trials. This prevention is not a vaccine but a monoclonal antibody that kills the Lyme bacteria in the tick’s gut.

The most effective strategy to avoid Lyme disease is to avoid ticks as assiduously as possible. It’s vital to be aware of the environment. When on a hike, stay on the trail. Clothing should be tick-proofed by wearing a repellent containing DEET. There are other repellents that contain more natural repellents — like lemon oil or eucalyptus — but those are not as effective as DEET at repelling ticks. If possible, wear light-colored clothing, so that ticks can be more easily spotted. Wear long pants and tuck them into your socks. And the most important thing that you should do is every time when you’ve been out in potential tick-laden areas is to shower and conduct a thorough tick inspection. This is a regular part of our routine after we have been doing gardening chores.

In general it takes 36 hours for a tick to cause an infection. Ticks like humid, warm areas to bite, so check all parts of your body, especially folds in the skin like at the elbows, behind the knees, or on the neck.

To properly remove a tick, grasp the tick close to the skin with fine-tipped tweezers and then pull straight up and out. It’s important not break the tick’s body and leave part of it buried. If possible, get the tick tested is there’s a local facility. And it would be a good idea to have tweezers that are dedicated to the particular task of tick removal.

Early symptoms of Lyme disease include the classic erythema migrans rash – the “bull’s eye rash” – which is a red, ring-like rash that spreads. This may develop within days or weeks, but sometimes a rash doesn’t occur at all. Other less common symptoms include a flu-like illness with fever, headache, and achy joints.

If you suspect Lyme disease, it’s important to seek treatment. The best way to recover quickly is to take antibiotics as soon as you can.
Last year, on August 16th, Doc Gumshoe posted a full-length piece about Lyme disease, including a list of all likely symptoms and a recap of the recommendations by the CDC and other official bodies. Also what that lengthy blog included was a fairly detailed discussion of Ross Douthat’s case. Douthat is a NY Times columnist. What is especially interesting about his case is that he probably contracted Lyme in Connecticut somewhere, but quickly returned to Washington DC, where at that time Lyme disease was essentially unknown. He developed a wide range of severe symptoms over several years before these symptoms were recognized as Lyme disease. He eventually required lengthy and heavy-duty treatment with massive doses of antibiotics. It was not a nice story.

The take-away from Ross Douthat’s story is summarized in the sentence above: If you suspect Lyme disease, it’s important to seek treatment.

Gene editing is nearly miraculous. Can it be made more affordable?

Jennifer Doudna, whose work on CRISPR earned her the 2020 Nobel Prize in chemistry, applauded the recent approval of a CRISPR-based gene-editing therapy to treat sickle-cell disease. The therapy was approved by the FDA in 2023, and studies showed it was very effective at reducing the severe pain that accompanies the life-threatening blood disorder. As we’ve discussed in previous posts, the sickle-cell gene almost certainly became prevalent in Africa because persons with one copy of the gene are mostly immune from malaria, a mosquito- borne disease which is common in Africa. Persons with one copy of the gene are not adversely affected. However, those who get two copies – one from each parent – develop sickle-cell disease, which is by no means trivial. The disease results in anemia, pain, swelling, and can lead to dangerous infections.

CRISPR-based therapies can address hard-to-treat ailments such as sickle-cell disease, but major hurdles that still stand in the way of widespread use. The therapy uses a process similar to that of a bone-marrow transplant. Blood stem cells are extracted from a patient’s bone marrow, genetically engineered, and then reinfused into the marrow to produce blood cells that greatly reduce disease symptoms and dangerous complications.

That process is physically challenging for patients and extremely expensive, with each treatment costing more than $1 million. Those factors explain why only 250 people have received the therapy so far even though the condition afflicts 90,000 to 100,000 in the U.S. and millions worldwide.

Doudna recently said in a talk at Harvard Medical School that if CRISPR is to match its promise to reduce human suffering, new delivery methods are essential. She described several efforts underway in her lab and those of colleagues to create nanoparticle delivery systems that could, if perfected, relatively simply and cheaply deliver the CRISPR-based gene editor to target cells in various tissues.

That would allow the gene-editing process to occur inside the patient’s body rather than in the lab, as occurs with current sickle-cell treatment. That would avoid the expensive and arduous process of extracting cells from a patient’s body, engineering them to address a condition’s genetic causes, and then reinjecting them into the patient.

“How we can achieve in vivo genome editing, I increasingly think is the bottleneck in this field,” Doudna said. “Broadly speaking, what we need to be addressing is how these editors are going to get into target cells in the body. It’s a really interesting, really big challenge, and there’s many people working on it.”

The discovery of CRISPR/Cas9 in 2012 stemmed from basic scientific research into how bacteria fight off viruses. Researchers realized that a portion of the bacterial immune system contains molecules that precisely snip DNA at specific locations. Based on that, they developed the molecular scissors of CRISPR/Cas9 that allow the precise editing of human, plant, and animal DNA at specific locations – i.e., gene editing.

If the nanoparticle delivery system being worked on by Doudna and her associates becomes a reality, the expensive process – extracting blood stem cells from the patient’s bone marrow and tinkering with them before reinfusing them into the bone marrow – could be avoided. This would not only spare the patient a complicated and difficult ordeal, but make the CRISPR treatment option considerably more affordable – which, of course, would hugely expand the number of patients who could receive treatment, from the tiny number getting this treatment currently to, potentially, hundreds of thousands.

This would transform gene editing from an exceedingly interesting, innovative, but rarely-used technique to a medical option employed as needed. That’s the essential step in progress in medicine.

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The general subject of inflammation continues to demand attention in the health-care world. It’s complicated. It’s both a protective response and a process that leads to potentially harmful consequences. Doc Gumshoe will take another look at inflammation in an up-coming piece.

Stay well, and in your comments, please let me know what you’d like me to cover. Not COVID, I hope. I hope never to have to mention it again. Best to all, Michael Jorrin, (aka Doc Gumshoe)

[ed note: Michael Jorrin, who I dubbed “Doc Gumshoe” many years ago, is a longtime medical writer (not a doctor) and shares his commentary with Gumshoe readers once or twice a month. He does not generally write about the investment prospects of topics he covers, but has agreed to our trading restrictions.  Past Doc Gumshoe columns are available here.]