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Sunday, August 14, 2022

FBI Undercounts Armed Citizen Responders to Mass Killers, and Media Play Along

 The shooting that killed three people and injured another at a Greenwood, Indiana, mall on July 17 drew broad national attention because of how it ended – when 22-year-old Elisjsha Dicken, carrying a licensed handgun, fatally shot the attacker.

Guy Relford, Dicken attorney
Elisjsha Dicken, 22, armed citizen responder.

While Dicken was praised for his courage and skill – squeezing off his first shot 15 seconds after the attack began, from a distance of 40 yards – much of the news coverage drew from FBI-approved statistics to assert that armed citizens almost never stop such attackers: “Rare in US for an active shooter to be stopped by bystander” (Associated Press); “Rampage in Indiana a rare instance of armed civilian ending mass shooting” (Washington Post); and “After Indiana mall shooting, one hero but no lasting solution to gun violence” (New York Times). 

Evidence compiled by the organization I run, the Crime Prevention Research Center, and others suggest that the FBI undercounts by an order of more than three the number of instances in which armed citizens have thwarted such attacks, saving untold numbers of lives. Although those many news stories about the Greenwood shooting also suggested that the defensive use of guns might endanger others, there is no evidence that these acts have harmed innocent victims.

“So much of our public understanding of this issue is malformed by this single agency,” notes Theo Wold, former acting assistant attorney general in the U.S. Department of Justice. "When the Bureau gets it so systematically – and persistently – wrong, the cascading effect is incredibly deleterious. The FBI exerts considerable influence over state and local law enforcement and policymakers at all levels of government.”


As many on the left seek more limits on gun ownership and use in response to mass shootings and the uptick in violent crime, and many on the right seek greater access to firearms for protection, the media’s reliance on incomplete statistics in covering incidents such as the one at the Greenwood Park Mall takes on new significance.   

Google
Greenwood Park Mall: When shooting started, Dicken reacted in 15 seconds, at a distance of 40 yards.

The FBI defines active shooter incidents as those in which an individual actively engages in killing or attempting to kill people in a populated, public area. But it does not include those it deems related to other criminal activity, such as a robbery or fighting over drug turf.

The Bureau reports that only 11 of the 252 active shooter incidents it identified for the period 2014-2021 were stopped by an armed citizen. An analysis by my organization identified a total of 281 active shooter incidents during that same period and found that 41 of them were stopped by an armed citizen.

That is, the FBI reported that 4.4% of active shooter incidents were thwarted by armed citizens, while the CPRC found 14.6%. 

Two factors explain this discrepancy – one, misclassified shootings; and two, overlooked incidents. Regarding the former, the CPRC determined that the FBI reports had misclassified five shootings: In two incidents the Bureau notes in its detailed write-up that citizens possessing valid firearms permits confronted the shooters and caused them to flee the scene. However, these cases were not listed as being stopped by armed citizens because the attackers were later apprehended by police. In two other incidents the FBI misidentified armed civilians as armed security personnel. In one incident, the FBI simply failed to mention the citizen engagement at all.

For example, the Bureau’s report about the Dec. 29, 2019 attack on the West Freeway Church of Christ in White Settlement, Texas, that left two men dead does not list this as an incident of “civic engagement” because the perpetrator was fatally shot by a parishioner who had volunteered to provide security during worship. That man, Jack Wilson, told RealClearInvestigations he was not a security professional. He said that 19 to 20 members of the congregation were armed that day, and they didn’t even keep track of who was carrying a concealed weapon.

As for the second factor -- overlooked cases -- the FBI, more significantly, missed an additional 25 incidents identified by CPRC in which the active shooters were thwarted by armed civilians (see full list here). These include:

  • An August 31, 2021, incident in Syracuse, New York, in which a property manager pulled out a legally possessed 9mm handgun and fatally wounded a man who opened fire on a crowd outside a building. The district attorney credited the property manager with saving the lives of several individuals.
  • An August 11, 2021 incident in San Antonio, Texas, in which a woman who crashed into a parked car in San Antonio’s West Side neighborhood climbed out of her vehicle and began shooting indiscriminately at people who came out of their homes to rush to her aid. An armed resident fired back and shot the driver to death.
  • A February 13, 2019 incident in Colonial Heights, Tennessee, in which a man, after killing his wife, turned his gun on others in dental office where she worked. A patient who had a concealed handgun permit holder shot the murderer as he was aiming at another person.

 

Brazziell/Austin American-Statesman via AP, File)
Not counted by FBI: Jack Wilson, parishioner and killer of gunman, honored by Texas's Governor. 

