Hunter Biden's Criminal Defense Lawyer Quits Amid "Unease And Dissent"

 Hunter Biden's criminal defense attorney, Joshua Levy, has quit the 'first son's' legal team amid an environment of "unease and dissent" among the 4-lawyer legal team.

Levy's departure came after the addition of Abbe Lowell, who is also on Hunter's team, and was hired in December to defend Hunter and the Biden family amid nine congressional probes which include wire fraud and money laundering.

Levy was hired to work on opposing congressional investigations looking into the complex web of Biden family dealings, the NY Times reports. 

Mr. Lowell’s addition led to the exit of another lawyer — Joshua A. Levy — who specializes in helping clients facing congressional inquiries.

President Biden’s personal lawyer, Bob Bauer, had recommended Mr. Levy for the job. But Mr. Levy had clashed with Kevin Morris, a lawyer and close adviser to Hunter Biden who has lent him money to pay his back taxes and some other bills, according to a person familiar with the strategy. Mr. Morris and Hunter Biden brought on Mr. Lowell late last year, prompting Mr. Levy’s departure. -NY Times

According to the report, Levy was not pleased with Lowell's legal strategies - such as bombarding Rudy Giuliani, former Biden associate-turned-whistleblower Tony Bobulinski, and 12 others with "litigation hold" demand letters in order to preserve records from the "laptop from hell" - a strategy seen by some critics as a desperate PR stunt to change the narrative in favor of the Bidens.

According to Mike Davis, founder and president of the pro-Trump Article III Project, the letters were a "desperate, frivolous, and laughable" effort that would end up damaging the Biden family position since the lawsuit will lead to discovery, including Hunter Biden's on-camera deposition, Breitbart reports.

Lowell’s involvement in Hunter’s defense has not only forced the exit of Levy but has also triggered infighting with attorney Chris Clark, another high-profile attorney who leads Hunter’s criminal defense. Clark’s professional history includes working as a partner at the same Washington, DC, law firm where Rep. Liz Cheney’s husband works. The firm’s biography of Clark says he represents Hunter in the “grand jury investigation regarding tax issues.” -Breitbart

In December, NBC News reported that Lowell will be primarily responsible for coordinating Hunter Biden's response to the anticipated congressional oversight investigations, as well as other legal issues.

The incoming House Oversight Committee chairman Rep. James Comer, R-Ky., said at a news conference in November that Hunter Biden and other Biden family members will be a major focus, specifically if the family’s business activities “compromise U.S. national security and President Biden’s ability to lead with impartiality.”  -NBC News

The White House in November accused Congressional Republicans of stoking long-debunked conspiracy theories" in regards to allegations from House lawmakers that President Biden was actively involved in overseas business dealings with his son Hunter.

"Instead of working with President Biden to address issues important to the American people, like lower costs, congressional Republicans’ top priority is to go after President Biden with politically-motivated attacks chock full of long-debunked conspiracy theories," said White House Counsel office spokesman, Ian Sams.

Except, here's former Biden business partner Tony Bobulinski explaining how the Biden family brought him in on a shady Chinese energy company deal.

https://www.zerohedge.com/markets/hunter-bidens-criminal-defense-lawyer-quits-amid-unease-and-dissent

Animals Dying Across Ohio State Parks After East Palestine Train Derailment

 After a catastrophic train derailment in East Palestine, Ohio, early last month, President Biden, Transportation Secretary Pete Buttigieg, corporate media outlets, Ohio Governor Mike DeWine, Environmental Protection Agency, and some local officials have ensured air monitoring and water sample tests show everything is under control. 

But is it? Well, not according to the local newspaper Ohio Star. Reporter Hannah Poling said a confidential source told her that a wildlife biologist and consultant for the federal forestry received hundreds of reports over the last several days from forestry workers discovering "hundreds of dead animals in Ohio's parks." 

Several labs across the country have received specimens of whole minks, deer, elk, worms and livers of such animals, and they are finding toxicities that are off the charts, the source said. 

"These highly toxic levels are the exact chemicals that were released from East Palestine. Wayne National Forest and Shawnee State Forest in Ohio, are downriver from East Palestine and are two parks where samples are from," the source continued. 

