About specks, beams, and fake news

No doubt that fake medical news and junk science are dangerous not only in their specific fields but also in the widest sense of eroding trust in democratic conversation and expertise. As we know from Plato, either democracy is balanced by expertise, or it is destined to be ruled only by the law of the strongest and by incompetence. This principle is nicely reaffirmed by the article “Academics fight back against junk science, health scams” by Sylvain Comeau, published on University Affairs, the newsmagazine of Canada’s university community. What is missed by this article is the other side of the problem, scientists and medical doctors. If there is something that I have learned in my clinical practice as a psychoanalyst, it is that one could raise awareness in other people only if he(she) is self-aware. Blind spots in your eyes prevent you right addressing other people’s problems. What are the major scotomas in scientists and medical doctors’ eyes? Let me cite at least three of them,

• Scientists and medical doctors’ tend to underestimate the amount of medical and scientific disinformation which is transmitted every day through accredited scientific and medical channels. This is due to many reasons, including the awful habit to present preliminary results in press conferences or through press releases, before these results are controlled. Also, the quality of peer review is dramatically decreasing as denounced by many scholars; it is not infrequent that, even in the context of serious papers by accredited scholars, one finds references to fake studies or unproved, or manifestly biased, statements. 
• Medical doctors pretend to ignore the huge amount of pseudoscientific theories and practices colonizing current medical practice. So-called “alternative medicines” (ranging from homeopathy to the treatment of alleged “alimentary intolerances”) are often and often practiced not only by charlatans but also by registered MDs without anyone takes effective action to halt this unacceptable phenomenon.
• Scientists often tend to forget the foundational principles of science, which are doubt and inquiry. Too many scientists speak of “Scientific Truth,” oblivious that these two words rarely match when are written in capital letters. A “scientific truth” is not stronger than other truths – as many scientists seem to believe – on the contrary, it is weaker and humbler, the weakest and humblest existing truth; it is a little, local, truth which is discreetly waiting for being contradicted by further little, humble, truths.

In conclusion, to “fight back against junk science and health scams” is unconditionally laudable. Without forgetting Matthew 7:3 "Why do you see the speck in your brother's eye but fail to notice the beam in your eye?”

HEARING AT EUROPEAN PARLIAMENT ON ASSISTIVE TECHNOLOGY

Emilio Mordini: GDPR, The Great Gatsby, and Mark Zuckerberg

Emilio Mordini: GDPR, The Great Gatsby, and Mark Zuckerberg: Heterogonie der Zwecke  (heterogony of ends) is an expression coined in 1886 by German psychologist Wilhelm Wundt, to indicate an intenti...

GDPR, The Great Gatsby, and Mark Zuckerberg

Heterogonie der Zwecke (heterogony of ends) is an expression coined in 1886 by German psychologist Wilhelm Wundt, to indicate an intentional action which ends up achieving unexpected, even opposite, ends. The General Data Protection Regulation (GDPR), enforced by the European Union on May 25th, 2018 to protect the “fundamental rights and freedoms of natural persons and in particular their right to the protection of personal data” (art.1), offers some amusing examples of heterogony of ends (read the full article) 

DOGS, VACCINE AND AUTISM

On the 24th of this past April, the breakfast show “Good Morning Britain” tweeted the bizarre  request  to be contacted by “pet owners who haven't given their pets vaccinations because they're concerned about side effects - as well as people who have done so and now believe their pet has canine autism as a result”.   Such an odd request raised several remonstrations and criticisms, because “in a single tweet they managed to perpetuate the myth of a link between autism and vaccination, and the myth that autism is something that can be contracted. But even more than the harm this does to public health, the comparison between autistic people and poorly-trained pet dogs is immensely insulting and hurtful”.  The British Veterinary Association (BVA) immediately reacted with a tweeted statement “There's currently no reliable scientific evidence to indicate autism in dogs (or its link to vaccines). Potential side effects of vaccines are rare & outweighed by the benefits in protecting against disease”.  Yet, not all the experts share their views, for instance Lisa Tenzin-Dolma, book author, chair of the International Companion Animal Network, and founder of the International School for Canine Psychology and Behaviour, stated   “We don’t have scientific evidence to back claims of canine autism, however, we have seen anecdotal evidence of dogs having a marked change in their behaviour (‘canine dysfunctional behaviour’)”.

