Monthly Archives: July 2022

Vivek Subbiah, MD, discusses the FDA approval of dabrafenib plus trametinib for the treatment of patients with BRAF V600Emutated unresectable or metastatic solid tumors.

Vivek Subbiah, MD, an associate professor in the Investigational Cancer Therapeutics Department and the Center Clinical Medical Director of the Clinical Center for Targeted Therapy, Cancer Medicine Division, at The University of Texas MD Anderson Cancer Center, discusses the FDA approval of dabrafenib (Tafinlar) plus trametinib (Mekinist) for the treatment of patients with BRAF V600Emutated unresectable or metastatic solid tumors.

In June 2022, the FDA approved the combination for the treatment of adult and pediatric patients aged 6 years and older with unresectable or metastatic solid tumors harboringBRAFV600E mutations who have progressed following previous treatment and who have no satisfactory alternative treatment options. In the phase 2 ROAR basket study (NCT02034110) and arm H of the NCI-MATCH study (NCT02465060), the doublet produced overall response rates of up to 80% in patients withBRAFV600Emutated solid tumors, including high- and low-grade glioma, biliary tract cancer and select gynecological and gastrointestinal cancers.

Previously, agents were approved for the treatment of patients with melanoma harboring BRAF mutations, and studies were then conducted across multiple solid tumor types that had a provenance for BRAF V600E mutations, Subbiah notes. However, patients with BRAF V600Emutated colorectal cancer (CRC) did not respond to BRAF-targeted agents. Subsequently, CRC was found to be an exception for BRAF inhibition due to EGFR creating a mechanism of resistance. As such, treatment for patients with BRAF V600Emutated CRC required the addition of an EGFR inhibitor, Subbiah adds.

Despite the resistance in CRC, BRAF inhibitors, when combined with a MET inhibitor, were found to be active across cancer types harboring BRAF V600E mutations, Subbiah continues. The combination of dabrafenib and trametinib is a testament to how precision medicine can help shape new treatments spanning different cancer types, Subbiah concludes.

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Dr. Subbiah on the FDA Approval of Dabrafenib/Trametinib in BRAF V600EMutated Solid Tumors - OncLive

Introduction

Postoperative pain foremost refers to the acute pain that occurs immediately after surgery and consists mainly of pain from somatic and visceral trauma caused by surgical operations and pain from inflammatory irritation around nerve endings,1 which attributes to injurious pain.2 If it continues to be poorly controlled, pathological remodeling of the central and peripheral nervous system occurs3 and the nature of the pain changes to neuropathic pain or mixed pain, then it progresses to chronic postoperative pain. More than 300 million patients undergo surgery worldwide each year.4 Between 30% and up to 80% of patients report moderate to severe pain in the days following surgery, and approximately 20% developing chronic pain.5 Persistent pain not only affects the patients recovery and leads to longer hospital stays,6 but also adds to the psychological burden of the patient, causing anxiety and depression.7,8 For families and society, both the direct increase in hospitalization expenses and consumption of medical resources, and the consequent indirect decline of individual labor force and even unemployment,9 are issues that should not be underestimated.

Currently, pharmacological analgesia remains the dominant modality for the treatment of postoperative pain. Analgesics can meet the requirements of short-term and rapid analgesia, however, their side effects such as the addiction of opioids,10 the gastrointestinal harm and possible cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs),11,12 are also evident. Furthermore, although numerous postoperative pain management recommendations have been available over the years, the drugs recommended are generalized for all procedures.13 The efficacy of pain medication may vary depending on the type of surgical procedure,14 so it is difficult for specialists to find an effective solution for a particular procedure, and many patients report unsatisfactory results in terms of postoperative pain control.15 This all indicates to the fact that pharmacological analgesia is not a long-term solution. Searching for green, safe, low adverse effects and targeted analgesia gradually becomes one of the most important concerns of clinicians.

Acupuncture therapy, a series of traditional Chinese medical treatment internationally accepted and applied for its undeniable effectiveness of therapeutic effects in the treatment of various pain-related conditions and nerve disorders,16,17 is one of the ideal non-pharmacological treatments to control post-operative pain. Studies have found that acupuncture therapy can intervene in pain through mechanisms such as increasing endogenous opioid peptides in the brain,18,19 modulating abnormal neurological function,20 and influencing intracellular signaling pathways.21 A randomized controlled trial (RCT) showed that acupuncture was effective in relieving postoperative pain in patients undergoing hemorrhoidectomy.22 Another RCT also found that acupuncture therapy was safe and effective in the management of post-cesarean pain.23

Bibliometric analysis is a method for evaluating and quantifying literature information using mathematical and statistical methods,24 which can help to recognize the research advances in a specific field of science comprehensively.25 This analytical method has been applied to many areas with a large body of research accumulated, including pain management. In one of these studies, Gao et al26 analyzed the field of acupuncture for analgesia, and it can be seen in this study that acupuncture therapy for postoperative pain has also received considerable attention. However, despite the heat in the clinical and research area, no studies have yet explored current research trends in the treatment of postoperative pain with acupuncture therapy and continued in-depth study of this field using bibliometric analysis is highly warranted.

The approach of bibliometric was applied in this study to analyze the literatures about acupuncture therapy for postoperative pain over the last 20 years, through multiple perspectives such as journals, authors, institutions, countries, keywords, and references. And the results were presented in the form of scientific knowledge maps by using the CiteSpace software, then the maps were further interpreted and analyzed, to gain an intuitive and comprehensive understanding of the research in the field, identify research hotspots and provide new research ideas.

All data for this study were obtained from the Web of Science (WoS) core collection database on 1 March 2022. The data search strategy included the topics postoperative pain and acupuncture therapy, with the publications period of the literatures ranging from 200101-01 to 202202-28. Only English-language papers were included, the country and category of the study were not restricted. Duplicates and articles without full text were excluded. Secondary search for references and relevant reviews in the literatures was conducted in order to avoid omissions. The specific search strategies and results were shown in Table 1. Eventually, 840 articles were obtained.

Table 1 The Topic Search Query

This research applies CiteSpace (V5.8.R3 64-bits) combined with Excel to organize and visualize data for analysis, including: (1) statistical and descriptive analysis: for parameters such as annual publication volume, authors, countries, institutions and journals; (2) collaborative network analysis: mainly for the three dimensions of countries (regions), institutions and authors;(3) co-occurrence analysis: for keywords; (4) co-citation analysis: for authors, journals and references; (5) citation burst analysis: mainly for keywords and references; (6) cluster analysis.

The specific parameters for the visualization analysis were set as follows. The threshold of Top N% per slice was 50 for all calculations. The time span was from January 2001 to February 2022, and the time slice setting for all analyses conducted with CiteSpace was 1 year per slice. Clustering labels were extracted by using the LLR algorithm.

The nodes in the maps generated by CiteSpace represent the objects being analyzed (such as different authors, institutions, or keywords); the size of the diameter of the nodes reflects the frequency (such as the output or citation frequency.); different colors correspond to different years (such as the year of publication); the lines between the nodes indicate the collaboration or co-occurrence relationship between the two, the color of the line indicates the time of the first collaboration and the thickness of the line reflects the strength of the relationship between the two.

The retrieval of database found that a total of 860 articles have been published in the field of acupuncture therapy for postoperative pain in the past 20 years, and the number and trend of annual articles are shown in Figure 1. 2001 to 2014 could be seen as one phase. During this period, the annual number of articles published showed a fluctuating and slow growth trend, with an annual average of about 24 articles. There were four small peaks of growth successively, but all of them were quickly followed by a fall back. 2015 to the present is another phase. The number of publications in 2015 surged to 60, and after a small rebound, 2016 to 2019 saw a sustained and significantly accelerated increase in the number of publications, with the heat of attention increasing and stabilizing at an average of over 80 publications per year for the period 2019 to 2021, which was the highest record over the past 20 years. Only two months of data are currently available for 2022, but based on the above, it can be deduced that the number of publications this year will also be considerable and the research fever in the field of acupuncture for postoperative pain will continue.

Figure 1 The number of annual publications on acupuncture treatment for postoperative pain.

