SGU Episode 862

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SGU Episode 862
January 15th 2022
(brief caption for the episode icon)
SGU 861                      SGU 863
Skeptical Rogues
S: Steven Novella
B: Bob Novella
C: Cara Santa Maria
J: Jay Novella
E: Evan Bernstein
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Introduction

Voice-over: You're listening to the Skeptics' Guide to the Universe, your escape to reality.

S: Hello and welcome to the Skeptics' Guide to the Universe. Today is Wednesday, January 12^th 2022, and this is your host, Steven Novella. Joining me this week are Bob Novella...

B: Hey, everybody!

S: Cara Santa Maria...

C: Howdy.

S: Jay Novella...

J: Hey guys.

S: ...and Evan Bernstein.

E: Good evening folks!

S: How is everyone feeling, we're right at the peak of the Omicron surf.

B: Woo-hoo!

S:

E: I'm feeling fine.

S: It's amazing to think, if I told you two years ago, that in two years, we would be breaking records for new infections with the pandemic that would've been mind-blowing.

J: Yeah.

B: Yeah.

C: Oh yeah, yeah we would definitely think we'd be on a downswing by now.

E: Yeah, these variants, though. Who knew there could be, I don't know 50 variants by now?

C: Probably most epidemiologists (laughs) They were like we totally saw this coming.

J: Well, of all the zigz and zagz though I mean this, this potentially could be the normalization or downturn of the pandemic, you know? Like things might actually start to become a little more normal.

E: You mean it burns itself out?

J: Yeah, like, you know, Omicron is less dangerous to a certain degree. Right, this is what I'm reading.

S: More infectious.

C: Depends on what you mean by dangerous.

S: It's still a bad virus. Don't, I think the reason most people who are getting infected have a very mild infection, cause they're vaccinated. Among the unvaccinated they're still going into the hospital and dying. It's still a severe illness.

E: Yeah, oh my gosh, so scary.

J: And at this point, they're not gonna get vaxxed, you know, the numbers are so moving slowly slowly. So I wanted to ask you Evan...

E: Jay.

J: Are you experiencing any fatigue?

E: You mean still, now that I'm basically three weeks removed from my initial diagnosis? My initial test?

J: Yes, yeah.

E: My fatigue has gone, I'm back to feeling myself again pretty much head to toe. But, but, for about 14 or maybe 16 days there I was feeling fatigue, no doubt about it. Took me a couple weeks to get right.

J: Yeah, I'm still feeling it. I'm still feeling that fatigue and I was reading about it and you know it's like they're saying like it's totally legit. You know having a virus like this could, can fatigue you up to weeks, some people up to months.

C: Yeah and people with long Covid even longer, people who had super severe infection and are still dealing with that. It's also one of those hard things cause there is so many Jay variables at play. Like I was looking into, I have friends that are pregnant right now and some of them who have Covid. And I was trying to look at the literature on pregnancy outcomes and I came across some interesting studies that in some findings are showing that there is a slight correlation of like low birth rate. But not with active Covid infection. They were finding that people who tested positive and those who tested negative who gave birth during the pandemic have lower birth rate on average.

E: So what's that attributable to...

C: Stress.

B: Yeah.

C: You know it's not a healthy time for anybody. And so it's one of those really hard things where it's like, I'm fatigued and I ain't even had Covid. And I think that this is a common experience for a lot of people. We're isolated, we're not having the same interactions that we'd been having with colleagues, with coworkers. We're constantly feeling that sort of chronic fear and concern about infection, you know, all day every day, thinking about what if, and thinking about life out there versus the safety in here. It's not a healthy way to live.

J: Oh yeah, I know I mean I have friends who are telling me things like 'I don't care anymore, I gotta get back to my life'. And you know, as I'm talking to them and I'm saying, my inner voice is saying 'you should tell them don't do that'. But I, lately I've been going 'yeah man, I get it' (laughs) you know what I mean? Like I totally understand like I can't even argue anymore. Like enough already.

C: Yeah. It's like how do we find that happy medium.

S: It's a combination of a new variant that's very infectious and pandemic fatigue that's responsible for the explosion, you know, the spiking numbers. I mean I can't it seems like everyone I talk to either has recently had Covid or know somebody who has family members or people close to them who did. Very different that at any point during the pandemic, really, you could feel how much more common it is at this point in time.

C: It's so common and also anecdotally in my experience all of my friends and sort of people that I know who caught it traveled over the holidays.

E: Interesting.

S: Yeah the holiday was another factor. But we'll get through it, you know a lot of people are asking us, is this the way to herd immunity, and the answer is yes and no. I mean because so many people are catching it that will absolutely increase antibody resistance afterwards. But it's still not the way that we wanna get there. Because it's still a bad idea and absolutely do not deliberately catch it for the immunity part of it, cause you're better of getting immunity from the vaccine ad it could still be a serious illness, you get still get long Covid. Don't count on this being mild and should continue to try to avoid getting the disease. But we're, we're at the hospital getting overwhelmed peak now, you know.

C: It's seems like the most promising evidence though coming out of South Africa is that this hopefully will not be a long lived peak. Like South Africa is already sort of on the other side of their peak. And so the hope is that that's going to happen to us soon. Think it was a umber of things, we happen to get Omicron at the right time like you said, at sort of the time where everybody was dealing with pandemic fatigue. And also right over the holidays.

S: And over the holidays. The perfect storm.

E: Yeah the holidays.

C: Yeah, yeah yeah yeah but hopefully it is gonna sort of slow down soon. And we will get that relief. What I'm finding too, are you seeing this Steve, that a lot of e-mails that I'm getting from the hospital are saying things like, they're back to cancelling─

B: Elective.

C: ─certain surgeries, yeah elective surgeries and things like that. But they're saying it's not so much because they're overloaded with patients but because so much of the staff is out sick.

S: Yeah, exactly. Like with schools we can intend to keep the schools open but teachers are out quarantining cause they have Covid, you know.

E: Right, what's the point.

S: Might not have a choice. GET VACCINATED.

News Items

S: All right let's move on to some news items, I'm gonna start. This is a cool one.

Xenotransplant from Pig Heart (06:43)

• Breakthrough Heart Xenotransplantion from Pig

S: The short upfront is, the headline is: 'transplanted a bioengineered pig heart into a human'. A live human. So, here's the story, this is the same company that provided this pig heart, this bioengineered pig heart that provided the bioengineered pig kidney over the summer. Remember so over the summer we talked about they did surgery where they connected a kidney to a patient who was brain dead, right, so because they were brain dead, but their organs were still alive.

C: Yeah we just did that, it was like a month ago, right?

S: It was over the summer.

C: Oh, pff, Jesus (laughter) sense of time.

B: Where were you being girl.

C: Wow.

E: Wow, time warp.

S: And they kept it connected for 54 hours and they just to see is it going to is there gonna be some immediate rapid rejection. Or it will let survive and it did survived, it filtered the blood, you know it made urine so that was a positive test. That kidney only had one gene modified. Not the same company Revivicor, they have pig hearts that have been genetically engineered to reduce rejection you because they are, you know that's a transplant from a different species. And they have ten genes that they modified. They silenced four genes, three of which to minimize rejection one of which was to keep pig heart from growing to big. And then they inserted six genes. So these are to essentially make the pig heart have more of a human like immune system and to just stop some of the, to make it less immunologic. Less likely to trigger an immune response and also to be more compatible with a human recipient.

B: Steve, what technique did they use to insert inside...

S: You know I could not find─

B: What?

S: ─I looked specifically for that and I could not find the answer to that.

B: Are you kidding?

