PAAM Medical Letter, Vol. 10(1), March 2, 2023

PAAM Medical Letter

Vol 10, Issue 1, Mar 2, 2023

Dear Colleagues!

Welcome to the tenth-year issue of the PAAM Medical Letter! Thank you for your patronage and support. Today’s issue has several different types of important topics and articles.

Please note: This Letter is for your thoughtful consideration and personal research, and is not to be taken as something dogmatic to believe in, nor is it promoted as something official from PAAM or the international Anthroposophic medical movement.

Meditation

The meditation linked below by Steiner may be read from left to right across the columns. The middle column with 3 verses shows the threefold soul forces of thinking, feeling and willing. The columns on the left and the right indicate the relationship (often not conscious) between imagination and true thinking, between feeling and dreaming, and between willing and sleeping. Click here to read the meditation.

Calendar of the Soul

Verse #47

There wills to emerge out of the world-womb,
Quickening the senses’ semblance, joy of becoming.
May it find my thinking’s strength
Well-armed through powers divine,
Which strongly live in my inmost being.

Verse #6 (Complementary verse)

There has arisen out of my egohood
My Self, and it finds itself
As world revelation
In forces of time and space;
The world, it shows me everywhere
As godly archetype,
The truth of my own image.

Virtues of the Month

Aquarius (2/21-3/1): Discretion or reticence becomes meditative strength, meditative capacity
Pisces (2/21-4/1): Magnanimity becomes love

Medical and Relevant Literature

Attachment 1: Note: this attachment is a modified and slightly expanded version of what previously appeared published in Stella Natura (www.stellanatura.com).

From PAAM Member, Branko Furst, MD, comes an Anthroposophic perspective piece on the importance and relationship between a broader concept of nutrition that includes human nutrition for the physical body, the etheric body, astral body, “I,” and its “I”-organization, as well as cosmic nutrition. Branko does the difficult task of trying to summarize a lot of Rudolf Steiner’s thoughts and perceptions scattered throughout his writings and lectures, and bring them into a coherent and concise form. For those interested, a helpful bibliography is provided for further reading. What is unique and helpful about Anthroposophy’s view on nutrition is its non-materialistic way to confront the mysteries of how we truly nourish ourselves. Our nutrition to maintain healthy functioning involves much more than just eating food, even though this is obviously important. Steiner points to the added importance of the supersensible nutrition we receive from the cosmos (planets, sun and zodiac) directly from our sensory environment through the senses, as well as the cosmic effects on planets and animals, some of which becomes our foodstuffs. Nothing in this view denies the facts of the material aspects of nutrition, but it avoids the common natural science’s ideological mistakes of materialistic reductionism. With the limited lens of science, much is missing about our complete nutrition and its dependence on the cosmos. It should be remembered what Steiner once said in a response to a question why, despite so many people mediating, there was so little evidence of genuine spiritual experiences. He said it was a question of nutrition. What that meant was certainly the inadequate nutrition in food, but he may have also meant the lack of adequate refined nutrition coming through the senses that perceives natural sunlight, warmth, air and nature in general.

Attachment 2 and Attachment 3: These attachments are both open access review articles on the published research done on biodynamic agriculture (BD agriculture) that is based on the insights and suggestions of Rudolf Steiner. Most of the indications he gave were given in an eight lecture series entitled, Agriculture or The Agriculture Course, 1924. Attachment 2 was published in 2019 and included 86 peer-reviewed articles that included both English and German publications, but without stating the authors’ method of selection. They did categorize the articles into topics such as effects of biodynamic preparations, soil quality and health, food quality and viticulture (wine grape cultivation). One important comment made was that the studies reviewed almost always applied classical analytic methods from natural science that followed materialistically reductionist approaches. Since biodynamic agriculture takes a holistic and transdisciplinary perspective on the effects of the whole human organism, then a reductionist approach looking at single material parameters (or in combination) may not be the best approach to find relevant effects. The authors of the first review concluded that the “studies provide substantial evidence for the effects of biodynamic management on agroecosystems and food quality.” “The effects on soils are usually system effects of biodynamic management, where compost application plays a crucial role. The biodynamic preparations create measurable effects on food chemical composition and food quality. Further, biodynamic management as a whole, and the application of biodynamic effects in particular, causes a differentiation between biodynamic and non-biodynamic vineyards.”