Meanwhile, the BBC reported: 

Nearly 45,000 animals have died as a result of a toxic train crash this month in an Ohio town, environmental officials have said.

 The figure from the Ohio Department of Natural Resources updates the initial estimate of 3,500 animals dead after the 3 February derailment.

The source also told the Ohio Star that Governor DeWine attempted to block scientists from entering state parks:

The governor and the railroad were blocking scientists from getting soil samples in East Palestine, but they were able to still grab some for testing. Likewise, the soils are highly contaminated," the source said.

The source claims that the Ohio governor only uses his own hand-picked scientists to "give him the results he wants."

"It is heartbreaking to me that politicians like DeWine make an issue like this political. It should not be. He should be doing all he can to protect people, animals and the environment and not just cover his own behind," the source added.

There have been countless reports of health concerns by the residents of East Palestine and surrounding communities following the derailment of ten railcars carrying hazardous materials, including vinyl chloride, that first responders eventually burned off. 

After the burn, "some residents say they have been diagnosed with bronchitis, lung issues, and rashes that doctors and nurses suspect are linked to the chemical exposure," said Ohio Star. 

According to local TV station WKBN, residents have sent a list of demands for Norfolk Southern and the federal government, outlining the much-needed help their community deserves after a botched response. 

Below is the list of demands:

1. Relocation for anyone who wants it. Folks don't feel safe and aren't getting their questions answered. Anyone who wants to be relocated to hotels or safe housing should have the opportunity to do so, paid for by Norfolk Southern.
2. Independent environmental testing. The EPA must immediately begin and continue to test soil, water, and air, including for dioxins throughout the region, and commit to regular public meetings to explain findings. Norfolk Southern must pay for an independent scientist, hired by residents, to represent the community and participate in all technical meetings regarding testing, cleanup, and safety plans.  
3. Ongoing medical testing and monitoring: We still don't know what the short and long-term health impacts of this disaster will be. Federal Health & Human Services must provide ongoing health monitoring to evaluate those in the impacted region, guarantee health coverage, and Norfolk Southern must cover the cost.
4. Dispose of the toxic waste safely: The EPA cannot take the solid waste from the derailment and dispose of it in the Heritage Thermal toxic incinerator, in nearby East Liverpool, that has already been polluting our communities for years. This will only further spread the contaminants. Norfolk Southern must stop destroying evidence – we need a safety plan before resuming cleanup from the derailment site.
5. Norfolk Southern pays 100% of the costs. Taxpayers shouldn't foot this bill. Norfolk Southern made this mess, they should clean it up. The company must commit to paying 100% of the costs for testing, relocation, cleanup, medical monitoring and costs, and an independent science advisor.

The Biden administration's lack of leadership and physical presence after the train derailment was a crucial mistake. What happened is that Biden's opponents, such as former President Trump, seized on this opportunity for political points ahead of the 2024 presidential election cycle. Trump met with local officials and residents last week. Some have said this is "Biden's Katrina." 

https://www.zerohedge.com/medical/animals-dying-across-ohio-state-parks-after-east-palestine-train-derailment

Lower Dementia Incidence Linked With Vitamin D Supplements

 Vitamin D supplements were linked with lower dementia incidence and longer dementia-free survival, prospective data showed.

In a sample of 12,000 older adults, exposure to vitamin D supplementation was associated with a 40% lower dementia incidence rate compared with no exposure (adjusted HR 0.60, 95% CI 0.55-0.65), reported Zahinoor Ismail, MD, of the University of Calgary in Canada and the University of Exeter in England, and co-authors.

Results were consistent across three vitamin D formulations, the researchers wrote in Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoringopens in a new tab or window. Effects were greater in females, in apolipoprotein E ε4 (APOE4) non-carriers, and in people with normal cognition versus those with mild cognitive impairment.

The study may offer insight about who might benefit from vitamin D supplementation, Ismail suggested. "We know that vitamin D has some effects in the brain that could have implications for reducing dementia, however, so far, research has yielded conflicting results," he said in a statement.

But the findings don't mean vitamin D supplements should be used to prevent dementia, observed Claire Sexton, DPhil, senior director of scientific programs and outreach at the Alzheimer's Association in Chicago, who wasn't involved with the study. "It is not recommended to start vitamin D supplementation to reduce dementia risk," she told MedPage Today.

