Honestly, I had planned on not blogging today, mainly because I have an August 4 grant deadline. However, the pandemic being the pandemic and antivax conspiracy mongering being antivax conspiracy mongering (meaning that it never sleeps), I decided I had to say something about Bronny James.
LeBron (Bronny) James Jr. is the 18-year-old son of NBA legend LeBron James. If you’ve paid any attention to the news over the last day or so, you’ll be aware that on Monday Bronny James suffered a cardiac arrest during a USC Trojans basketball practice:
Bronny James, the older son of NBA star LeBron James, suffered a cardiac arrest during basketball practice at the University of Southern California and was hospitalized Monday, according to a statement from a family spokesperson.
He is out of the intensive care unit and in stable condition, the statement said.
“Yesterday while practicing Bronny James suffered a cardiac arrest. Medical staff was able to treat Bronny and take him to the hospital. He is now in stable condition and no longer in ICU,” the statement said.
“We ask for respect and privacy for the James family and we will update media when there is more information.
“LeBron and Savannah wish to publicly send their deepest thanks and appreciation to the USC medical and athletic staff for their incredible work and dedication to the safety of their athletes.”
Bronny, 18, is an incoming freshman for USC’s basketball team after graduating from Sierra Canyon High School in Los Angeles this spring. The 6-foot-3 combo guard was rated a four-star recruit and shined in the McDonald’s All-American Game in March featuring some of the country’s top high school basketball players.
Like most people, I was happy to learn that James survived and appears to be on the mend—also to be reminded that AEDs are so widely available. (They really do save lives, people.) Like others who pay attention to antivax conspiracy theories, I was simultaneously anxious, because I knew what was coming next. Sure enough, it didn’t take long before antivaxxers started insinuating that it must have been COVID-19 vaccines that caused the cardiac arrest, invoking the “died suddenly” conspiracy theory mainly by JAQing off about whether Bronny James had been vaccinated against COVID-19.
Sadly, one of those doing the JAQing off was Elon Musk himself:
Note the leap, a common leap made by antivaxxers, specifically: The mRNA-based COVID-19 vaccines can cause myocarditis (which is nearly always mild and self-limited); so that must mean that in this case the vaccine could have caused a cardiac arrest.
But enough of the Chief Twit and his tendency to amplify the very worst people on his platform. Here’s a quack named Dr. Weston “Wiggy” Saunders, who wasted little time posting a video speculating on why Bronny James might have had a cardiac arrest. Last night he asked “Why?”:
Then this morning he posted this:
I perused Dr. Saunders’ Twitter feed, and, suffice to say, it’s a cesspit of quackery (e.g., touting high dose vitamin C as a “miracle“) and antivax nonsense (e.g., amplifying bogus “studies”). His website leads to a page saying it’s down for 72 hour maintenance, but a quick gander through the almighty Wayback Machine shows that it’s just a supplement store. However, a Google search did find his practice website.
So it’s as little of a surprise as noticing that Dr. Saunders is a Twitter Blue Check that to notice how begins his video by asserting confidently that it’s Not Normal for an 18-year-old like Bronny James to have a cardiac arrest. This is, of course, true as far as it goes, but not in the way Dr. Saunders appears mean it. A cardiac arrest during strenuous exercise is a sign of an abnormality, just not the abnormality that Dr. Saunders wants you to believe it’s a sign of, namely that the cardia arrest must have been due to the dreaded mRNA COVID-19 vaccine. To try to convince you of that point, he then complains about how we are “normalizing” cardiac arrests, apparently because “They” don’t want you to know that it’s the vaccines:
I do think it’s important for us to be asking some questions because this is not a normal event and we shouldn’t be trying to normalize an 18-year-old having a cardiac arrest. That is not a normal thing, and we shouldn’t be seeing that. So, there are a handful of things that I think could be contributing, but I think we need to be asking some of these questions.Gee, guess which question is at the very top of Dr. Saunders’ list of “these questions” that we “need to be asking.”