The second attachment is an academic and critical review of 68 studies on biodynamic agriculture that appeared in “highly-ranked” scientific journals published in the English language. The authors selected only the top quartile of articles with an impact factor (IF) greater than 2 (source: Journal Citation Report TM from the Web of Science TM). Of course, this approach has an advantage of filtering out poorly done research and it relieves the authors of directly reading all the relevant literature, but it also prevents the authors coming to their own critically considered conclusion about an article, irrespective of the article’s impact factor. Their overall conclusions were: 1) BD agriculture enhances soil quality and biodiversity; 2) The impact of agricultural practices showed BD agriculture to, in general, be better than conventional ones (there were some exceptions), and that comparing BD farming and organic farming revealed a mixture of superiority of one or the other and that the majority of comparisons were equal in performance; 3) Both BD agriculture and organic agriculture were more sustainable only in some measures than conventional agriculture; 4) BD farming practices promote overall agroecosystem biodiversity and the soil’s healthy and diverse microbiome better than organic and conventional agriculture; 5) The food quality was slightly better for BD agriculture than conventional, but no difference could be found between BD and organic products; 6) BD products are nutritionally richer than conventional ones (more phenolic compounds, flavonoids and antioxidant activity); 7) A frequent observation on the robustness of the results showed they can be greatly affected by production and site-specific conditions of the experiments. This is a common problem in all fields of agricultural research.

For more introductory information about BD agriculture and for an overview of the research, look at the Biodynamics Association’s website (https://www.biodynamics.com/).

Attachment 4: Is early-onset cancer an emerging global epidemic? Current evidence suggests that it is. This is peer-reviewed, multiauthor review article published in Nature Reviews Clinical Oncology (doi.org/10.1038/s41571-022-00672-8). These are some of the major conclusions: 1) The preponderance of evidence indicates that the incidence of cancer of various organs in <50 years of age has been rising in many parts of the world. These organs include breast, colorectum, endometrium, esophagus, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, bone marrow (multiple myeloma), pancreas, prostate, stomach and thyroid. Notice that most of these are digestive or metabolic organs belonging to the metabolic limb system (even if they are outside the metabolic/abdominal pole); 2) This rise in incidence can be called the “early-onset cancer epidemic”; 3) There are clear differences in epidemiological, clinical, pathological, and molecular characteristics between early-onset and late-onset cancers. The article goes into detail about this; 4) The authors’ expert opinion is that the early-onset cancer epidemic is only partially due to better screening and early detection for some cancers (like breast, prostate and thyroid), but that increasing incidence of early-onset cancers in several organs (e.g. pancreas and colorectal cancers) are unlikely to be fully explained by screening alone. The epidemic is probably attributable to changes in patterns of exposure in early life and young adulthood; 4) Data from many birth cohort studies demonstrate a “birth cohort effect” with increased incidence of various cancers of multiple organs such as colorectum, endometrium, esophagus, gallbladder, extrahepatic bile duct, kidney, bone marrow (multiple myeloma) and thyroid; 5) Likely culprits contributing to the early-onset cancer epidemic in those under 50 are unhealthy diet, detrimental lifestyle behaviors and morbidities such as obesity, diabetes mellitus, and in utero exposures. Only passing allusion to the environment is mentioned. Box 2 lists the temporal trends in possible detrimental exposure in adolescents and children; 6) Molecular pathological epidemiology research (the integration of tumor tissue analysis into epidemiological studies) can play a helpful role in early-onset cancer research by linking unidentified or suspected risk factors to specific tumor phenotypes; 7) Unfortunately, current evidence suggests that certain early-onset cancer types are more likely to be at an advanced stage and to have worse survival outcomes; 8) Many identified cancer risk factors are also risk factors for other chronic diseases, such as type 2 diabetes mellitus and inflammatory bowel disease. For example, altered sleep patterns such as night shift work is an identified risk factor for metabolic disease (obesity and type 2 diabetes mellitus), as well as for cancer; 8) There are still substantial gaps in research on early-onset cancers that have to be rectified.

In terms of potential solutions the authors recommend: 1) Better screening in high-risk patients with genetic syndromes that lead to cancer; 2) Encourage and popularize healthy diet and lifestyle while avoiding unhealthy foods and beverages, physical inactivity, early alcohol consumption, smoking, and other unhealthy behaviors; 3) Reform the food and food distribution systems; 4) Strongly consider health-related taxes (e.g. cigarette and sugar-sweetened beverage taxes); 5) Minimize night shift work to the absolute minimum and provide higher wage compensation for night shift workers; 6) Encourage use of electronic medical records, computational analyses and “-omic” analytic research to further the field; 7) Conduct prospective, long-term, life-course cohort studies (RTCs aren’t possible nor ethical); 8) Address health disparities and social determinants of health in research of cancer to reduce disparities gaps between different racial and ethnic groups.