The notion of “canine autism” is not new, it dates to a paper “A syndrome in the dog resembling human infantile autism” published in 1966 on the Journal of the American Veterinary Medical Association, by Dr. Michael W.Fox. British veterinarian and former vice president of the Humane Society of the United States,  one of the most influential animal protection organizations in the U.S. Dr. Fox is an expert in animal behaviour and passionate animal advocate. His scientific production is vast and assorted - ranging from animal rights to sustainable agriculture, to vegan cat foods –including also eccentric papers, such as one devoted to the evidence of the Oedipus complex in dogs.  Dr. Fox is also a prolific journalist.  As a columnist, he regularly collaborates to the Washington Post, where he publishes about post-traumatic stress disorders in cats,   obsessive-compulsive disorders and panic attacks in dogs, and so on.  Brief, Dr. Fox is not just a scientist, he has a mission,  "To help heal the broken bonds between my own species and other living beings and the natural environment for the good of all: One Earth, One Health."

However, notwithstanding Dr. Fox, it was only recently that the notion of “canine autism” became mainstream. In facts, searching “canine autism” on Google, one gets 11,500 results (the query “dog autism” gets many more results, which also include dog companions to assist autistic people, while “canine autism” is quite selective). Surprisingly enough, restricting the query to a smaller date range (from Jun 1966 – Fox’s paper publication -  to Jun 2014), one gets only 154 results. The remaining 11,150 results have been all produced in the last four years. What happened in 2014 to justify such an explosion of interest? On October 2014, Translational Psychiatry - a prominent academic journal, issued by the Nature group, with an impact factor of  5.601 and an article influence score of 1.943 -  published an original paper authored by a team of biologists, veterinarians, and psychiatrists, led by T.C. Theoharides, chair of the Department of Integrative Physiology and Pathobiology, at Tufts University School of Medicine.  The paper was devoted to comparing serum neurotensin and CRH levels in children with autistic spectrum disorders and tail-chasing Bull Terriers with a “phenotype similar to autism.” The paper goal was to propose a new animal model for human autism, more reliable than those based on mice and parrots. According to the team, Bull-Terriers affected by compulsory tail-chasing showed stereotypic movements very close to those exhibited by autistic children, as well as behavioural problems (aggression, seizures, fixed stare, and immobility) similar – authors claim - to behaviours characterising autistic spectrum disorders in children. Authors also suggest some biological markers, which would be shared by human and canine syndromes. Michael W.Fox, probably considered more an activist than a pure scientist, was not referenced in the bibliography, or otherwise mentioned, by the paper. Theoharides’  paper was a signal of the zeitgeist. Always in 2014, the Tufts University Cummings School of Veterinary Medicine and the University of Massachusetts Medical School – in collaboration with the Southwest Autism Research & Resource Center,  the  American Humane Association, and the Translational Genomics Research Institute – launched the research project “Canines, Kids and Autism”, involving both dogs and children, with the primary aim to investigate the causes of obsessive-compulsive disorders in dogs, “in hopes of pinpointing those genes that might be responsible for atypical behaviors” in dogs and autistic children.

So, the notion of “canine autism” grew in popularity and captured the imagination of general press, social media, and, presumably, pet owners. Finally, in 2017, a “pet anti-vax movement” also emerged,  becoming soon in fashion among  Brooklynites: more and more, in New York, “the young and the hip are refusing to vaccinate their dogs against such potentially lethal diseases as distemper, hepatitis and rabies, because vaccines absolutely, positively cause autism”. From New York, the “pet anti-vax movement” spread in the U.S.  and now also in the UK. Dr. Amy Ford of the Veterinarian Wellness Center of Boerum Hill, one the most reputed animal hospitals in  Brooklyn, said: “We do see a higher number of clients who don’t want to vaccinate their animals, this may be stemming from the anti-vaccine movement, which people are applying to their pets.” Most commentators used the same argument to explain the “pet anti-vax movement.”  They are only partly right.