These omissions and discrepancies are not surprising given the limits of data collection and the judgment calls involved in categorizing such incidents. Law enforcement agencies around the country do not provide comprehensive reports of active shooter incidents, so local news coverage is a crucial source of information. The FBI contracts out this work to the Advanced Law Enforcement Rapid Response Training Center at Texas State University and then reviews and refines its findings.

The CPRC discovered cases the Center missed, but even the CPRC’s approach almost certainly misses incidents. “[T]here’s no reason to think that the [CPRC’s] list is complete, since there may well have been such incidents that weren’t covered in the news in a way that would come up on the Center’s searches,” UCLA Law Professor Eugene Volokh wrote in June.

Asked about these discrepancies, the FBI declined to address them. A representative from the Advanced Law Enforcement Rapid Response Training Center, M. Hunter Martindale, suggested that its numbers were not definitive:

We do appreciate you sending potential active shooter cases for the FBI team to review for inclusion in the active shooter dataset. As promised, I sent the email chain to the FBI team yesterday. As I’m sure you know, the FBI Active Shooter reports are released on an annual basis. My assumption is that any amendment retroactively adding cases would likely be included in a release with the annual report.

Although collecting such data is fraught with challenges, some see a pattern of distortion in the FBI numbers because the errors almost exclusively go one way, minimizing the life-saving actions of armed citizens.

“Whether deliberately through bias or just incompetence, the FBI database of active shooters cannot be trusted,” said Gary Mauser, an emeritus professor at Simon Fraser University in Canada who has extensively studied gun control and defensive gun uses. Mauser’s concern dovetails with those voiced by Rep. Jim Jordan  in a July 27 letter to FBI Director Christopher Wray. Jordan alleged that whistleblowers have come forward claiming political biases in the FBI’s domestic terrorism data.

AP
"No correction was necessary," the AP reporter responded.

Despite these problems, the FBI’s numbers are routinely cited as authoritative by the news media. In its coverage of the Greenwood mall attack, the Washington Post linked to a Bureau report while informing readers, “In recent studies of more than 430 ‘active shooter incidents’ dating back to 2000, the FBI found that civilians killed gunmen in just 10 cases.”

In its Greenwood article, the Associated Press reported, “From 2000 to 2021, fewer than 3% of 433 active attacks in the U.S. ended with a civilian firing back, according to the Advanced Law Enforcement Rapid Response Training Center at Texas State University.”

When my organization emailed Ed White, the AP reporter who wrote that article, about omissions in the Texas State numbers, he responded: “Our reporting, citing the specific research by Texas State U. over a 20-year period, was accurate. No correction was necessary.”

News outlets often raise concerns that allowing concealed handgun carry will result in innocent bystanders being shot or in police accidentally shooting permit holders. White’s AP dispatch on the Greenwood shooting quoted Adam Lankford, identified as “a criminal justice expert at the University of Alabama,” who stated: "While it’s certainly a good thing in this mall shooting that someone was able to stop it before it went any further, let’s not think we can substitute that outcome in all past and future incidents. If everyone’s carrying a firearm, the risk that something bad happens just gets much larger."

Carl Moody, a professor at William & Mary who studies mass public shootings, told RCI that such warnings are misleading:

The media and gun control advocates always seem concerned with the worst possible outcomes when firearms are involved. We know that armed citizens do, in fact, stop active shooters. And while there’s a possibility of a bystander getting hurt, the data show that an armed citizen has yet to accidentally shoot an innocent bystander. We also know that the police have accidentally shot the hero citizen just once. That was in Colorado on June 21, 2021. That’s not something that would normally happen, because the police usually arrive long after the incident is resolved.

Experts interviewed by the Washington Post and New York Times argue that stopping these attacks should be left to the police. “I think you might get more individuals carrying, sort of primed for something to happen, which is particularly dangerous … in reality that’s the job of the police,” Indiana University Bloomington law professor Jody Madeira told the Washington Post.

PoliceOne
"In reality that’s the job of the police”: But in a 2013 survey, many in law enforcement begged to differ.

But many in law enforcement disagree. In March 2013, PoliceOne surveyed its 380,000 active-duty and 70,000 retired law enforcement officer members. Eighty-six percent of members believed that casualties from mass public school shootings could be reduced or “avoided altogether” if citizens had carried permitted concealed handguns in those places. Seventy-seven percent supported “arming teachers and/or school administrators who volunteer to carry at their school.” No other policy to protect children and school staff had such widespread support.

“A deputy in uniform has an extremely difficult job in stopping these attacks,” Sarasota County, Florida, Sheriff Kurt Hoffman told RCI. “These terrorists have huge strategic advantages in determining the time and place of attacks. They can wait for a deputy to leave the area, or pick an undefended location. Even when police or deputies are in the right place at the right time, those in uniform who can be readily identified as guards may as well be holding up neon signs saying, ‘Shoot me first.’ My deputies know that we cannot be everywhere.”