First of all, I have to wonder. Dr. Saunders says he’s board certified in Family Medicine. Has he never had to do sports physicals for children and adolescents who are signing up to play school sports? My wife, who is a pediatric nurse practitioner, has done more sports physicals than she can remember. There’s a reason why sports physicals are generally required before adolescents and even young adults can play school sports, and it’s because—believe it or not, Dr. Saunders!—young athletes could and did suffer cardiac arrests playing sports before the pandemic. Even more than that! Although rare, it’s not so rare that there aren’t foundations dedicated to improving knowledge and awareness of the phenomenon that were founded long before the pandemic. There are even books about it from before the pandemic:
As well as infographics:
It’s not so rare that we don’t know risk factors that might indicate a higher risk in a given young person to suffer a cardiac arrest and even genetic and biochemical abnormalities that predispose to it. Indeed, the syndrome even had a name before the pandemic, Sudden Arrhythmic Death Syndrome (SADS). There are even review articles like this one (note the year):
Sudden death in the young is of cardiovascular origin in the majority of cases. A considerable rate of SD cases remains of unknown cause on post-mortem. Apart from channelopathies, subclinical forms of inherited structural heart diseases would appear to be implicated in SADS. Clinically guided genetic screening has a significant diagnostic yield and identifies affected families that would have been missed by the current suggested molecular autopsy panel.
It’s also a condition that has been studied since the 1970s:
Sudden Arrhythmia Death Syndrome (SADS) occurs when a person’s heart appears to stop without cause, often in what appear to be perfectly healthy, young adults or those in middle age. SADS was first noted in the late ’70s and early ’80s by the CDC as “ sudden, unexpected nocturnal death syndrome .”
SADS can be caused by a range of disorders responsible for irregular heartbeats (arrhythmias), but are subtle enough to go undetected or are so rare that they are not tested for in routine checkups. These conditions do not cause physical abnormalities or damage to the heart, and instead, interfere on some level with the electrical impulses that causes the heart to beat. Because the heart stops beating after death, it is often difficult to diagnose these arrhythmias, which then leads to the mysterious label. Modern technology, however, has shed light on a few likely causes.
Approximately 600 Canadians die from SADS each year, according to the Canadian SADS Foundation , an organization established in 1995.
The US-based SADS Foundation has said that over half of the 4,000 annual SADS deaths of children, teens or young adults have one of the top two warning signs present.
Those signs include a family history of a SADS diagnosis or sudden unexplained death of a family member, and fainting or seizure during exercise, or when excited or startled, reported news.com.au.
One source, pointed out in refutation of another antivaxxer, estimates that approximately 2,000 young athletes per year in the US suffer SADS:
The differences in the figures generally boil down to differences defining what does and does not definitely count as a SADS case and to whether the study includes just athletes or both athletes and non-athletes, but it is clear that SADS, while, uncommon, is hardly rare and that there is not some sort of “epidemic” of SADS associated with COVID-19 vaccination. Indeed, if you look at the data showing an increase in cardiac deaths in young people, you’ll see that it corresponds far more closely to COVID-19 itself, not the vaccine:
Most physicians who are not COVID-19 antivax conspiracy theorists know that SADS happens and has always happened. We know how tragic such deaths are, given that they happen unexpectedly in children, adolescents, and young adults. We also know how puzzling they are to family, friends, and the physicians who take care of these patients. In general, such deaths tend to be due to conduction abnormalities in the heart, frequently congenital. Indeed, Sudden Arrhythmia Death Syndrome, with arrhythmia meaning a heart rhythm abnormality, and the term was first observed in the 1970s and 1980s, when the CDC reported the observation of a “sudden, unexpected nocturnal death syndrome.”
I’ve wrote about SADS in depth about a year ago, but before I go on I think it’s worth again quoting a source that I quoted in my original post that describes the known causes, if only to point out what a fool or grifter Dr. Saunders is:
Long QT syndrome. Long QT syndrome can be both genetic or caused by certain medications, according to Johns Hopkins Medicine . In a healthy heart, an electrical impulse causes the heart muscles to contract in a co-ordinated manner that we know as a heartbeat. In long QT syndrome, the cells take longer to recharge for the next heart beat than would be expected. This can lead to torsades de pointes , a potentially fatal heart rhythm in which the lower chambers (ventricles) of the heart beat faster than the upper chambers (atria). There usually aren’t any symptoms for long QT, although some patients may experience heart palpitations, dizziness, fainting or seizures. It can also be diagnosed through an echocardiogram (ECG).
Brugada syndrome. A genetic condition in which sodium channels in the heart cells malfunction, Brugada syndrome causes an irregular heartbeat, according to Cedars-Sinai . In extreme circumstances, the lower ventricles of the heart may start to beat faster than the atria, which can lead to cardiac arrest. This condition is very rare, affecting roughly five of every 10,000 people globally.
Progressive cardiac conduction defect. A rare, genetic condition, progressive cardiac conduction defect slows the electrical impulses that make the heart beat, according to the British Heart Foundation . Over time, this can lead to a third-degree heart block , where the electrical impulses don’t reach from the top of the heart (atria) to the bottom (ventricles). Patients identified to have this type of heart rhythm may be fitted with a pacemaker to ensure their safety.Seriously, I bet there was at least one question about SADS on Dr. Saunders’ last board recertification exam in Family Medicine. Of course, he could have gotten a question or two wrong and still passed to quack again.