One glaring absence in this review is a scholarly discussion on the ubiquitous presence of chemical carcinogens in our environment, including our homes and personal care products. There are absent or lax US Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) standards for most chemicals used by agriculture and agricultural manufacturers in the US. There does exist basic scientific and epidemiological toxicology research pointing to the important role of chemical pollutants as risk factors for disease. Unfortunately, in the US the National Institutes of Health (NIH), the National Cancer Institute (NCI), and the American Cancer Society (ACS) do little sponsorship of this type of cancer research. From an AM perspective, besides the increase in hostile “physical forces that revolt against the etheric body” and are from “outer nature inimical to Man” (R. Steiner, Lecture 13, Spiritual Science and Medicine, CW 312), there are also weakened etheric bodies today and a lack of properly balanced and directed Nerve-Sense-System forces that carry the “I”-organization and astral body impulses to help keep the integrity, functioning and resistance of a healthy etheric body in our current toxic environment.

Finally, this review article demonstrates the strength and weakness of current scholarly medical reviews and is also an example of the strength and weakness of current medical thinking. There is a lack of a coherent holistic view of the human being and his environment.

Attachment 5: Research into COVID-19 illness is fraught with poorly designed, biased and poorly implemented clinical studies, and with inappropriate conclusions made and promoted. Many have rightly criticized the studies. To take one area of COVID-19, two researchers recently looked at long COVID studies in high impact journals. This article is a 6-page clinical research study on the published literature (83 studies, 96.4% were observational (all types of designs) and only 3 were RCTs) and is freely available on the US National Library of Medicine’s PubMed Central website (doi.org/10.1016/j.amjmed.2023.01.005). The researchers found that only ~58% used a comparison group, only ~50% did any adjustments for cofounders, and those studies that did adjust for covariates (confounders), only ~43% adjusted for 4 or less variables. The researchers were clearly disappointed and critical of the current research in high impact journals. They rightly state that including a control or valid comparison group is a crucial step in ensuring that symptoms of long COVID are not due to some other personal, social or environmental characteristic, including, for example, aging, health status and policy implementations by public health.

Attachment 6: This recent, peer-reviewed study in Lancet Regional Health-Europe, Vol 25, Feb 2023 (doi.org/10.1016/j.lanepe.2022.100554), freely available on US National Library of Medicine’s PubMed Central, is not subject to the last study’s criticism of the long COVID literature. The current authors did a 12-month longitudinal, cohort observational study of children, ages 11-17 years, looking at online self-reported outcomes at 0, 6 and 12 months during the Delta wave (Oct 2020—March 2021). The two groups (positive and negative PCR tests for COVID) were comparable because the test-negative comparator group was tested because of comparable URI symptoms at presentation. What makes this study exceptional is that they crucially looked at within-individual examination of the study participants. They also eliminated any subsequent reinfections in either group to isolate the effects of one COVID vs. non-COVID illness on chronic, persistent symptoms. Figures 2-8 summarize their findings. They demonstrated that the prevalence of all symptoms lessen at 6 and 12 months for both groups who originally reported that symptoms at time 0. In about 10-20% of both test-positive and test-negative groups (depending on the symptom) there was persistent symptoms, even at 12 months. These symptoms were usually shortness of breath, fatigue, pain and emotional difficulties. What was notable was that, while the overall prevalence of two important symptoms (shortness of breath and fatigue) actually increased, they appeared in different children at 6 and 12 months. In other words, the within-individual examination of the data demonstrated that new symptoms developed in both groups at 6 and 12 months that were not present at time zero, suggesting that they have been likely caused by multiple factors and not just long COVID.