Similarly, Massad Ayoob, a self-defense advocate who has taught police techniques to law enforcement since 1974, noted: “When a life-threatening crisis strikes and seconds count, the real first responders are the citizens present.”

The FBI’s active shooting reports do not mention whether the attacks occur in gun-free zones. “The issue is that when places are posted as gun-free zones, law-abiding citizens obey those rules and would be unable to stop the attacks in those areas,” notes Professor Moody.

Surveys show that criminologists and economists had the same top four preferred policies for stopping mass public shootings. On a 1 to 10 scale where 1 was the least effective policy and 10 the most, American criminologists rated the following policies most highly: Allow K-12 teachers to carry concealed handguns (6.0), allow military personnel to carry on military bases (5.6), encourage the elimination of gun-free zones (5.3) and relax federal regulations that pressure companies to create gun-free zones (5.0). The top four policies for economists were the same, but in a different order: encourage the elimination of gun-free zones (7.9), relax federal regulations that pressure companies to create gun-free zones (7.8), allow K-12 teachers to carry concealed handguns (7.7), and allow military personnel to carry on military bases (7.7).

The general public seems to agree. An early July survey by the Trafalgar Group showed that a plurality of American general election voters believe that armed citizens are the most effective element in protecting you and your family in the case of a mass shooting. First on the list was “armed citizens” at 42%, followed by “local police” (25%) and “federal agents” (10%). [“None of the above” was the answer chosen by 23% of respondents.] A survey by YouGov in May – before the Uvalde, Texas, attack – found that by a margin of 51% to 37% American adults supported letting schoolteachers and administrations carry concealed handguns.

https://www.realclearinvestigations.com/articles/2022/08/10/how_the_fbi_undercounts_armed_citizen_responders_to_mass_killers_-_and_media_play_along_847128.html

Chip could make treating metastatic cancer easier and faster

 Researchers at the Georgia Institute of Technology have found a detection method that could revolutionize cancer treatment by showing how cancers metastasize and what stage they are.

Cancer spreads via circulating  (CTCs) that travel through the blood to other organs, and they are nearly impossible to track. Now, researchers at the Georgia Institute of Technology have found a detection method that could revolutionize  by showing how cancers metastasize and what stage they are. This could lead to earlier and more targeted treatment, beginning with a simple blood test.

When a tumor starts metastasizing, it sheds its cell into the blood. An individual cell often doesn't survive the bloodstream on its own, but clusters of cells are much more robust and can travel to other organs, effectively pushing the cancer to a metastatic state.

CTCs have proven difficult to study, let alone treat. Blood contains billions of cells per milliliter, and only a handful of those cells would be CTCs in a patient with metastatic cancer. Such intense filtration has been inaccessible using conventional lab methods. Most traditional filtration is too aggressive and would break the cluster back into  and ruin the ability to study the effect of a .

"That's what got engineers like me interested in this because we are really good at creating sensors, or small devices that actually do sensitive analysis," said School of Electrical and Computer Engineering Associate Professor Fatih Sarioglu. "We started developing technologies to catch these precious cells to help manage cancer better."

Sarioglu presented the research in "High Throughput, Label-free Isolation of Circulating Tumor Cell Clusters in Meshed Microwells," recently published in Nature Communications.

Creating the Cluster-Well chip

Sarioglu's lab invented a new type of chip called the Cluster-Well, combining the precision of microfluidic chips with the efficiency of membrane filtration to find CTC clusters. Using micron-sized features,  can precisely locate each cell in a  and determine if it's cancerous.

"Microfluidic chips give you more control as a designer to actually ask whatever question that you want to ask those cells," Sarioglu said. "It increases the precision and sensitivity, which is what you need for an application like this because you want to find that single cell out of many blood cells."

To rapidly process a clinically relevant volume of blood, the researchers relied on membrane filtration to make the chip operation more scalable. In effect, the chip looks like a standard membrane filter, but under an  the  reveals its delicate structure used to capture clusters while letting other blood cells pass through.

Practicality was just as important as functionality to the researchers. Although the chip is initially fabricated with silicon just like a  in a computer, it is later transferred to polymers to make it accessible, affordable, and single-use, while still retaining its delicacy and precision.

"We really created only the traps that we need to have for recognizing the clusters with the microfluidic chip, and the rest is just a standard filter holder," Sarioglu said. "Compared to a conventional microfluidic chip, you will get a much more practical assay with orders of magnitude improvement in throughput and a higher sensitivity."