"It is important to note that this study is an observational study, not an intervention, so it cannot establish causation," Sexton pointed out.

"Also, a significant limitation to the study is that neither vitamin D levels at baseline and follow-up, nor dose and duration of supplementation, were available or analyzed," she added. "As a result, further research is needed in this area."

Ismail and co-authors studied 12,388 participants in the National Institute on Aging National Alzheimer's Coordinating Center

opens in a new tab or window (NACC) database who had normal cognition or mild cognitive impairment at baseline. Participants came from Alzheimer's Disease Research Centers from 2005 to 2021.

Exposure to vitamin D supplementation was based on NACC medication forms that assessed three formulations: calcium-vitamin D, cholecalciferol, and ergocalciferol. Participants with baseline exposure to any vitamin D supplement were considered the vitamin D-exposed group, while those without any exposure at all study visits were considered non-exposed. People with no baseline exposure who subsequently were exposed to vitamin D were excluded.

The final sample included 4,637 people in the exposed group and 7,751 people in the non-exposed group.

Mean baseline age was 71.2 years, and there was no significant difference in APOE4 status between groups. However, there were more women (70.5%) in the exposed group than in the non-exposed group (46.9%), and the exposed group had higher education levels. Both mild cognitive impairment and depression were more frequent in the non-exposed group (P<0.001 for all). Results were adjusted for age, sex, education, race, cognitive diagnosis, depression, and APOE4 status.

Over 10 years, 2,696 participants progressed to dementia. Among them, 74.8% (2,017 people) had no exposure to vitamin D supplements.

Five-year dementia-free survival was 83.6% (95% CI 82.3-84.9) for those exposed to vitamin D and 68.4% (95% CI 67.1-69.7) for the non-exposed group. Each vitamin D formulation on its own was linked to a lower dementia incidence rate compared with no exposure.

The study had several limitations, Ismail and co-authors acknowledged. NACC medication sheets did not record information about exposure history, and there was no accounting for differences in exposure duration. Because dosing and baseline vitamin D levels were not available, it's unknown whether incident dementia rates differed based on doses or vitamin D deficiency, the researchers added. Confounding factors also may have influenced results.

Disclosures

This study was supported by the National Institute for Health and Care Research Exeter Biomedical Research Centre. The NACC database is supported by the NIH.

Ismail reported relationships with Otsuka/Lundbeck, Biogen, and Roche. Co-authors had no disclosures.

Sexton had no disclosures.

Primary Source

Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring

Source Reference: opens in a new tab or windowGhahremani M, et al "Vitamin D supplementation and incident dementia: Effects of sex, APOE, and baseline cognitive status" Alzheimer's Dement 2023; DOI: 10.1002/dad2.12404.

https://www.medpagetoday.com/neurology/dementia/103316

'Alarming' Rise in Colon Cancer Rates Among Younger People

 Diagnosis of colorectal cancer (CRC) in younger people has almost doubled since 1995, a steeper increase than previously recognized, according to a study from the American Cancer Society (ACS).

The proportion of new diagnoses in patients younger than 55 increased from 11% to 20%. New cases of CRC rose by 2% annually among individuals younger than 50 and those 50-54. The incidence declined among people 65 or older, a trend that started in 2011.

The overall rate of decline in CRC incidence and mortality has slowed substantially since 2000, and the number of newly diagnosed advanced cancers has increased, reported Rebecca Siegel, MPH, senior scientific director of surveillance research at the ACS, and coauthors, in CA: A Cancer Journal for Clinicians

opens in a new tab or window.

"We know rates are increasing in young people, but it's alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population," Siegel said in a statement. "The trend toward more advanced disease in people of all ages is also surprising and should motivate everyone 45 and older to get screened."

Explanations for the concerning trends remain elusive.

"We have to address why the rates in young adults continue to trend in the wrong direction," said Ahmedin Jemal, DVM, PhD, senior vice president of surveillance and health equity. "We need to invest more in research to uncover the cause of the rising trends and to discover new treatment for advanced-stage disease to reduce the morbidity and mortality associated with this disease in this young population, who are raising families and supporting other family members."