This study does have limitations. It is obviously not an RCT. However, it is not possible to do one (logistically and ethically), so a prospective longitudinal design with valid comparators is the best we can likely hope for. The study relied on self-reports, which are subject to recall bias, and the reports may not have been as accurate or objective as in-person medical interviews. There was a significant drop out of subjects at 6 and 12 months, losing ~62% of the original sample size from time 0 (~13K). Nevertheless, the study still had 5,086 subjects, and it tells us a lot about the natural history of long COVID, and that new symptoms can develop 6-12 months later in both test-positive and test-negative patients (with viral URIs) during the Delta wave of infection. This study reminds us of what we already know- that post-viral neurastenia (mental and physical fatigue) is real and should be anticipated and treated. AM offers many modalities to build up the etheric body, tone down an overactive and misplaced astral body, and appeal to the “I”-organization for further strengthening and orchestrating the whole human organism.

Attachment 7: This an excellent, short expert opinion piece published in the History and Philosophy of the Life Sciences journal in June 7, 2021 (doi.org/10.1007/s40656-021-00422-6). It is freely available in The US National Library of Medicine’s PubMed Central. The authors remind us that over-reliance on modelling studies during the COVID pandemic will give spurious results if historical data are not also used as analogues to the current pandemic crisis. They wisely point out that both epidemiological-mathematical modelling of future scenarios (actually extrapolations) and analyses of historical data are both liable to errors of inputs, assumptions and interpretations; they should both be considered “wrong, but useful,” and that greater awareness of historical data may improve pandemic preparedness and responses. Of course, the right historical analogue must be chosen for analysis. The two fundamental approaches to the pandemic can be corrective to each other, and thus can be complementary, and perhaps give the best predictive result. The authors state that, with respect to historical data, some amount of epistemic humility is necessary, but the apparent bias in favor of modelling approaches over analyses of historical data should be discarded.

Attachment 8: From The Cochrane Collaboration comes an important and thorough systematic 2023 review of 78 RCTs (both traditional and cluster RCTs) looking at various types of physical interventions “to interrupt or reduce the spread of respiratory illness”. This is an open access, multi-authored, published article, freely available at doi:.org/10.1002/14651858.CD006207.pub6, with Tom Jefferson as the lead author. This is an updated review from their 2020 Cochrane Review that includes 11 new RCTS, six of which were done during the COVID-19 pandemic. For this update the authors decided to focus only on RCTs because they feel they are: 1) the highest level of evidence; 2) there were a sufficient number of RCTs to analyze; and 3) observational studies, while often finding stronger protective effects for masking, for example, have important biases and important confounding (not truly valid comparison groups) that likely lead to overly optimistic effect estimates. Nevertheless, the reviewers found that nearly all the RCTs had important potential sources of biases, or had other problems. Therefore, their conclusions are based on either low or moderate certainty of the quality of the evidence. They express the need to have more high-quality RCTs to properly evaluate non-pharmacologic, physical strategies. They report their disappointment that during the current COVID-19 pandemic, no rigorous planning, effort, nor funding were done towards high-quality RCTs on the basic public heath measures recommended. In the US this responsibility went to the National Institute of Health (NIH) under Francis Collins, the National Institute of Allergy and Infectious Disease (NIAID) under Anthony Fauci, the Centers of Disease Control and Prevention (CDC) under Rochelle Walensky, and the Food and Drug Administration (FDA) under Mariannne Woodcock, Director, and Peter Marks, Head of the Vaccine and Biologics Division. In Europe this responsibility went to the European Medicines Agency (EMA). These regulatory agencies, more than others, have the clout and resources to run or sponsor appropriate RCTs. Very few of the 78 RCTs looked at adverse events—another common failing in current medical RCT research.

The overall results were that only hand hygiene (washing hands) had a modest protective benefit against acute respiratory viral illnesses (relative RR 0.86, CI 0.81-0.90, moderate certainty of the evidence). Summary of Findings Table 1 revealed a relative RR of 0.95 (CI 0.84-0.90, moderate certainty of the evidence) for surgical/medical masks, compared to no mask, to prevent viral respiratory illness (influenza/COVID-like illness) and a relative RR of 1.01 (CI 0.72-1,42, moderate certainty of the evidence) for laboratory-confirmed influenza/SARS-CoV-2 (see p. 5 & p.174). Summary of Findings Table 2 revealed a RR 0.70 (CI 0.45-1.10 very low certainty of evidence) for N95 respirators compared to surgical/medical masks to prevent influenza-like illness in healthcare workers in the hospital, a relative RR 0.82 (CI 0.66-1.03, low certainty of evidence) in households, and a relative RR 1.10 (CI 0.90-1.34, moderate certainty of evidence) for laboratory-confirmed influenza (households and hospitals), (see p.6 and p.174). Under this topic of N95 respirators vs. surgical/medical masks, this systematic review was unable to include a peer-reviewed, negative RCT published 11.29.22 by Loeb M, et al in the Annals of Internal Medicine (doi:10.7326/M22-1966 ) in the formal analysis. Nevertheless, it was a negative RCT in healthcare workers in various countries. The formal conclusion in that study was that surgical/medical masks were not inferior to N95 respirators because the N95 respirators could not demonstrate a two-fold reduction in laboratory-confirmed SARS-CoV-2 infections.