Note: In this figure, the number of articles published in 2022 is marked with an * and indicated by a dashed line, since only two months of data are available for this year.

The total number of journals that published these 860 articles on acupuncture treatment for postoperative pain was 344 and the top 10 journals with the highest cumulative number of publications were listed in Table 2. The most published journals, accounting for about 14% of the total number of articles published, were Evidence-Based Complementary and Alternative Medicine (40 articles), Acupuncture in Medicine (39 articles), and Medicine (38 articles). Anesthesia and Analgesia had the highest impact factor (IF) of 5.178, with 21 articles published, ranking 5th.

Table 2 The Top 10 Journals with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

In conjunction with centrality, CiteSpace was used to generate a map of cited journals with 645 nodes and 5770 links (Figure 2), reflecting the co-citation relationships between journals. A node represented a journal, which gave a total of 645 journals involved in co-citation in the field of acupuncture therapy for postoperative pain. Shown in Table 3, the top five contributing journals as cited are Pain, Anesthesia and Analgesia, Anesthesiology, British Journal of Anaesthesia, and Acupuncture in Medicine. In the cited journal map, the purple ring outside the node reflected the size of the centrality of the journal it represented. Table 4 listed the journals with the highest centrality in the field of acupuncture therapy for postoperative pain, with Clinical Journal of Pain and European Journal of Anaesthesiology being the top, both at 0.07.

Table 3 Top 5 Cited Journals with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

Table 4 Top 7 Cited Journals with the Highest Centrality on Acupuncture Treatment for Postoperative Pain

Figure 2 Co-citation map of journals on acupuncture treatment for postoperative pain.

Statistically, articles on acupuncture therapy for postoperative pain mainly came from 53 countries. The five countries with the highest contribution to the number of articles and the highest centrality were shown in Table 5 respectively, and a map of country cooperation networks was generated accordingly (Figure 3). As seen from it, China, the top publisher, has a weak chain of partnerships with other countries and need more international cooperation to enhance the global promotion of acupuncture therapy for postoperative pain. As the first of the pivot nodes, the US published a large amount of relevant literature and established collaborative relationships with quite a few countries. In addition, several countries forming a salient hexagonal circle of cooperation were visible in the upper right of the map. The mutual cooperation between these countries was developed early and closely. Meanwhile, they also maintained a certain cooperative relationship with Germany, one of the pivot nodes.

Table 5 Top 5 Countries with the Highest Frequency and Centrality on Acupuncture Treatment for Postoperative Pain

Figure 3 Map of countries cooperation network on acupuncture treatment for postoperative pain.

The top five institutions in terms of volume and centrality were listed in Table 6. China Medical Univ and Kyung Hee Univ both ranked first with 25 articles, followed by Korea Inst Oriental Med, Chinese Acad Sci and Shanghai Univ Tradit Chinese Med. China Med Univ, which had the highest number of articles, had the the highest centrality meanwhile, and Shanghai Univ Tradit Chinese Med was also tied. The inter-institutional collaboration network was generated accordingly, as shown in Figure 4. During this process, it was found that there were many instances where the names of institutions were not written normally, causing CiteSpace to identify the same institution as a different node. Such cases were all merged manually.

Table 6 Top 5 Institutions with the Highest Frequency and Centrality on Acupuncture Treatment for Postoperative Pain

Figure 4 Map of inter-institutional collaboration network on acupuncture treatment for postoperative pain.

A total of 623 authors contributed to these 840 articles in the field of acupuncture therapy for postoperative pain and a map was generated using CiteSpace to show the collaborative relationships between the different authors (Figure 5). The nodes marked with names in the graph were the authors with three or more publications. And the authors with more than five publications, seven in total, were the core authors in this field. The most prolific author was Inhyunk Ha, with 10 publications. With him at the center, the graph presented a collaborative block linking up highly productive authors such as Byungcheul Shin (8 publications) and Meriong Kim (6 publications). Man Zheng was also active, with 6 publications, and he was part of the same team as Zhen Zheng, who had 5 publications. Lianbo Xiao and Di Sessler also had 5 publications. The map also manifested some loosely linked teams, most of which were multiple authors of the same paper. The collaborations between the different teams were less. Other relevant information about core authors were listed in Table 7. The Year column in the table manifested when the author first published, reflecting how early the author had been interested in the field. The Nationality column showed that the core authors were mainly from Korea and China. Moreover, the Author and Country modules were overlaid to obtain a new graph (Figure 6), where the distribution of authors by nationality can also be observed.

Table 7 Top 7 Authors with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

Figure 5 Map of authors cooperation network on acupuncture therapy for postoperative pain.

Figure 6 Authors-countries collaboration map on acupuncture therapy for postoperative pain.

In combination with centrality and applying pathfinder and pruning sliced networks, CiteSpace was used to generate a co-citation map of authors from the field of acupuncture therapy for postoperative pain with 745 nodes and 2824 connected lines (Figure 7). The five most frequently co-cited authors whose articles had the highest impact were Han JS, Sun Y, Lee A, Lin JG and Wang SM, listed in Table 8. The seven authors with the highest centrality were demonstrated in Table 9, with four of them, Han JS, Vickers AJ, Wang SM and Ernst E, having centrality greater than or equal to 0.1.

Table 8 Top 5 Cited Authors with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

Table 9 Top 6 Cited Authors with the Highest Centrality on Acupuncture Treatment for Postoperative Pain

Figure 7 Co-citation Map of Authors on Acupuncture Therapy for Postoperative Pain.

The 840 articles of acupuncture therapy for postoperative pain brought together a total of 517 keywords. Pathfinder and pruning sliced networks applied, a co-occurrence map of keywords, Figure 8, was generated. The 10 most frequently occurring words have been listed in Table 10, and 6 keywords occurred more than 100 times. Of interest were the electroacupuncture ranked 4th and auricular acupuncture ranked 8th. The frequency of these two keywords about therapeutic techniques was particularly high. Meanwhile, the keyword auricular acupuncture and two keywords related to electroacupuncture research, electrical stimulation and electrical nerve stimulation, had a high centrality (Table 11).

Table 10 Top 10 Keywords with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

Table 11 Top 11 Keywords with the Highest Centrality on Acupuncture Treatment for Postoperative Pain

Figure 8 Co-occurrence map of keywords on acupuncture therapy for postoperative pain.

Further clustering based on the co-occurrence map resulted in a total of 12 clusters presented in Figure 9. The five largest clusters were #0 postoperative nausea, #1 spinal nerve ligation, #2 systematic review, #3 postoperative ileus, #4 gi endoscopy, #5 undergoing autologous hematopoietic stem cell transplantation. These were the most talked about topic in this area. Transforming the map into a Timeline view (Figure 10) allowed to observe the evolution of hot spots in the field of acupuncture therapy for postoperative pain research over the last 20 years.

Figure 9 Cluster map of keywords co-occurrence on acupuncture therapy for postoperative pain.

Figure 10 Timeline map of keywords co-occurrence on acupuncture therapy for postoperative pain.

A total of 855 references were extracted from the 840 articles of acupuncture therapy for postoperative pain to analyze cited references. The earliest cited literature was published in 1996 and the most recent reference was published in 2020. The five most frequently cited publications were listed in Table 12. Three of these were systematic reviews, one clinical randomized controlled trial, and one review. The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis by Wu MS et al,27 published in 2016 topped the list with 44 citations. Table 13 demonstrated the top 5 papers ranked according to centrality. Three of these were clinical randomized controlled trials, one was a systematic review, and one was a review article. Written by Sun Y et al, Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials,28 published in 2008 had the highest centrality of 0.22.

Table 12 Top 5 Cited References with the Highest Frequency on Acupuncture Treatment for Postoperative Pain

Table 13 Top 5 Cited References with the Highest Centrality on Acupuncture Treatment for Postoperative Pain

As shown in Figure 11, there was a co-citation map of references generated by CiteSpace. All references marked on the graph were those with more than 8 citations, and it can be seen that a large number of highly cited literatures were published in the last 10 years. Based on this, 19 valid clusters were obtained (Figure 12). The five largest clusters were #0 acupuncture analgesia, #1 evidence-based nonpharmacologic strategies, #2 postoperative complication, #3 randomized controlled trail, #4 ambulatory anesthesia, #5 capsicum plaster.

