One of the accepted side-effects of the Covid vaccines is increased risk of myocarditis. This risk was first identified in a leaked report produced for the Israeli Government, which was followed by several months of the denial of any link by the vaccine manufacturers and various governments until eventually the evidence for this side-effect became overwhelming and it was added to the growing list of official side-effects.
Of course, once a potential risk of myocarditis was identified there were some attempts by epidemiologists to sift though available data to try to identify the impact of this risk on the vaccinated population. The most recent paper to study this side-effect appeared in late August out of the Nuffield Department of Medicine in Oxford Radcliffe hospital by a team led by Julia Hippisley-Cox. This paper purports to show that the risk of myocarditis following vaccination is much lower than the risk following infection with Covid and that the risk of myocarditis following infection in the vaccinated is much lower than the risk in the unvaccinated. Thus the paper implies that the vaccines are appropriate to use even with this ‘rare’ side-effect. However, there are some complexities in the paper that warrant further attention.
My main concern with the Hippisley-Cox paper is that it is based on the results of a self-control study. With this methodology, the baseline data (i.e., the rate of myocarditis that you’d expect without the vaccines) are gathered from the same individuals as took the vaccine, only outside of the ‘risk window’ that is said to be associated with the vaccines. This methodology is well established and has many advantages, the most important of which being that so long as the study is well designed there is only a low risk of bias because the same group of individuals acts as its own control. The ‘so long as the study is well designed’ in the previous sentence is, however, crucial: pivotal in the design assumption is that the risk window contains all of the additional risk and that the risk returns to baseline outside of this window. If this condition doesn’t obtain then the incidence in the ‘control group’ will be elevated and this will reduce the apparent excess in the ‘treatment group’.
For the Hippisley-Cox paper the main assumption is spelt out in the methods section (emphasis added):
We defined the exposure risk intervals as the following prespecified time periods: 0, 1-7, 8-14, 15-21 and 22-28 days after each exposure date, under the assumption that the adverse events under consideration are unlikely to be related to exposure later than 28 days after exposure.
The pertinent question, then, is: is this assumption correct? Let’s have a look at the risks identified in the paper for the 28 days following the first dose of vaccine, split into four week periods.
To be clear – if the paper’s assumption that all of the vaccine risk occurs within the four weeks following vaccination then we should see a gradually falling risk over the four week period, preferably to a relative risk of 1.0 (no additional risk) by week 4. Arguably we do see this pattern for the “All, AstraZeneca” data – it appears that most of the risk is in the first week following vaccination, the risk drops away to a halfway point by week two and falls to around 1.0 for weeks three and four. However, the data for the Pfizer vaccine are far less clear – I suggest that it looks more like the risk starts to fall away (e.g. see the “all” and “men” bar-charts) but then bounces back for week four post-vaccination. The fact that the ‘bounce’ appears for women given the AstraZeneca vaccine even suggests that this might be a common factor for all vaccines, but the pattern appears strongest for the Pfizer data. Further investigation into the Pfizer vaccine specifically suggests that this pattern is fairly reliable, with only younger women not showing the bounce.
What I’d expect to see in a paper using a self-control method would be to have a ‘sensitivity analysis’ in the supplementary data, showing that the risk did actually return to baseline by week five (or however long it took to return to baseline), however there are no such data. Thus the authors expect the reader to believe that the above bar-charts all miraculous return to baseline for the fifth week – I believe that their data suggest that this is unlikely and that the risk of myocarditis is maintained beyond 28 days post vaccination, at least for the Pfizer vaccine. The situation is less clear for the AstraZeneca vaccine, and while the data for the Moderna vaccine (not shown) suggest that it is associated with a much higher risk of myocarditis, the relatively low numbers vaccinated with Moderna make it difficult to see if it also suffers from the ‘bounce’ in myocarditis risk.
It is important to note that if the risk is maintained beyond 28 days then there are two consequences:
- The risk is higher than the paper suggests, as it persists over a longer period of time;
- The baseline data will have some post-vaccine myocarditis mixed in with them; this will elevate the baseline risk and thus make the post-vaccine risk appear lower.