Other conditions associated with SADS include Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C), Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), short QT syndrome, Wolff Parkinson White (WPW) syndrome, and Timothy syndromes.
In fairness, I must mention that Dr. Saunders does go on to list—after vaccines, of course—some of the known causes of SADS. It bothers him not at all that by doing so he contradicts his initial clear implication that such cardiac arrests never happen absent vaccines. On the other hand, he does bat each nonvaccine cause down one by one as much so much less unlikely as causes than the vaccine, because, again, he led his video with the assertion that it is “not normal” for an 18-year-old elite athlete like Bronny James to have a sudden cardiac arrest. So he mentions an undetected cardiac conduction abnormality or congenital heart abnormality or the possibility of some drug use as potential “other causes” that he considers so much less likely than COVID-19 vaccines. He even trots out the example of Damar Hamlin, who almost certainly suffered his cardiac arrest during a nationally televised NFL game because of commotio cordis, a cardiac arrest caused by a blow to the chest.
Again, all of this is true, but only as far as it goes and not for the reasons that Dr. Saunders insinuates when he concludes that “in my opinion this is most likely a…COVID vaccine injury from the mRNA vaccine” that caused a “low level myocarditis” that led to cardiac arrest when an extra demand was placed on the heart by high intensity physical activity. Dr. Saunders should, as a family medicine doctor, know that in many cases no definitive cause of SADS is ever found and that even detailed pre-competition evaluation of elite athletes in college and professional sports have a significant false negative rate. As this review points out, even more intensive genetic screening has a downside and is likely to miss a number of cases:
Furthermore, the sensitivity of genetic testing of inherited cardiac disease is limited (range 25–75%) even when the clinical diagnosis is definite.10 It is well established that the presence of a genetic mutation alone cannot provide clinical evidence and especially missense mutations should be interpreted with great caution. Genetic tests must be viewed in most cases by clinicians as probabilistic tests, not binary (positive/negative) tests.13 Therefore, this model presents some serious disadvantages for implementation in routine health care that increases further if the high cost of non-targeted genetic testing is also considered. Recently Bai et al.25showed that the blind/not clinically guided screening of family members of SCD victim on LQTS and BrS genes is largely ineffective and costly.
While this review article specifically about sudden cardiac death in athletes notes that in-depth screening requires specialized knowledge:
Evaluation extending beyond a history, physical exam, and ECG is indicated if any of these preparticipation tests are abnormal and/or an athlete presents with symptoms during the course of practice or competition (Figure 1). It is critical that downstream testing, which can include cardiac imaging, exercise testing, and electrophysiological evaluation, is delivered and interpreted by physicians (typically cardiologists) who understand the cardiovascular adaptations to exercise training and resultant physiologic changes in the heart’s structure and function—the so-called “athlete’s heart.” In most athletes, cardiac changes induced by exercise are modest and easily distinguishable from cardiac pathology. However, in a small subset of athletes, vigorous training is associated with more profound electrical and structural changes that may overlap with phenotypically mild manifestations of cardiac disease. For example, sports with significant isometric exercise may induce left ventricular hypertrophy with wall thicknesses in the 12- to 14-mm range, the same range as that of mild HCM (“gray zone” hypertrophy).39 A small but significant proportion of endurance athletes will have dilated left ventricular (LV) cavities with low normal LV function, which overlaps with findings of a dilated cardiomyopathy.40 These physiologic changes to the left ventricle may be accompanied by right ventricular (RV) dilation and reduced systolic function, which could raise concern for ARVC in the appropriate context. In these types of cases, it is crucial that an expert team—including cardiologists familiar with the care of athletic patients—select and interpret the required testing to more clearly distinguish cardiac pathology from physiologic remodeling. Comprehensive exercise testing (typically including cardiopulmonary exercise testing) is a critical component of the evaluation of such patients. For the cases of gray zone hypertrophy, techniques such as prescribed detraining (assessing for LV hypertrophy regression after a period of inactivity) may need to be employed.41
The bottom line is that it’s not trivial to identify athletes at risk for SADS, and it requires specialists to evaluate those found to have risk factors for the condition. None of this stops Dr. Saunders from concluding with some despicable conspiracy mongering:
But, you know, if the family is not asking these questions and they’re not trying to get to the bottom of what actually happened, then we may never know, but that’s just my thoughts and why we should be asking some of these hard questions.Word to Dr. Saunders: It’s not a “hard” question to conspiracy monger about vaccines as the cause of something that they do not appear to cause. It’s just antivax conspiracy mongering.
