Up From Facebook

  As a subject in the Moderna phase III trial, I've been combing the latest reports on the SARS-Cov-2 variants for tests of the Moderna vaccine. Saw this good news just now: "Vaccination with the Moderna COVID-19 Vaccine produced neutralizing titers against all variants tested, including additional versions of the Beta variant (B.1.351, first identified in South Africa), three lineage variants of B.1.617 (first identified in India), including the Kappa (B.1.617.1) and the Delta variants (B.1.617.2); the Eta variant (B.1.525, first identified in Nigeria); and the A.23.1 and A.VOI.V2 variants first identified in Uganda and Angola, respectively." https://investors.modernatx.com/news-releases/news-release-details/moderna-provides-clinical-update-neutralizing-activity-its-covid/?fbclid=IwAR0y52rP-UWkTKYpX3o0tA_qm0Hqwkgl-z4Hyfy4VZ0YNaILL8re02iVmYg

  I’ve been a PhD geneticist and molecular biologist for nearly 40 years. During that time, I’ve seen the cloning of many human genes for which inherited diseases were known (e.g., cystic fibrosis, Huntingtons, Duchenne/Becker muscular dystrophy). Each paper reporting the gene cloning concluded with an obligatory paragraph noting that this opened the door to gene therapy. Sadly, the promised gene therapies have lagged decades behind the discovery and cloning of the affected genes. Instead, most of the progress since cloning has been in diagnostics: we could tell you whether or not you carried a lethal mutation and if so, when and how you would die. Many patients refused to be tested, since nothing could be done anyway. The rate-limiting step in gene therapy turns out not to be cloning of the gene in question or understanding how and where it is expressed. The challenge has been to deliver the therapy to the proper tissue in therapeutic quantities. CRISPR/Cas9 genome editing could f...

  A couple of years ago, I had a robotic laparoscopic hernia repair. This is one of the most common surgeries in the US, and it certainly resolved my hernia. I was never exactly clear on what the advantage to robotic surgery was. Apparently, there is none, except to the bottom line of the practice. It’s more about branding than outcomes: “The authors looked at every single randomized controlled trial study for mostly gynecologic, gastrointestinal, and urologic procedures. Things in the abdomen and pelvis, which is the bulk of robotic surgery. And what they found was notable. They found just over 40 trials, and not all of them but most of them reported the rates of complications, something over 30. And when they reported complications, sometimes the robot came out ahead, but sometimes the robot didn't and laparoscopic or even open surgery did just about the same. There appeared to be much more cost if you use the robot. And you were in the OR just as long as you were if you had an ...

I was a varsity athlete my freshman year in college: I ran cross-country for Vanderbilt, up to and including the SEC conference meet in Tallahassee FL in 1973. After I transferred to UT-Knoxville, I ran in local track and 10K competitions, but didn’t bother to go out for varsity sports at UT, since so many of their athletes were on athletic scholarships. I did compete against Olympic steeplechase star Doug Brown once in the mile, but he finished over 20 seconds ahead of me—it was never even close, and I’m sure he was just loping. Since high school, I lost interest in vicarious participation in sports, college and pro. So the NCAA v. Alston SCOTUS decision that allows “student-athletes” to market their images and otherwise receive outside compensation didn’t bother me. It’s only a matter of time before colleges are allowed to pay their players, which upends the college sports business model. As Kevin Drum says: “If a dozen universities basically run pro programs that are farm teams for ...

  We've lived in St. Louis for nearly 39 years. So far, this has been the nicest spring and summer I can recall. The basic way to measure how much "extreme" (of a certain type) weather you have is to add up heating degree days plus cooling degree days. 65 is the base, so a day that is 90 is a 25 degree cooling degree day, and a day that is 40 is a 25 degree heating degree day. 65 degrees every day would add up to zero over the year. Lots of high temp days and low temp days give you a big number. There are hotter places and there are cooler places, but St. Louis is really hot in the summer and really cold in the winter.