Analyzing patient tumor cell clusters

The researchers used the chip to screen blood samples from patients with ovarian or  through a partnership with the Emory and Northside Hospitals. They isolated CTC clusters ranging from two to 100 or more cells from prostate and  and used RNA sequencing to analyze a subset.

The chip's unique design means CTC clusters are filtered in microwells and can later be accessed for further analysis. Even a single CTC can contain a significant amount of data on the patient and their specific cancer, which can be critical for managing the disease. For example, the researchers noted hundreds of CTCs in clusters in the blood of ovarian cancer patients, some still alive, a finding that could be consequential to the spread of the disease.

Also, by sequencing the RNA in prostate CTC clusters isolated by the chip, the researchers identified  expressed by these metastasizing . Importantly, CTC clusters from different patients were shown to express different genes, which can be potentially utilized to develop personalized, targeted therapies. Sarioglu envisions Cluster-Wells as being a routine part of the treatment process to determine what stage the cancer is at from a simple blood draw.

"Finding these clusters was very elusive," Sarioglu said. "But this is a technology that allows these precious circulating tumor cell clusters virtually in any cancer to be accessed with precision and practicality that has not been possible before."


Explore further

A new microfluidic system could keep tabs on cancer treatment

More information: Mert Boya et al, High throughput, label-free isolation of circulating tumor cell clusters in meshed microwells, Nature Communications (2022). DOI: 10.1038/s41467-022-31009-9
https://medicalxpress.com/news/2022-08-chip-metastatic-cancer-easier-faster.html

New way to control pain after knee replacement surgery

 In a recent study, Houston Methodist researchers presented clinical evidence supporting the safety and efficacy of injecting pain medication directly into the tibia during knee replacement surgery for better postoperative pain management.

The double-blind, randomized trial detailed in The Journal of Arthroplasty revealed that patients receiving a mixture of morphine and the antibiotic vancomycin injected into the tibia (more commonly known as the ) of their knee joint have less  post-surgery compared to those who received the infusion without morphine during surgery.

"Despite many technological advances, controlling pain after  can be challenging; most patients experience considerable pain and discomfort, especially in the first couple of weeks into their recovery," said Kwan "Kevin" Park, M.D.,  at Houston Methodist. "Intraosseous infusion, which involves injecting medication directly into the bone marrow, allows us to control pain pre-emptively so that patients don't have to take as much pain medicine later on."

Total knee replacement is the recommended treatment to alleviate  caused by damage to the knee joint from arthritis or injury. According to the 2021 American Joint Replacement Registry Annual Report, primary knee replacement surgeries accounted for 54.5% of the nearly two million hip and knee replacement procedures performed between 2012 and 2020.

Despite the high frequency and favorable outcomes of the surgical procedure, the manipulation of soft tissue and resurfacing damaged bones during knee replacement cause pain in the early postoperative periods.

"Twenty years ago, patients would remain in the hospital for several days after their surgery and receive extremely high-dose narcotics to help with their postoperative pain," Park said. "But there has been a ; patients are often discharged the same day after , and we use multimodal pain management techniques that work much better for  and require fewer narcotics."

These multimodal regimens, he added, often include a combination of medications, such as nonsteroidal anti-inflammatory drugs, opioids and neurogenic agents that act on the nervous system, administered both pre-emptively and after the surgery. However, opioid medications, although very effective in managing pain, have known side effects, like constipation and nausea, and some individuals are allergic to opiates. Opioid medication can be highly addictive, as well. Furthermore, a consensus on the optimal preoperative protocol to mitigate pain is lacking.

Previously, the researchers demonstrated that injecting the antibiotic vancomycin directly into the tibia before surgery helped in reducing infection by reaching a higher concentration of the drug in the knee. Motivated by this success, they investigated whether adding morphine into the tibial bone with a standard antibiotic solution could improve postoperative pain management.

For the study, the team included 48 patients needing total knee replacement surgery. Of these patients, half were randomly assigned to receive vancomycin and morphine injected directly into the bone marrow, using an infusion device that was inserted into the tibial tubercle region. The remaining were only administered vancomycin. Post-surgery, the researchers monitored patient-reported pain, nausea and opioid use for up to 14 days after surgery. Park's team collaborated with Francesca Taraballi, Ph.D., assistant professor of orthopedic surgery and director of Houston Methodist's Center for Musculoskeletal Regeneration, to measure the serum levels of morphine and an inflammatory marker called interleukin-6 in all study participants for 10 hours after the operation.

