Sarah writes:

Dear TWIV team,

It has been a tough year for anyone who thinks of Public Health.  I suppose if you dismiss Public Health out of hand, maybe it has been a good year for you.  I’m a MD with a MPH.  I have tried to explain “Public Health” to a lot of people in the last year.  Many of them have been family members, neighbors and friends.  Mostly I feel like I have failed.  I feel that way because they don’t always totally agree with me.  

Is that a failure?

This brings me to finally write to you about a subject I am a bit concerned about.  When I was younger I thought the CDC was the BEST.  They could figure anything out.  It may have influenced me to study Public Health.  Currently the CDC is headed by a very good MD, Infectious Disease clinician and leader.  But Public Health principles challenge teachings of patient-focused medicine.  And it is in the friction place of the two where I contemplate.  As a Pediatrician I initially gave Oral Polio Vaccine.   I read articles about breakthrough Polio cases in the US from vaccination.  These were rare, but if they were in your child or patient, it wasn’t rare.  As a Public Health student, I looked at the world wide prevalence/incidence, the cost of IPV vs OPV, and tossed up my hands and watched the US change to IPV.  I can argue it both ways. 

It is the friction between being a bedside Pediatrician and a Community-thinking Public Health explainer that challenges me.  It should challenge all of us.  Historically I have thought of the CDC as the disease-centric institution and the WHO as the community (break down, vulnerabilities) institution.  Generally as Americans we want the quick fix pill, the cure, the disease model, the CDC.  We all know it is harder than that.  Smoking, obesity, lifestyle disease are the hardest challenges.  Just like masking, avoiding indoor contaminated air, and other non-pharmacologic interventions are challenging. 

I don’t have any answers, but more discouraged questions.   

You all have kept me sane and hopeful through this last year.  I wish there was a Public Health podcast with people like you all.  Could you clone yourselves?


Marissa writes:

NYT piece in the business section today about stick shifts. Favorite quote: “…being able to drive a manual is a badge of being a true car person”. Amen!



John writes:

Dear Vincent et al:

A partly-cumulus-cloudy and astonishingly comfortable 31C because of not-unreasonable humidity in Greater Braddock today.

The interview with Laurie Garrett was excellent.  I’ve encouraged my non-scientific friends on FB to watch it. 

I wouldn’t add this to my stack of emails except for one thing.  Whenever anyone mentions the Asilomar Conference, I always think back to General Biochemistry at Rutgers when I was a first-year grad student. George Pieczenik was newly-arrived in 1975 and IIRC (=if I recall correctly) only gave one lecture in the Nucleic Acids section, on DNA sequencing.  I’ll always remember him asking if we’d seen the picture from the Asilomar Conference in Rolling Stone.  I think Francis Crick (with whom he had published speculating on protein synthesis origins) must have been in the pic.  He was quick to note that he was standing just outside the frame of that picture.

I really had almost no other interactions with him in those following years, but today I wondered if by chance he was still @ Rutgers.  Indeed he is, altho apparently doing something on the side with J&J.  And that led me to this:

Since I learned a few episodes back that you don’t (always have a chance to) open links sent, if you search [ identification unique epitope pieczenik ] you’ll get what’s billed as a Review Article in Med Clin Case Reports from just a couple months ago.   It’s only 1.5pgs/6refs, so it might qualify for the Guinness Record shortest Review Article, but it advances the hypothesis, anyway, that the clotting disorders seen with adenovirus spike vaccines are due to anti-Spike antibodies binding Platelet Factor 4 because of recognition of an almost-identical hexapeptide segment in PF4: AGFCAS vs AGICAS in the Spike.  Anything mentioning Peptide Segment catches my attention, but I believe that you mentioned in an earlier episode that the cross-reaction is from the adenovirus vector. 

The paper is also somewhat oddly-written, and looking to try to gather whether the journal is legitimate I note that it’s in Vol 1 #1 which of course is also worrisome, but I thought that it might at least amuse you how an idle reference in 773 led to turning up something that then led right back to SARS-CoV-2.

With continued esteem,


Rich writes:

Wired Magazine, July/August issue.