S: But it's probably CRISPR, so there's a, there a several companies that are doing this. There's another company who is working on bioengineered animals as organ donors. You guys remember George Church his book at...

B: Yeah.

C: Oh yeah, the de-extinction guy.

S: Yeah, Harvard geneticist. So he co-founded a company called eGenesis and they are using CRISPR to bioengineer pigs for organ transplantation. They're not quite at the point yet where Revivacor is however.

B: So they're bioengineering it at the embryo stage.

S: Yeah, they they need, have to grow till they're big enough so the organs are big enough to be transplanted. So it could take years. All right so they, they provided the heart and this is now more bioengineered than previous attempts. This is not years of research leading up to this. The surgery was done on a gentleman but the name of David Bennett, he's a 57-years old and has terminal heart disease. Basically he was he has very short time to live. And his choice was, get the experimental pig heart transplant or you die. That was literally his option. Now because he was otherwise terminal the FDA gave the emergency use authorization under their compassionate use guidelines, right, so they authorized the whole procedure. The procedure also includes, there's like three experimental─

B: Beautiful.

S: ─aspects to this. One was the pig heart itself. He also is receiving experimental immunosuppressive drug, anti-rejection drug.

C: Oh so that kind of confuses things a little.

S: Well, you know they just, that's always the debate when we're doing trials like this. If you do several things at once you have a greater change of success but then you don't know what the effect of each individual component was. But in this case you have to do this, right, you have to.

C: No of course I mean compassionately you have to.

S: So that's there's a drug being developed by Kiniksa Pharmaceuticals and also co-developed by Muhammad Mohiuddin who is director of the University of Maryland School of Medicine’s cardiac xenotransplantation program, they're the ones who did the surgery. The actual surgeon was Bartley Griffith, this is the third component, he had to develop the surgical technique to adapt the pig heart to the anatomy of human vascular system. It's not an exact match, so you had to do, you had to be creative to get everything to hook up properly. So that's it.

B: So xeno, did you say xenotransplant? Is that what they do aliens now? What the hell, whaa...

(laughter)

C: Species to species, right?

B: Xenomorph.

S: Alien to humans. Yeah.

C: So cool.

S: So this happened, this is Wednesday, happened last Friday, so you know the patient has been doing well. Still getting some cardiovascular support, so he's not completely independent of machinery yet, I think they're just making sure the heart's working, it's not, there's no immediate rejection, but you know it started functioning, started beating, the heart seems to be working. So far so goo, but we'll see. We'll se how long, how long this lasts. This is obviously the point of all this, it's experimental, but he's now on borrowed time so everyday he lives with this heart is a bonus essentially.

B: Wow man.

S: Of course this, for little bit of background, you know the success of transplantation, it's all about the genetic match, right? The closer the match, the less of a probability for rejection, the more distant the transplant and the donor genetically the more likely that the there's a Graft-versus-host disease the transplant organ can essentially reject the host, but also the host can reject the organ.

B: Oh wow.

S: The closer the match the better, that's why like if you have a close family member who's a very very close genetic match that's always best.

B: That's why I love you Steve and Jay.

S: Or an identical twin, right? Obviously would be optimal. Now going to pig is really farther field, it's not even a primate. There'd be no chance of viability. If you just transplanted a normal pig into a human.

B: You said it would be immediate, would that be like like the hot wire hitting the alien blood, I mean what would happen?

S: Yeah, but it would be within days. Yeah, like immediate rejection. The heart does not even start to function you know. That's why they did that 54h kidney test. OK, good, it survived, the immediate like rapid rejection phase, that's good. And again this heart is ten times as many genetic modifications. So if all goes well, how big of a deal is this, right? How big is this? I think it's potentially huge. Assuming that he survives for a year or two, let's say. Let's say reasonable long time. That it would be worth the whole process. Even if it's only for, say, months, we would be further away from where we need to be but it would still be an incredible milestone.

B: Yeah and imagine you can give all these people a few more months of life. That's more time on the list and more of a chance to get a real heart or...

S: It could bridge to a human donor, so there's over a 100 000 people on the waiting list in the United States alone for an organ.

J: Oh my god.

B: 17 die a day.

S: 17 people fie every day, yep, on the donor list. Anything that could decompress this list would be a huge, would be huge. And so for now, clearly, you now it's still highly experimental, so for now I imagine only people who are otherwise not a candidate for a human door, which he was not, and would die without the transplant would be eligible again like on a compassionate experimental use. But at some point, we'll get enough evidence, enough data, it could get approved for routine use. At some point assuming the technology continues to work. It could actually replace human donors. Like be as good as human donors. And then there's no reason why it can't get even better than human donors, because─

B: Aaaa, let's explore that.

J: How's that?

S: Because for a human donor obviously we're not genetically engineering people to be organ donors.

C: Right so there's still a massive rejection─

S: Remember that movie The Island?

B: Yes!

E: Oh yeah.

S: Yeah, you still need a lifelong immunosuppressive drugs. Where rich people had clones of themselves like live on an island and then when they needed organs they would harvest, you know, their clones? So that's not gonna happen, right?

B: Why!?

S: In animals you can genetically engineer them so we could theoretically and there's no reason why we cannot do this we may run into obstacles, but there's no theoretical reason that we know of right now, we could not only generically humanize the immune system, the proteins in the pigs that they more compatible with the human recipient. We could also just reduce the extent to which they provoke an immune response. And then you could theoretically make either sub types or even tweak the hell out of the genetics of a pig for example to be a really close match to the intended recipient. You just need some lead time but a lot of people have a long lead time, they know, yeah, in five years they're gonna need a transplant, that's like the longest you're gonna be able to live in this situation. So we could get to the point when we're growing really high quality tightly genetically matching organs for human transplantation.

J: Steve wouldn't the lifespan of a pig come into play here?

S: Yeah that's a good questions, what's the lifespan of a pig heart in a human.

B: Interesting.

E: Unknown.

S: There's no reason that it couldn't theoretically survive as long as the person does. Like it wouldn't be the limiting factor.

B: Do a lot of pigs die from heart attacks?

S: We will have to find out. Yeah, over time.

C: I'm wondering if there's any sort of ethical backlash and this maybe a bit of a logical fallacy but my mind goes to you know, it's an unsavory premise, this idea of sort of like farming animals so that we can use their, harvest their organs for human life extension or human treatment. And the logical fallacy comes in cause like yes, we already do that, we already do that all the time. We have done it for as long as there has been medical history and we do it for food.

S: We raise a hundred million pigs a year to slaughter them for food.

C: For food, exactly. But that does necessarily, because we already do it, does that necessarily sort of give us a blanket, like yeah, so that just mean this is ok, and we should, we don't even need to consider any of the ethics around it.

B: It's not a new line, I mean.

C: That's what I'm saying. Just because it's not new, does that mean like let's keep extending the practice for example.

S: This discussion is happening within professional circles, what are the ethics of doing this. And it's again the idea is as long as the animals are treated humanely, it doesn't violate any existing rules on using animals for research or medical purposes. So it can be completely compatible with existing ethical laws. And again looking at, I know if you're like a 100% against any use of animals this is one more use you're not gonna be for it, right? But we live in a world where animals are raised and slaughtered for food. What I predict is there will be pushback, there will be pushback from the Luddites who are like you can't mix animal and human proteins like there was with a girl, Baby Fae with the baboon heart. And there are people who just, just protest anything. It's against gods plan or whatever the hell.

E: Yeah it's not, yeah right.

C: And I do think that there's a certain level of legitimate ethical concern about using animals at all for as sort of like a harvesting, a sort of like a conduit and a reservoir for us to just use them as we want in order to increase human you know health and wellness and lifespan. I do think that that's legitimate concern but you're right in the context of what we already do we have to take with all of that information. But I don't think everybody who's against this kind of work is necessarily...

