By DAVID WARMFLASH, MD

Robert W. Malone, MD MS, is a physician-scientist who will live in infamy, thanks to the Joe Rogan Experience Podcast boosting his visibility this past December regarding his criticism of COVID-19 vaccines, particularly the mRNA vaccines (Moderna and Pfizer-BioNTech). Subsequently, Malone was banned from Twitter, which further boosted his celebrity status. Describing himself as the inventor of mRNA vaccine technology, he has been reaching a growing number of people with a narrative that makes COVID-19 vaccination sound scary. We cannot embed clips from the Rogan interview, which lasted about three hours, because it is accessed only on Spotify. But we can pull quotes from the interview transcript and we can see how Malone addresses non-scientists in shorter appearances, like the following clip from Wisconsin Morning news aimed at parents:

…Before you inject your child – a decision that is irreversible – I wanted to let you know the scientific facts about this genetic vaccine, which is based on the mRNA vaccine technology I created…

There are three issues parents need to understand:

The first is that a viral gene will be injected into your children’s cells. This gene forces your child’s body to make toxic spike proteins. These proteins often cause permanent damage in children’s critical organs, including

○ Their brain and nervous system

○ Their heart and blood vessels, including blood clots

○ Their reproductive system

○ And this vaccine can trigger fundamental changes to their immune system

The most alarming point about this is that once these damages have occurred, they are irreparable

○ You can’t fix the lesions within their brain

○ You can’t repair heart tissue scarring

○ You can’t repair a genetically reset immune system, and

○ This vaccine can cause reproductive damage that could affect future generations of your family….

Along with the alarmist theme, there are some phrases in the excerpt that people with little knowledge of biology could take the wrong way. The ‘toxic’ spike protein terminology warrants unpacking later, because Malone’s more farfetched ideas rest upon his disagreement with experts who have worked on that very spike protein. This is a protein that SARS-CoV2 (the virus that causes COVID-19) makes and uses to enter body cells, and is the basis of most of the COVID-19 vaccines that are approved throughout the world. In the case of the genetic vaccines (the mRNA vaccines of Pfizer-BioNTech and Moderna and the viral vector vaccines of Johnson and Johnson and AstraZeneca), the vaccines do not actually contain spike protein. Instead, they contain a recipe for cells of a vaccinated person (not all the person’s cells, but just a small sampling) to make spike protein —in very small amounts and for a very limited time— and display it on the outer part of their cell membranes. This allows the immune system to use that vaccine-generated spike protein for target practice, so you can build immunity against the virus without the virus infecting you.

Even more blatant in the excerpt than ‘toxic’ spike protein is Malone’s statement about the viral gene injected into children’s cells. He is talking about a gene made of messenger RNA (mRNA), but fails to distinguish that from DNA, which constitutes the genes of the child’s cell. DNA is not changed by mRNA, despite a new piece of misinformation that anti-vaxxers have been adding to their narrative lately, based on an article that a group of researchers from Sweden published this past February in Current Issues in Molecular Biology. Not only does this journal have a low ranking, based on metrics, such as its papers not being cited much by other published studies, but it also charges high fees to publish manuscripts of authors who don’t think that they can get their work published in better journal. A reading of the paper also suggests that the journal’s editorial team doesn’t even bother editing grammar. yet, anti-vaxxers are referring to this paper as evidence that vaccine mRNA becomes DNA that is incorporated into the genes of body cells. Were this the case, such a manuscript would appear in a major journal, like Science or Nature, but transforming cell genetics is not even what the paper claims. The issues are technical, but basically the researchers put liver cancer cells in a laboratory situation that forced the cells to use information from mRNA of the Pfizer-BioNTech vaccine to make small numbers of DNA fragments called amplicons. That is a long way off from transforming a cell’s genome, it’s collection of genes, which certain viruses can do, but there is no evidence, nor reason to suspect, that the mRNA vaccines can do it. In fact, even the COVID-19 vaccines of Johnson and Johnson and AstraZeneca, whose business end consists of DNA rather than mRNA, do not transform a cell’s genome, since having a piece of DNA is only one step in the process. I’m not saying that Malone is citing this Swedish study, since its publication was very recent, but anti-vaxx-minded people who admire Malone certainly are citing it, so it’s now weaved into the vaccine misinformation milieu.

Asked about his conflation of RNA with DNA during a brief phone call with me, Malone’s response was:

“I speak to a wide range of audiences. For some, I have to go short and simplify everything.”

But even in the three hour discussion with Rogan, during which DNA and RNA came up many times, Malone didn’t explain that mRNA cannot change a cell’s DNA, nor that the mRNA from the vaccine does not even go to the same part of the cell where the DNA is stored. Thus, he left out a major point, namely that the small amount of mRNA in each jab does not multiply itself. It merely persists in cells for just a short time, during which it produces a finite amount of spike protein, before enzymes destroy it.

Before elaborating on Malone’s misinformation, I want to give him credit for what he gets right.