I’m always disappointed when self-control studies make this mistake. In science it is acceptable to have assumptions in a method, but it is necessary to test those assumptions and ensure that they are valid. In this case they appear to have declared that it is necessarily true that all additional myocarditis cases lie within the 28 day post vaccination period, and that it is not necessary to even consider that the declaration is false (I suggest that this is how religions work, not science).
One point that is encouraging about the data from the Hippisley-Cox myocarditis paper is that the data suggest that the bounce in myocarditis risk in the 21-28 day period after the first dose of vaccine doesn’t appear for the second and third doses. Of course, it might be that a bounce occurs after a longer delay for subsequent doses – but without additional data and with only sparse information on potential mechanisms that can only be a guess. Nevertheless, there is a suggestion that risks in the first seven days after vaccination are higher with the second and possibly third doses – this is consistent with the conclusions of other recent papers on myocarditis risk from Nordic countries and France, although these other papers do suggest that the risk after the second dose is higher than indicated by the Hippisley-Cox paper.
One potential mechanism that might explain the data seen is that following vaccination there is a two stage process – firstly a myocarditis related to direct damage to the myocardium from the fast-acting innate immune system, followed a few weeks later by (additional) damage caused by an adaptive (auto-)immune response (e.g. see this study). This potential mechanism would also explain the lack of a bounce in later doses, as the body would be primed to produce the adaptive (auto-)immune response rapidly following the appearance of new spike proteins.
There’s another aspect to the paper that is troubling – this lies in a small sentence also tucked away in the method (emphasis added):
Incidence rate ratios (IRR), the relative rate of hospital admissions or deaths caused by myocarditis in exposure risk periods relative to baseline periods, and their 95% CIs were estimated by the self-controlled case series model adjusted for calendar time.
The adjustment for calendar time means that they took into consideration the risk change given the time of year. Again, this is reasonable as it might be expected that myocarditis risk varies with the season – indeed, there is some evidence that the background rate of myocarditis is greater in the winter, although other studies suggest that myocarditis risk doesn’t vary much by season (science is inconsistent like this).
We can estimate the magnitude of this adjustment using the data on the increase in the risk of myocarditis after infection with COVID-19 by vaccination status. In the study all participants were vaccinated, thus the majority of infections before vaccination will have occurred early in the study and those post-vaccination will have occurred later. Luckily, the infection risk during the study was split into two periods – a winter Covid wave (Alpha variant), a period of low Covid incidence for several months and then a sustained period of moderate risk from mid-summer (Delta variant). This is illustrated in the chart of Covid infections for England during 2021.
In the paper the authors provide information on the relative increase in risk of myocarditis for the pre-vaccine and post-vaccine Covid infections, the number of cases of myocarditis that occurred and also the total number of infections pre- and post-vaccination. Using these data we can estimate the background rate of myocarditis used in the paper for the pre- and post-vaccination periods (mainly Jan/Feb and Jul-Dec respectively).
Hmm. This is troubling – we’ve got an increase in background myocarditis rate for a period that includes the summer (0.45), compared with the background rate for winter (0.34). This goes against the evidence that myocarditis risk is either independent of season or has a greater incidence during winter.
I suggest that what we could be seeing here is the impact of an extended period of increased risk of myocarditis post-vaccination (as discussed earlier in this post), which has increased the baseline used in the paper for the post-vaccination period. These data suggest an increase in risk of around 30%, which seems plausible given the data given for the 28-day post vaccination period.
This isn’t an undeniable proof that the paper is underestimating the risks of myocarditis after vaccination, but it adds to the red-flags that suggest that its methodology isn’t correctly identifying the increased risk.
There’s one more aspect to the paper. The authors claim that the vaccines reduce the risk of post-infection myocarditis to about half that seen in the unvaccinated. Is this merely an artefact caused by a changing baseline – which would explain much of the difference in risk for the first week after infection? Note that the vaccines don’t appear to reduce the risk of infection with Covid, thus if there is no reduction in the risk of myocarditis post infection in the vaccinated then there are only increased risks of myocarditis following vaccination without any ‘benefit’ (considering only myocarditis risk).