S: No, there's range, there's again there is the let's explore the legitimate ethical considerations here and at the other end there are the luddites who will just say this ain't natural.

C: Yeah, exactly (laughs) yeah.

S: But, I predict that when these organs are actually saving people's lives all of those complaints will be overwhelmed.

B: Like test tube babies.

S: Yeah, it will be like, the protest, it will be just as successful as pushing back against test tube babies. there was kind of a splash in the culture. And then it just became in vitro fertilization and the only one who cared about it were the doctors and the people, and parents who wanted kids but couldn't otherwise have them. If you have somebody in your life who is going to die without an organ transplant, you're gonna be really in favor of this technology. I mean...

E: Yep.

C: You know what this reminds me of, is I'm seeing all over social media now sort of like memes and tweets of physicians saying it's really funny how many patients don't wanna listen to me when I tell them about why vaccines are so important prophylactically but they're more than willing to take all of my advice and all of my treatment when they get sick with Covid.

J: Yeah the more desperate you are...

E: Their mode changes.

B: Steve, what about the idea that I have heard for cloning, what if you could develop, what if you could raise, create a body, your twin but like, what's the term - decefalized, with no brain.

S: Anencephalic, yeah.

B: I can imagine there would be anymore near the amount of pushback if it's just tissue...

S: No I think there would me more.

C: Whoo, o way that's ever gonna pass ethical boards. I think it's gonna be way more pushback for something like that.

B: So like, so raising a pig, so creating a pig with no brain to take it's heart it's gonna be worse than a real...

C: No you just said people.

B: Well I mean I was comparing, I was comparing it.

C: (laughs) There's a big difference there.

B: Well there is but I was just pointing out the similarity, the same thing is said about people. About clones. If you're like, like the Island. If you're raising, if you're raising a clone, purely for transplant tissue and of course there's a problem with that, this is a living breathing human being. It's obvious to me and to a lot of people all of us I assume that you just can't raise a person like that as in the movie and then harvest their organs when you need them. But if it had no brain, you know, makes it a little bit of an easier decision.

C: But it's not an easier sell. I don't think.

B: Should be.

S: Bob, Bob there's already a group of people who are fighting for the rights of anencephalic children to live. To be treated as a whole person.

E: Oh my gosh.

S: So a certain percentage of infants are born without a brain, their brain never develops so they're literally called anencephalic, meaning no brain. And they have no brain, right? But there are parents who vigorously defend their right to do anything medically necessary to keep them alive as long as possible. Even though it's kind of futile care.

B: I'm sure.

E: How long a body can last without a brain?

S: Just to put this into perspective, if we consider the alternatives to this, you know, one would be cloning I think that's just nowhere on the radar ethically, culturally acceptable, scientifically acceptable at this point in time. Human cloning is just not on the table at present. You could make mechanical organs, like mechanical heart, etc. And that technology is incrementally advancing but it's really challenging and getting them it's just a challenging technology. Why don't we have flying cars, it's the same kind of thing there's some inherent problems. How are you gonna power it? How are you gonna make it soft and gentle on the blood cells. Even being a little bit harsh around the blood cells really can reduce the life expectancy of your blood cells and the mechanical heart has to function perfectly for years, it's very challenging. I think that's headed towards a stop gap measure, just making better and better mechanical ways to keep people alive while they're waiting for their biological heart transplant. And then there's the 3D printing organs, right?

B: Yeah, scaffold and stuff.

S: Using some kind of stem cells, on a scaffold, I think that's really tricky and I just don't think it's gonna happen anytime soon. And then you could grow organs on animals, remember like the mouse with an ear on it or a nose. So you could take like, that's like the closes we get to cloning when we're gonna take your genetics, sort of your basically, but not a whole you, just grow like your organ so would we grow human heart in an animal. Or we genetically engineer the animal to be compatible so I think of all the various options, this is the best one, it's I think scientifically most viable.

C: Politically it's the most viable too.

S: Practically it's the most viable, this is I think thing that's gonna happen first. Once we can grow hundreds of thousands of organs for transplantation it's gonna be such a game changer medically. Noone's gonna look back. Noone's gonna wanna go back.

C: Yeah like can you imagine being able to like legit schedule organ transplantation? Like right now it's, it's a lot when organs become available. it's a rush.

S: Yeah, it's a whole elaborate system of matching the donors and the recipients it's geographic as well as genetic. It's really challenging. We had someone close to us, Mike Lacelle, dear friend of us that we met through the show and worked with us for a while. And we knew from the early days of our relationship that he had a bad heart, he had a developmental abnormality and he knew that he wasn't gonna live old age with that heart at some point he was gonna face that transplant or die kind of branching point.

E: He had like five surgeries in his the course of this life.

S: Oh yeah, just to get him going. He got to that point and they told him you're not a candidate for a heart. That was it. And he didn't get one and he died. Would you be ringing your hands over the ethics of growing a heart in a pig if that was made available and he was still alive today because of it? Not for a nanosecond.

J: Not a chance.

S: Not for a moment.

C: Yeah it's very easy to talk about these kind of things in the abstract.

S: In the abstract, yeah.

C: It's much harder to do when it applies to you that's for sure.

S: Absolutely.

All right, let's move on, Jay tell us how scientists are already thinking about the next pandemic.

Managing the Next Pandemic (25:46)

• Preparing for the Next Plague

J: So the question is how do we prepare for the next one? And it's incredibly complicated answer because of how many moving parts there are.

B: You write down what we learn and you don't throw it away.

(laughter)

J: Exactly.

C: Yeah, right?

E: Or ignore it.

C: You actually look at the books that were left for your administration.

J: So most people particularly in the United States you know like back in 2016 the Obama administration created a pandemic response 'playbook'. But that you know really in the big scheme of things whit all the things that are going on now, that really is pretty minor, you know, there's just so much effort going on now. So both the US National Institute for Autoimmunity and Infecious Disease or NIAID and the US Defense Advanced Research Projects Agency DARPA they bent resources to create pandemic countermeasures and this has been going on for a while now. As an example the mRNA vaccine platform that created the Covid vaccine was funded by both of these agencies. And that goes back well over a decade now. The mRNA platform worked amazingly well, right? I mean other than the people who completely deny science most people agree with that statement and this is partly because Covid was an easy target do to it's spike protein. And also there was extensive existing research on the SARS-Cov-1 outbreak in 2002, meaning we had an incredible amount of very useful information to go along with the mRNA platform. You know to develop the exact right spike protein situation that we needed to fight the virus. Next time you know new virus comes around we might not be so lucky, right? It could be something that is very difficult to build a response for. I think a lot of people were thinking, oh you know the mRNA platform did such a good job and they can find a cure in a week, you know. That was for this particular virus. And keep that in mind. The next one, it might not, it could take a year, two years imagine before they could develop a vaccine. So prior to and particularly since Covid scores of companies and organizations they've been revving up their research to develop new ways to deal with pandemics situations. It's actually really encouraging to know that billions of dollars are being invested into research and development right now, right, this money is out there, lot's of people are very excited about putting money into this because of how important it is and because there is an economic, a chance to make money. Of course, like business drives the world. So the people who are currently working on the mRNA vaccines have begun already working on ways to fight the next pandemic, whatever it is. The mRNA platform has significant advantages over previous ways to create vaccines and a one particular feature is that they can target more than one pathogen in the same vaccine. In the case of Covid this would allow us to make a vaccine that would work on more than one variant. Here we are we're somewhere in this pandemic a lot of us are hoping that we are tail end of the pandemic, and there's been 3 variants that have had a global footprint that have made a big splash in the water. There's been quite a few other of course but these are the big ones which you know, when the pandemic first came out, I never even thought about variants and all the complexity of what the variants introduce here. So in the case of Covid this would allow us to make a vaccine that would work on all the variants, imagine that. If we get a vaccine that can handle any variant that may come out in the near future as well. Or how about a vaccine that includes the flu vaccine, right, this technology─

C: Well I would love a combined flu and Covid vaccine, that sounds great.