Adjusting Vaccine Doses and Schedules

Malone suggests that too many vaccine doses are being given to too many healthy people, especially the young ones. This is something that vaccine experts actually have been discussing publicly. One prime example is Paul Offit, MD, Professor of Pediatrics and Director of the Vaccine Education Center at Children’s Hospital of Philadelphia. Offit, who is an authentic co-inventor of a vaccine, the vaccine against rotavirus, is as pro-vaccine as one can get. Yet, Offit has publicly questioned the practice of giving third doses to young people with no health risk factors, and thinks that a case of COVID-19 probably should count as a dose.

Let me elaborate on the last part, because it’s important. Earlier we noted how vaccination gives the immune system target practice, but getting infected with the SARS-CoV2 virus also gives the immune system target practice. In the Rogan interview, Malone talked about vaccine side effects being stronger, and more common, in people vaccinated after having COVID-19 than in people vaccinated with no history of COVID-19. This is correct according to studies and it makes perfect sense. If you have had COVID-19 and you receive your first vaccine dose, your immune system reacts as if you are getting your second dose, and as if your first dose was an overdose. Then, after your second vaccine dose, it reacts as if it were your third, and, as if you received your third dose far too early. Consequently, there is an increased rate of typical vaccine reactions, such as soreness, fever, chills, headache, and fatigue, and such reactions are worse, on average, following the second dose of Moderna vaccine compared with Pfizer-BioNTech in people under age 45, and in females of any age. Considering such reactions, Moderna prepared a half dose (50 micrograms) that is now given as the third dose in people without health risks, at least five months after the full dose (100 micrograms) second jab.

Now in the Rogan interview, Malone —who is over the age of 45, and suffered COVID-19 early in the pandemic, then later received the Moderna vaccine— described what happened to him subsequent to receiving the second Moderna jab:

…with the second dose I developed stage three hypertension with systolic blood pressure of up to 230 okay I’m lucky to be alive you know what it means is I’ve had a stress test of my aorta and my cerebral vascular system and I didn’t have a stroke and I didn’t tear my aorta all to shreds but it’s a good thing I had I had irregularities of heartbeat incredible hypertension, [postural orthostatic tachycardia] PoT syndrome, narcolepsy, restless leg syndrome, these are all known side effects that are associated with the vaccine…

We cannot be sure about cause and effect, but if Malone suffered a life-threatening reaction to his second dose (which is exquisitely rare, but the number is not zero) it would be a case of his immune system reacting as if the second dose were a third dose, since had suffered previously from COVID-19. To the immune system, this de facto third dose would be too high (100 micrograms instead of 50) and far too soon (1 month after the previous jab, instead of 5 months). Unfortunately, rather than connect his anecdote with the issue of jab schedules, he basically just left it hanging there as a scary anecdote for Rogan’s viewers to interpret as they please.

Anecdotes, especially scary anecdotes, can be a very effective way to influence people to believe that something is dangerous, even when you warn that it is an anecdote, as Malone did. Anecdotes also work in the other direction, making something look good, which Malone also did in the Rogan interview, in connection with repurposed drugs.

Repurposing drugs means that you take a drug that is used and approved for other conditions and you administer it to treat a different condition. This is what Malone was working on, just prior to the pandemic and it’s a strategy that actually is part of the overall pandemic response. Dexamethasone is an old medication used widely for various conditions that involve inflammation. It is now the most important therapeutic agent given to people when they have moderate to severe COVID-19, although it’s very bad to give to people with mild cases. Testing out dexamethasone and similar agents made sense medically from the onset, because of lung inflammation in COVID-19, but drug repurposing also involves computer algorithms identifying candidate drugs. The candidate drugs are then tested in the laboratory for a new use, such as fighting a virus. Working on such projects, Malone had reason to think that the drug famotidine would be effective against the SARS-CoV2 virus. The normal use of this drug is for treating ulcers of the stomach and small intestine and gastroesophageal reflux disease, commonly known as heartburn, because it stops the stomach from producing acid.

Thus, in telling Rogan about his own case of COVID-19 in early 2020, Malone said,

..my lungs were burning, until I took famotidine and that relieved that..

Not to deny that Malone was suffering, nor the seriousness of his condition, but we should note that heartburn manifests as a burning pain in the chest, which subsides when you take a drug like famotidine.

Now, Malone also has suggested putting the particular dosage of each jab up for discussion, which makes good sense. Remember how the Moderna vaccine has two approved doses. The third dose for healthy people is half the dose of the first two jabs (people with certain health problems get the full dose for third shot, even for a fourth). The Pfizer-BioNTech vaccine also comes in two different doses, so far, one for ages 12 and up, the other for children ages 5-11. Another dose is under study for children below the age of 5. My 13 year-old, who was 12 when he received his first two jabs, and 13 when he received the third, got the adult dose (30 micrograms). Meanwhile, the pediatric dose (10 micrograms) produces excellent immunity in children ages 5 years to even one day below the age of 12. Clearly, that pediatric dose would have worked fine in my child who, given his size and weight, could easily pass for a 10 year-old. This is relevant to an adverse effect that Malone discussed with Rogan, called myocarditis, because, though rare, it is an issue in teen and adolescent boys after Pfizer-BioNTech jabs of the adult dose, but not in boys age 11 and under after the pediatric dose of the same vaccine. Why, if there’s a dose that provides excellent immunity in children age 11 years and 364 days, should a child showing up one day later, on the child’s 12th birthday, receive triple the dose that was indicated the day before? That would be a reasonable issue to raise, rather than scaring audiences with anecdotes of rare events.