The ACS data back up what colon cancer specialists have observed in clinical practice, said Michael Shusterman, MD, of the NYU Langone's Perlmutter Cancer Center in New York City.

"We have seen an increase in patients in their 30s and 40s with rectal and left-sided colon cancers, consistent with the ACS report on epidemiological trends," Shusterman told MedPage Today via email. "This population has unique needs including concerns regarding fertility, sexual health, and long-term cancer survivorship. Particularly for rectal cancer, our team has worked in a multidisciplinary patient-centered fashion to bring modern total neoadjuvant therapy protocols, where applicable, to allow for organ preservation in appropriate patients."

The ACS data "underpin recent guideline changes from the USPSTFopens in a new tab or window [U.S. Preventive Services Task Force] and the ACS for adults 45 to 75 years of age to be offered screening for colorectal cancer with one of several modalities," Shusterman added. "Awareness of this change and sensitivity among primary care providers is critical to ensure that screening is provided to all newly eligible individuals."

Siegel and coauthors gleaned the findings from an analysis of the NCI Surveillance, Epidemiology, and End Results program and the CDC's National Program of Cancer Registries for the years 1995 through 2019. National mortality trends through 2020 came from the National Center for Health Statistics.

From the data, investigators estimated that 153,020 new cases of CRC will be diagnosed during 2023, and 52,550 people will die of the disease. The totals included 19,550 new cases and 3,750 deaths among individuals younger than 50.

Key findings from the analysis included:

• Rates of decline in CRC incidence and mortality slowed from 3-4% annually during the early 2000s to 1% for incidence and 2% for mortality in the past decade
• Men had a 33% higher incidence during 2015-2019 (41.5 vs 31.2 per 100,000)
• Incidence continued to decline among people 65 or older, stabilized in the 50-64 age group and increased by 2% annually in people younger than 50 and those 50-54
• CRC mortality increased by 1% annually among people younger than 50 and by 0.6% a year in the 50-54 group
• Advanced-stage disease (locally advanced and metastatic) now accounts for 60% of all newly diagnosed CRC, as compared with 52% in the mid-2000s

CRC incidence is highest among Alaska Natives (88.5/100,000), American Indians (46/100,000) and Black individuals (41.7/100,000), and lowest among whites (35.7/100,000), with similar trends for CRC mortality"These highly concerning data illustrate the urgent need to invest in targeted cancer research studies dedicated to understanding and preventing early-onset colorectal cancer," said ACS CEO Karen E. Knudsen, MBA, PhD. "The shift to diagnosis of more advanced disease also underscores the importance of screening and early detection, which saves lives."

Disclosures

The study was supported by the American Cancer Society.

Siegel reported having no relevant relationships with industry.

Primary Source

CA: A Cancer Journal for Clinicians

Source Reference: opens in a new tab or windowSiegel RL, et al "Colorectal cancer statistics, 2023" CA Cancer J Clin 2023; DOI: 10.3322/cacc.21772.

https://www.medpagetoday.com/hematologyoncology/coloncancer/103323

Stress-Related COVID Vaccine Reactions May Mimic Anaphylaxis

 Many reported anaphylactic reactions to COVID-19 vaccination may in fact be attributable to vaccine-induced immunization stress-related response (ISRR), suggested findings from a small study presented here.

Cases of ISRR -- a non-allergic condition that mimics many of the symptoms of anaphylaxis -- may help explain why rare anaphylactic reactions to mRNA COVID vaccines have been somewhat higher than those reported for conventional vaccines, according to Muhammad Khalid, MD, a clinical fellow at the National Institute of Allergy and Infectious Diseases.

In an interview with MedPage Today at the American Academy of Allergy, Asthma & Immunology annual meeting, Khalid said ISRR appears to be a widely underrecognized anaphylaxis mimic, and he suggested that the true rate of anaphylaxis following vaccination with mRNA COVID vaccines may be lower than reported.

The double-blind study included 16 adults (15 women and 1 man) who had experienced systemic allergic reactions soon after receiving their first dose of Pfizer/BioNTech or Moderna's COVID-19 vaccines.