There is no doubt that anti-vaccine movement deeply influenced (and took advantage) of the urban myth of “canine autism,” but – as I pointed out – such a myth was fuelled, if not created, by distinguished medical and academic institutions. Even more seriously, these scholars implicitly supported the anti-vax movements. The first lines of 2014 Theoharides’ paper are appalling, notably if one considers that they were published by a journal ranked 22/142 in Psychiatry: “Autism spectrum disorders (ASD) are neurodevelopmental disorders (…)Fifty percent of such children regress at 2–3 years of age, often after a specific event such as reaction to vaccination, infection,  trauma, environmental toxins or stress (…) Recent evidence suggests that ASD involve some defective immune responses in many ASD patients and their relatives,  as well as some neuroimmune component, especially allergic-like symptoms”. As far as this author knows, no one in the academic world has ever protested against such a grave, misleading, statement.  Admittedly, this silence is more perturbing than anti-vaxxer barks.

Emilio Mordini: Collateral Campaigns, Universal Flu Vaccine, Healt...

Emilio Mordini: Collateral Campaigns, Universal Flu Vaccine, Healt...: Launched in October 1994 , with 123.9 million visitors from Nov 2017 to Jan 2018, including 23.33 million monthly unique visitors (www.sim...

Collateral Campaigns, Universal Flu Vaccine, Health Communication

Launched in October 1994, with 123.9 million visitors from Nov 2017 to Jan 2018, including 23.33 million monthly unique visitors (www.similarweb.com), Wired is not only a “historical” online technology magazine, but it is still one of the most authoritative. It is rare that Wired dedicates one of its main articles to a health theme,  yet, on Feb 1,  the magazine published a full piece entirely devoted to flu vaccines. This article is part of a wider media campaign on next-generation flu vaccines, which are expected  - as the story goes - to meet the challenges posed by ongoing virus mutations.

Why are media so interested in flu vaccines? The search for the universal flu vaccine is not at all novel, although new approaches are in the pipeline. This flu season has been one of the worst of the last decade, and this could be a possible explanation. However, the actual reason is probably more mundane; quite simply, 2018 is the 100th anniversary of the 1918 influenza pandemics. Anniversaries prompt ideas, initiatives, and, ultimately, business.

On  January 15th, Vaccitech, an Oxford University spin-out company developing a universal flu vaccine, announced  to have been granted with £20m by two major venture capital firms, GV (the venture capital arm of Alphabet, the parent company of Google), and Sequoia Capital China, the fifth yuan-denominated fund, which has in its portfolio internet giant Alibaba.  On January 19th, Vaccitech announced to be about to start a phase 2 trial for a universal flu vaccine.

Many other teams are working on next-generation flu vaccines, including the Palese Laboratory in the Department of Microbiology at Icahn School of Medicine at Mount Sinai in New York, supported by GlaxoSmithKline and Gates Foundation;  and the American biotech firm, FluGen, which was awarded on October 2017 with $14.4 million by the U.S. Department of Defense to enter human trial with RedeeFlu, an experimental flu vaccine.

The most challenging enterprise, is, however, the Universal Influenza Vaccine Initiative (UIVI), launched by the Human Vaccines Project, “a global nonprofit that brings together leading stakeholders across academia, industry, governments and nonprofits”,  funded inter alia  by The Robert Wood Johnson Foundation, the Vanderbilt University Medical Center, the J. Craig Venter Institute, and drug companies such as GlaxoSmithKline, Janssen, Pfizer, Sanofi Pasteur, and still others. The Universal Influenza Vaccine Initiative is more ambitious than any other project previously mentioned because it aims “to harness the human immune system to prevent and control disease in ways previously considered unimaginable (…) Decoding the human immune system holds the key to the development of such new and improved vaccines. Deciphering the human immunome, the universal and common elements of the B and T cell receptors that make up the adaptive immune system, will facilitate germline targeting and structure-assisted vaccine discovery”.  The UIVI proposes itself as the new Human Genome Project, the greatest scientific enterprise for the next decade. This is also echoed by Michael Osterholm - director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, and influential public health and a biosecurity  scientist – who argues that universal  flu vaccine needs an initiative similar to the Manhattan Project, the U.S. atomic bomb programme during World War II.