  By the time I finished high school, I decided I wanted to be a physician. That didn't happen and it's a good thing: I would have made a terrible doctor (OK, maybe a radiologist or a pathologist). Medicine requires a collaboration between the physician and the patient. Key to this collaboration is a bond of trust, and the glue for that bond is patience and compassion. No amount of clinical knowledge or skill can substitute. I'm temperamentally unsuited to be a doc. My friend and colleague Ken Haller (pediatrician, educator, singer, writer, advocate, actor, improviser) posted a story on FB and his blog illustrating how compassion and patience are essential parts of a physician's toolkit: "The two first-time parents sat across from me. I had just examined their 5-day old baby who was there for her first visit to the office after everyone went home from the hospital. Breathing, feeding, peeing, pooping. Yep, all the plumbing was working. The baby looked great. Mom ...

  To follow up on yesterday's post, not getting vaccinated during a pandemic is reckless: it endangers you and everyone else. Not only do you become a vector for disease, you also become a potential incubator for the next variant that may be more contagious, more deadly and/or more resistant to existing vaccines. No, I don't mean we need a police state that ties you down and vaccinates you against your will. But if you choose not to be vaccinated, you need to be sequestered away from the rest of civilized humanity. Lose your job. Quarantined at home. Good to see some employers putting their foot down in the interest of public health: "More than 150 employees of Houston Methodist resigned or were terminated over the last 2 weeks, after refusing to get vaccinated against COVID-19, the health system confirmed Tuesday. Houston Methodist set a deadline of June 21 for all of its employees to either be fully vaccinated or be approved for a religious or medical exemption allowing ...

  It doesn't matter if it's true or even if it makes sense. This isn't about reality, it's pure grievance-mongering, and tens of millions of Trump cult believers will be duped by this. “Doing this, they say, will ensure voting files are up to date, while at the same time ensuring voter integrity in future elections. BUT WHAT ABOUT THE LAST ELECTION? WHY WASN’T THIS DONE PRIOR TO THE NOVEMBER 3RD PRESIDENTIAL ELECTION, where they had us losing by a very small number of votes, many times less than the 101,789 figure? This means we (you!) won the Presidential Election in Georgia.” Wrong on many counts: By definition, the purged voters didn’t participate in the last election, and by federal law, purges aren’t performed ahead of federal elections. *snip* “Exactly 0 registered Georgia voters who may be canceled voted in last year’s election. Voters aren’t purged until they miss 2 general elections,” Atlanta Journal-Constitution reporter Mark Niesse noted, fact-checking Trump’...

  Infectious diseases beset all living things, even bacteria. In the past ten thousand years of human history, there have been epidemics and pandemics of plague, smallpox, yellow fever, cholera and other diseases, with millions of deaths. Herd immunity was achieved by natural infection at the cost of many deaths, and was only temporary: when the next generation appeared, it lacked immunity, setting the stage for the next epidemic. When Europeans arrived in the Americas, they brought infectious disease to which they had herd immunity but the natives lacked (measles, smallpox). This devastated the indigenous people as much or more than war or starvation. Infectious disease has been around for thousands of years. Our understanding of infectious disease epidemiology is much younger. Most vaccines are less than 100 years old. Vaccines are a way of bypassing natural infection and risk of death or disability to achieve immunity, and ultimately herd immunity. Polio was a scourge in America...

  I remember all the bleating shortly after the 9/11 attacks that America would be changed forever, finally united in goodwill among fellow citizens and a unity of national purpose. That let to the US military invasion and occupation of Iraq and eventually to that paragon of American "greatness," Donald Trump. No, 9/11 didn't change things, except how we are screened before boarding airlines (just locking the door to the flight deck would have stopped the 9/11 attacks). Now, COVID-19 is the new 9/11, spawning endless bafflegab about how we'll be changed forever. I don't buy it. But lets hand the mike to Kevin Drum: "And while we're on the topic, can we please, once and for all, give up on the "COVID has changed life forever" genre? It hasn't. It's already obvious that things will return almost completely to normal over the next few months and that the experience of living through a pandemic has neither enriched our lives nor taught us to...