Participants received a second dose of the Pfizer vaccine or a placebo shot on the first of two consecutive days, with the other shot given on the following day. All vaccinations occurred at the intensive care unit of the NIH Clinical Center in Bethesda, Maryland, under close medical supervision and monitoring.

Three of the 16 patients experienced an allergic reaction after receiving the second dose of mRNA vaccine (one mild and two moderate) while none developed allergic reactions after receiving the placebo shot. The allergic reactions occurred a median of 4 minutes after vaccination.

However, non-allergic reactions consistent with ISRR occurred in 11 study participants receiving the placebo shot and nine after receipt of the mRNA vaccine, with a median symptom onset of 3 minutes after delivery. Non-allergic symptoms included numbness, tingling, dizziness, throat tightness, dysphagia, and hypertension, which have all been linked to ISRR, Khalid said.

Thirteen of the 16 study participants went on to receive a third, unblinded booster dose of the mRNA vaccine in the supervised medical setting, and 10 developed symptoms consistent with ISRR, with a median symptom onset of 7 minutes.

Khalid said the COVID-19 pandemic and the public health push for universal vaccination once vaccines became available represented something of a perfect storm for anxiety-related reactions that are not directly related to the vaccine product.

"People were already under stress due to COVID, and they were getting a brand new vaccine and hearing about adverse reactions," Khalid said. "All of this created an atmosphere where these very real symptoms resulting in real distress were occurring, which were unrelated to the vaccine itself."

In a 2019 report,

opens in a new tab or window the World Health Organization (WHO) first proposed the term "immunization-stress related response" to refer to "any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine."

The WHO report identified four overlapping groups of reactions as ISRRs, including acute anxiety and stress responses, vasovagal reactions, mass psychogenic illness, and functional neurological disorders.

Khalid said several common symptoms associated with non-allergic ISRR reactions mimic allergic reactions, including tingling, numbness, and tightening of the throat.

But unlike allergic reactions these symptoms do not usually get worse with time, he said.

Rapid elevation in blood pressure and heart rate are also a typical symptom with ISRR reactions, while blood pressure tends to decrease in people experiencing allergic reactions to vaccine, he said.

The WHO report highlights common differences in presentation, including:

• Onset: Anaphylaxis reactions typically occur 5 minutes after immunization, but may be delayed up to 60 minutes, while general acute stress responses can occur before, during, or shortly after (<5 minutes) immunization.
• Skin: Common anaphylaxis reactions include generalized urticaria or erythema, angioedema, generalized pruritis with or without skin rash, localized injection site urticaria and red/itchy eyes. Reactions common in acute stress response more typically involve pale, sweaty, cold, or clammy skin.
• Respiratory: Common anaphylaxis respiratory symptoms include persistent cough, noisy breathing and airway constriction, wheeze, stridor and -- in severe cases -- respiratory arrest. Hyperventilation is more common in ISRR.
• Cardiovascular: Anaphylaxis reactions typically involve elevated heart rate with a drop in blood pressure, while blood pressure tends to spike with ISRR.

Khalid said that use of rescue epinephrine can be reduced by carefully monitoring patient reactions, although he acknowledged the challenges in distinguishing between vaccine-related anaphylaxis and ISRR.

Disclosures

This research was funded by the National Institute of Allergy and Infectious Diseases. Khalid reported no disclosures.

Primary Source

American Academy of Allergy, Asthma, and Immunology

Source Reference: opens in a new tab or windowKhalid M, et al "COVID-19 mRNA vaccine-induced immunization stress-related response (ISRR) and anaphylaxis: an early look at COVAAR clinical outcomes" AAAAI 2023.

https://www.medpagetoday.com/meetingcoverage/aaaai/103335

'How to Keep Patients Safe During an Adderall Shortage'

 The ongoing, prolonged prescription stimulant shortage

opens in a new tab or window in the U.S. is cause for alarm. In 2016, approximately 16 millionopens in a new tab or window patients were prescribed stimulants -- an increase of 250%opens in a new tab or window over the preceding decade. Since the onset of the COVID-19 pandemic, more prescriptions for stimulantsopens in a new tab or window have been written, with an increase of almost 6 million more prescriptions in 2021 compared to the year prior. When prescription medication is no longer available from pharmacies and trusted sources, people who depend on these pills are often left feeling abandoned and desperate for solutions to be able to continue functioning as they had before the shortages. For some, the solution may be to turn to the unregulated -- and increasingly toxic -- drug supply.