Figure 11 Co-citation map of references on acupuncture therapy for postoperative pain.

Figure 12 Cluster map of references co-citation on acupuncture therapy for postoperative pain.

Burst keywords refer to keywords that have seen a spike in citations over a period and represent the research hotspot for the corresponding time. The 840 included articles were measured via CiteSpace and a total of 16 burst keywords were extracted, as shown in Figure 13. These keywords first appeared in 2001 or before, but the burstness began and ended at different times (shown as the red bars). Among them, postoperative nausea had the highest value of burst intensity, with a Strength of 8.36. Keywords having the longest duration of the burstness were acupuncture analgesia and trial, both beginning in 2008 and ending in 2016. The three latest burst keywords, pain relief from 2018, systematic review from 2019 and osteoarthritis from 2020, have been still ongoing.

Figure 13 Top 16 keywords with the strongest citation bursts.

A reference citation burst is a surge in the frequency of the reference being cited over a period, which can help to identify areas at the forefront of current research. A total of 15 references of citation burst were extracted for this study and were displayed in Figure 14. Four references with the latest burstness were identified. An article by Zhang RX published in 201429 and an article by Lee A published in 201530 both began bursting in 2017, with the former ending bursting in 2019 and the latter in 2020. The next burst reference was the same as the most frequently cited article (Wu MS, 2016),27 and meanwhile it had the highest value of burst intensity (15.32). This reference and another one by Chou R were both published in 2016,31 with their citation bursts beginning in 2018 and continuing until now.

Figure 14 Top 15 references with the strongest citation bursts.

The 840 publications included spanned the period from January 2001 to February 2022. Analysis of the annual volume of literature published revealed that the volume of publications in the field of acupuncture for postoperative pain had increased to varying degrees each year. This increase was relatively steady in the early stage, more prominent after 2015, and stabilized at its highest level during the latest 3 years. This indicates that the field is in a period of rapid development and has great scope for exploration and research value. From the analysis of journals, the impact factors (IF) of the top ten journals with the highest cumulative number of publications are generally low. This indicates that the influence of acupuncture techniques for postoperative pain control in international applications is still relatively limited, and the quality of relevant publications needs to be improved. The highly cited journals mainly reflect the sources of journals that are the knowledge base of the relevant literatures. Most of them are comprehensive medical journals that serve as a bridge of knowledge between conventional and complementary alternative therapies, and they are more influential, with having a higher impact factor.

In terms of the number of national publications, the contributions of China and USA are the most prominent. The parameters of the cooperation map show that the density of national collaborative networks is not low, which means that to some extent an international environment for collaborative research in the field of acupuncture for postoperative pain has been formed, with European and American countries such as the USA, UK and Germany playing a larger role, while Asian countries, represented by China and Korea, have more fragmented links. Institutions in Chinese and Korean are the main locations for research in this field. Medical schools and their affiliated medical institutions are the main institutional form. None of the top five institutions in the centrality ranking has a value above 0.10, suggesting that even the representative institutions are only collaborating on a small scale.

In terms of authors, Inhyuk Ha and his partners have published the most articles, focusing on the application of acupuncture therapy for postoperative pain in the low back, with the most influential article being cited 42 times. This meta-analysis has provided evidence to support the use of acupuncture for acute pain occurring within one week of back surgery.32 From China, Man Zheng is member of a research team investigating the role of acupuncture therapy in perioperative pain prevention, particularly in thoracic and abdominal surgery. A randomized controlled trial conducted by the team demonstrated that in patients undergoing gynecological laparoscopy surgeries, a single electroacupuncture session within 24 hours before surgery was effective in preventing postoperative pain.33 The author who has the highest frequency of being cited and centrality is Han JS, whose most cited paper is a review published in Pain in 2011,34 which focuses on the consensus and controversy surrounding the research on the efficacy and mechanisms of acupuncture-related therapy, including the selection of acupoints, stimulation methods and intensity, and neurological effects, providing a reference for both clinical application and trial protocols.

Keywords and references reflect the content of the research from different aspects. Observed in the spatial dimension, the level of their frequency, centrality and burst intensity, and clustering distribution can suggest research hotspots. And in the temporal dimension, the dynamic changes of them can reflect research trends and help identify research frontiers.

Based on the frequency and centrality of the keywords, it can be determined that electroacupuncture and auricular acupuncture are probably the therapeutic techniques that have received the most attention from researchers in this field. A multicenter randomized controlled trial demonstrated that electroacupuncture combined with conventional care was superior to conventional care alone for the relief of non-acute pain following back surgery.35 Another randomized controlled trial also showed that auricular acupuncture could provide postoperative analgesia and reduce the application of analgesic medication and was safe to perform.36

Studies on the control of postoperative pain with acupuncture have covered a variety of surgical types, including low back surgery, osteoarthritis surgery, lung cancer surgery, cardiac surgery, brain surgery, laparoscopic surgery, tonsillectomy, hysterectomy, total knee replacement, hip replacement, caesarean section, oral surgery, spinal surgery, shoulder and neck surgery, gastric cancer surgery, and anorectal surgery. The studies on chronic lower back pain due to the aftermath of low back surgery are the most, with 58 occurrences of related keywords.

The results of clustering and burstness of keywords revealed a consistently high level of concern for postoperative nausea. The largest cluster was postoperative nausea. Of the 16 burst keywords, postoperative nausea was the keyword with the earliest occurrence (beginning in 2002) and the greatest intensity of burstness. Moreover, the keyword nausea had a second citation burst in 2014. Both nausea and pain are the most common complications after surgery. Meanwhile, there is also a degree of causality between the two. Opioid analgesics have been found to be one of the main causes of postoperative nausea and vomiting.37,38 The problem of nausea can be addressed to a great extent if postoperative pain can be relived with minimal use of such medications. Acupuncture therapy has attracted the attention of researchers as an excellent complementary and alternative therapy. A systematic review by Pouy S et al showed that acupuncture therapy can prevent and reduce the occurrence of post-tonsillectomy pain and nausea in pediatric patients.39 A popular direction of research derived from this research hotspot is PC6 acupoint stimulation. The acupoint of Neiguan (PC6), located on the pericardium meridian, is a specific point for the treatment of nausea and vomiting.40 Studies on the relief of postoperative complications of pain and nausea have been conducted as early as 1996 by applying pressure to the Neiguan point.41 A systematic review and meta-analysis by Cheong KB et al demonstrated the safety and effectiveness of acupuncture stimulation of the PC6 acupoint or with the combination of other acupuncture points to alleviate postoperative vomiting associated with anesthetic analgesia.42

In addition, transcutaneous electrical nerve stimulation (TENS) is another hot direction of research in this field, as reflected in the keyword clustering and burstness. This technique is also combined with auricular acupuncture techniques.43 A similar technique arising from the disciplinary crossover is transcutaneous electrical acupoint stimulation (TEAS).4446

From an overall perspective, keywords whose burstness occurred in the first decade mainly reflected a concentrated discussion of postoperative pain management and acupuncture analgesic techniques, with the main form of research being mostly RCTs. In the recent decade the main focus has been on pain symptom relief and postoperative quality of life, with a gradual increase in the number of systematic reviews. Moreover, animal experiments, as well as mechanism-related studies, also have a place, as evidenced by the burst keyword rat and the second largest cluster #1 spinal nerve ligation (a kind of rat modelling technique). Looking at the three newest burst keywords, pain relief shows the constant attention received by the topic of postoperative pain management. The rise in heat of systematic review reflects the development of evidence-based medicine in this field. 2020 saw the burstness of the term osteoarthritis, indicating that in the last two years acupuncture analgesic techniques have started to be used in osteoarthritis surgery more often and intensive research has been conducted.47,48