  If you're unwilling to foster children to LGBT parents, you need to get out of the foster care business. You don't care about children, you care about advancing your parochial prejudices. Needy children shouldn't be held hostage to superstition.   https://talkingpointsmemo.com/news/supreme-court-lgbtq-rights

Tom Cotton isn't stupid, but he sure plays it well. I'm an expert on genetics and genomics. This is just bat-shit crazy: "In the letter, Cotton warns Biden that Beijing plans on using the 2022 Winter Olympics as a giant funnel for precious American DNA, harvesting the nation’s fittest and finest for their genomic information as part of a plan to achieve military dominance. Written in the language of a Cold War-era B-movie and filled with a mixture of sci-fi scheming, eugenics, and stentorian warning, Cotton demands that Biden withdraw American participation from the 2022 winter Olympics absent guarantees from China that it will not collect the data or DNA of visiting American olympians. “In 2022, thousands of world-class athletes will gather to compete in China,” the letter reads. “Their DNA will present an irresistible target for the CCP.” He added that, “thus, we should expect that the Chinese government will attempt to collect genetic samples of Olympians at the Games, ...

The FDA approved the COVID-19 vaccines on an emergency basis, but is withholding full approval until the completion of the phase III trials, over a year from now. Of course, anyone who wants to can be vaccinated under the emergency approval. The scientific/medical reason for waiting is the (remote) possibility that there will be significant vaccine side-effects during the second year of the trial. I’m staying in the Moderna trial for the full two years. I could have dropped out when I unblinded myself last October, or when I was officially unblinded in the trial in January, but since I have a vaccine card, I’m good with staying in. The choice isn’t between the “risk” of the vaccine and no risk, it is between the unknown risk of the vaccine and the known risk of contracting COVID-19 without the vaccine. The latter includes not only significant risk of death but also risk of long haul syndrome. I understand the FDA position, but if any healthy person asks me, I'd tell them to get the...

 Evangelical churches today are businesses that cloak themselves in a veneer of religion to avoid taxes. They are violating the church-state wall by engaging in politics.  Israel provides an object lesson in the danger of mixing church and state. While one may celebrate the assembly of an opposition majority to depose the criminal Netanyahu, Bennett is more right wing. The Israeli right is not only immoral, they are playing a losing demographic game.  " The Ultra-Orthodox or Haredim are about 8 percent of Israel’s population, but under Netanyahu (himself a secularist), they have wielded political power far beyond their numbers and have garnered special perquisites for their members, some of whom prefer to study the Bible than to work and who want to be exempt from military service. They are thus analogous to the American Evangelicals, who are only 16 percent of Americans but who have captured the Republican Party and have it do their bidding." https://www.juancole.com/202...

  One of the original disadvantages of the mRNA vaccines was the necessity to store them at ultracold conditions. Turns out, it wasn't necessary after all: "CAMBRIDGE, Mass.--(BUSINESS WIRE)--Nov. 16, 2020-- Moderna, Inc. (Nasdaq: MRNA), a biotechnology company pioneering messenger RNA (mRNA) therapeutics and vaccines to create a new generation of transformative medicines for patients, today announced new data showing that mRNA-1273, its COVID-19 vaccine candidate, remains stable at 2° to 8°C (36° to 46°F), the temperature of a standard home or medical refrigerator, for 30 days. Stability testing supports this extension from an earlier estimate of 7 days. mRNA-1273 remains stable at -20° C (-4°F) for up to six months, at refrigerated conditions for up to 30 days and at room temperature for up to 12 hours." https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-longer-shelf-life-its-covid-19-vaccine

I enrolled in the Moderna phase III COVID-19 vaccine trial last August. The trial lasts two years. Initially, it was a double-blind trial, although I knew I was in the vaccine arm 12 h after the booster and unblinded myself with the spike antibody test a month later. In January, all subjects were offered unblinding and the placebos were offered the vaccine. Meanwhile, the Moderna vaccine has emergency use approval for everyone over age 12, so the number of people vaccinated outside the trial dwarfs the number in the trial. So the issue is whether the FDA should relent and give full approval to this (and the Pfizer, J&J and AstraZenica) vaccine before the phase III trial is done. Trial participants like me are subject to a much higher degree of surveillance than the rest of the vaccinated public (weekly phone log, monthly wellness calls, six month clinical visits and blood samples) for research purposes. I can understand why the FDA would want the trials to be completed, but what if...