We've been here before -- at the beginning of the opioid crisis. Throughout the early 2000s, the number of patients prescribed opioids skyrocketed, with a peak of over 255 million

opens in a new tab or window opioid prescriptions in 2012 (an opioid dispensing rate of 81.3 per 100 persons). Over concerns about the increasing supply of opioids, a systematic restriction on prescribing started, where patients with previous prescriptions were no longer able to refill their medications, and those dependent on opioids turned to alternative sources with a higher chance of overdose. As fentanyl began to infiltrate the drug supply, we've seen overdose deaths reach record highsopens in a new tab or window over the past few years.

Similarly to opioids, people use stimulants for a wide variety of reasons including as prescribed for medical reasons (e.g., attention-deficit/hyperactivity disorder [ADHD]) or without prescription to function at work or school, to stay awake in dangerous situations, and to counteract the effects of other drugs. Though a debate exists on the degree of dependence prescription stimulants may have, many patients describe feeling depressed, fatigued, and unable to function when going "cold turkey" on their medications. Similarly to opioids, withdrawal itself is uncomfortable but not medically a risk for death. Instead, it's a risk for unhealthy and desperate use, and thus overdose.

An illicit market of unregulated stimulants remains available in the U.S., including diverted pharmaceutical pills, counterfeit pharmaceutical products, and more traditional stimulants for recreational use such as methamphetamine and cocaine. It is only a matter of time before patients who can't get their medications from their usual pharmacies turn elsewhere

opens in a new tab or window to feel normal again and maintain the quality of life they had while taking stimulants.

Our patients deserve better -- and deserve partnership and real solutions when our healthcare infrastructure fails them.

First, we must acknowledge that dependence on stimulants for any reason -- either from a stimulant prescription or because of a stimulant use disorder -- must be met with compassion and without stigma. As clinicians, it is our job to validate the discomfort associated with acute and chronic stimulant withdrawal. There is no role for taking a moral stance against those using non-prescribed stimulants; with disparitiesopens in a new tab or window in ADHD diagnosesopens in a new tab or window and increasing demands for functioning, we must recognize the many valid reasons individuals may have chosen to use non-prescribed stimulants.

We must meet patients where they are, and come up with individualized treatment plans that are patient-centered and harm-reductionist in nature. For some this may mean prescribing alternative stimulant medications that are still available, or attempting to use different types of drugs to treat symptoms (e.g., bupropion

opens in a new tab or window [Wellbutrin], tricyclic antidepressantsopens in a new tab or window, viloxazineopens in a new tab or window [Qelbree], atomoxetineopens in a new tab or window [Strattera] for focus, clonidineopens in a new tab or window [Catapres] for hyperactivity). For others, nonpharmaceutical interventions may be more reasonable: cognitive behavioral therapy (CBT), work and school exemption notes, or suicide prevention hotlines. For patients with a true stimulant use disorder and interest in treatment, extended-release naltrexone with bupropionopens in a new tab or window or contingency management referralsopens in a new tab or window may be appropriate.

Third, it is essential to decrease barriers to safe prescription stimulants. As physicians start prescribing second- and third-line stimulants to those previously on Adderall (mixed amphetamine salts), we must remove prior authorizations and waive higher copays for more expensive medications.

Our patients need access to accurate information -- either through establishing a hotline for patients and doctors to ask questions and obtain guidance, or through providing increased coverage for out of network providers when seeking assistance related to stimulant use.

Lastly, we must recognize that some patients may continue to need to use non-prescribed stimulants. This is an opportunity to invest in public health messaging around fentanyl contamination of the non-opioid drug supply, and make fentanyl test strips available not just at harm reduction centers but also through prescriptions to pharmacies. Messaging can teach the public about identifying an opioid overdose and acting with Narcan administration. To make a real impact, Narcan kits must be made more widely available.