Furthermore, the pre-vaccination infections were with Alpha variant, whereas the post-vaccination were nearly all Delta-variant. How much of the reduction in risk seen ‘post-vaccination’ were caused by Delta variant having a different risk of myocarditis? Indeed, the paper considers that the varying risk of hospitalisation with myocarditis is purely related to vaccination or infection with Covid – were there other factors that resulted in a change in the probability of hospitalisation? Perhaps the public became more aware of the symptoms of myocarditis and being more likely to seek healthcare, or those infected with Covid were more likely to be hospitalised with Covid and had myocarditis diagnosed during the admissions process. And, of course, let’s not forget the cardiac risks arising from climate change, sitting incorrectly and drinking the wrong types of carbonated beverage that have suddenly appeared over the last 18 months.
It is worth pointing out that the very low risks identified in the paper were for hospitalisation because of myocarditis. The paper gives no information on the number of cases of myocarditis that might have warranted hospitalisation but that were ignored by the individual concerned, or for myocarditis with only mild symptoms. I note that a paper published recently on the topic of indicators of post-vaccine cardiac damage in young males suggests that this risk might be rather high. Unfortunately, there’s little information on the potential longer term consequences of this vaccine-associated myocarditis or other cardiac damage (of whatever clinical significance).
It also needs to be added that the paper only discusses one particular risk associated with the vaccines; other risks have been identified, and there may be other health impacts over the longer term that are currently being ignored. The paper is also deficient in that it does not consider the role of natural infection in potentially lowering the risk of post-infection myocarditis (this is important given that nearly everyone in the U.K. will have now had at least one Covid infection).
What disappoints me most of all is that we have ended up with a plethora of observational studies, each of which has attempted to identify ‘the scientific truth’ with incomplete and messy data. The reality is that we had a set of under-tested vaccines that were unleashed onto many multiple millions of individuals without any attempts to undertake large prospective matched cohort trials, even though such trials are normal on the release of a new medical product, there have been vast amounts of money thrown at Covid-related projects and after the initial rollout to the most very vulnerable there was sufficient time to organise such trials (there aren’t even signs of such a study on the rollout of the bivalent Covid vaccines, which appear to be somewhat under-tested). Indeed, we’re now in the era of ‘big data’ where such studies could readily have been integrated with real-time GP and hospital data to get a good and timely understanding of risks as they emerged (rather than the rather pathetic Yellow Card system).
But, then again, if you don’t look you won’t find.
Amanuensis is an ex-academic and senior Government scientist. He blogs at Bartram’s Folly.
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I don’t enough about all of this to comment on the rights and wrongs, but it does strike me how much more advanced alternative media seems to be in the USA compared to here. I wonder if we will ever catch up.
The slower we ‘catch up’ the better I will like it
Well, the USA seems madder than here, but the opposition to the madness is much stronger. I think whatever comes to the USA will come here, sooner or later, in spades, so opposition here needs to get a lot stronger. We’re still largely asleep – present company excepted.
They are much more commercially confident.
The Daily Sceptic for example.There is no doubt in my mind this can be a challenger publication to the establishment press. I’m so disillusioned with my subscriptions to the Times and The Telegraph. I’ve cancelled my The Times subscription due to their shockingly unacceptable full-on Fascist censorship. The Telegraph is only a tiny bit better and is just hanging in by a thread.
However The Daily Sceptic need an aggressive business plan, proper finance (which also implies taking a risk) and need to charge a subscription. Maybe like the Spectator offering a set number of free articles each month.
Sure the many existing readers will bitch and moan, but I for one would subscribe and I would rather they are a commercial success and rival to the establishment globalist agenda driven press.
I’m happy to pay my £5 a month
Luke Johnson is on the board but I guess he has limited time and would like it to be commercially self sufficient after an initial investment. A big problem is that they are blacklisted by the advertising intermediaries.
You’ve just made me feel bad because I’ve remembered that is an option and I chose to make a once off contribution. So I will put my money where my mouth is and pay a monthly sub. However I do think it should be mandatory. There is no getting away from the fact people either prepared to pay for what you have or they aren’t. IMO hedging around that can only worsen the finances.