Upon analyzing their data, the researchers found that the patients who were given morphine in the tibial bone had lower pain scores after their knee replacements compared to those who did not. This was effective up to two weeks after surgery. Further, these patients also reported having less pain for several days even though they had similar interleukin-6 inflammatory marker levels as the control group. Taken together, although the patients who received pain medication infused directly into the tibia during surgery had comparable inflammation, these patients were taking less pain medication post-surgery.

Park noted that this infusion of opiates directly into the  during surgery could potentially even facilitate a swifter recovery of the knee joint.

"By infusing  intraosseously we're able to reduce postoperative pain for up to two weeks, reduce the number of pain pills  need and even possibly improve the function of the knee over time," he said. "Our technique also can improve the multimodal pain management protocol we have been using for  replacement over the years."


Explore further

Duloxetine added to multimodal pain management reduces opioid use after knee replacement

More information: Ava A. Brozovich et al, Intraosseous Morphine Decreases Postoperative Pain and Pain Medication Use in Total Knee Arthroplasty: A Double-Blind, Randomized Controlled Trial, The Journal of Arthroplasty (2022). DOI: 10.1016/j.arth.2021.10.009
https://medicalxpress.com/news/2022-08-pain-knee-surgery.html

Heart disease after COVID: what the data say

 Saima May Sidik

Some studies suggest that the risk of cardiovascular problems, such as a heart attack or stroke, remains high even many months after a SARS-CoV-2 infection clears up. Researchers are starting to pin down the frequency of these issues and what is causing the damage.

In December 2020, a week before cardiologist Stuart Katz was scheduled to receive his first COVID-19 vaccine, he came down with a fever. He spent the next two weeks wracked with a cough, body aches and chills. After months of helping others to weather the pandemic, Katz, who works at New York University, was having his own first-hand experience of COVID-19.

On Christmas Day, Katz’s acute illness finally subsided. But many symptoms lingered, including some related to the organ he’s built his career around: the heart. Walking up two flights of stairs would leave him breathless, with his heart racing at 120 beats per minute. Over the next several months, he began to feel better, and he’s now back to his normal routine of walking and cycling. But reports about COVID-19’s effects on the cardiovascular system have made him concerned about his long-term health. “I say to myself, ‘Well, is it really over?’” Katz says.

In one study1 this year, researchers used records from the US Department of Veterans Affairs (VA) to estimate how often COVID-19 leads to cardiovascular problems. They found that people who had had the disease faced substantially increased risks for 20 cardiovascular conditions — including potentially catastrophic problems such as heart attacks and strokes — in the year after infection with the coronavirus SARS-CoV-2. Researchers say that these complications can happen even in people who seem to have completely recovered from a mild infection.

Some smaller studies have mirrored these findings, but others find lower rates of complications. With millions or perhaps even billions of people having been infected with SARS-CoV-2, clinicians are wondering whether the pandemic will be followed by a cardiovascular aftershock. Meanwhile, researchers are trying to understand who is most at risk of these heart-related problems, how long the risk persists and what causes these symptoms.

It’s a gaping hole in an important area of public health, says Katz. “We don’t understand if this changes the lifelong trajectory for risk of a heart attack or stroke or other cardiac events — we just don’t know that.” Here, Nature looks at the questions that scientists are asking and the answers they’ve uncovered so far.

How many people are at risk?

Doctors have reported cardiovascular problems related to COVID-19 throughout the pandemic, but concerns over this issue surged after the results of the VA study came out earlier this year. The analysis by Ziyad Al-Aly, an epidemiologist at Washington University in St. Louis, Missouri, and his colleagues is one of the most extensive efforts to characterize what happens to the heart and circulatory system after the acute phase of COVID-19. The researchers compared more than 150,000 veterans who had recovered from acute COVID-19 with their uninfected peers, as well as with a pre-pandemic control group1.

People who had been admitted to intensive care with acute infections had a drastically higher risk of cardiovascular problems during the next year (see ‘Cardiac concerns’). For some conditions, such as swelling of the heart and blood clots in the lungs, the risk shot up at least 20-fold compared with that in uninfected peers. But even people who had not been hospitalized had increased risks of many conditions, ranging from an 8% increase in the rate of heart attacks to a 247% increase in the rate of heart inflammation.

Cardiac concerns: graph that shows the increased risk of developing various cardiovascular conditions after a COVID-19

Source: Ref. 1

For Al-Aly, the study added to the growing body of evidence that a bout of COVID-19 can permanently alter some people’s health. These kinds of change fall under the category of post-acute sequelae of COVID-19, which covers problems that emerge after an initial infection. This disorder includes — and overlaps with — the persistent condition known as long COVID, a term that has many definitions.

