Francois writes:

Hi Twiv team,

This one is for Alan.

In TWiV 335, he linked the european defiance for GMO rice to a supposed protectionism of french rice farmers.
Yes, we’ve got our fair share of nutcases in Europe (GMO bad, vaccines bad, mobile phone antennas bad, gluten bad … bla,bla,bla etc)

But here my issues with Alan’s comment :
– French rice production is around 80 000 tonnes per year to compare to 700 million tonnes worldwide … at this low level of production, you’re not even in the stats anymore.
– On the 160 000 T imported in France, around 4% comes from the US and 80% from Pakistan, Cambodia, India & Thailand. Let’s be honest — US farmers will not produce at lower cost than those guys …So no, french rice farmers are not worried about US GMO rice for economic reasons.

– Europeans & GMOs.
There’s some reserve about heath & GMO in the general population, but the GMO mess really began with the “Substantial equivalence” concept, the non GMO labeling & most of all, reports on Monsanto’s Seed Police.
Another problem is the socio-economic cost & food security issues raised by allowing some few all powerful private interests to own the rights to control the free growing of an essential food source.
Remember, in continental Europe not so long ago, all means of food production were owned by a few powerful private interests (the nobility & the clergy) that were enforcing their own rules and influencing the government through financial contributions.

Really love the show.

Jackson writes:

Kia Ora TWiV,
Listening to TWiV335 on my way to class at the University of Otago, in Dunedin New Zealand where it is currently 14 C and partly cloudly, I realized there is an easy extension to always have the rim shot for a joke on hand if you use google chrome( I didn’t make the extension I just found it and was hoping it would be helpful.
Thank you for the wonderful podcast


Jeff writes:

Hello Learned Hosts,

I would love to hear your thoughts on this article:

And paper that it is reported from:

Does the vitreous humour make a particularly good or unique place of a virus to reside? Are there other bodily reservoirs that could present a problem if the patient were to become immune-repressed?

It’s 59F in San Francisco, and we still haven’t gotten any rain.

Thank you,

Martin writes:

Why don’t you talk about this?


Fernando writes:

Hi TWiVers,
Some sanity prevailed at the USPTO for a change, main claims of podcast “patent” invalidated:
Two strikes for podcast freedom!

Marcia writes:

Hi you guys! (“Guys” being generic and including the feminine gender also),

I’m one of your occasional correspondents, having first found out about TWIV when XMRV was booted about as a possible cause.

I’d like to share a few thoughts about CFS (or ME, or CFS/ME, or SEID). I *want* to write a comprehensive account… but since I’ve got CFS and the limitations that come with it, I’ll just have to do the best I can.

First, please let me gently correct you (I forget which you) on terminology. Someone referred to the condition as “chronic fatigue”. There are many situations & illnesses that lead to chronic fatigue, which means you’re tired a lot of the time. “Chronic fatigue syndrome” is something more specific. One definition of “syndrome” swiped off the internet is “A set of signs and symptoms that appear together and characterize a disease or medical condition. AIDS is an example of a syndrome.” Another example is “Heterotaxy Syndrome”, in which organs form on the wrong side of the body.

A condition or illness is often referred to as a syndrome when the cause is not known, but there is a consistent collection of signs and symptoms by which it can be identified. Sometimes the syndrome is named after the person who first described the condition. Sometimes the use is humorous, such as “white coat syndrome” (when a patient’s blood pressure goes up just because they’re in a doctor’s office). In the case of CFS, the choice of adjective was unfortunate, because the word “fatigue” is so common. If I tell someone I have Chronic Fatigue Syndrome, they often say, “Oh, yeah, I get tired a lot too.”

Common thought used to be (and with many doctors still is) that CFS is a diagnosis of exclusion. However, clinicians who have seen many CFS patients, and the patients themselves if they’ve studied it extensively, can usually recognize someone with CFS by a particular set of symptoms.

First and foremost, the ever-present overwhelming fatigue. I’m not talking “Gee, I’d like to take a nap” kind of fatigue, I’m talking the “Taking a 15-minute shower wears me out and I have to rest for an hour afterwards” kind. And sleep doesn’t help.