This editor has not the scientific expertise necessary to evaluate whether we truly need a new Manhattan Project (admittedly, it is not the most reassuring comparison one could use). The recent history is full of attempts to build great scientific enterprises; sometimes they succeed, other times they just generate bombastic “collateral campaigns,” to evoke Musil’s novel, “The Man Without Qualities.” One thing is for sure; the current universal flu vaccine campaign makes one wonders about scientists’ communication skills. Using the 100th anniversary of the 1918 influenza pandemics to raise public awareness is laudable but doing it by overturning years and years of health communication policies is crazy. Since October 2017, when news about universal flu vaccine started spreading, web searches on “universal flu vaccine”  have been going up and fluctuating in parallel with queries on “flu vaccine effectiveness” and on “flu shot side effects.”  For ages, people have been told that vaccines are always effective – although medical literate people knew that things were more nuanced than  naive popularizations  - now nonchalant articles and broadcasts are informing everybody, almost casually,  that “flu vaccine is only about 10 percent to 30 percent effective”. The least that could happen is that those who vaccinated themselves, feel deceived, and those who did not, find their doubts fully confirmed.  

Emilio Mordini: Dialogue of an Almanac-Pedlar and a Passer-by

Emilio Mordini: Dialogue of an Almanac-Pedlar and a Passer-by: January unavoidably brings predictions . Old and new media rival one another to publish forecasts and more mundane prophecies around the ne...

Dialogue of an Almanac-Pedlar and a Passer-by

January unavoidably brings predictions. Old and new media rival one another to publish forecasts and more mundane prophecies around the new year; old-fashioned horoscopes, scientific foresight, experts’ opinions, they all work well in January. No one would be willing to replicate without any change even one of the last twenty years of his life -ironically noticed Giacomo Leopardi in his Dialogue of an Almanac-Pedlar and a Passer-by –we all prefer a future at random, although it is very unlikely that the future will be happier than the past.

A special class of new year predictions regards medical breakthroughs.  There are many of these medical predictions (including politically oriented ones); one of the most accredited is a list published, since 2010,  by a panel of physicians and scientists convened by Cleveland Clinic.  These  Top 10 Medical Innovations are announced in October, but  they are usually “re-discovered” and amplified in January. In 2018, they include in order of relevance, 1)  Hybrid Closed-Loop Insulin Delivery System; 2) Neuromodulation to Treat Obstructive Sleep Apnea; 3) Gene Therapy for Inherited Retinal Diseases; 4) The Unprecedented Reduction of LDL Cholesterol; 5) The Emergence of Distance Health; 6) Next Generation Vaccine Platforms; 7) Arsenal of Targeted Breast Cancer Therapies; 8) Enhanced Recovery After Surgery; 9) Centralized Monitoring of Hospital Patients; 10) Scalp Cooling for Reducing Chemotherapy Hair Loss.