Studies indicate that the coronavirus is associated with a wide range of lasting problems, such as diabetes2, persistent lung damage3 and even brain damage4. As with these conditions, Al-Aly says that the cardiovascular issues that occur after a SARS-CoV-2 infection can decrease a person’s quality of life over the long term. Treatments do exist for these problems, “but they are not curable conditions”, he adds.

Despite its large size, the VA study does come with caveats, say researchers. The study is observational, meaning that it reuses data that were collected for other purposes — a method that can introduce biases. For example, the study considers only veterans, meaning that the data are skewed towards white men. “We don’t really have any study like it that goes into more diverse and a younger population,” says Eric Topol, a genomicist at Scripps Research in La Jolla, California. He thinks that more research is needed before scientists can truly quantify the frequency at which cardiovascular problems strike.

Daniel Tancredi, a medical statistician at the University of California, Davis, points out another potential source of bias. One of the control groups in the VA study had to get through more than a year without catching SARS-CoV-2 to be included in the study. There could be physiological differences that made the control group less likely to contract the disease, which could also affect their susceptibility to cardiovascular problems. Still, Tancredi thinks the study was well designed and that any bias is likely to be minimal. “I wouldn’t say that these numbers are exactly right, but they’re definitely in the ballpark,” he says. He hopes future prospective studies will fine-tune Al-Aly’s estimates.

Some other studies do point in the same direction. Data from the England’s health-care system5, for example, show that people who had been hospitalized with COVID-19 were about three times more likely than uninfected people to face major cardiovascular problems within eight months of their hospitalization. A second study6 found that, in the 4 months after infection, people who had had COVID-19 had a roughly 2.5-fold increased risk of congestive heart failure compared with those who had not been infected.

Health modeller Sarah Wulf Hanson at the University of Washington’s Institute for Health Metrics and Evaluation in Seattle used Al-Aly’s data to estimate how many heart attacks and strokes COVID-19 has been associated with. Her unpublished work suggests that, in 2020, complications after COVID-19 caused 12,000 extra strokes and 44,000 extra heart attacks in the United States, numbers that jumped up to 18,000 strokes and 66,000 heart attacks in 2021. This means that COVID-19 could have increased the rates of heart attack by about 8% and of stroke by about 2%. “It is sobering,” Wulf Hanson says.

Indirect effects of the COVID-19 pandemic, such as missed medical appointments, stress and the sedentary nature of isolating at home probably further contributed to the cardiovascular burden for many people, scientists suggest.

These numbers don’t match what some researchers have seen in the clinic, however. In a small study7 of 52 people, Gerry McCann, a cardiac-imaging specialist at the University of Leicester, UK, and his colleagues found that people who had recovered after being hospitalized with COVID-19 had no greater rate of heart disease than did a group of people who had similar underlying conditions but remained uninfected. The trial was orders of magnitude smaller than Al-Aly’s, but McCann and his colleagues are working on a larger study with around 1,200 participants. The results have yet to be published, but McCann says “the more data we’re acquiring, the less impressed we are with the degree of, let’s say, myocardial injury”, or heart problems.

Despite having an incomplete picture of COVID-19’s cardiovascular effects, doctors recommend caution. An expert panel convened by the American College of Cardiology advises doctors to test people who have had COVID-19 for cardiovascular problems if they have risk factors such as being older or immunosuppressed8.

How are researchers gathering more information?

Answers to many questions about the long-term impacts of COVID-19 could come from a large study called the Researching COVID to Enhance Recovery, or RECOVER, project, which aims to follow 60,000 people for up to 4 years at more than 200 sites in the United States. The study will include participants with long COVID, people who were infected and have recovered, and others who were never infected. “It’s enrolling across the lifespan,” says Katz, who is the principal investigator of the trial. He and his colleagues plan to study children, adults, pregnant people and the infants who are born during the trial.

Most RECOVER participants will fill out questionnaires about their health and undergo non-invasive tests. Researchers aim to collect extra information for about 20% of participants, for example, by temporarily inserting small tubes into adults’ hearts to obtain localized measurements of indicators such as blood pressure and oxygen levels. After several years, scientists hope to have completed a catalogue of long-COVID symptoms, formed an understanding of who develops them and begun to understand why they occur.

In the United Kingdom, McCann leads the cardiovascular working group for a similar project called the Post-hospitalization COVID-19 study, or PHOSP-COVID. This multi-centre study focuses on people who were hospitalized with COVID-19, and aims to uncover the prevalence of lasting symptoms, who is most at risk and how the virus causes lingering health problems. Thus far, the group has found that only about one-quarter of people who were hospitalized feel fully recovered one year after infection. And the team has identified immune markers that are associated with the worst cases of long COVID9.

How does the virus harm the heart?