One of the most characteristic symptoms is referred to as “post-exertional malaise” or PEM. If someone with CFS exerts themselves, they might be able to approach a normal level of effort for awhile (a few minutes, an hour, several hours, a day), but then will “crash” and require one or more recovery days. The difference in how a normal person recovers (even a deconditioned normal person) and how someone with CFS recovers can be shown objectively with two VO2 Max exercise tests, performed a day apart. The data from this test cannot be faked, and is useful for legal reasons such as applying for disability benefits. My own theory for why this happens is that the body is not recycling ATP properly, and recovery has to wait for more ATP to be built “from scratch”, but that’s just a guess.

Another common symptom is “brain fog,” similar to what cancer patients call “chemo fog”.

Next, signs of past or present infection by Epstein-Barr Virus and others in the herpes virus family. Many CFS patients report a sudden onset in which they came down with a viral illness and never fully recovered. Other pathogens besides herpes virus have also been proposed as a trigger, but that’s the most common one.

When I was first tested for pathogens (many years after I’d started telling my doctors I didn’t feel well), I tested positive for Epstein-Barr Virus, cytomegalovirus, mycoplasma pneumoniae, and two or three others that escape me now. When I saw those results, it struck me that the problem wasn’t any one of those pathogens, it was that my immune system wasn’t working right. Dr Nancy Klimas thinks that the illness currently known as CFS is primarily an immune system disorder, and/or possibly a type of general dis-regulation of the body’s systems.

When the Institute of Medicine undertook a review of the state of medicine vis-a-vis Chronic Fatigue Syndrome, like many other patients I was concerned that there were no CFS experts on the panel. However, in the long run I think that “distance” from the field turned out to be beneficial, because no one can accuse the final report as biased. Their report, “Beyond Myalgic Encephalomyelitis /Chronic Fatigue Syndrome: Redefining an Illness” was released February 10th, 2015.

The only part of the IOM report I really take issue with is their attempt to come up with a new name. I think we might as well stick with what we’ve got, even if it’s not great, until we discover the actual cause of the illness. There have been continuous “name wars” amongst various parts of the patient community for so long, I don’t think adding a new acronym into the mix is helpful.

Okay, I’m fading, and this is probably long enough as it is. I’m attaching the IOM’s 15-page clinician’s guide, which explains the current state of understanding better than I can, in case any of you are interested.

Thank you as always for your entertaining discussions.

in Salem, Massachusetts

P.S. Dr Nancy Klimas is a delightful person, and she would probably be willing to be a guest on your show to talk about why herpes family viruses may be the culprit in CFS, and other viral-type stuff. You can find her through the Institute of Neuroimmune Medicine at Nova Southeastern University in Miami, Florida (she’s the founder and director of that institute).

Johnye writes:

Didn’t know if you had seen this. I thought it might be one for TWiV references on Ebola. While more clinical, it seems intuitive and something that could be easily carried out.

Also, yesterday I had the good fortune and pleasure of meeting Prof Stuart Firestein, from Columbia’s Dept of Biological Sciences. He was a speaker at an annual symposium on learning at Harvard Medical School (HMS). I asked if he knew you and of course he did, and mentioned he had been a guest on TWiV. I’ll look for that episode. I was delighted to learn he had been a guest. His discussion of “Ignorance” was provocative and an interesting view on teaching the scientific method.

Hope there is sun and blue skies where you are. It’s 14 C, with mostly sun and what appear to be altostratus clouds. Enjoy.

Johnye Ballenger

Nicola writes:

Dear TWiVome,

I was going to start this email by saying “aaarrrrrgh, the TWiVome has to stop uttering falsehoods about CFS”, but I quickly realized that when you do, it gives us patients a chance to write in with corrections, and where else can we get the attention of thousands of scientists and scientists-to-be whose curiosity might be sparked?

Rich is mistaken about the history of the 37 kDal RNaseL discovery that he mentioned in TWiV 331. It had no connection with XMRV. This discovery was made in the mid nineties in the lab of Robert Suhadolnik at Temple University, who published several papers on the upregulation of the 2-5A synthetase/RNaseL pathway in CFS. See “Biochemical evidence for a novel low molecular weight 2-5A-dependent RNase L in chronic fatigue syndrome.”