The citation status of the references also manifests a distinctly evidence-based medical color. The most influential literatures in this field are of a variety which is dominated by RCTs and systematic reviews of clinical studies. In the results of clusters, both #1 evidence-based nonpharmacologic strategies and #3 randomized controlled trail have a relatively large size. The most frequently cited reference suggested that certain modes of acupuncture did have implications for alleviating postoperative pain and reducing opioid use.27 That acupuncture could control acute postoperative pain and reduce the side effects of pharmacological analgesia was supported by the reference with the highest centrality.28

According to the newest burst references, electroacupuncture could alleviate pain by activating a range of bioactive substances including opioids, N/OFQ, 5-hydroxytryptamine, norepinephrine and others.29 Lee A et al evaluate the preventive effect of several methods of stimulating the PC6 acupoint on nausea and vomiting resulted from surgical analgesia and anesthesia.30 This fits in with the direction of research embodied in the keywords. The last is a guideline on postoperative pain management published in 2016.31 In this guideline, TENS is supported by moderate quality evidence and is recommended as a complementary therapy. In contrast, the effectiveness of other acupuncture therapies remains controversial, although there is adequate evidence for their safety. However, most of their citations and evidence are of results published before 2005 and their evidence needs to be updated. This suggests that the current focus in the field of acupuncture therapy for postoperative pain is still on proving the effectiveness of acupuncture therapy and that there is a long way to go in terms of conducting high quality clinical research.

In this study, the analysis of annual volume of publications and journals suggests that the field of acupuncture therapy for postoperative pain relief is currently in a period of rapid development. The analysis from country to institution to author shows a progressively more microscopic perspective of observation and consistency is evident among them: there may be more localized individual collaborations, but the overall collaborative network is not yet mature. In terms of keywords and references, electroacupuncture and auricular acupuncture (therapeutic techniques), low back surgery (types of surgery), postoperative pain, nausea and vomiting and their derivatives are research hotspots in this field. Improvement of postoperative life quality, proof of clinical efficacy and evidence-based evaluation are the current research trends and frontiers. Overall, the field of acupuncture for postoperative pain has great potential for development, and more international exchanges and collaborations as well as high-quality research results are needed in the future.

The strength of this study is that literatures on acupuncture therapy for postoperative pain were analyzed by applying bibliometrics and visualization for the first time, and the results were interpreted from multiple perspectives, with the information presented in the macroscopic perspective sufficiently explored, revealing the research hotspots and trends in the field. The limitation of this study is that only literature from the Web of Science was analyzed. This is because CiteSpace cannot combine and analyze data from multiple sources at the same time, and other databases cannot export the corresponding citation formats for citation analysis.

NSAIDs, non-steroidal anti-inflammatory drugs; RCT, randomized controlled trial; WoS, Web of Science; IF, impact factor; TENS, transcutaneous electrical nerve stimulation; TEAS, transcutaneous electrical acupoint stimulation.

The raw data of this article was collected from the online database WoS, which can be obtained directly by logging in or contacting the authors.

This study did not contain any human or animal test subjects. Thus, the requirement for ethics approval was waived.

The authors would like to express their appreciation to Prof. Chaomei Chen for developing CiteSpace and opening its access.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

This study was supported by the National Natural Science Foundation of China (U21A20404); the Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (ZYYCXTD-D-202003).

The authors report no potential conflicts of interest in this work.

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23. Usichenko TI, Henkel BJ, Klausenitz C, et al. Effectiveness of acupuncture for pain control after cesarean delivery: a randomized clinical trial. JAMA Netw Open. 2022;5(2):e220517. doi:10.1001/jamanetworkopen.2022.0517

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See the original post here:

Acupuncture Therapy for Postoperative Pain | JPR - Dove Medical Press

In stoking fear, uncertainty, and doubt (FUD) about vaccines, antivaxxers frequently try to induce disgust and revulsion. There have been many examples of this technique over the years, such as trying to portray vaccines as laden with horrific toxins (such as formaldehyde and mercury), ranting about the use of monkey cells or cells from other animals to make them, and claiming that they contain fetal tissue (or cells or DNA), with Mike Adams, for instance, going so far as to portray vaccines as child sacrifice in which doctors are injecting the child with foreign DNA extracted from other children sacrificed at abortion centers. (I can always count on Adams to provide me with examples of the most over-the-top version of any antivax tropes that I wish to discuss.) Over the years, Ive seen antivaxxers demonize mercury, aluminum adjuvants, all manner of vaccine ingredients (as long as they can be made to sound scary to people without much knowledge of chemistry), technologies used to make the vaccines, and basically anything about vaccines that can make vaccines seem dirty, contaminated, and dangerous. The latest example bubbled up over the last couple of weeks over the Novavax COVID-19 vaccine, which was granted emergency use approval (EUA) earlier this month, which was soon portrayed in a similar light, with special attention being paid to the moth cells used to produce the protein antigen for the vaccine and, to a lesser extent, the choice of adjuvant for the vaccine.

Before discussing the misinformation about Novavax, I will brieflyfor me!recount how the latest version of antivax rhetoric portraying vaccines as toxin-laden and horrific had already been successfully employed against existing COVID-19 vaccines. In this case, the key tool that antivaxxers have used to spread FUD about COVID-19 vaccines has been the newness of the technologies used to develop them. Although introducing mRNA into muscle cells in order to provide them with the template to make a specific proteinin the case of COVID-19 vaccines, the SARS-CoV-2 spike protein, which stimulates an immune response that also targets the virusis an old technology, dating back more than three decades, the Pfizer and Moderna mRNA-based vaccines represent the first successful use of mRNA encased in lipid nanoparticles as a vaccine administered to hundreds of millions of people. This has led to the repurposing of old antivax fear mongering about how vaccines alter your DNA or are transhumanism to result in antivax claims about COVID-19 vaccines that they permanently alter your DNAcontaminating it with that deadly spike protein!and, like attenuated live virus vaccines, lead to shedding. The same fears were expressed about the adenovirus-based COVID-19 vaccines, like Johnson & Johnsons. None of this is true and, as is almost always the case, the claims were based on distortions, misunderstandings, and misrepresentations of research and biology. However, such misinformation can seem believable to those without the background in molecular biology to recognize it as the BS that it is, which brings me to the Novavax COVID-19 vaccine.

The Novavax COVID-19 vaccine was granted emergency use approval (EUA) a couple of weeks ago. This particular vaccine has long been viewed with hope because, instead of being an mRNA-based vaccine (like Pfizer and Moderna vaccines) or a viral vector-based vaccine (like the Johnson & Johnson vaccine), Novavax is a subunit protein vaccine. For instance, this article about the EUA in Politico noted:

The vaccine, a two-dose series administered three weeks apart, is manufactured using a lab-made spike protein produced in insect cells and an adjuvant obtained from the bark of a tree native to Chile, offering a different and older vaccine technology than is used in the messenger RNA vaccines and Johnson & Johnson shot. It is authorized for people ages 18 and older as a primary series, meaning the shot is intended for the roughly 10 percent of adults who have not yet received a Covid-19 vaccine.

Novavax executives have said they hope the shot will see uptake in individuals who have expressed hesitancy toward other Covid-19 vaccines or are allergic to components of the others ingredients.

Todays authorization offers adults in the United States who have not yet received a Covid-19 vaccine another option that meets the FDAs rigorous standards for safety, effectiveness and manufacturing quality needed to support emergency use authorization, FDA Commissioner Robert Califf said in a statement.

While I welcome new vaccines against COVID-19 (and Novavax appears to be a decent one), Ive long been very skeptical of the Pollyannish hope expressed by public health officials and Novavax executives that this vaccine will somehow so reassure the vaccine-hesitant that theyll finallyfinally!after more than a year and a half get vaccinated against COVID-19 because an old school vaccine thats just protein and an adjuvant has been made available. Unfortunately, the history of the antivaccine movement and antivax fear mongering should have made it obvious that this would not happen. I expect that there might be some people for whom Novavax could possibly be the final development that reassures them enough to be vaccinated, but, as anyone whos dealt with the antivaccine movement knows, its probably going to be a small number, nowhere near enough to have the seemingly game changing effect that Ive seen predicted on occasion, for example:

Im not going to be as sarcastic as the person who responded to Dr. Griffin, but hes correct. Only those utterly unaware of the history of the antivaccine movement could think that the introduction of Novavax will have an effect on vaccine hesitancy other than at the margins.