COVID-19’s effect on the heart could be related to the key protein that the virus uses to enter cells. It binds to a protein called ACE2, which can be found on the surfaces of dozens of types of human cell. This, says Al-Aly, gives it “access and permission to enter almost any cell in the body”.

When the virus enters the endothelial cells that line blood vessels, Topol says, that’s probably where many cardiovascular problems start. Blood clots form naturally to heal damage caused while the body clears the infection. These clots can clog blood vessels, leading to damage as minor as leg pain or as severe as a heart attack. A study10 based on more than 500,000 COVID-19 cases found that people who had been infected had a 167% higher risk of developing a blood clot in the two weeks after infection than people who had had influenza. Robert Harrington, a cardiologist at Stanford University in California, says that even after the initial infection, plaques can accumulate where the immune response has damaged the lining of blood vessels, causing the vessels to narrow. This can lead to problems, such as heart attacks and strokes, even months after the initial wound has healed. “Those early complications can definitely translate into later complications,” Harrington says.

SARS-CoV-2 could also leave its fingerprints on the immune system. When Akiko Iwasaki, an immunologist at Yale University in New Haven, Connecticut, and her colleagues characterized antibodies from hospitalized people during the acute phase of COVID-19, they found a plethora of antibodies against human tissue11. Iwasaki suspects that when SARS-CoV-2 ramps up someone’s immune system, it might inadvertently activate immune cells that attack the body — cells that stay quiet when the immune system isn’t in overdrive. These immune cells could damage many organs, including the heart.

Damage to blood vessels can compound attacks on the immune system. “You can think of this damage as accumulating over time,” says Iwasaki. When the cardiovascular system has been assaulted on enough fronts, that’s when people can experience serious consequences, such as a stroke or heart attack.

What about reinfection and new variants?

Vaccinations, reinfections and the Omicron variant of SARS-CoV-2 all pose new questions about the virus’s cardiovascular effects. A paper published in May by Al-Aly and his colleagues suggests that vaccination reduces, but does not eliminate, the risk of developing these long-term problems12.

Hanson is also eager to model whether reinfections compound the risk and whether the relatively mild — but widespread — Omicron variant will affect the cardiovascular system as drastically as other variants. “We are kind of chomping at the bit for follow-up data among Omicron cases,” she says.

Nature 608, 26-28 (2022)

doi: https://doi.org/10.1038/d41586-022-02074-3

https://www.nature.com/articles/d41586-022-02074-3

Q&A with Eric Barker, author of 'Plays Well with Others'

 There is shortage of online content on success and relationships. Very little of it has an basis in research. Eric Barker specializes in translating academic research into actionable advice. Barker’s first book, Barking Up the Wrong Tree: The Surprising Science Behind Why Everything You Know About Success Is (Mostly) Wrong, was a huge bestseller.

His new book Plays Well with Others: The Surprising Science Behind Why Everything You Know About Relationships Is (Mostly) Wrong is now out and continues this thread. This is not Eric’s first stop on his book tour. You can hear Eric on podcasts including: The Art of ManlinessMetaphysical MilkshakeSmart PeopleSuperPsyched and in print at The Next Big IdeaCNBCCrime Reads and with David Epstein.



AR: If we can barely make sense of our own thoughts and emotions, why do we think we can ‘read’ someone else’s emotions?

EB: Because being able to read others is a vital skill. Research shows even a slight edge here is quite powerful. “Accurate person perception” has a conga line of personal and interpersonal benefits. Studies show that those who possess it are happier, less shy, better with people, have closer relationships, get bigger raises, and receive better performance reviews. When we look more specifically at those who are better interpreters of body language and nonverbal communication, we see similar positive effects.

The problem is, on average, the vast majority of us are absolutely horrible at these skills. I mean, comically bad. University of Chicago professor Nicholas Epley found that when you’re dealing with strangers, you correctly detect their thoughts and feelings only 20 percent of the time. (Random chance accuracy is 5 percent.) Now, of course, you’re better when dealing with people you know… but not by much. With close friends you hit 30 percent, and married couples peak at 35 percent. In school that’s an F. Actually, it’s probably closer to a G. Whatever you think is going on in your spouse’s head, two-thirds of the time, you’re wrong.

We’re biased toward thinking we can read others pretty well because it’s so important. But the truth is, we do better when we ask people what’s on their mind.

AR: Contrary to the hype, we humans are really bad at detecting lies. How do ‘unexpected questions’ help suss out dishonesty?

EB: Most of the lie detection techniques we’ve heard about or seen on TV don’t actually work. Most of them, like the polygraph, rely on looking for signs of stress to identify deception. But this isn’t supported by the research.

