Posted by Curt on 22 February, 2023 at 9:45 am. 1 comment.


by Vinay Prasad

Dr Eric Topol once again is promoting bad science. Sadly, this time, his promotion has earned over 1000 retweets. Let’s take a close look at the study and why it is wrong. But first, here is the tweet.

This paper in question comes from the Mt. Sinai investigators, a point I will return to. Basically it claims that vaccination lowers the risk of major adverse cardiovascular events— which typically includes acute myocardial infarction (AMI), stroke, and cardiovascular mortality— after infection with sars-cov-2 documented in the EHR. You were considered vaccinated 2 weeks after your last dose, and you had to have sars-cov-2 documented in the EHR to be in this study.
Topol’s tweet misses the part that this is after EHR documented infection, not “during follow up”. MACE events that occurred without prior covid 19 are not included.
Why am I not surprised he missed this?
What does it mean to have COVID in the EHR? That comes from a linked paper. But basically you had to have a COVID19 code the dataset, but could have even tested negative for COVID. What a joke!

Once this code is placed in the chart, the authors see when MACE codes occur. Check it out. The answer is immediately. It occurs immediately more often in the unvax’d.

Because you were unvaccinated, you immediately have a heart attack when you get COVID— is the authors claim.
Is this true? Is this likely? Are there competing explanations?
In order to be in this dataset you have to have documented COVID19 in an EHR. The reasons vaccinated and unvaccinated people seek medical care is not known and may vary. The vaccinated person might be presenting with COVID19 with a mild cough and looking for paxlovid or other medical advice; the unvax’d person might be presenting to the hospital with a heart attack and then only incidentally found to have COVID19. Almost surely this is what is happening disproportionately. We know unvaccinated people are different in ways apart from vaccination, which I will return to.

The authors limits include blah-blah the usual boilerplate, but they do not mention the biggest limit. The paper assumes that unvaccinated and vaccinated people are seeking medical care for covid and apart from covid ENTIRELY EQUALLY— which is almost surely not true.

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