Overdose deaths from stimulants (usually mixed with opioids either intentionally or accidentally) have skyrocketed over the past few years. Patients with ADHD and individuals who use stimulants often are being treated or self-medicating for impulsivity and decreased executive function, conditions that come with a high risk of substance use. We must partner with our patients to find a solution so that we keep some of our most vulnerable patients safe -- and alive -- until the end of this Adderall shortage.

Eric Kutscher, MD,opens in a new tab or window is an internal medicine physician and addiction medicine fellow at NYU Grossman School of Medicine.

https://www.medpagetoday.com/opinion/second-opinions/103305

Hopkins' Makary Tells Lawmakers COVID Lab Leak a 'No-Brainer'

 Did the pandemic start with a lab leak? Is natural immunity protective? Should healthy children be vaccinated against COVID-19? Lawmakers discussed these and other questions during a hearing of the House Select Subcommittee on the Coronavirus Pandemic

opens in a new tab or window on Tuesday afternoon.

Underlying each of these questions were tensions over who should be trusted to answer them.

Rep. Debbie Lesko (R-Ariz.) cited reports in the media of Li-Meng Yan, MD, PhD, a Chinese virologist who said SARS-CoV-2 was "intentionally released," and that an accidental leak from a Chinese laboratory was not possible.

Marty Makary, MD, MPH, chief of islet transplant surgery, professor of surgery at Johns Hopkins University in Baltimore, and former editor-in-chief of MedPage Today, appeared to agree that a lab leak occurred.

That there is debate at all over the origins is due to the U.S. funding the lab, a connection that is "embarrassing" for the government to acknowledge, he argued. "The epicenter of the world [outbreak] is 5 miles from one of the only high-level virology labs in China ... It's a no-brainer that it came from the lab. I mean, at this point, it's impossible to acquire any more information, and if you did, it would only be affirmative."

Debate over the origins of the pandemic flared anew this week after the Department of Energy (DOE) changed its assessmentopens in a new tab or window and concluded with "low confidence" that the pandemic likely began with a laboratory leak in Wuhan, China; DOE's change followed the release of a new classified intelligence report.

Jay Bhattacharya, MD, PhD, professor of medicine at Stanford University in California, was more circumspect over the pandemic's origins at the hearing, but said the virus does not appear to have the characteristics of a bioweapon or something that would be intentionally leaked.

"The evidence that I've seen suggests that the lab-leak hypothesis is an active hypothesis, that it's quite possible that this was a lab leak as a result of gain-of-function work ... to try to get vaccines available for the next pandemic," Bhattacharya said.

"I also know that there's a lot of scientists that think it might also have been of natural origin," he said, adding that "Congress absolutely needs to get to the bottom of" this question.

Rep. Richard McCormick, MD, MBA (R-Ga.), argued that the government overstepped its role particularly with regard to vaccine mandates and booster recommendations, and said "the best thing Congress and the government can do is stay out of medicine. Leave this to the physicians."

Witnesses and some Republican lawmakers also questioned the rationale for vaccinating children against COVID-19 and adding the vaccine to the 2023 childhood immunization schedule

opens in a new tab or window.

"Has any young healthy child died in the United States of COVID in the last 3 years?" Makary said. Whatever the number is, "[it's] far less than other common respiratory viruses."

Georges Benjamin, MD, executive director of the American Public Health Association, acknowledged that experts were "surprised" by how well kids fared during the pandemic, but stressed that there are still approximately 9,000 kids with multi-system inflammatory syndrome in childrenopens in a new tab or window.

On the topic of natural immunity, Benjamin noted that early data from China showed that roughly 20% of people who had SARS-CoV-2 infections "got really sick," especially those with chronic diseases, of which communities of color bear a disproportionate burden. "You get 'immunized' [by natural infection], but you've got to survive to be immunized. I don't want to make that dramatic statement, but that's true," he said.

Asked by Rep. John Joyce, MD (R-Pa.), whether he believed in mandating vaccinations for children, Bhattacharya said he did not. "I've seen a rise in vaccine hesitancy for essential vaccines, like measles [and] DTP [diphtheria, tetanus, and pertussis], that's quite alarming," he said. "And I think a lot of the hesitancy is due to the mandates and due to the force. Rather than using ethical principles like informed consent, this mandate has demolished trust in vaccines more broadly."

https://www.medpagetoday.com/infectiousdisease/covid19/103341