(Pub med link: )

During the XMRV era this earlier research was said to be in support of the XMRV work. There was an RNaseL connection with prostate cancer, as Vincent mentioned. Anyway, the point I want to make is that the work on the 37 kDal RNaseL in CFS is an earlier and independent discovery and not tainted by the XMRV work.

At one time patients could be tested for this enzyme, (and maybe still can be), and there is a medication Ampligen, a synthetic dsRNA, that inhibits the pathway. Not all patients have this 37 kDal RNaseL, so it’s not a biomarker for CFS, but I have been told by several CFS doctors that it may be a marker for who would benefit from Ampligen therapy. There are doctors out there who do things for their CFS patients, although there are far too few of them. I have spoken to patients who have been greatly helped by this drug. I say this not as medical advice to anyone, but only to speak to the importance of this research.

Dr. Suhadolnik’s page at Temple describes his research in CFS.

Jennie mentioned in her letter read on TWiV 330 some research on abnormal response to exercise. This work goes back to the early nineties, but progress has been very slow, and I can only assume that is due to lack of funding. I was fortunate to have had exercise testing performed in 1995 by a CFS doctor, and to have it reviewed by an exercise physiologist, which taught me a lot about my disability and how to manage it. This kind of testing really needs to be more widely available, but I don’t think it will be without more research. Ampligen has never been approved, in part because the studies required for approval are costly.

I started listening to TWiV to get a perspective on XMRV from scientists who didn’t have a dog in the fight. I think you all did a great job covering that. I have to say, I did sometimes groan at your lack of knowledge about CFS, but then, I wasn’t listening to learn about CFS, I was listening to learn about the virology.

At some point I went back and listened to all the TWiVs from episode 1. Dickson’s way of talking about science and his storytelling skills in the early TWiVs led me to start TWiP from episode 1 also, even though before that I thought worms were just yucky. Now I’m a faithful listener of all the TWiX podcasts. They have brought science back into my life, after a budding career was cut short by CFS when I was very young.

Many Thanks,

P.S. No email to TWiV would be complete without the weather. Here in CT it’s currently 39 F, that’s 4 C, and cloudy. We are expecting frost before morning.

Alaina writes:

Greetings, TWIV, from Toronto Canada, where after a beautiful weekend of 20C we are experiencing rain, 4C, and 50km/h winds. I have a sweater, coffee, and two dogs who are keeping me warm, though.

I was the listener who wrote you about the WHO ebola sitrep (/twiv/twiv-312-letters/ : see? doesn’t it make you feel cool to say “sitrep?”).

I just watched the Dr Fauci ASM talk that Vincent picked a few episodes ago, and it reminded me to thank you for your continued updates on the ebola outbreak in West Africa. I’m sure I sounded neutral in my first letter, but I was experiencing continuous outrage through the beginning of this year about how the rest of the world was dealing with the outbreak. MSF was screaming for help months before anybody started to listen to them. In early September, several months into the outbreak, I remember reading Dr Joanne Liu’s presentation to the UN ( and having to take a walk, I was so angry.

When the outbreak was at its peak, most of the media was focused on stuff that shouldn’t have mattered (ebola spreading in North America or Europe) when the real stories were that people in Liberia, Guinea and Sierra Leone were getting sick and sometimes dying so fast that we couldn’t even count them, and that the world utterly failed in its response, its responsibility, and even its self-interest.

As the saying goes, the price of freedom is eternal vigilance. So thanks again for keeping a level head throughout your coverage, and for continuing to talk about the outbreak and the people and organizations who are fighting it. I feel like there are important lessons here that we as a society should learn, and keeping the discussion going is an important part of that.

All the best!

John writes:

Twiv team,

Listening to older episodes I listened to Ep. 252 and heard the comments driving and electric cars and Alan bending over backwards to excuse driving a huge engined gas eater type car as okay. If you believe in science and actually care about the planet you are leaving to your kids then driving this type of car (or a truck when not needed) is showing utter contempt for science and climate change. I know that Vince has said that his family was not that important to him (working all the time and not spending time with them) so it is almost not surprising that he would not care about what he is leaving for them.