Those who follow my not-so-super-secret other blog will realize that Ive already written about Novavax and the fear mongering thats started about it. (Actually, the fear mongering started in 2020, when the project was first announced.) Although there will be overlap between this post and what I wrote last week, over the weekend I had an idea for a take that I wish I had included; so Im going to discuss that take here. Also, I found out more about a certain purveyor of antivax misinformation and wanted to include that as well. So theres overlap, but theres also a lot more.

First, though, lets recount what happened soon after the news that Novavax had been granted an EUA broke. Company executives and some public health officials had expressed hope that this recombinant protein-based vaccine will be more palatable to the vaccine-hesitant than existing vaccines using new (and therefore scarier) mRNA and adenovirus platforms, but the reaction to two aspects of the vaccine demonstrated that, for antivaxxers, its the vaccine, not any platform or ingredient, thats scary, and unfortunately they have become very skilled at transmitting that fear to the vaccine-hesitant. This is a long-standing technique that needs to be addressed.

Before I discuss the antivaccine misinformation being used to stoke FUD about Novavax, Ill start by describing the technology that is actually used to make the Novavax vaccine. Oddly enough, I found a good source for this on an antivax website, specifically the official website of Barbara Loe Fishers National Vaccine Information Center, where they posted a link to an old Washington Post video about Novavax under the title How the Novavax Coronavirus Vaccine Uses Moth Cells. Ill include the video and a link to the original WaPo article for your information:

The video notes that the use of moth cells is nothing more than another technique to produce large quantities of recombinant protein to be used as the antigen in a vaccine, further pointing out that recombinant proteins produced by various techniques (like the use of baculovirus in moth cells) have long been used as antigens in vaccines against diseases like influenza, human papilloma virus (HPV) infection, and hepatitis B. Referring back to the Pollyannish optimism about such old school vaccines, I cant help but mention that, of course, weve long known that antivaxxers never, ever, ever portray vaccines like these using recombinant proteins as their antigens as toxic ineffective sludge, right? I think you know the answer to that question if youve been reading this blog.

Of course, the baculovirus/insect cell expression system is nothing new. Baculovirus is a viral vector (like adenovirus, lentivirus, and a lot of other viruses commonly used in molecular biology) thats long been recognized as a versatile system for expressing recombinant proteins in the lab. Its mainly used to infect insect cells and, like other viral vectors, induce them to produce whatever protein is encoded by the DNA sequence inserted into them. Baculovirus-insect cell systems as a means of generating recombinant protein used to be fairly tedious in that it was difficult to engineer the virus and to isolate the proteins produced from the cells, but a lot of advancements in biochemistry and technology have made it much more feasible to use this system to generate the large amounts of high-quality recombinant protein needed to manufacture a vaccine like Novavax. Baculovirus systems are also in wide use in research for purposes like cell-based assays, gene function studies, and, of course, production of recombinant proteins. As an aside, one other advantage of baculovirus and insect cells is that they allow for the generation of recombinant protein at a much lower temperature. Mammalian cells are generally grown at 37C; insect cells are often grown at 27C. One way to look at the baculovirus-moth cell system is that its just another method for using viruses to produce recombinant proteins in eukaryotic cells.

In brief, this is how Novavax scientists make their vaccine:

Again, one notes that baculovirus/insect cell expression systems have long been used to produce the protein antigen used in influenza vaccines. Indeed, a review article from 2006 shows the various methods by which baculovirus systems can be used to produce vaccines:

Flow chart showing four different methods to make a vaccine based on your favorite gene (YFG) in the baculovirus expression system: (1) protein expression in insect cell bioreactors using the polyhedrin locus for expression, (2) protein expression in insect larvae leaving the polyhedrin gene intact; expression is driven either by a duplicated p10 promoter or by the original p10 promoter, (3) baculovirus surface display methods where YFG is fused to GP64, and (4) DNA vectors with a mammalian promoter (mp) for synthesis of your favorite gene product (YFGP) in the target species. Subsequent steps in the process are: (A) selection and PCR amplification of YFG, (B) cloning into the appropriate baculovirus vector, (C) generation of recombinant BV particles or occlusion bodies, (D) production in insect cells in bioreactors or larvae, (E) purification of recombinant YFGP or collection of BVs loaded with either YFGP or YFG, and (F) delivery of prophylactic or therapeutic vaccines.

As you can see, the baculovirus expression system is indeed versatile, which is why baculovirus expression systems have been used to make vaccines for nearly two decades. Like all such systems, it has its advantages and disadvantages, one disadvantage being that it doesnt always attach the right sugars to glycoproteins because insects dont always attach the same sugars to their glycoproteins as mammals, but in many cases it can be an excellent choice to use to express recombinant protein. In the case being discussed, Novavax scientists inserted the genetic sequence encoding the SARS-CoV-2 spike protein into a baculovirus vector and then used this vector to infect ovary cells from the fall armyworm moth to produce large quantities of antigen for their vaccine. The scientific name for the species is Spodoptera frugiperda, which is why the cell line used with this particular baculovirus system is called Sf9. This cell line is a derivative of a cell line that has been around since the 1970s.

Ill begin with the misinformation about Novavax based on the portrayal of the baculovirus/Sf9 expression system as moth cells that contaminate the vaccine with moth DNA. After the announcement of the EUA for Novavax, in a counterpoint to Dr. Griffins optimism it didnt take long for me to start encountering Tweets like these:

This one was actually not quite so bad, simply claiming that Novavax is genetically engineered (and therefore presumably unnatural) and falsely stating that it wont result in the production of real viral antibodies (whatever he means by that).

Others were a bit morecritical:

Ill discuss the moth DNA angle in more detail shortly and conclude by comparing it to an example that more than a decade ago I used to write about quite a bit. In the meantime, lets move on to this one:

Lets just say that that video isquite something. For one thing, if the blurb for the video is any indication, Dr. Jane Ruby appears not to know the difference between DNA and mRNA. Also, WTF? Ruby refers to Novavax as a deadly moth DNA spike protein? What did she do? Throw a bunch of random antivax words into a blender? In any case, Dr. Ruby has not been featured on SBM before, although she was once mentioned as being part of a lineup of speakers targeting the Orthodox Jewish community in Brooklyn with COVID-19 misinformation. Elsewhere, I note that she is one of the prime sources of the myth that COVID-19 vaccines cause self-assembling clots with nanowires that kill; she also promotes the false claim that COVID-19 vaccines are laden with graphene oxide.

Who is Dr. Ruby, though? Heres what she claims on her website:

Dr. Jane Ruby is a medical professional and a pharmaceutical drug development expert with over 20 years of experience in regulatory processes for drug approval with the FDA and the EMA. She is also a published international health economist who has appeared on numerous TV and radio shows across America. Dr. Ruby worked on the human research studies to launch some of the most famous compounds in the world in Depression, Alzheimers disease, Addiction, and Cardio-pulmonary diseases.

If all thats true (doubtful), where did Dr. Ruby go so wrong that she would spew such idiocy as in the video? Its a hopeless question, I guess, given the long and depressing litany of health care professionals with advanced degrees who have become COVID-19 misinformation grifters since the pandemic started, a litany that includes, among many others, Peter McCullough, Robert Malone, Simone Gold, Stella Immanuel, the entire cast of the quack group Americas Frontline Doctors, and more doctors than I care to list here. However, as we will see later, Dr. Ruby is not actually a physician at all.

I must confess that I really struggled to get through the whole 18 minutes of Dr. Rubys video, because there was so much repetitive antivax nonsense in it that it actually made my brain, which has nearly 25 years of experience dealing with nonsense like this, hurt. Early in the video, Dr. Ruby mentions that shes gotten lots of emails and questions about Novavax from people who refuse to take mRNA-based COVID-19 vaccines who ask her if they should take Novavax instead, given that its not an mRNA vaccine, but rather a potentially more acceptable recombinant protein-based vaccine. On the surface, this would seem to support the idea that Novavax might entice those afraid of new mRNA technology in vaccines to accept an old school vaccine. It doesnt. Predictably, Dr. Rubys answer is not only just a No, but an Oh, hell no! After that, she starts listing every antivax trope you can imagine about the vaccine, starting out by claiming that Novavax is no more a vaccine than the Pfizer or Moderna vaccines, which, as youll recall, were falsely characterized as gene therapy and not vaccines.

