Thread by @Loretta_Torrago

Unhappy with the CDC’s paltry number of myocarditis cases attributable to mRNA vaccines, @TracyBethHoeg et al set out on the vast sea of VAERS in hopes of catching more fish by using "broader search and inclusion criteria" aka a bigger, but definitely not better, net. 🧵

Admirable if only for the nakedness of its ambition, the authors don’t hide that their aim is to “update” the CDC’s estimate,

or that, by “update” they mean “inflate”.

So after vacuous statements about how the CDC's undue sensitivity “may have failed”, the authors search for reports, not just where myocarditis is diagnosed, but, more broadly, for reports of “chest pain” bc armchair cardiologists can do their own diagnostics thank you very much.

Though the authors claim to align themselves with the CDC’s case definition of “probable myocarditis”, where they part ways is telling.

Typically, the broader the search, the greater the need for careful exclusion criteria but, unsurprisingly, for a crew focused on addition and not subtraction, exclusion is a more limited enterprise. Where the CDC excludes cases where abnormal findings have ANY alternate cause,

the authors’ dedication to collection limits exclusion to just cases where viral myocarditis or pneumonia is an alternate explanation.

This is problematic because first, they don’t actually exclude viral myocarditis despite a positive rhinovirus test,
h/t @jhowardbrain

or viral myocarditis being mentioned as likely in clinical notes,

or where notes indicate results for viral myocarditis are pending,

or, though not mentioned, where viral myocarditis remains possible given the presence of other symptoms associated with viruses.

In other cases, Covid itself is present,
h/t @jhowardbrain

or had been which certainly may matter.

Second, since elevated troponin in the presence of chest pain is our armchair epidemiologists’ dream team of vaxx-induced myocarditis, the many other causes of elevated troponin are overlooked. Definitely read this whole excellent thread.

Third, elevated troponin together with chest pain allows the authors to diagnose vaxx-related myocarditis even when, as the CDC puts it, there is some “other identifiable cause of the symptoms and findings” as here where the clinician’s notes indicate possible pulmonary disease,

or here where both viral myocarditis and MIS-C are alternatives under consideration.

None of this is to say that the cases from this non-exhaustive list are definitely not vaccine related but, rather, that given the presence of a competing explanation, it is at best premature to add these to the tally of vaccine related cases as if we knew that they were.

Expand what you include, minimize what you exclude & your bigger net catches more. But don’t be surprised if your new additions turn out to be, not good epidemiological evidence but, instead, clutter & junk. Which, given the problematic VAERS, is just about what you’d expect.

Sincere apologies to @JHowardBrainMD who I incorrectly h/t'd as @JHowardBrain and whose screenshot of the PCR + case got mixed up with the rhinovirus case.