Usually I am behind what Alan and Rich and Kathy have to say but recently Vince has seemed to be upset that Lipkin discovered MERS in bats was upset that something was not to his liking in another story and was adamant that he would prove it by starting to study it and seemed to be dead set to prove it regardless of where the actual facts led.

I do feel sorry for his family and I am really sorry that his son may have CFS and I really mean that. I am really sad that a show I have really enjoyed has seemed to go down hill so much.

Anthony writes:

“It’s unclear how the virus gets into the largely enclosed poultry
barns, but experts believe the droppings of migratory birds carrying
the virus are tracked into barns by workers, equipment or rodents, or
in other ways.”

# # #

This speculation appears in more than a few news articles. It’s
remarkable that so many workers are tramping around on influenza-laden
wild bird droppings when it seems that investigators can’t find any
infected wild birds in the area.

What if this was H7N9 and nobody knew how it was travelling?


Anthony writes:
A Flu Epidemic That Threatens Birds, Not Humans

Human flus can infect people who inhale only one to 10 virus
particles, he said, but it takes 100,000 to 1 million particles of an
H5 bird flu to infect a human.

“That’s why people who sleep under their chickens in markets in Asia
get it, and we don’t get it on Fifth Avenue,” Dr. Palese said.

# # #

As luck would have it, this morning I was listening again to TWIV 19
where you mention people sleeping with chickens. I wondered why there
is the difference in the number of matches needed to light the fuse?
Are the human flus better at evading the immune system? With the vast
quantities of progeny and the short interval between generations, does
constant exposure just increase the probability of contacting an
outlier bird flu that is by mutation equipped to infect people? On
other TWIVs I heard about animals innoculated via nasal spray. Are
the human flus just better at dealing with the mucus and cilia of the
nasal pasages? Does long exposure of people to bird flus just make it
more likely that one will find its way past outer barriers?

Thank you,


Anthony writes:

A Flu Epidemic That Threatens Birds, Not Humans
By DONALD G. McNEIL Jr.MAY 4, 2015

Officials have also advised that everyone who was recently in contact
with affected poultry operations — workers, truckers, veterinarians
and so on — take Tamiflu, a flu preventive.
# # #

Avian flu becoming more resistant to antiviral drugs, says University
of Colorado study

The avian flu, an Influenza A subtype dubbed H5N1, is evolving a
resistance to a group of antiviral drugs known as adamantanes, one of
two classes of antiviral drugs used to prevent and treat flu symptoms,
said CU-Boulder doctoral student Andrew Hill, lead study author. The
rise of resistance to adamantanes — which include the nonprescription
drugs amantadine and rimantadane — appears to be linked to Chinese
farmers adding the drugs to chicken feed as a flu preventative,
according to a 2008 paper by researchers from China Agricultural
University, said Hill.

A TWIV 15 Link:

Why Meat in China — and the U.S. — Has a Drug Problem
A new study shows widespread antibiotic resistance on Chinese farms,
where use of the drugs to speed animal growth is common. That could
have scary impacts for the rest of the world

By Bryan Walsh @bryanrwalshFeb. 12, 2013

But there was always one country where that plan never quite worked:
China. Chinese chicken farmers had an unfortunate habit of
prophylactically dosing their birds with Tamiflu, the only antiviral
drug that showed any effectiveness against H5N1. (U.S. preparations
for a possible bird-flu pandemic included stockpiling millions of
doses of the drug.) As a result, it became that much more difficult
for health officials to track H5N1 outbreaks because Tamiflu-dosed
chickens could still get infected and spread the virus but without
showing the symptoms that would set off medical alarm bells. And
overusing Tamiflu also eroded its effectiveness as over time the H5N1
virus was able to develop a resistance to the drug. Had an H5N1 human
pandemic ever occurred, we may well have been helpless.

Mauricio writes:

Dear Twivsters,

My twin brother, who is an epidemiologist, sent me this awesome vaccine/epidemic game made by The Salathe Group. It is extremely fun to play and reinforces the importance of vaccination and quarantine but in the context of human networks.

Hope you like it


Mauricio Comas-García, Ph.D.
HIV Drug Resistance Program
National Cancer Institute
Frederick National Laboratory for Cancer

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