After I finished facepalming over Dr. Rubys claim that Novavax uses the same mRNA technology as the Pfizer and Moderna vaccines, I was curious how someone claiming to knowledgeable about COVID-19 could say something so utterly at odds with molecular biology. So I kept watching. To explain what she means, Dr. Ruby references this illustration. I took a screenshot:

See! See! The baculovirus DNA encoding spike protein is transcribed into mRNA in the moth cells! Checkmate, provaccine New World Order-loving fascists!

I just kept facepalming. Dr. Ruby went on and on and on about how supposedly Novavax is using synthetic codes for proteins never before seen in natureshe even uses the term in silicoto stimulate moths to make billions of copies of the toxic spike protein that they then extract noting that your body isnt making the evil toxic spike protein (as is the case in mRNA vaccines) but that the moth cells are. This explanation, while technically correct (barely) deceptively conflates the use of a baculovirus containing the specific cDNA code to serve as the template for moth cells to make spike protein, which is later extracted, isolated, and used to make a more traditional protein-based vaccine, and the mRNA technology that induces the cells of the recipient of the vaccine to produce spike protein. Yes, mRNA serves as the final template for protein manufacture in both systems, but its not as though the Pfizer and Moderna vaccines involve harvesting cells from your deltoid muscle and isolating the spike protein being made by them due to the mRNA vaccine. This explanation is so deeply stupid that there are only two possible explanations. Either Dr. Ruby is deeply ignorant of some very basic molecular biology that was basic three decades ago when I first studied biochemistry and molecular biology, or shes lying, knowing that her audience is deeply ignorant of very basic molecular biology. Take your pick. (I suspect the latter, but will concede that the former is quite possible.)

Dr. Ruby also describes how the spike protein is isolated with moth DNA thats included in the nanoparticles, so that you still have a problem with a genetic code that is going to embed in your cells and God knows what its going to create from the moths and then you have directly injected billions of these toxic spike proteins, which will supposedly wreak havoc in your body, including causing infertility.

Dr. Ruby goes beyond that, though. In her world, apparently, those rendered infertile by Novavax will be the lucky ones. Why? Well, let her explain, as I suggest that I deserve hazard pay for taking the time to transcribe this passage:

If you are lucky enough to conceiveand this goes for all of these shotsthe next generation through recombination of mom and dads genetic material can have offspring that will suffer and be damaged and freakfreak manifestations. We dont even know what those are going to look like yet. So stop looking at Novavax as a possible safer alternative. To what? To tyranny? To a sick, psychopathic cabal that wants to damage God-given DNA forever and say, Wooo, were better than God?

She expands on this theme in other videos, such as Ask Dr. Jane: If The Jab Changes Your DNA, Will It Show In Your Offspring, but I will spare you the pain. (I couldnt get through the video, even though its only 12 minutes long, because it was so bad that it made my brain hurt.)

This is very much like the idea of purebloods that antivaxxers co-opted from the Harry Potter novels, the idea being that, like the magical purebloods in the story, who are untainted by muggle (nonmagical) blood, those who are unvaccinated have pure blood. As Ive long pointed out, a huge part of alternative medicine relies on the concept that contamination (these days more frequently referred to as toxins) cause most, if not all, disease, and various detoxification regimens that make up so much of alternative medicine (and, not coincidentally, the basis of many treatments for many conditionslike autismthat antivaxxers used to attribute to vaccines) have more in common with religious purification rituals than they do with science or medicine. The concept is so pervasive in antivax circles that sometimes antivaxxers would rather risk death than contamination. For example, Del Bigtree came dangerously close to death from bleeding hemorrhoids because he refused a transfusion with vaccinated blood. (I kid you not. Read the details if you dont believe me.)

This concept of purity versus contamination (implied to be with evil) also has a lot to do with the idea that natural immunity to a disease and has so infected the discourse over COVID-19 vaccines that one of my go-to video clips when discussing this topic is of Brigadier General Jack D. Ripper from one of my favorite movies of all time, Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb explaining how fluoridation is a Communist plot to sap and impurify the precious bodily fluids of real Americans, mainly because anti-fluoridation, antivaccine, and anti-GMO pseudoscience all tap into the alternative medicine fear of contamination as a cause of ill health and purity of essence (again, from Dr. Strangelove) as key to good health. In this case, Dr. Ruby is portraying the vaccines as tampering with God-given purity and setting humans up as better than God.

In a truly facepalm-worth bit, Dr. Ruby then goes on to claim that Novavax uses the mRNA technology and that it doesnt make it safer and it doesnt make it better than mRNA vaccines, while repeating yet again that Novavax is not a vaccine. Rather, to Dr. Ruby, Novavax is a toxic poison designed to change your DNA forever, which, she notes, is the long game and the endgame. She then disingenuously claims that shes not trying to scare you, just to scare you out of taking any more shots.

Then she moves on to the adjuvant, because of course she does.

Consistent with old antivax narratives, Dr. Ruby also complains about the use of lipid nanoparticles in the vaccine, just like the Pfizer and Moderna vaccines do! Specifically, she refers to the use of tree bark toxins as an adjuvant, as it turns out that, instead of using the aluminum-containing adjuvants that many older vaccines do, the Novavax vaccine uses a lipid adjuvant. This is a theme that has arisen about Novavax in antivaxland. Heres an example from Robert F. Kennedy Jr.s Childrens Health Defense claiming that the nanoparticle adjuvant (which Novavax calls Matrix-M) is horrifically harmful:

Nevertheless, in pre-COVID-19 studies of experimental vaccines containing Novavaxs Matrix-M, researchers waxed enthusiastic about the nanoparticle-based adjuvants significant and potent action including its strong immunostimulatory properties even without any accompanying antigen.

And, where nanoparticles are concerned, the Novavax COVID-19 shot actually delivers a double whammy, combining Matrix-M with genetically engineered spike protein nanoparticles.

As Novavax explains it (for some reason putting the word adjuvant in quotes), The spike protein is the signal, but we want your immune system to hear that signal loud and clear [and] that signal boost comes from our Matrix-M adjuvant.'

Matrix-M has been around a long time; for instance, heres a study from a decade ago showing its immunostimulatory properties. Adjuvants, of course, have long been used to increase the immune reaction triggered by an antigen in a vaccine, thus allowing the use of much less protein; the most commonly used adjuvant is, as most of you know, aluminum. (And we all now that antivaxxers trust aluminum adjuvants, right? Just kidding! They hate aluminum adjuvants as much as they hate mRNA in vaccines!)

Where, however, did the bit about tree bark come from? It turns out that Matrix-M is a natural product, specifically a saponin derived from the soapbark tree (Quillaja saponaria), so-named because its bark contains saponins, which can be made into soap.

As noted in this study:

Saponins, particularly those obtained from Quillaja saponaria Molina, are known potent adjuvants and Quillaja saponins (QS) have for long been used in animal vaccines. Saponin-based adjuvants can be formulated in different ways; in free form [2], with aluminium hydroxide [3], in ISCOMs (immunostimulating complex) [4] or in ISCOM-Matrix/Matrix structures [5]. QS constitute a heterogeneous mixture of related but different chemical structures with various immunostimulatory activities, safety profiles and particle forming properties. By purification of the QS raw material, distinctive fractions with different characteristics can be defined.

The ISCOM, a potent adjuvant formulation first described in 1984 by Morein and co-workers [4], consist of stable complexes composed of saponin, cholesterol, phospholipid and incorporated antigen(s). The hallmarks of the ISCOM technology are the dose-sparing potential [6], induction of high and long-lasting antibody titers and potent T cell responses [7]. However, later it was shown that antigen incorporation is not critical for these immune properties. Antigen and empty ISCOMs i.e. ISCOM-Matrix/Matrix could simply be mixed with sustained vaccine efficacy [5]. In this study we use a novel adjuvant formulation based on two different Matrix particles made from two separate purified fractions of saponins, yielding Matrix-A and Matrix-C [8]. These Matrix particles, approximately 40 nm large, are subsequently mixed at defined ratios to get the Matrix-M adjuvant.