E: Yeah please one shot, cover it all.

J: Well guys, it can do it. The technology that we have today, they can do it. In fact the company says in theory there's no limit to the number of RNAs that can be combined in the same vaccine. Please don't let your takeaway be that we're gonna start developing vaccines that have a hundred different things that it's gonna treat. Like right now they have two different that they're testing, one is in Phase III trails that has 6 mRNAs and another one that has 10 but it's not so fr down in the approval process. So these, you know this take time to develop. But they're saying theoretically they could develop a mRNA vaccine that could have dozens, tons of different things in there that could help lots of different viruses.

C: Quick question are they working, these ones that are in development, are they for viruses that we do not yet have existing vaccines for are they trying to replace older types of vaccines with mRNA vaccines?

J: That's an awesome question Cara, they say it.

C: OK.

J: I don't know, I couldn't find any information about that. This is what I do know though, they've tested theses multi variant vaccines that encode different proteins and they can detect antibodies against each individual protein. Which, think about how awesome that is. We don't know what they are, Cara, wish I had the answer for you but they're testing them right now and they're saying, hey we have antibodies for the three specific or for the six specific or the ten specific viruses that were targeting and the certain proteins that were targeting, we have antibodies for them, they can detect that. So it's working, the technology is working this mRNA platform is very, very dynamic it's gonna enable us to do a lot in this fight. But it's not the only thing out there. It's not the only thing, I'll get into that in a second. So Moderna says that they can likely speed up the vaccine creation process with their mRNA platform by improving their existing manufacturing and also their clinical readiness. So their initial Covid vaccines took 63 days from them sequencing the virus to beginning trials. That is so short. But developing the all the other things that need to happen after they sequence it, then a lot of that time is approval processes, you know, they have to get tons of testing done and approval and all that stuff. Now that hundreds of millions, are we at the billion mark yet? So many of these vaccines have been administered, we've learned so much the way that they work biologically and their overall safety. Hopefully, and this is what the researchers are saying that this will allow precious time to be saved during the approval process moving forward, because they've already jumped through so many of these hoops. And we'll know what's gonna happen biologically, ahead of time. So researchers are also working on like I said other ways to vaccinate using something called virus-like particles or VLPs. Don't confuse this with what are those called Cara? The NFTs?

C: Oh NFTs yeah (laughs) Non-fungible tokens.

E Non-fungible tokens.

J: Yeah don't confuse those with NFTs, these are actual Virus-like particles, they're not virtual, they're real. This kind of vaccine can be very easy inexpensive to manufacture meaning rollout can be much faster. So many other companies and organizations are developing new vaccine technologies which we're going to need because we don't want mRNA, the mRNA platform to be the only game in town. The Coalition for Epidemic Preparedness Innovations, C-E-P-I, or I'm sure they call in cepi, is working on ways to accelerate the development of vaccines that will target emerging infectious diseases. So along with that they wanna improve, here's the list, here's what the community at large that is working on vaccine technology wants to improve. They want to improve the stability, the productivity, lowering costs, improving safety and improving how long the vaccine response lasts inside our bodies. Now when you think about that that's quite a bit of things that they want to improve which means, that there's a lot of head room to make a lot of advancement here. We're at, in a way, we're at like a new era of technology with vaccines and there's so much growth to happen here, there's so much improvement which is encouraging if you think about it. It's really good to know that there's, you know we're not like squeezing out the last remnants of the technology that we have and the returns are gonna be minor. There is a whole world of stuff in front of us, that we could be using in new technologies that we could be developing to help fight against pandemics.

C: And not just pandemics, I mean that's the really cool thing about what you're talking about is you can look forward and say how can we use this new technology to fight against the new thing that's on the horizon, but you could also look backward and say how can we improve global health in regions were we've constantly fallen short.

J: Right.

C: You know if we have a multi-valiant vaccine for you know childhood illness that we can take into developing nations and say single shot, now you're protected against ten of the most common causes of death in children you know from birth to age five, like oh my god.

J: It's amazingly huge. Yeah, it game changing.

C: Game changing.

J: Absolutely. And we also have other organizations that have been working on RNA based vaccines, and these have also been proven to be effective. And other companies are developing monoclonal antibodies, now you've heard about these in the news, there are some treatments that are coming out, that are using this technology. There's enormous investments in to these technologies with many more companies and organizations involved that I couldn't get into. I mean when I was doing the research here, there is just so many companies that are doing this and adding to the body of knowledge. What we're seeing is that there are two standard approaches to preparing for the next pandemic. We have platforms like the mRNA vaccines that could be quickly developed, produced and distributed. Or, the second way we could handle this is we have pre-made stocks of broadly effective treatments like antivirals, antibodies and vaccines that are already created, already in the can, already ready to go waiting, you know it's like a bandaid package in your drawer that's just waiting to be used and these thing I know some of them are perishable but we would keep restocking them and have these types of medications ready, so when the virus does hit, we have all this stuff ready to go right out of the gate at hospitals. These broadly effective treatments, they won't target specific viruses but they'll work on viruses in general. So well-funded organizations are working on ways to target the 25 families of viruses that are pathogenic to humans and this means that in time we could be prepared to create cures for whatever kind of virus ends up being the next one. So we're gathering information about all of theses different types of viruses that we actually should be worried about. And then we prepare a body of knowledge for all this. This body of knowledge is being shared by other groups that are working on cataloguing all the current information we have and making it available globally so when the time comes to develop a cure more organizations can hit the ground running. This is really important, because ramp up and just distributing information and having them at the ready, you know especially during a time, like during the pandemic when you know human, human power could be at, at a premium, right, we need people to do things quickly. You know scientist might not have time to prepare information to be sharing with the community at large. So having all of this stuff ahead of time in the queue ready to go is very very beneficial. And again the next virus might not be so easy to deal with. So we need researchers around the world working on this to ensure that we have the technology that's there and also the money behind it, because like I said, you know money is the driver here. And that money, it takes a while for monies to be allocated and we need these programs in place, we need nations to have already allocated the money when the next pandemic hits.

S: Reminds me of the Ebola virus, you know? That, we knew what we had to do, and we didn't, just didn't do it and so we had a massive outbreak. OK now we really gotta do it and we only sort of prepared for the next one.

C: Don't we have a vaccine, that's kind of starting to show some effectiveness?

S: Yeah, it's getting there.

C: That's exciting.

S: It's getting there, absolutely. All right, Cara, tell us about bogus hangover cures.

Bogus Hangover Cures (37:51)

• PSA: Hangover Cures Aren't Supported by Scientific Evidence, Scientists Say

C: Yeah, I'm really liking this study that was hilariously I just discovered, cause the write-ups all came out earlier this year, you know like last week but this study was actually published on December 31^st, on New Year's Eve, it's all about hangover cures.

E: Yeah, New Year's of course.

B: Nice.

C: So there's a new-ish, no it's pretty new, study that was published in Addiction and it was a systematic review of multiple randomized placebo controlled trials. They couldn't do a meta-analysis because they found that in the published literature very few if any proposed hangover cures were tested multiple times, so there's not really reproducibility within the literature and so they weren't able to do a meta-analysis. So instead what they did, is they said we're gonna look at any sort of pharmacological intervention that has been proposed, to help with a hangover. I learned something new in reading this study, I did not know there is a medical term for hangover...