Steven writes:

Dear TWIV team,

Found the paper and your discussion of the anti-Dengue strategy centered around Wolbachia bacteria-infected mosquitoes to be fascinating and a welcome diversion from COVID19.  I’m sure Dickson might be aware, but did the rest of you know that AbbVie, in conjunction with the DNDi (Drugs for Neglected Diseases Institute) have another clever strategy against a different pathogen that involves Wolbachia.  The disease is river blindness caused by filarial worms and rather than attack the worms directly, they target the Wolbachia bacteria that are symbionts and that the worms depend on for growth, survival and reproduction.  The therapy is called ABBV-4083, also known as TylAMac.  It may not be lost on everyone, but the complexity of dealing with not only human PK and ADME but worm ADME as well is not insignificant.  Good news is that in P1 studies it was well tolerated and it is now in Phase 2 trials in Africa (DRC).

Oh, couldn’t resist one COVID19 question and comment- Have you read Michelle Goldberg’s OP-ED in the NYT titled “Finally, Experts Break the Silence on J.&J. Boosters”?  I received the J&J vaccine in March and have been urged by others to get an mRNA booster of some kind which I have so far resisted.  I tend to agree with the comments from a reader “R” which I’ve reproduced below.  Would like to know your and Daniel’s opinion as well.


July 3

Just to confirm, then: 

A) you compromised the J&J trial quality and violated the contract of your participation and public service through that participation. It is hard to overstate how serious a broach of public trust and data integrity this is. 

B) you manipulated (at best) and abused (at worst) the health system (withholding relevant information that affects eligibility, data collection, and equitable distribution is an abuse of the system)

C) you set an example for millions of readers that it is okay to mix and match untested agents (now, you say you don’t mean to encourage this, but your actions speak louder than your words). Maybe this combo will prove sound. But it is also possible this will lead to increased side effects, unknown significant bodily harms, and even diminished vaccine trust. 

D) you over-indulged with a third helping of resources that should be shared with other parts of the world. What about the healthcare vacuum so many others live in?

E) You allege there is an info vacuum kept by “experts.” You undermine the point of this vaccine – accessibility. You undermine trust efforts. You fan the flames, fallaciously, of conspiratorial thinking (believe it or not, no panel of experts is trying to keep info from you.)

Jarrett writes:

Greetings TWIVians,

Writing to you from a currently rainy Austin, TX, where Rich and I have been getting alternately soaked and steamed at an extremely soggy 77°F, or 298.15 Kelvin if we want to be very precise about it. (Point is, it’s gross out there.) I’m not sure if this email should go to “TWiV Main” or “TWiV Clinical,” so I trust Vincent to route it appropriately if it’s better addressed by Daniel. My hope is that my concern can be addressed by whoever has the best connections at CDC.

To wit: over the past few months I have grown increasingly dismayed by a prolific barrage of comments on every one of CDC’s Facebook posts relating to COVID-19. An example post of this kind of content is here: But, as a sample:

“VACCINES ARE THE POISON” (submitted with the pseudonym “Linda Foreveryourslord”)

“I have decided conclusively that we will not be indulging any organizations by pretending this “vaccine” is legitimate. Sorry, it is not going to happen”

“No one wants this science experiment, we know people are dying everyday from the gene therapy, the jig is up.”

There are two things about this pattern that really bother me: first, there are names that pop up repeatedly on successive posts, and people replying to them to amplify their comments repeatedly such that they float to the top of the “most relevant” comment filter Facebook provides. They are never banned; their comments are never deleted. What this means is that CDC is, by lack of moderating action, permitting COVID/vaccine deniers to organize on their Facebook posts. To me, this is completely unacceptable. For many reasons over the past five years we’ve had ample reason to believe that Facebook can be a powerful tool for amplifying disinformation. Permitting this kind of activity on a high-profile federal government social media account means that more people will be exposed to more dangerous nonsense than they would otherwise have been. As far as I can tell from my research, there exists no law or regulation requiring government social media outlets to permit unmoderated commenting, so it’s unclear what the motivation is here for the lack of control on the comments.

Second, this phenomenon is occurring in the context of the following very sobering report:  Polling increasingly demonstrates that resistance to vaccination is solidifying in certain populations. It is hard to imagine this having nothing to do with conspiracy theorist content spreading all over social media. This kind of activity is amplifying an already treacherous public health risk, and I hope someone starts addressing it before gets even worse. I have tried messaging the page, but unsurprisingly never received a reply.

Thanks and happy 4th to everyone,