And there you have it! The dreaded nanoparticles! Recall how antivaxxers fear mongered about the lipid nanoparticles used in the Pfizer and Moderna vaccines to encapsulate the mRNAs used and assist their entry into cells. Again, fear mongering about lipid nanoparticles is nothing more than the toxins gambit reborn and retooled for COVID-19 vaccines, sometimes with some truly off-the-wall versions. Given that Matrix-M is a form of lipid nanoparticle as well, the antivax attacks on the Novavax COVID-19 are very predictable. Youd think that antivaxxers, being all about natural immunity and natural medicine, would be more accepting of an adjuvant that is a natural product, the story of whose repurposing and sustainable production is actually quite fascinating.

Dr. Ruby spends several minutes basically saying the same sorts of things that RFK Jr.s minions said, while bragging that no one else is warning about Matrix-M, even though RFK Jr. is spreading the same misinformation about it. In any case, the claim that vaccines cause autoimmune disorders, by whatever proposed mechanism (whether sort of plausible or completely fantastical), is an old antivax trope. In this case, RFK Jr. references antiphospholipid syndrome (APS), an autoimmune disorder characterized by recurring blood clots as well as fetal loss, fetal growth retardation and other obstetric complications. I might have to address this hypothesis (if you can call it that) in more detail in the future, as the same claims pop up over the lipid nanoparticles used in mRNA-based vaccines. Until then, Ill just refer you to Yehuda Shoenfeld and ASIA as examples of how the false claim that vaccines have caused a massive increase in incidence of autoimmune disease started and persists.

And, of course, to Dr. Ruby and other antivaxxers like RFK Jr., because Novavax uses lipid nanoparticles, even though they are quite different from the lipid nanoparticles used by Pfizer and Moderna to encapsulate their vaccines, the Novavax vaccine must also cause infertility and all the other bad things that antivaxxers have been falsely blaming on lipid nanoparticles since the mRNA-based vaccines were first approved for use.

After suffering through her video, I started wondering: Who the heck is Dr. Ruby? The last time I wrote about this over at my not-so-super-secret other blog I didnt really look too hard into this. I assumed that she was just some physician who used to work for pharmaceutical companies who somehow got into COVID-19 disinformation grift. While I was correct that Dr. Ruby is into disinformation grift, I was wrong to assume that she is a physician. I rather suspect thats the whole point behind her shtick, as you will see.

A search of PubMed for Dr. Ruby does show that at one point she worked for Medical Affairs at Endo Pharmaceuticals Inc. in Malvern, PA. She does appear to have 23 publications dating back to the 1990s, although most of them appear to be about outcomes of opioid treatment or concerning healthcare costs, not, as she claims, clinical trials of groundbreaking drugs. (If she did indeed do such work, it isnt reflected in her PubMed record.) She also appears to have worked at various times for other pharmaceutical companies (SK Life Science, Pear Pharmaceuticals, Indivior, and Forest Laboratories, which is now Allergan) in HEOR (health economics and outcomes research). Before that she was a nurse and nurse practitioner/advanced practice nurse, not a physician, having gotten a masters in nursing at the University of Rochester. Now dont get me wrong. I love NPs. Ive defended them on many occasions against outlandish attacks by my fellow physicians. However, Dr. Ruby does not appear to have a doctorate even in nursing. What she does have are a PhD in psychology from Kennedy Western University in Psychology and a Doctor of Education (EdD) from the University of Rochester, as well as masters degrees in nursing and International Health Economics. One cant help but conclude that Dr. Ruby is definitely trying to give the impression that she is a physician, complete with her frequently appearing with a stethoscope and lab coat. Id be willing to bet that her audience thinks shes a physician. She isnt, and if her CV is any indication she hasnt even practiced nursing for over 20 years.

These days, Dr. Ruby lists as her position President at Ruby Health Consulting HEOR (again!), and, of course, she has her own show hosted on the Stew Peters Network, for which she made the video above. Just a perusal of this show, which is on Rumble, of course, shows that its a full-on right wing conspiracy and medical misinformation show. Dont believe me? Just peruse the list of videos for yourself. Also, note how her sponsors include lots of companies marketing quackery and supplements, including her own superfoods line of products.

Again, one of the hallmarks of science denial is fake experts, often with credential inflation, and thats what we have here. Not only does it appear that its been over two decades since Ruby has practiced nursing, advanced practice or otherwise, but theres nothing that Ive been able to find about Rubys history to suggest that she has any special expertise in the relevant fields of infectious disease, virology, molecular biology, epidemiology, immunology, or, well, any field relevant to commenting authoritatively on the safety and efficacy of vaccines other thanmaybe, judging from her publication recorda bit of epidemiology in unrelated fields.

Her credentials, such as they are, do appear to be unfortunately more than adequate to provide a veneer of scientific expertise good enough to fool her audience.

None of the reaction to Novavax is a surprise to any of us whove been combatting antivaccine misinformation for a long time. It was entirely predictable that antivaxxers would latch onto the use of a moth cell line to portray the vaccine as dirty, foreign, and contaminated. As I like to point out, the idea that the animal used in the process of making vaccines dates back all the way to Edward Jenners time, as shown in this classic cartoon from the early 1800s portraying the fear of antivaxxers that the cow pock used to vaccinate against smallpox would turn people into cows:

Even a few years after Edward Jenner introduced the smallpox vaccine, the idea that vaccines somehow permanently alter humans had begun. (Source: Wikipedia and the Library of Congress, Prints & Photographs Division, LC-USZC4-3147, color film copy transparency.)

Going back to the NVIC article citing the WaPo article with the video describing the use of moth cells to make spike protein. In the comments, a commenter named Pam observed:

I am not an entomologist but I do garden a lot and see many moths. Since the video only talked about proteins and mRNA, I wanted to know more about what moths can do to a human in general. Moths are of the paraphyletic group meaning many have a common ancestor. Does that suggest what affects one species genetically may affect other species? Not sure. Did they say what species of moth they used in the Novavax? I did some online research and found some moth caterpillar species cause lepidopterism (caterpillar dermatitis) if touched. Lymantria dispar, the spongy moth (has black and red spots in caterpillar stage) carries the NPV (spongy moth virus). Could this NPV make its way into moth vaccines? Would make a great sci-fi novel plotevery vaccinated person grows antennae and makes coccoons [sic]. The comment about Mothman cometh brought all sorts of sci-fi musings to mind. Have not gotten a vaccine since 2006 and wont be wanting ANY soon. Adjuvants are on my no-list since the allergist said this may be what I react badly to when getting a vaccine. Being out in natural settings with Nature is wonderful. Science should stop messing with the genetic make-up of any living being. Sometimes the cure is worse than the disease.

David Hedison as the titular character in the 1958 horror film The Fly, which also starred Vincent Price.

Jeff Goldblum in the 1986 remake of The Fly. David Hedison, Vincent Price, and Jeff Goldblum all agree: No insect cells and DNA, ever!

Is Pam joking about Novavax turning its recipients into moths? My interpretation is that she was only partially joking. She is, however, echoing a very old antivax trope, namely the idea that vaccines somehow change your very essence to be more like the vaccine. In the 1800s, it was cows because cow pox lesions were used to vaccinate against smallpox. Now? Its moths. The NVIC article, of course, is nothing new, just a resurrection of the same fear mongering about moth cells that had been going on ever since antivaxxers had discovered that spike protein to be used to manufacture Novavax was to be produced using a Baculovirus system and moth cells.

There are other examples, of course. For instance, you might remember how about a decade ago antivaxxers were making a big deal out of the use of monkey kidney cells to produce polio virus for the oral polio vaccine in the late 1950s and early 1960s, which Mike Adams, for instance, described as vaccines routinely containing hidden cancer viruses derived from diseased monkeys. While it is true that the oral polio vaccine was contaminated with a monkey cancer virus (SV40) during that time period, even though there is no good evidence that this contamination resulted in an increase in cancer.