I guess the issue is not to put off the casual reader with a paywall but I’m sure there are established approaches to that.
A lot of the BTL community here were indignant about the £5, and some pointed out they had other sites and publications in a similar space to which they subscribed. I have some sympathy for that but I was surprised by those who seemed to think they were entitled to free articles based on their BTL contributions.
I think advertising needs to be part of the mix. There is already some but possibly not paying much.
I’m £10 a month. Probably need to up it a bit. I pay Daily Wire an annual subscription. Daily Sceptic really needs to look into getting some financing from the USA.
Well done. I give to TCW too, though I don’t ever look at it – lack of time…
Fair point about the USA – could be a good market for them
You make a good point. I’d subscribe.
I can confirm that none of this matters to me.
It might not appear to be that important but it could be. Quite a few people I assumed were independent (e.g. Jordan B Peterson, Matt Walsh) have on their Facebook page, “The Daily Wire is responsible for this content” so that’s a bit strange if they’re independent. But who owns the Daily Wire? It’s not easy to find out (I watched a guy going through the process of trying to find out). As we don’t know who owns The Daily Wire, it could mean nothing very much but it could also be a brilliant way of dampening down independent voices?
The penalties in these contracts are massive for missed content and all kinds of other things and of course the enticement of $50 million is an offer most people can’t refuse. And other ways of raising funds are often difficult, one alternative news website recently was denied access to its own bank account, having been banned off all the usual social media sites, down listed by search engines etc . It’s potentially a brilliant scheme, offer ludicrous sums of money to stars/independent voices and penalise them heftily if they stray off course or even take a sick day whilst at the same time, making it hard for truly independent voices to fund themselves. Something to think about – not entirely sure what the answer is apart from as always, support things you don’t want to disappear – shops, cafes, independent voices etc but as usual question everything.
I cannot afford the mental cost of caring about every issue and this one is so far remote from my experience that it is not worth investing in it. I have reached an age and financial status (only modest) where I can plough my own furrow.
Take all your points on board about the continual censorship of any comment that doesn’t fit whatever the current narrative is etc, but can we just put this into perspective? 50 mill over 4 years divided by 365 days/year = $34,246 A DAY. I’d take a few limitations on gobbiness for that sort of cash. Having watched Crowder’s vid it just looked like he was having a hissy fit, and there were/are much more mature ways of dealing with contract negotiations. Perhaps he reckons it’s good publicity.
The key thing is that the term sheet was a starting negotiation draft. Crowder is already demonetised. So was Candace Owens, so that aspect of the terms sheet would be an immediate redline.
Crowder has gone berserk over a terms sheet, to be clear. Essentially, Crowder’s operation is one run by him and his parents and he doesn’t seem to have bothered to get his lawyers involved in negotiations. Candace Owens spent five months in negotiations. Crowder threw his toys out of the pram on day one.
Lauren Chen has done an excellent appraisal of the situation on her YouTube channel. She’s worked for The Blaze and had negotiations with Crowder and The Daily Wire.
the £100K per episode penalty was not for a sick day … it was for a voluntary decision to just not make a show … the ‘sick day’ was $60+K equivalent to the per show fees.
Crowder has been known to just clear off.
“I’m certainly not going to be goaded into a conflict with allies unless I can think of a way to monetize it.” [BabylonB, adapted]
It wasn’t the Daily Wire it was the Babylon Bee.
Yes, BB can always be relied on to take the sting out of a situation.
Meanwhile, in the latter-day sodom and gomorrah known as Davos, megalomaniacs are plotting our enslavement to technology and other worthless idols of the modern age. That seems like the real elephant in the room right now, not some guy and his job contract
Yes it does appear to be the case, that after every Davos, the thumb screw is turned a little more against the pleb. I can’t wait to hear how wonderful they are in whatever format they wish to publish it.
I lean towards the Wire on this one too. Crowder comes across as petulant and entitled. Imagine having to do 190 shows per year for a measly $50m, oh the inhumanity! It’s practically modern slavery.