B: Oh, what is it?

C: Veisalgia.

B: Never heard that one.

C: Of course 'algia' we know means, is the suffix that means pain or suffering so analgesics help with pain and suffering. But it comes from Norwegian 'veis' which literally translates to 'uneasiness after debauchery'.

(laughter)

B: Oh awesome.

C: I love that so much. So yeah, a lot of people have been interested in developing a cure or at least a good treatment for veisalgia. And what these researchers, it was partially funded by the NHS, in the UK, it was also I think King's College in London. What these researchers did is they said we're gonna look at the literature, we're gonna look at everything that's been published and we're gonna try and understand the state of the published literature. And they were able to find 21 studies with the total of 386 participants, so not huge, clearly not something that people have said I wanna actually look at this scientifically. And they mentioned that no two studies used the same intervention. So like I said, they couldn't do a meta-analysis. And here were their main findings, what do you guys think were their main findings, if you had to guess?

E: I don't know, hydration is a key? Staying hydrated helps.

C: And if they had looked at that I think that they would have found that too, but you're right─

S: None of them works, nothing works.

B: Yeah, don't drink.

C: ─specific things, yeah. So not only do kind of none of them seem to work, the ones that do seem to maybe work, are, it's really hard to say that they work because their main finding was the methodology was garbage across all of these studies. They found that across these 21 studies basically none of them did they think what their standards should be valid. They found that there was a handful of things that you know may show promise like Tolfenamic acid or Pyritinol like they actually did show a statistically significant effect but that the methodology was so bad, that it's hard for them to say was it because of that, was it because they didn't control for certain things. Like some of these studies only looked at men, just straight up, like it's 1940. They're just like, no, we're not gonna test this on women at all. A lot of them is just a really low quality studies. So basically the outcome here is that hangover cures very likely don't work, even if they seem to work it could be that something else is at play. And it was interesting in the discussion I was reading, like why do you think hangovers happen?

S: Because of the downstream metabolites of alcohol.

E: Yeah what Steve said.

C: Right, and why do you get those downstream metabolites of alcohol?

S: Cause your liver metabolizes the alcohol into other molecules.

B: Drink to fast, to much to fast.

S: And they, well they build up. What's the main one, I'm forgetting the name of the top of my head the main metabolite that makes you feel like crap. Acetaldehyde and formaldehyde.

C: Acetaldehyde. Punk! Yeah so I'm actually gonna quote from the article really quickly and I think that this is a kind of solid overview, it's right at the beginning of their introduction.

Alcohol-induced hangover, or veisalgia, refers to the combination of negative mental and physical symptoms that can be experienced following a single episode of alcohol consumption starting when blood alcohol concentration (BAC) approaches zero

so tight you're not drunk anymore, it's after you were drunk.

The physiological mechanisms underpinning hangover are complex and not fully understood. Although alcohol and its metabolites are responsible for some symptoms, severity typically peaks when BAC has reduced to zero. Other factors including dehydration, immune dysregulation, hypoglycaemia, the presence of additional biologically active compounds in alcoholic drinks (i.e. congeners) and an individual's genetic factors are all thought to play a role in the manifestation of hangover symptomatology

. And of course in the, which I think is important, right, it's a complex interplay but you're right these metabolites are really important as part of that complex interplay. But in the discussion section, you know, one I think important thought is you feel like crap after you drink because you're drinking stuff that is not good for you.

S: It's poison.

C: It's poison! And you feel bad, and so although it would be great to come up with hangover cure it might actually be disastrous the same way that sometimes too much pain medication can actually prevent healing. Because you wanna not feel pain, of course, but pain is evolutionary important.

S: It's protective.

C: It tells us that something is very wrong, that's happening. And we know from people who have a genetic issue when they can't feel pain they often die younger, they often brake bones and don't realize it─

E Aaah, those stories are heartbreaking.

C: ─they have internal hemorrhaging, yeah the stories are terrible. And I think we can kind of use that as a metaphor here. Is it a good thing to completely cure a hangover? I don't know. Is that just going to sort of make drinking in large quantities more ok? Is it going to allow for people to do it and not worry about the negative consequences, because so often the immediate negative consequences of the hangover are the only indicator of how bad that drinking was for you because we don't often feel the chronic effects until it's too late.

S: Yeah.

C: Yeah, interesting. But interesting study, so you know, whatever you read on the internet in not always true my friends and that folk thing that somebody tell you oh just drink some ginseng and you will be fine, well the literature does not back that up.

S: Home remedies don't work, shocker [sarcasm].

E: Put an onion and some vinegar and put it by your bed.

C: Yeah (laughs)

S: All right Bob, I know that we've been talking a lot about the James Webb telescope but there's some actual updates for us, so tell us what's going on.

James Webb Telescope Update (45:46)

• The James Webb Space Telescope is fully deployed. So what's next for the biggest observatory off Earth?

B: So yeah James Webb Space Telescope in the news of course cause there hasn't been that long since it's launched. So the 10 billion dollar USD James Webb Space Telescope has officially, officially prevented me from having a heart attack by finally becoming structurally deployed in space. Fully structurally deployed. So what's next and what are some cool aspects of this mission that you may not have heard about? So most recently as we know it launched December 25^th, the secondary mirror tripod and both the primary mirror wings are in place so essentially what has happened at this point, as of Wednesday, January 12^th is that the origami shape that it hidden for launch has been completely undone, it's unfolded. But there's still a lot to do, but nothing that's nearly as high risk as what's already been done hence my lack of a heart attack. And so major milestones included that are coming up, there's a three month process of aligning all the Webb's telescope optics, this also insertion of its' final orbit around January 23^rd among many other, many other steps that need to be done. I've been so nervous though, partly though because I remember Hubble, I was around, I was alive when Hubble was going through its birthing pains─

E: Remember that well.

B: ─If you remember yes they discovered that it's mirror had a spherical aberration, yeah because they didn't wanna do the million dollars on the Earth cause they figured, aaa - we got it. It's flat enough. And it wasn't, huge disaster.

S: And the company, the company that made that mirror is in Danbury, Connecticut.

E: Yeah, Connecticut.

B: Near where we grew up, yeah.

S: It was actually local news for us, yeah.

B: And I remember it was a butt of jokes all the late night TV shows were making fun of NASA and Hubble it was, oh it was bad and very extremely disappointing cause of course we were so into it and so disappointed at that major screw up.

E: Right, the hype was huge, the hype was enormous.

B: Oh my god the buildup was like it what's it's been for James Webb, it was gargantuan. This was the first really, you know the first really of its kind at least I guess in optical wave-lengths. But, luckily Hubble was in low Earth orbit and they had an amazing, oh my god, an amazing mission that was able to repair it. But this repair cannot happen for Webb, because you know it's orbit is literally a freaking million miles away. If just one of the many complex mission critical steps failed, you'd have a very expensive piece of space junk, you'd have scientific carers in shambles essentially and you'd have crushed astro enthusiasts all over the world, especially me, most importantly. So many cool future scientific discoveries will then be pushed much further in the future. Sure, we'd eventually discover them, but how long will that take? I'd probably be dead. And I've enough of that, I've had enough of that delayed scientific discovery awesomeness in my life, thank you─

E: That's right.

C: Five to en years, you know.

B: ─very much. So yeah, so why then, why risk giving me an acute myocardial infarction and put the space telescope so far away from us, that repairs are basically impossible. When I first learned of this I was like, wait, why are we doing this? That makes no sense at all. But of course, it makes a lot of sense.