A more direct predecessor to the claim that moth DNA from Novavax will somehow corrupt your DNA to the point that your offspring afterwards will be freaks is less obvious. The claim that moth DNA from Novavax will somehow wreak havoc in your body is very much of a piece with old antivax claims that the HPV vaccine will contaminate your DNA with stray fragments of DNA leftover from the production of other vaccines could permanently alter your DNA and wreak havoc in your body. For instance, one favorite antivax talking point before the pandemic was that there was sufficient resemblance between nucleotide sequences in HPV and some human genes that when HPV sequence got into human cells, it could result in molecular mimicry that would target the recipients for attack by the immune system and produce autoimmunity. (Theres no good evidence that this actually happens, as the amount of HPV DNA in HPV vaccines is truly minuscule.)

Another favorite antivax mechanism for vaccine-induced harm was the concept that human DNA from the cell lines (you know, those awful fetal cells) could get into cells in the central nervous system, recombine with the DNA in those cells, and produce proteins that the immune system saw as altered self, resulting in an autoimmune reaction that damaged the brain to cause autism. This particular idea provoked a lot of laughter among molecular biologists because of how antivax reporter Sharyl Attkisson (whos since gone on to become an all-purpose conspiracy reporter) quoted the author of an antivax review article proposing this idea thusly:

Why could human DNA potentially cause brain damage? The way Ratajczak explained it to me: Because its human DNA and recipients are humans, theres homologous recombinaltion tiniker. That DNA is incorporated into the host DNA. Now its changed, altered self and body kills it. Where is this most expressed? The neurons of the brain. Now you have body killing the brain cells and its an ongoing inflammation. It doesnt stop, it continues through the life of that individual.

Homologous recombinaltion tiniker instead of homologous recombination (the actual process by which very similar pieces of DNA can integrate themselves into a genome) will never not be funny to me. Its an idea that persists until today and has been applied to fear mongering about mRNA-based COVID-19 vaccines. As much as the misspelling echoes through a very specific segment of those who oppose antivax disinformation even 11 years later, its the same idea, that vaccines somehow contaminate you.

Then there are adjuvants. It was easily predictable that any adjuvant used in a COVID-19 vaccine would be targeted by antivaxxers to be portrayed as horrific sludge that will kill you or, failing that, cause autoimmune disease. After all, aluminum adjuvants have long been a target of antivaxxers, who falsely describe it as poison that kills.

Of course, fear mongering about adjuvants, moth cells and DNA, fetal cells and DNA, HPV DNA, spike mRNA, lipid nanoparticles, and other vaccine ingredients, is just a subset of a larger antivaccine narrative, one that I like to refer to as the toxins gambit. Its a narrative that seeks to portray vaccines as so riddled with horrific toxins and awful substancesaborted babies!that youd be crazy to inject them into your body. Two decades ago it was the mercury in the thimerosal preservative used in several childhood vaccines that was falsely blamed for autism, with evidence continuing to accumulate showing no link. Then it was the formaldehyde used to inactivate viruses used in vaccines never mind that the body makes formaldehyde as a byproduct of metabolism and that the amount in vaccines is much smaller than the small amount that the body routinely makes. Then theres the claim that theres antifreeze in vaccines. Theres not. This claim was based on the confusion between ethylene glycol (which is in antifreeze) and polyethylene glycol (PEG), a polymer used in many topical and medical products. Basically, PEGylated drugs have been around a very long time.

I could go on and on, but I think that Ive described enough examples. You get the idea. For antivaxxers, its all about the vaccines, not the ingredients, the adjuvants, the cells used to produce the antigen, or the platform used to make the vaccine. Prove that one of these is safe, and theyll move the goalposts, effortlessly shifting to another. You could produce a vaccine thats nothing other than protein antigen and buffered saline, and antivaxxers would find a way to blame the antigen and/or the saline. Thats because its vaccines and vaccination that frighten antivaxxers. The rest is just window dressing, made-up reasons antivaxxers find to justify their fears. Unfortunately, these antivaxxers then transmit those fears to those predisposed to distrust pharmaceutical companies, doctors, drugs, and all that is associated with them.

We have little choice but to play Whack-A-Mole to refute fear mongering about individual vaccine ingredients, but we shouldnt forget that these are just distractions from the real issue: Vaccination itself. A common narrative among antivaxxers is that vaccines are disease matter injected unnaturally into the body. It is a potent narrative designed to cause revulsion, and its unfortunately very effective at that. Its also the narrative that we most need to overcome far more than obviously ridiculous claims about moth DNA turning people into insects. It doesnt matter if its recombinant protein and not whole virus that is used. It doesnt matter if the antigen is produced by injected mRNA or just injected as protein. Its the vaccines. Its always been the vaccines. It will always be the vaccines.

Here is the original post:

Novavax: Its the vaccine that scares antivaxxers, not moth DNA or any ingredient in any vaccine - Science Based Medicine

A health ministry order that effectively spelled the end of unlicensed weed sales was revoked late Wednesday, hours after it spooked many shops into suspending operations with fears of arrest.

Dispensaries may continue operating, for now, after a top health official said late Wednesday afternoon that the order for instructing police to arrest those selling cannabis without official sanction had been withdrawn an order that came despite there being no such licenses or legal requirement to possess one.

Thats exactly why it was pulled, according to Arun Avery of cannabis advocacy Highland, which operates a dispensary of the same name in Lat Phrao. Eager to show they were cracking down, he said, officials jumped the gun by insisting on licenses that dont actually exist nor were required by law.

Thats exactly the point, he said. Welcome to Thailand.

Thai weed in disarray after arrest order, insider says dispensaries should never have existed

The health officials who pulled back the order insisted they only meant to protect minors and other vulnerable groups amid a chorus of complaints from some sectors that the government moved legalization too fast and recklessly.

Speaking at a 5pm news conference, alongside Yongyos Thammawut of the Traditional and Alternative Medicine Department, Deputy Secretary of Health Narong Saiwong said he would review the order and reconsider the matter again for whatever can bring utmost benefit to people.

As for concerns that there will be enforcement and arrest, I assure you that it probably wont happen yet, Yongyos told reporters at the hastily arranged news conference.

People who [sold weed] before this announcement are not culpable, he added, before stressing the medical benefits of cannabis.

The sudden backlash came as cannabis sellers blossom across the capital, from expensive storefronts to folding tables on the sidewalk at a rate that has alarmed some.

Yongyos said vendors who sell weed on the streets or sell to promote smoking in the public may get a warning from authorities.

Im insisting that were trying to limit the recreational use of cannabis as much as possible, he said.

Yongyos said health officials will design a convenient license process.

Though no regulations were put in place before cannabis was fully legalized last month and certainly no license requirements there did seem to be a placeholder form awaiting applicants today at the health ministry.

Arun said that when Highland rushed to the health ministry today to ask about the nonexistent licenses, they were given a simple, generic, one page form to complete and asked to pay THB3,020 for a license to be issued by the Department of Traditional and Alternative Medicine, which has authority over cannabis.

Arun was told the license would be issued within two weeks, but that there was no reason people needed to halt sales until receiving it.

This latest reminder that policy makers rarely present a unified and thoughtful approach to their policymaking reactive and piecemeal being the norm took place within a 24-hour period during which the health ministry appeared to pull the rug out from the nascent commercial cannabis industry by threatening to arrest everyone and then hit the undo button.

Many dispensaries closed today amid confusion over the order. One of the people consulting lawmakers on amendments to the bill to regulate cannabis went so far as to tell Coconuts Bangkok this morning that unlicensed dispensaries never should have existed, and the order was meant to put an end to them.

Some dispensaries that closed Wednesday confirmed to Coconuts Bangkok that they would resume operations Thursday.

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Thai weed in disarray after arrest order, insider says dispensaries should never have existed

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Weed whiplash: Arrest order for dispensary operators revoked after spreading confusion, fear - Coconuts