The fuss about the social media clauses could also be taken out of context although It’s harder to tell on this one. I doubt the Wire rely on YouTube or Facebook revenue whereby they could not cope if a presenter is demonitised, but if Crowder did a YE and got banned entirely then it’s not unreasonable for an employer in the entertainment industry to impose penalties for that.
Agree. Crowder has a point but has used completely dirty and bad faith tactics to make it. It isn’t an exposé that needed to be made like that. If he really felt that strongly (and isn’t acting in bad faith – but I think he is) he should have spoken to the Daily Wire and said, look guys, I think this is a big enough issue for the industry, sorry I’m compelled to talk about it publicly. Even if he gave them no time for a lawyer response before doing so, that would have been a better way to handle it, consistent with someone acting in good faith.
Who are these people? Astonishing that they can be paid so much money and I don’t remotely recognise them or what they do!
Crowder is an idiot. I like what he ofter says, but he seems to have decided to start his own network by trying to destroy the Daily Wire. It’s the old idiocy that infects all sides: the desire for ideological purity. On the right, there is always more individualism and diversity of opinion, because the right doesn’t have the hive mind aim of a communist utopia that the left does. The trouble is that the most prominent voices on the right no only fail to get along, but spend more time slagging each other off than keeping an eye on the enemy. It goes back decades. Ayn Rand, Isabel Paterson, Murray Rothbard, William F Buckley Jr all flirted with each others ideas, but ended up hating each other. The Ayn Rand Institute spends hours slagging off The Objective Standard and The Atlas Society, plus anyone one else vaguely right of centre, acting as if only they know best. The Daily Mail has spent decades slagging off its right of centre ‘rivals’ while pumping out gallons of borderline pornography.
Unfortunately no one seems to get it into their thick skulls that there’s a war going on and we’re losing. Six or seven thousand people globally have got themselves into key positions in politics, big business, the media, civil services, medicine, governments and education and are systematically dismantling Western society… scratch that! … have dismantled Western society. We’re fighting a rearguard action and the people who are supposed to be on our side are too busy measuring the lengths of their d**ks!
I’ve been a Daily Wire subscriber for ages. They’re a good site – an oil billionaire-financed text and streaming site aimed at taking on Hollywood at their own game, making classy documentaries and moving into entertainment. A major part of their deal with Jordan Peterson was that Peterson could guarantee there was somewhere his work could be kept safe as the wolves have been set on him in the public arena. But DW represent one prong in the rearguard action (I’m beyond thinking we can win in our own countries: the best we can hope for is the foundation new countries or havens or ghettos to we which we or our descendants can flee in the next couple of generations.) And Jeremy Boreing is well known as a lover of negotiations. Daily Sceptic is another significant ‘prong’ in the fight.
The right needs to end the infighting. While they slag each other off, the left laughs and continues to hand out puberty blockers to children and teach them horrifying lies in school. And in 25 years’ time, many of us middle aged people will be lying in hospital for some sort of operation while these Red Guard kids will doctors be deciding whether to treat us properly or ‘allow’ us to die on the operating table because they’ve been taught to hate our politics.
Although extremely dark your comment is about right …. sadly.
I’ll keep believing in the white pill though because Ive got a 20 yr old son and have to
Thank heavens I’m not a fan of overpaid American alternative media ‘celebrities’. I do hope this doesn’t disqualify me from the Daily Sceptic?
Of course not. But the alternative scene is more than just media in the USA: it’s becoming a full blown alternative economy. When Harry’s Razors stopped advertising on Daily Wire, tossing a woke hand grenade on the way out talking about a ‘values misalignment’ in order to cozy up to the far left, Jeremy Boreing launched Jeremy’s Razors and they proved to be a big success.
Eric July, rapper and libertarian pundit has launched his own comic book company. So has Ethan Van Sciver, formerly a successful creator at DC Comics. They aren’t creating conservative or libertarian comics: they’re simply creating comics that don’t have woke messaging. For that, they’re under constant attack as ‘far right’.
Unfortunately, this kind of alternative economy doesn’t exist in the UK and the extremists who run our country won’t let it happen. When Gillette went woke and attacked their male customer base, I stopped using them, but I’ve yet to find as good a brand of razor as a replacement, having used them for 30 years!