C: (laughs)

B: And it has to do with feeble infrared light, the minute heat signal that Webb is designed, was built to detect, are easily overwhelmed. So you have to keep the Earth, Moon and Sun behind it, 24/7, it's gotta be behind it and basically invisible, that would be ideal and that is what the Earth-Sun Lagrange 2 or L2 allows us to do. So L2 is a point a million miles or 1.5 million km away on the far side of the Earth, directly opposite from the Sun, right? Now Lagrange points, obviously I've done some reading today about this and yesterday and of course I've been reading about that for years. And oh boy, they've got some onion layers. Lagrange points, fascinating stuff. But let's see what NASA says about it.

Lagrange points are positions in space where objects sent there tend to stay put. At Lagrange points, the gravitational pull of two large masses precisely equals the centripetal force required for a small object to move with them.

So, essentially, the gravity of the Sun and the Earth and Coriolis and centrifical forces are interacting such that a third, far smaller object can basically hang out, like you know like it's in a parking spot. Once you're there little or no effort is required to stay there. Relative to the primary bodies, right? That's the Lagrange point. So, so this is where the James Webb Space Telescope will spend the rest of its life, until it's collected in a hundred years to be put in a museum of course.

S: A hundred years? I don't know.

B: Eeee, you know, yeah, I'm I'll predict a hundred years. It depends, you know how the singularity goes and stuff.

E: Isn't the mission only like a four or five year mission for this?

B: Oh, oh boy we will get there dude, we will get there.

E OK, all right.

B: But, did you know that Webb won't be exactly at the Lagrange point? Did you know that?

E: Till July or something.

B: No! No! It will never be at the Lagrange point. Never.

E: Always be kind of inching towards it?

B: No, no, not even that. This was a little bit of a surprise to be as well. I will be orbiting around it, at a distance greater than the Moon's orbit around the Earth.

E: Interesting.

B: Around, so that was fascinating.

E: So what it's compensating, it's a compensation for something.

B: We ll this is called a halo orbit it's very, it's very you know well known type of orbit. And they exist simply because they're intrical part of all Lagrange points with their, you know like I said, with their complex interplay of the two large gravitational fields and this centrifical force. That's just something that's spontaneously allowed because of the very nature of a Lagrange point itself. So they're using this orbit one one of the many, one of the primary reasons why Webb's that Webb is using it's specific halo orbit and of which there are many, there's lots of different halo orbits you can use, it's using it keep it out of Earth and the Moon's shadow at all times, right, so a great reason. You wanna, you wanna have your back to all that heat and light and you also you wanna stay out of the shadow, you don't wanna be in the shadow. So all of this with the Lagrange point and the halo orbits all that all of this is so Webb won't get fried by the infrared behind it. So further and definitively isolate from that heat it has its now famous tennis-court-size shield, right?

E: Shield, yeah.

B: Giving it essentially a SPF of one million, so Webb, I had it, I had analogy on this one, Webb is like that old failed McDonald's hamburger, remember those? Cara, you probably don't but basically it was cold on one side and hot on the other side.

E: Yeah, keep the hots [inaudible]

B: And then you put them together, and you put them together before you ate them and I think─

C: What?

B: Yes!

S: The hot stays hot and the cold stays cold.

B: Yeah and we are totally showing our ages again so we will stop it.

C: (laughs)

E: It was the nineties, it wasn't that long ago.

B: Oh man yeah it was a while ago, it was a while ago, didn't last very long, wasn't a horrible idea, I remember eating one, it was all right.

E: (laughs)

B: So in this Webb-burger you've had this (laughter) hot side facing us, so you have the hot side facing us, and that's almost at the boiling point of water, it's hot, very very hot. Right, so on that side you've got the solar panels of course, right they've got to be in the Sun, duh. You've got the computer, you've got the steering mechanisms and of course you've got the comms antenna which is always facing Earth and that's a huge benefit, that's a huge benefit of Lagrange too, for any mission that's been there, and there's been multiple missions there already. You've got the comms antenna always facing towards Earth it's always right there just a million miles away, that's really nothing. At least according to communicating frequencies. That's fantastic. So that's wonderful. But then on the other side of the heat shield is the cold side. The cold side of the burger is really cold.

E: Super-cold.

B: Its -388 degrees Fahrenheit, -233 Celsius. You could freeze nitrogen, that is crazy crazy cold. So on that side of the heat shield you've got the science instruments, you've got the detectors, you've got filters and of course you have the now iconic mirrors, they're all on the cold cold side. Here's another interesting thing I've discovered - there's another benefit to Lagrange point, and I mentioned it. You don't need to expand much fuel to maintain your orbit, right? In fact, Lagrange 4 and 5 orbits are very stable but L1, 2 and 3 are meta-stable. Now the difference between those, I found a great analogy online, somebody compared them to the flat top of the hill, which is the stable orbits, to a saddle, which is the meta-stable orbits, right? I think that was just a wonderful analogy. So imagine if you're in the gravitational field we're liking the gravitational field to the top of the hill. Which is easy to you know, walk around, hang out, no problems. But if you're on a saddle, you kinda gotta, you gotta work it, you gotta, you can stay on top of the saddle but it's not gonna be easy, you gotta work a little, so that's a difference between the different Lagrangian points, OK? Some are stable, some are meta-stable. L2 is meta-stable. So what that means then, is that Webb needs on board fuel to maintain itself on that L2 gravity saddle, right? Over the years, you gotta tweak your orbit a little bit so that you stay in L2, so you're gonna need this fuel. Now in fact NASA planned on enough fuel but get this, ten years. They say, aaa, OK.

C: That's it?

B: Will have ten years of fuel and that is just ridiculous. And I think at some point after all those meeting deciding how much fuel it would have, they finally realized, whoa, this was really stupid, so they were actually seriously considering planning inexpensive automated mission to bring it fuel in the future. But, then they got a Christmas present on launch day which was, f course, actually Christmas, so it made it especially appropriate. That's when the European Space Agency's Ariane 5 rocket really strutted it's stuff, that's the rocket that of course launched ad sent Webb on its way to L2. So it did its job so efficiently and so accurately that NASA now estimates that the fuel that it has remaining that it still has on-board in Webb's tanks should essentially double the space telescope's lifetime. From ten years to twenty years.

C: All because of that happy accident?

B: No, that's no accident, Ariane 5 is a kick ass, kick ass rocket system that's been developed for many many years and the European Space Agency worked especially hard on this rocket. Because they, all the components are modular for the Ariane 5's, right? They're all modular pieces, you stick'em together, you have a rocket. But when they were creating this individual sub components of this Ariane rocket that was made for Webb this was like, this was flagged for Webb, this is for the James Webb Space Telescope. So when they were making it and they were testing the sub units, if one sub unit tested especially well, like really really well, like of the charts, like this one is especially well made. They said, let's put that on the James, the James Webb rocket. So for the past, I don't know, year, two, or three, when they were assembling the rocket for James Webb they made sure that they put all the best components, the ones that just happen to be really you know a little bit better than all the other ones, that were identical, right? They're generally identical, but they were so of course, they were awesome, because they knew this was a very very high priority, very expensive, very important mission, so they made sure that James Webb had the best rocket. And because of that, not only are they just generally awesome, but just because of that extra attention, that is was so flawless, performed so efficiently, that there was much more fuel left over than NASA anticipated.

C: Yeah that's what I meant by 'accident'. It wasn't an accident, but they didn't plan for it, right, they anticipated only ten years which to bee seems so short-sighted. How long have we been using Hubble?

S: You have to think about it more is like this was a range of possibilities and they were, we just happen to end up at the high end of the range of possibility. So everything turned out as good as it could possibly have turned out.