Ranked only sixth in this list, “Next Generation Vaccine Platforms”  is thus considered less significant than, e.g., “Neuromodulation to Treat Obstructive Sleep Apnea” and “Unprecedented Reduction of LDL Cholesterol”; families involved in  5 million child deaths, worldwide caused, still  in 2016, by communicable and infectious diseases,  would probably disagree. The real issue is not, however, in this cliched comment (families could be finally wrong from a global perspective), rather in what the panel describes as a medical breakthrough. According to the Cleveland Clinic panel “in 2018, innovators will be upgrading the entire vaccine infrastructure to develop new vaccines more rapidly and break ground on novel mechanisms to better deliver vaccines to vast populations (…)  Companies are finding faster ways to develop flu vaccines using tobacco plants, insects, and nanoparticles. Oral, edible and mucosally delivered vaccines, intranasal vaccines, and vaccine chips are being developed. In 2018, a bandage-sized patch for flu vaccine is expected to be on the market. These new ways of developing, shipping, storing and vaccinating are anticipated to help stave off current and future diseases and epidemics”. Similar arguments are also proposed by Innovation House in its list of 2018 top medical breakthroughs, ranking “Next generation vaccination” 5^th; by the list provided by Health24, which ranks “Next-generation vaccines” 9^th; and even by the list of 2018 technology breakthrough proposed by MIT Technology Review.  All these arguments are based on old rhetoric expedient – first described by Aristotle – called “enthymeme,” an argument in which a critical supporting fact is omitted or only implicitly suggested.  If one looks more in-depth, the argument about next-generation vaccines first states that significant technical innovations in vaccines are expected in 2018; second, it affirms that this will dramatically contribute to avoiding infectious diseases and epidemics; what is missed? An explicit statement about the relationship between “new ways of developing, shipping, storing, and vaccinating” and the occurence of diseases, in real human, environment, and zoonotic communities. The argument takes as granted that this relationship is linear, while it is not. 

Vaccines are hardly drugs aiming to cure an individual; they are a way to modify the state of immunization of a population. A vaccination campaign fight against an infectious disease by increasing the number of hosts who are resistant (immune) to the particular microorganism that produces the disease in a community.   This modification is not a goal per se, rather it is instrumental to prevent, control, or eliminate the infectious disease. More targeted, better distributed, easily delivered, vaccines, are welcome, but 1) we know that this is only an element, hardly the most important one, in real life vaccination; 2)  there are several critical societal, economic, cultural, variables that are more important in determining failure or success of vaccination campaigns; 3) ultimately, the relationship between infections and diseases is rather complex, in many cases it is very difficult to predict from modifications of the immunity status of a population, the real evolution of  the  disease. Vaccines do not provide any certainty to the single individual, because individual immune response depends on the whole of host-pathogen interaction, including the overall health conditions, state of nutrition, pathogenic variability in hosts, the germ loads, and so.  The mere fact that one has been vaccinated does not guarantee against developing the disease – as well as it is not the sole possibility to avoid it; further preventive measures are always necessary, they are sometimes even more important than vaccination. Failing to communicate this central tenet could easily jeopardize any vaccination campaign.

Vaccinations have two possible objectives: 1) the elimination, or 2) the containment of the disease.  Elimination means full removing of the disease and its causal agent from a geographical area. Elimination requires universal vaccination, which is very difficult to achieve and could be even risky at the individual level. For instance, universal infantile vaccination raises the age in which the disease appears (“building up of susceptible”), and some infectious diseases may have a more severe course in adulthood (e.g., mumps), with a grave impact on population health. Moreover, the objective to drastically raise the “herd immunity,” inherent to any infectious elimination campaign, depends on many factors falling outside vaccine technology, such as modes of transmission, interspecies transmission, the degree of genetic and antigenic variation, and so. If these concepts are not communicated and well understood, vaccines could raise excessive expectations, easily followed by disillusionment and skepticism. Containment aims instead to reduce morbidity and mortality to “acceptable” levels.   In such, more frequent, cases, selective vaccination of groups and individuals is the most appropriate strategy. Also, with containment, communication strategies are thus a critical variable, because targeted groups and individuals should be convinced to take a preventive measure (vaccination), which is not asked to the majority of the population.

In conclusion, if the objective of medical breakthroughs should not be mere modifications of some biological parameters, but the real health conditions of a human population, it would have made more sense to consider current trends on data science and predictive analytics to influence individual and collective behaviors. Like it or not, they are the real breakthrough which is promising to change, for good or bad, the global vaccination scenario in 2018 and further.