The criticisms made against public health and medical authorities that community masking with cloth or surgical/medical masks has little good scientific support now has a more complete and solid evidentiary base. Because of the very low to moderate certainty of the evidence of these analyzed trials, one can’t conclude that there is no benefit possible, just that there is little to no good evidence that these measures work in prevention. The current evidence is still perhaps consistent with a small benefit 10-15% under the right circumstances that the trials in aggregate failed to show. This Cochrane Review is long, but pp.1-35 and pp.173-183 are the most important sections.

Attachment 9: This is a published, well-referenced, personal opinion article published in Lancet Infectious Disease Vol 21, Sept 2021 (doi.org/10.1016/s1473-3099(20)30982-8). In contrast to the above Cochrane Review, these authors argue on the basis of laboratory, animal and observational human studies that masking, distancing, ventilation and hand washing are effective against reducing the spread of viral illness, including SARS-CoV-2. This is a well-argued and well-referenced personal opinion. Some of the references are helpful in showing the evidence of the viral load and in explaining the transmission dynamics in animals and humans, but not in terms of the altered severity of the illness, once it has been transmitted and established in a new host. They criticize various design limitations of the first and negative RCT of masking in the community done in Denmark, 2020. The Cochrane Review above also pointed to several flaws in that study and in others. However, the authors of this personal opinion ignore all the other negative RCTs for cloth, surgical/medical masking and N95 respirators. One can imagine that the Cochrane Reviewers would probably say that these authors are engaged in wishful thinking. Real world settings are messier than controlled laboratory and animal studies.

There is good literature that points to the usefulness and need for large, well-designed observational studies that have comparable groups and are adequately adjusted for confounders or covariates. When this occurs in any type of observational studies (case-control, retrospective and prospective designs), then the results are, by and large, comparable to RCTs in their effect sizes. Furthermore, the observational design per se should not be used as a reason for the sometimes different results from the two types of studies. (Anglemyer A, Horvath HT, Bero L. Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials. Cochrane Database of Systematic Reviews 2014, Issue. Art. No.: MR000034, DOI: 10.1002/146518548.MR000034.pub2). Another good opinion piece, well-referenced, and published in the BMJ (BMJ 1996;312:1215-8) by biostatistician, Nick Black, delineates the reasons why observational studies are still needed and important, and why RCTs have both inherent and logistical limitations that can be overcome with observational studies.

Attachment 10: This is a very recent (published 2/16/23), peer-reviewed, open access, systematic review and meta-analysis in The Lancet of studies looking at the risk of reinfection after a prior SARS-CoV-2 infection (doi.org/10.1016/s0140-6736(22)02465-5). After the first 9-12 months, throughout the COVID-19 pandemic, there has been scientific evidence against the assertions by the US CDC, FDA, NIAID of the US NIH, the US Administration, as well as state and local public health, and other medical authorities, that natural immunity isn’t very good, wanes rapidly, and that vaccine-induced immunity was superior. This systematic review and Bayesian meta-regression analysis looked at 65 observational studies of various types (no RCTs have been done) from 19 different countries that compared the level of protection from past infection to those without a prior infection, including those with vaccinations up to one booster after full vaccination. Hybrid immunity studies were not included. Their meta-regression demonstrated substantial natural immunity protection against reinfection and symptomatic disease for pre-omicron variants with a relative RR between 82.0-90.0% (collective CIs 54.8-98.4). For past SARS-CoV-2 infection, protection against omicron BA.1 for both infections and symptomatic disease waned rapidly and was only 44.0-45.3% (collective CIs 17.3-76.1) by 40 weeks. However, for severe disease (hospitalization & death), natural immunity provided substantial and long-term protection against tested strains of 78.1-97.2% (collective CIs 34.4-99.6) for up to one year, based on only a few studies (1-4) depending on the variant. (See figures 2-3.) Comparing natural immunity vs. vaccinations with or without 1 booster (figure 4), the data demonstrate equivalent or higher protection for reinfection, symptomatic disease, and severe disease with past SAR-CoV-2 infection for up to 40 weeks. A previously-reported, large retrospective study of the Swedish total population, published in 6/2022 in Lancet Infectious Disease (doi.org/10.1016/S1473-3099(22)00143-8), and discussed in a previous PAAM Medical Letter, showed 87% natural immunity protection against hospitalization for up to 20 months. The authors of the attached article above describe six primary limitations to their study, but still feel their study suggests a high level of protection from severe disease with natural immunity, and the level of protection by variant and over time is at least equivalent, and many times higher, than from two and three doses of vaccination. This systematic review and meta-regression analysis supports the AM view that, in healthy people undergoing a febrile illness (even a severe, challenging one), when properly treated, opportunity is provided for detoxification, overcoming biological and psycho-spiritual obstacles, resolution of past karma, and the attainment of enhanced strength and health.