Of course Dr. Saunders is one of the “reasonable” antivaxxers JAQing off about Bronny James’ cardiac arrest. Leave it to Dr. Paul Alexander to be really unhinged about it in posts like If LeBron James was vaccinated for COVID, was his son Bronny? I argue yes, until we are shown conclusively he was not and did not have myocarditis or pericarditis…we keep the vaccine as the cause of and Bronny James, LeBron James son (literally died) suffered a cardiac arrest on court, must thank God had urgent help (CPR etc.) & is at high risk of death here on! ‘Vaccine induced ‘silent myocarditis’. (Dude’s headlines tell you how he writes.) Seriously, when I say unhinged, I mean unhinged:
No basketball or football player or no teen, no one, no airline pilot, none, no one who took the shots and engage in physical activity (even accounting for the deaths we see when people are ‘rising’ at dawn, waking from sleep, the adrenaline rush as we ‘rise’ or wake strains the myocarditis damaged heart that was ‘silent’ and our partner may find us dead in the morning next to them) or work in stressful situations (that results in adrenaline, catecholamine being released into the blood stream) must take to the field, the court, the cockpit etc. until their industry mandates the right testing to rule out silent myocarditis;
this is a catastrophic sequelae for the mRNA technology based shots by Weissman, Bourla, Malone, Sahin etc. scars the heart and disturbs electrical conduction across the heart, the heart forever will be sub-optimal and when the teen with the silent myocarditis with no symptoms, takes to the field, the adrenaline baths the scarred heart muscle and it is too much, it places the scarred heart under strain; irregular atrial rythms results etc. and eventual cardiac arrest and possible death; Bronny James likely suffered this sequence and he is lucky to be alive; my hope is that high-level people like this would use their disaster to inform and educate the public and the world! And not conspire with pharma and the government and CDC etc. to cover this disaster up!
Until his vaccine status is shown and his myocarditis status and until it is ruled out, then the mRNA vaccine is on the table as the key cause, direct or indirect. This is the 10 ton elephant in the room.
Unsurprisingly, Dr. Peter McCullough is on the “died suddenly” conspiracy train about Bronny James too; only he generalizes it to more athletes because he had been promoting a nonsensical conspiracy-laden narrative that claims that 1,887 athletes have “died suddenly” because of the vaccines.
Basically, Dr. Saunders is just Dr. Alexander and Dr. McCullough in a more reasonable-sounding visage. Unfortunately, every time one of these sorts of tragic collapses of a young person happens, the family will be besieged by questions about vaccines, thanks to antivaxxers desperately wanting to link these cardiac arrests to COVID-19 vaccines, including by right wing media:
Yet Musk was not alone in playing up a supposed link between Bronny’s cardiac arrest and Covid vaccines. Fox News host Martha MacCallum repeatedly questioned her guest, Fox Medical Correspondent Dr. Janette Nesheiwat, regarding the validity of a link between vaccinations and increased rates of heart failure while referencing Musk’s tweet in the process.
Nesheiwat stated that James would need to undergo testing to determine the cause of his cardiac arrest.
The horror of the “died suddenly” narrative goes beyond just its stoking fear, uncertainty, and doubt about COVID-19 vaccines. The idea that vaccines cause SADS in young athletes subjects the family of such victims to harassment and questioning that implicitly blames the family (e.g., LeBron James and his wife Savannah) or their loved one (like Bronny James) for having “brought it on” the victim. It goes along with a lot of the victim blaming at the heart of antivax narratives and alternative medicine.
A few people on “our side” are irritating the hell out of me with their oh-so-“moderate” and -“reasonable” takes like:
Here’s the take that irritates me:
#1 The media, who is attacking Musk for stating that “We cannot ascribe everything to the vaccine but, by the same token, we cannot ascribe nothing,” are taking things overboard a bit. Focus on better things. I know this gets you clicks.
“Taking things overboard a bit”? Dude, it’s a big deal when someone like Elon Musk JAQs off in order to amplify the “died suddenly” antivax conspiracy theory. Saying that people are attacking Musk because they want the clicks is basically the same thing as the “pharma shill” gambit is when employed by antivaxxers: Claiming that someone is doing something for primarily mercenary reasons rather than because they believe in it, all in order to discredit them. And then to say something as stupid as, “Focus on better things.” WTF? That’s tone policing. One wonders if Mr. Krassenstein is in essence sucking up to Mr. Musk, because that’s how it comes across to me.
People like this are almost as irritating to me as antivaxxers. Sometimes more so, if only because they should know better.