What does effectively indicate lies is what is called “cognitive load.” Basically, lying takes more brainpower than we assume. And if we increase the amount of thinking someone needs to do, their deception can be a lot easier to notice.

A good way to accomplish this is by asking unexpected questions. You want to focus on questions that would be easy for a truthteller to answer but that a liar might not be prepared for. Say you’re a bartender and someone comes in who is clearly underage. Ask them how old they are and they’re just going to say “21.” But what if you asked them the year they were born? This is exceedingly easy for someone telling the truth to answer but a liar is likely going to have to pause to do some math. That gap is a big giveaway.

Airport screeners usually catch less than 5 percent of lying passengers. When they used unexpected questions, that number shot up to 66 percent.

AR: Dale Carnegie was right about a lot of things. What one thing was he wrong about?

EB: We have to give Carnegie some credit. “How to Win Friends and Influence People” was written long before the advent of most psychology research, yet the bulk of his techniques have been validated by science. That said, he did get one thing wrong.

Carnegie’s eighth principle said we should try to see things from the other person’s point of view. Sounds great but we’re terrible at this. Nicholas Epley says attempting to take someone else’s perspective has never been shown to be effective. In fact, studies report it actually makes us worse at relating to them. We usually make inaccurate assumptions about what the other person is thinking.

AR: Loneliness is a huge societal issue today, but it really didn’t exist before 1800. How is that possible?

EB: This was some of the research that really surprised me. Turns out we get loneliness all wrong. It’s not really about being proximate to others; it’s about a feeling of connection. At some level we know this — we’ve all felt lonely in a crowd. The leading researcher on loneliness, John Cacioppo, said that loneliness isn’t just about being physically close to others; loneliness is how you feel about your relationships. When we feel emotionally close to others but they’re not nearby, that’s fine. We call that solitude and it’s a positive. But if we feel emotionally disconnected from others, we can be surrounded by people and still feel terrible.

Before the 20th century, we were all a part of groups. We were embedded in religions, tribes, and families. There was really no other way to survive. You never questioned whether you were a part of something bigger. And when Fay Bound Alberti at the University of York looked at old texts she found that the word “lonely” didn’t have the negative stigma attached to it. It just meant “apart”, not that you were emotionally suffering. But in the 19th century, individualism exploded and societal connections started to break down. To beat loneliness we don’t just need to spend more time with others, we need to deepen those bonds so that we feel like we’re “in it together.”

AR: What the heck happened in 1997? Was that really the beginning of our problems?

EB: Harvard’s Robert Putnam tracked the decline of American community throughout the latter half of the 20th century. He attributed this movement away from groups to the rise of television. Between 1985 and 1994 there was a 45 percent drop in involvement in community organizations. No time for bowling leagues and Boy Scouts anymore. The time spent on family dinner dropped by 43 percent. Inviting friends over dropped by 35 percent. Putnam writes, “Virtually all forms of family togetherness became less common over the last quarter of the twentieth century.”

In 1997 we saw the rise of the internet. This only accelerated the trend. Between 1980 and 2005, the number of times that Americans invited friends over to their house declined by half. Club participation dropped by two-thirds in the three decades after 1975. And we are experiencing severe picnic deprivation. Yeah, picnics are down 60 percent over the same period.

AR: Disasters tend to bring Americans together. Were you surprised by our collective reaction to the Covid pandemic?

The Disaster Research Center at the University of Delaware reviewed over seven hundred studies and found that when things are at the worst, we’re often at our best. The majority of the time it’s not “every man for himself”; people cooperate and help one another.

The toughest thing about the pandemic was that unlike most tragedies, like war or earthquakes, this was a disaster where we were forced to be apart to fight the virus. It’s difficult to assist and soothe others when you have to stay away from them. That made it really hard for us to feel united in the struggle.

AR: Investors and financial advisers are correct to focus on wealth accumulation. Your book tells us an investment in ‘belonging’ will likely bring more happiness. Is that a contradiction or just a different emphasis?

EB: Money’s great (and essential) but time with those you care about often provides a more efficient happiness return. A 2008 Journal of Socio-Economics study found that while changes in income provide only a minor increase in happiness, more time with friends boosts your smiling to the equivalent of an extra $97,000 a year.

And if making money crowds out good relationships you may not like the result. Repeated studies have shown that what the happiest people have in common is good relationships. One economics paper put the happiness value of a better social life at an additional $131,232 per year.

We all need to make money but there’s a threshold where you need to ask if one more hour at the office is going to improve your life more than that same hour spent with those you love. Call it “emotional opportunity cost.”

https://abnormalreturns.com/2022/08/09/qa-with-eric-barker-author-of-plays-well-with-others/