Many studies suggest that hybrid immunity, especially two-dose vaccine-induced immunity, may be superior to natural immunity, at least up to 6-7 months, and perhaps longer. See the Swedish study cited above as an example. However, the mean follow-up time in that study for two-dose hybrid immunity was only 66 days, so the long-term data is sparse. In addition, it may be hard to conceive of hybrid immunity improving protection against severe disease very much over an already high level (but not perfect level) of natural immunity.

What are some of the risks in relying on getting a potentially severe infection to obtaining durable, broad natural immunity? In healthy, non-vulnerable people the risk is low, but it’s still possible to get at least a serious complication, and possibly die. The illness will still require patients to be at home, missing work or school, and will require they get competent home and medical care to reduce potential complications. For high-risk, vulnerable populations, there is a higher risk of hospitalization, ICU admission, death, and chronic morbid complications. Proper individualized treatment as an outpatient has been successful (for the acute illness and for complications) for many practitioners and patients, and can therefore be an option in a well-informed consenting patient. It is unlikely that the risk of severe disease or death can be completely eliminated, and patients need to be informed about this. Vaccination may be option for high-risk individuals if they are first given adequate informed consent without direct or indirect coercion (something that has not happened in the US and much of the world).

What are some of the risks of receiving full vaccination with 1-3 additional boosters? While many patients seem to benefit from a series of COVID genetic vaccines, there are well-established adverse vaccine reactions with currently published risk estimates of 1/800 to 1/1000 for serious, debilitating vaccine injuries (see last issue of the PAAM Medical Letter Vol 9, Issue 4, attachments # 5 and #6). The recently released US FDA and CDC’s Vaccine Adverse Events Reporting System (VAERS) also shows the proportional reporting ratio (PRR) is elevated in about 700 disease and symptoms categories. The fully vetted data to know for sure has been suppressed, and is unavailable to the public and independent researchers. There is a temporarily associated increase in deaths from genetic COVID vaccines (see J Rose. Science, Public Health Policy, and The Law Vol 2:59–80 May 2021 Clinical and Translational Research; reported previously in the PAAM Medical Letter). The long-term risks of these gene-based vaccines have not been adequately studied, so they are therefore not fully known. The positive studies showing high effectiveness of the genetic COVID vaccines have been criticized by many independent scientists, physicians, and biostatisticians as seriously biased, corrupt, compromised, and as over-estimating their true effectiveness. There is also the serious and potential issue of immune imprinting (original antigenic sin) from repeated vaccinations against the SARS-CoV-2 Wuhan variant that would impair the person developing a more complete and broad-based immunologic response, and therefore risk increased vulnerability to newer variants (see previous issue of the PAAM Medical Letter Vol 9, Issue 3, attachment #5). If a serious or debilitating injury does occur, there is virtually no good option to bring a lawsuit to the vaccine manufacturer nor the mandating private or governmental organization to recuperate the medical and social costs because of the current indemnity law, applicable under current Emergency Use Authorization (EUA) for the vaccines in the US. This is likely to be true in many countries around the world. There is currently no available genetic COVID vaccine in the US that has full FDA approval and would be subject to vaccine injury compensation.

On behalf of the PAAM Board, and to you, our valued colleagues,

Ricardo R. Bartelme, M.D.

Emeritus Assistant Professor
Department of Family Medicine
Integrative Medicine Program
University of Michigan Medical School
Ann Arbor, Michigan, USA 48109