C: Why are we limited to such a low range?

S: Well, listen, we can sit here and speculate, I'm sure there's a ton of legitimate reasons why that you know in terms of they have to balance a lot of things, you know. You got the rocket equation to deal with, you have the overall cost of the mission, the amount of equipment that's in there. If you put in more fuel, something's gotta come out or you gotta put it on a bare rocket. Whatever, there's all kind of reasons why this is a compromise they settled on and we're just lucky that we turned out at the upper end of the range of possibilities.

C: Totally. Which is great. I think it's one of those funny things that in hindsight so often we look at big missions and we luck out in the sense and maybe it's a Voyager bias, but we luck out in the sense that stuff seems to last longer than we ever anticipated. So why do we keep anticipating that it's not gonna last very long? (laughs)

S: I think that is partly marketing. I think you know─

B: Scotty, the Scotty effect. Montgomery Scott a little bit.

S: Yeah, undersell it and then go hey it worked out better than we hoped.

C: Right.

S: If you oversell it and the it looks much worse.

B: That's a best case scenario.

C: That's true but let's at least make sure that all the components are present so that if it does last longer we can do all the stuff we wanna do in that time.

B: I say based on my research that I think 20 years and all that fuel that was left over, I think that exceeded their best case scenario. That's just my take, I didn't hear that specifically but I think it exceeded it a little bit. My last thing is congratulations to the entire Team of humans and their digital helpers that they, this is an engineering tour the force, this is an amazing feat that they've accomplished, congratulations, this is just, this is one for the history books, this is decades. 10 billion dollars!

E: One of the greatest science accomplishments of all time, no doubt about it.

B: The fact that, the fact that when that this our civilization can put this much effort and this much money into something like this gives me the tiny little scintilla of hope that we're not doomed.

E: Power of science.

C: And robots, yey robots.

E: Yey robots, yes.

Battlefield Acupuncture (1:00:19)

• Authors unhappy as “battlefield acupuncture” paper earns an expression of concern

S: All right Evan we've spoken before about battlefield acupuncture. Essentially true believers trying to push into the military this idea that you're you know. Some soldier's been blown apart and you gonna stick needles and that's gonna help his pain or whatever.

C: Oh god.

S: So tell us the latest on this.

E: Yep, yep, because I read this very recently. But first! Battlefield acupuncture! That was a book by L. Ron Hubbard.

B: What?

E: Which was a work of fiction, like everything else he's written. Was set a thousand years in the future, when an alien race... oh, wait, no no, that's Battlefield Earth.

C: (laugs)

B: Nice, nice.

E: Sorry.

S: Can I tell you a guilty secret?

E: Yes please.

B: Yes! I may, Steve!

S: I liked that movie.

(laughter)

E: The movie!

B: Steve.

J: I mean there's nothing redeemable about it.

B: Wait, Steve, I'll join your side I saw it with of course not low expectations, negative expectations.

S: Yes.

B: What I've been hearing about it, I watched it and you know that wasn't nearly as bad as I thought. It wasn't horrific, it was you know, whatever, not a complete ant utter wast of an hour and a half. I was expecting far worse. And some of the tech, some of the tech was kind of cool. I kinda forget what it was now, but I remember thinking 'that tech was kinda cool'.

E: Well your opinion is I have to say in a minority.

B: Yeah so is Steve's.

S: I recognize it.

E: Rotten Tomatoes is fairly indicator, audience rating at Rotten Tomatoes - 12%, 50 000 screaming reviews.

B: It does not deserve 12%, I'll say that much.

E: The critics review it at 3%.

C: Oh god (laughs)

E: But that aside, I'm sorry, let me start over. Battlefield acupuncture. By it's name, Steve as you said, and I think our audience can really piece it together, acupuncture on the battlefield administered to wounded soldiers, it is, yeah, it's a real practice. And no, acupuncture is not medicinal, not on the battlefield, not in the hills, not in the streets or sees or space, nowhere it does not work. Steve I think you should write a blog post about it and title it: 'Let this be your last battlefield acupuncture'.

(laughter)

E: Cara that's a Star Trek reference fro TOS.

C: I like it, I like it.

E: Just so you know. So I found this at Retraction Watch, Cara, you like Retraction Watch?

C: Oh yeah.

E: Well they posted an article recently concerning battlefield acupuncture. So anytime I see acupuncture in a news item I'm like, bat with sonar, shark with radar, any other failed animal metaphor you can think of to describe my curiosity being peaked. 2011. Just a little bit of history. Forbes magazine dubbed battlefield acupuncture as the worst pseudoscience of the year. So it was invented at of whole cloth, I'm gonna read just a paragraph from that article: 'invented out of whole cloth by military doctor Richard Niemtzow' Nimsou, no Nymsow, is it Nimsou or Nymsow?

S: I don't know.

C: Who knows.

E: Richard Niemtzow. N-I-E-M-T-Z-O-W. And he runs or at least run an acupuncture clinic out of Andrews Air Force Base in Maryland. He was the leading advocate for the use of acupuncture or wounded soldiers, and yeah, his efforts have gone frankly a long way. The military publication start and strips reported this was in August 2011 that the Air Force had launched the program to train more than 30 military doctors to use acupuncture in war zones and at their base clinics. They were gonna expand the program as well, to certify 60 active duty physicians as medical acupuncture. That was 2011. Now, in 2017, we'll jump to 17, Stars and Stripes again, and their headline reads: Acupuncture becomes popular as a battlefield pain treatment. Yep, the US Arm Forces had hosted a hands on workshops in Germany, inviting other countries to come and see the effectiveness of battlefield acupuncture. They, it's a form of auricular or ear-acupuncture.

C: Wait so they think by sticking needles in your ear the fact that your leg has just blown off won't hurt anymore?

E: Effectively yes.

(laughter)

C: I don't understand that.

S: r they make more wishy-washy claims that are not falsifiable.

B: I think they were using it on battlefield splinters.

C: (laughs) Exactly, right? It's only effective.

S: So whenever acupuncture comes up, you know we always get some feedback about we're not being fair─

B: Oh god.

S: ─we're being dismissive, told you about there was like one bad review of our book, there's more then one, but the top tier review of our book was somebody who was, their main criticism was that we're critical of acupuncture, right? So I just have to give the very very quick version. Acupuncture is not scientific, it is not based on science, acupuncturists have no idea where the acupoints are, they can't agree on where they are, they have no basis in reality. And if acupuncture points don't exist then acupuncture doesn't work.

C: Right.

S: And there's no single indication for which acupuncture, meaning sticking acupuncture needles into acupuncture points has been proven to be effective over placebo i any kind of replicable paradigm. Doesn't exist, it's like ESP. It is the ESP of medicine. But I have to sort of give that overview every time it comes up.

C: And it's just bananas, that is has so much following.

E: Oh so much.

C: Given that it's not, it's like people would like to say just because there's no evidence to support something doesn't mean that it doesn't work, and it's like no, but we have active evidence to reject it.

S: Yes.

C: Like that's a very important distinction.

S: It's been studied to death, thousands of acupuncture studies, over decades and they have not been able to demonstrate efficacy. that's a failed treatment.

B: Yes. And that gives you the right, to be dismissive.

E: Yes it is.

C: Yes, exactly.