  "Start with the Alamo. So much of what we “know” about the battle is provably wrong. William Travis never drew any line in the sand; this was a tale concocted by an amateur historian in the late 1800s. There is no evidence Davy Crockett went down fighting, as John Wayne famously did in his 1960 movie The Alamo, a font of misinformation; there is ample testimony from Mexican soldiers that Crockett surrendered and was executed. The battle, in fact, should never have been fought. Travis ignored multiple warnings of Santa Anna’s approach and was simply trapped in the Alamo when the Mexican army arrived. He wrote some dramatic letters during the ensuing siege, it’s true, but how anyone could attest to the defenders’ “bravery” is beyond us. The men at the Alamo fought and died because they had no choice. Even the notion they “fought to the last man” turns out to be untrue. Mexican accounts make clear that, as the battle was being lost, as many as half the “Texian” defenders fled the m...

  Mirabile dictu Washington (CNN) Republican members of Oregon's House of Representatives have called on an embattled member of their caucus to resign after newly surfaced video showed him appearing to give protesters insights into how to access the state Capitol, which led to a scuffle between protesters and police last year. In a letter sent by every Republican in the chamber to GOP state Rep. Mike Nearman on Monday, the lawmakers say they "strongly recommend" he resign from his position in the legislature. https://www.cnn.com/2021/06/08/politics/oregon-mike-nearman-resignation-calls/index.html?fbclid=IwAR14BtZYFri63W6qT1UdH6zI4olXlG2mTPb8uAGmEQ_wXjiGX2NWyluU5CU

  We have a saying in the science research camp: if you hear hoofbeats behind you, expect horses, not zebras. Yes, there are two theories about SARS-CoV-2. One is a natural origin and the other is a virus that escaped from Wuhan Institute of Virology. But having two theories doesn't make them equally likely. Here's a lay language piece that provides some useful framing. https://ncse.ngo/remember-when-we-said-dont-jump-gun-we-need-say-it-again

  From 'Augustus: First emperor of Rome' (p.37): " Caesar's father, aided by his sister's marriage to the popular hero Caius Marius, easily reached the praetorship and his sudden death--he collapsed and died putting on his shoes one morning--prevented him from going further." There's a lesson in this somewhere.

  Republicans these days are seeing UFOs everywhere, it seems: * Fully 53% of Republicans in the poll said that Donald Trump was the "true" president, while 47% said Joe Biden, who is the actual president. * Another 56% of Republicans say that the results of the 2020 election were "the result of illegal voting or election rigging." * More than 6 in 10 GOPers either "strongly" (39%) or "somewhat" (22%) agreed with the statement that the 2020 election "was stolen from Donald Trump."

  As Kevin Drum says over at Jabberwocking: Needless to say, this is all because Congress acted with a bigger and faster rescue package than ever in history—and the Fed cooperated during the entire downturn with loose monetary policy. Among other things, that makes the next couple of years a terrific experiment in monetary and fiscal policy. If we recover faster than ever, and do so without sparking an inflationary spiral, it will be a strong indication that our past responses to economic downturns have been routinely too timid. "New businesses are popping up at the fastest pace on record. The rate at which workers quit their jobs—a proxy for confidence in the labor market—matches the highest going back at least to 2000. American household debt-service burdens, as a share of after-tax income, are near their lowest levels since 1980, when records began." https://www.wsj.com/articles/the-economic-recovery-is-here-rebound-jobs-stock-market-unemployment-biden-aid-package-116226...

  "Stop the steal" was the bleat of the Trumpenproletariat in the wake of the 2020 election that rejected their orange deity. It was an explicit charge that Democrats stole the election. And like everything that Republicans charge others of, it is projection. They were the ones trying to steal the election, not just from Biden, but from the American people, a majority of who rejected Trump--twice. But now Republicans are already starting the steal for 2024: "The White House does see a risk in the possibility that Republicans—whether local election officials, GOP-controlled state legislatures, or a potential Republican majority in the U.S. House or Senate—will refuse to certify clear Democratic wins in the 2022 and 2024 elections. The senior Democrat told me, “Given how things have developed since January 6, if the situation is not brought under some control and this isn’t countered effectively, then I think there is a significant risk” that “Republican officials, unlike ...