Myocarditis and Pericarditis

Of the potentially concerning adverse effects that Malone brings up in his talks, the only one that has shown up in the statistics for the mRNA vaccines is myocarditis (inflammation of the heart’s muscular layer) and pericarditis (inflammation of the membrane that surrounds the heart). Myocarditis and pericarditis can result from viral infections, including during COVID-19. Yet, for all of Malone’s discussion with Rogan of myocarditis as a vaccine adverse effect, he avoided mention that this cardiac inflammatory condition occurs as a manifestation of COVID-19 and plays a significant role in the morbidity and mortality of the disease. A recent update on COVID-19 and cardiovascular effects, based on more than 100 studies, reports, and systematic reviews, cites reports of up to seven percent of COVID-19 deaths being secondary to acute myocarditis. Also relevant, but not mentioned in Rogan’s interview of Malone is a rare, but serious, pediatric complication that can occur subsequent to COVID-19 (usually 2-6 weeks after COVID-19 seems to resolve), called multisystem inflammatory syndrome in children (MIS-C), which includes myocarditis as a component in roughly 75 percent of cases.

Medical journals, like the New England Journal of Medicine, the Journal of the American Medical Association, and the British Medical Journal, have reported rates of myocarditis, pericarditis, and myopericarditis (myocarditis and pericarditis together) very low in association with mRNA vaccines, mostly after the second jab. It’s less of a problem after the first and third jab. The rates differ in the different studies, but they are all notably lower than the rates of myocarditis and pericarditis in those who develop COVID-19. To be sure, we need to factor in that the chances of a young, healthy person developing COVID-19, is fairly low, and the chances of developing MIS-C, even lower, even when unvaccinated. Countering this however, we need to consider how the post-vaccination myocarditis/pericarditis compares to the myocarditis/pericarditis of COVID-19. It turns out that people suffering these complications after a vaccine jab usually recover quickly with rest and anti-inflammatory medication, or no medication at all. In other words, the mRNA vaccines we’re talking about a myocarditis/pericarditis that’s usually mild, in contrast with heart inflammation occurring with COVID-19.

During the Rogan interview, however, Malone claimed that there were no data showing the vaccine-related myocarditis to be mild. Ironically, he did this while referring to a published study from Hong Kong that actually shows the condition to be mild. Describing the occurrence of myocarditis and pericarditis after mRNA vaccination, in mostly males ages 12-17, the study authors reported an incidence of 1 case per 2,700 vaccinations. This rate is about two to five times higher than the rates in the three studies that I cited above, depending on age groups, but the major problem is that Malone told Rogan that they were serious cases on the basis of the fact that the patients were hospitalized. But a reading of the study itself reveals that the kids with myocarditis and pericarditis actually had mild cases and recovered easily with minimal treatment, or no treatment. They were hospitalized, only because it was a scientific study looking specifically for such adverse effects, so the researchers running the study needed them to receive detailed workups (testing that included MRI scans of their hearts) and monitoring. A science podcaster, Wendy Zukerman, confirmed this by reaching out to the first author on the study, pediatrician Mike YW Kwan, who also confirmed what you can read in the paper, that all the children evaluated for myocarditis and pericarditis recovered quickly and returned home.

But even with such myocarditis/pericarditis cases usually being mild, the Hong Kong government took the occurrence of such adverse effects seriously. The guideline, which used to call for a 4 week spacing between jab 1 and jab 2 for everyone, now calls for a minimum of 12 weeks between those two jabs for teens. Along with the safety issue as spreading out the doses lowers the myocarditis/pericarditis risk, this guideline change also dovetails with some findings during the first have of 2021 suggesting that spacing the two jabs from 4 weeks to 8 weeks, and especially 12 weeks, might provide better immunity, although that issue is now subject to a fairly nuanced debate involving different aspects of immunity. Meanwhile, health authorities in other countries, including our own US Center for Disease Control and Prevention (CDC) also are not ignoring the issue of heart inflammation. As of February 24, the CDC now says that the interval between the first two shots can be extended to eight weeks, particularly for males ages 12-39 years. This change is reasonably aligned with the myocarditis/pericarditis concern, but very much out of line with the basic theme running through the long discussion between Rogan and Malone, namely that health authorities are involved in some sort of coverup.

Meanwhile, Malone’s mischaracterization of scientific studies puts him on the sidelines with respect to the American Academy of Pediatrics, which recommends COVID-19 vaccination “for all children and adolescents 5 years of age and older who do not have contraindications using a COVID-19 vaccine authorized for use for their age”. Furthermore, for reasons to which we’ll turn next, Malone is also out of whack with the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine, which recommend COVID-19 vaccination of pregnant women and those planning pregnancy.

David Warmflash, MD (@CosmicEvolution) is a medical researcher, astrobiologist, and science communicator. Part 2 of this piece is here