E: But does that stop things like the US military from engaging in it? No, in fact by again, 2017 a hundred military doctors were in the practice and they've received budgeting for development and implementation, education and training, about 6 million bucks over the course of 3 years, to advance the practice of battlefield acupuncture. In fact according to the director of the Air Force Acupuncture Program, that's in all caps, so that's an official program, the Air Force Acupuncture Program. 60%, this is 2017, 60% of their bases are trained up in battlefield acupuncture. And it says we're looking to get battlefield acupuncture as part of standard care versus a separate thing where we say you can have an alternative medicine. All right so that leads us to the Retraction Watch now late 2021 and I'll read to you their intro here: 'A journal has slapped an expression of concern on a 2021 paper reporting on the utility of self-administered “battlefield” acupuncture in soldiers', it's not an argument whether acupuncture is real, not, works, doesn't, no, the read... it was brought up by readers who said that the FDA has not approved the devices for that use, for self-administered battlefield acupuncture. So at this point I mean I'm paragraphing, I'm shaking my head, I'm like, what FDA approval of acupuncture needles as medical devices? Yes! Believe it, it's so true. 1996, the first year for the CSS to the FDA gave acupuncture it's first seal of approval when it classified acupuncture needles as medical devices.

S: No, Evan, no, that's not true.

E: That's what I'm...

S: I know that's what you're reading─

E: That is what I'm reading.

S: ─but that is a false I think impression of what's going on. The FDA did not give any kind of approval to acupuncture as a practice. They solely were approving the needles as medical devices which has exactly nothing to do with how their used. It just means they're not gonna brake off in you and you know kill you that way, that's it, the device approval has nothing to do with efficacy. It only has to do is that the devices themselves are not inherently unsafe.

E: And I know you understand that and I understand that but the practitioners and the people who are promoting it and marketing it, they take that and they say FDA approves this─

S: Yeah I know.

E: ─because look, they approved our needles and they make hey out of it.

S: Yeah, they lie.

C: It's so dangerous.

E: Yeah they basically lie.

E: Unfortunately the FDA is kind of in a situation where they have to do something like that, but it gets distorted, taken out of context and it contributes to the public consumption to snake oil, magical thinking─

S: Totally.

E: ─it helps to it. All right back to the paper real quick, now the study, the study that they were talking about in Retraction Watch it appeared in the journal Medical Acupuncture, that's the name of the journal, hmm, where they looked at the experiences of a dozen veterans at an Ohio VA hospital who purportedly self-administered acupuncture to treat chronic pain. So, ok a journal titled Medical Acupuncture, now I'm not tryana judge a book by its cover─

C: Right (laughs)

E: ─or it this case a journal by its name but I would wager that Medical Acupuncture the journal, not maybe most rigorous it at all scientific journal─

C: And something tells me it's not very critical of acupuncture either

E: ─that might be out there. So looking into it, oh, battlefield acupuncture which was pioneered, like I said by Richard Niemtzow a physician and now retired Air Force colonel, is a full time physician, acupuncturist in the arm forces, he is the editor in chief of Medical Acupuncture. All right, yeah, no conflict of interest there, no ethical considerations.

S: Evan, for little bit of further background, Medical acupuncture is a specific field. It is the use of acupuncture beyond just treating symptoms like pain, for treating things like actual disease. Cancer, whatever. Medical acupuncture is even, is an order of magnitude more pseudoscience and snake oil than just acupuncture for symptomatic treatments.

E: That's awful.

C: Right, because is there a world in which sticking a needle in your skin helps distract you from other kids of pain? Like is there a world in which the mechanism is not the mechanism they're saying it is, but that there is a relaxing effect or that there's you know, which is why we see sometimes self-report data that you know you see it anecdotally all the time people go, I get acupuncture and I feel great.

S: Yeah it is an elaborate placebo─

C: Right, right, right.

S: ─that's what it is. But of course the problem with that is that then people think 'acupuncture works', so I might as well use it for my cancer, that's the problem.

C: Yikes, god that's scary, there's no reasonable mechanism by which it should work. Like it has no face validity.

B: Right.

S: Exactly.

B: And plausibility is defining characteristic of scientific [inaudible].

S: Acupuncturists themselves cannot demonstrate that acupuncture points exist in their own research.

C: Even if they did, it would kind of only make sense for pain, like I don't even understand how acupuncture can do anything for cancer. Like it's just, oh it just blows my mind, it makes me so angry.

S: That's when you're getting to the magical chi-energy.

E: Yeah.

C: Yeah, yeah yeah.

S: Again it's like chiropractic for back pain against chiropractic for your asthma, you know.

C: Right those are like two different levels of bananas right there.

S: Yeah, right, they're both bananas but...

C: They're both bananas but one at least has a semi-plausible like sometimes people feel relaxed, they get their back popped, they go to see somebody, somebody touches them, it feels good to be touched, it's like, it's like massage, right, we know massage feels good, people feel good after they get a massage but there's not a lot of evidence to say it has any long-term benefit. Whereas, yeah, saying that you're going to get a massage in order to treat you're like kidney problems, is...

S: Yes, that's like saying I'm squeezing the toxins out of your feet or whatever─

C: Yeah, extra level.

S: ─this is going to cure this disease, that's the same relationship there. Yeah massages can feel good, but detoxifying deep massage, which is a thing is bogus.

C: Yeah totally, or craniosacral therapy or the thing where they don't even touch you, what is that, oh reiki.

S: Reiki, yeah.

E: Cara you wanna hear what one particular Air Force lieutenant colonel has to say. This is a consultant to the Air Force surgeon general. Her name is Patricia Macsparran, OK? This is what she says about battlefield acupuncture, I'm reading this as a quote:

She explains the science behind it with a reference to Dr. Seuss. When the body perceives pain, it sends a lot of fluid with anti-inflammatory products to fix it, she said. Under a microscope, those products “look a lot like Dr. Seuss monsters,” she said, and the body has a hard time clearing them out. “Acupuncture is sort of like a traffic cop,” she said. “If you know where to place those needles to push ionic flow to get things moving, you basically release that traffic jam so the body can heal itself.”

J: My god.

C: What. Oh my god there's like so many mixed metaphors and like non scientific things going on.

E: Oh my gosh.

S: The gobbledygook, yeah.

E: Here's the capper: 'Every organ in the body, including the brain, is represented on the ear. It’s a microsystem'. This is a homunculus, this is, I mean, this is dark ages thinking.

C: Yeah this is debunked hundreds of hears ago.

E: Oh my gosh, this is, this is, and Dave Gorski wrote─

B: This is Theodoric of York.

E: ─Dave Gorski put is so well, he said auricular acupuncture: is based on a physiological principle that makes every bit as much sense as reflexology, and I mean that in the worst way possible, basically the idea is that parts of the ear map to other parts of the body like a homunculus.

C: Yeah it's like iridology, like I can look in your iris and know what's going on in your pancreas.

S: Yes, exactly.

C: It's so made up.

E: It is so made up. Now the Retraction Watch has summed up their Retraction Watch piece it basically became, so it's self-use, FDA didn't clear people to use themselves it only by practiced people. And then the proponents of the acupuncture all came out and said, oh they totally disagreed with that, that's a misrepresentation, it's totally inefficient. And they said the criticism doesn't have anything to do with the data or scientific content of the study. Obviously, you know, having to defend the practice again. So you know we're talking about it sort of in this Retraction Watch piece and this narrow context of who's allowed to basically use the needles, can the people us it themselves or you know practiced, practitioners have to be the ones to use it based on FDA rules and stuff. Which is kind of narrow. But none of it touches the fact that you know, the whole thing, the macro of all of this is just the most blatant pseudoscience perhaps that's out there around today. And all codified and absorbed by US military and government institutions, we'll never get rid of it.

S: It has the best marketing of any pseudoscience in medicine, the best marketing, absolutely.

E: Crazy.

S: It's just crazy, yeah. All right, thanks Evan. Jay, it's Who's That Noisy time.

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