Shingles vaccine(s) and dementia: the only medical intervention to work faster than Tums

Do you believe in magic?

I am going to talk about how fast shingles vaccines reverse dementia across 4 papers. Turns out the effect is near instant. But before I do that, let us agree on some facts about the nature of the evidence used to make these claims.

Fact: Observational studies and even “natural” experiments have methodologic challenges.

1. People who get a vaccine and those who don’t are different.

2. If you see a doctor, you are more likely to get a diagnosis. Show me a healthy person, and I will show you someone who hasn’t gotten enough tests.

3. Diagnoses change over time. A dementia diagnosis in 2017 and 2018 may not be the same thing. Doctors may become more or less disease aware. They may be incentives to add diagnoses to the chart to make more money. They may code the same exact forgetful elderly man differently* based on a single calendar date.

4. Doctors may consciously or unconsciously offer more preventive care to people who appear well.

5. The medical record aka “chart” doesn’t truly capture how well people look.

Here are some other facts, which I don’t think can be disputed

1. There has been no truly successful treatment for dementia. We have a few drugs with effects so abysmally poor, we can debate if they work at all. Dementia is not a disease with a series of advances. It seems like we barely understand it biologically.

2. This is despite huge financial investments.

3. Dementia is a slow process that takes years to manifest. By the time you forget who you are, you have likely had symptoms for a long time.

With this background, lets turn to a scientific hypothesis:

What if the shingles vaccine reduces dementia?

I am willing to consider this hypothesis. Maybe less episodes of shingles— which is debilitating— and you get less dementia. Probably would take a few years or maybe a decade to see the benefit, if true. Powering a randomized trial for this would be gargantuan. Observational studies or natural experiments are probably useless due to the challenges with the data and endpoint adjudication, but that never stops a scientist up for promotion.

Now let us look at the 4 papers:

“Experts” offer a series of papers making ludicrous claims. They argue because the claim is consistently ludicrous— it must be true— rather than the same sources of bias plague the literature. The earth is flat because it looks flat when you look around in every direction.

In annals of IM this week.

Wait, if you get ADMITTED to a nursing home—in less than a year—maybe as soon as 200 days—you get less dementia because of the Shingles vaccine. Within 3 years there is a 5% ABSOLUTE reduction in dementia. This vaccine must go inside neurons and repair them. It is what Ponce De Leon was looking for. A huge effect size that is also rapid.

In the JAMA paper, by 100 days, the shingles shot is already halting dementia. I don’t have dementia— at least I think I don’t— if I get 3 doses, I will probably be able to build Anthropic or Space X in a week— the brain benefit is so rapid.

The Wales paper doesn’t include K-M time to event plots. Sad. Why omit data when it will be so amazing? The US data is great. Obviously it confirms that the effect is near immediate.

And it includes a hazard function— thank you!— which makes it easier to see the fast action of the shingles vaccine. It makes Tums look slow acting.

Wait, what if this is true for every vaccine given to adults. What if the effect is not just shingles vaccines, but all vaccines. Perhaps they are miraculous as a class.

Check out this meta-analysis— it is true. Every vaccine prevents dementia!

Which is more likely?

Shingles vaccines (and maybe all sorts of other vaccines) instant act to reverse dementia. Even though nearly no drug in 50 years has achieved this. Despite tremendous effort and hundreds of billions of dollars. And this discovery just so happens to occur at a contentious time when vaccine science has taken on a left-right political bent, and coincidentally all the liberal outlets know the truth, while the conservative outlets spread misinformation (Option 1)…. or

The speed of the result is preposterously fast, the pretest probability abysmally low, and the desire to deceive ourselves astronomically high. (Option 2)

Future steps

Write to the annals of internal medicine and ask the editors to make the authors provide a Kaplan-Meier (time to event plot) of all cause mortality. (falsification endpoint)

Write to the Wales/ nature editors and ask for a time to event plot for dementia.

My understanding is that the NIH is planning on commissioning a randomized trial on this question. Encourage them to do so. (Equipoise is in the population of individuals who would do it, if and only if, this claim were true).

If there is a betting market on this trial, get a shingles shot to boost brain health before you vote.

Conclusion

The media coverage of this topic is deeply concerning. As I wrote recently in Sensible medicine, the media is unable to cover health and medicine without in house expertise in clinical trial appraisal. The status quo is untenable.

Coming soon, let me discuss that whole body ultrasound ;)

PS, if you enjoy these analyses, please subscribe

*say before or after a 2024 election

UPDATE: Since I posted this someone drew my attention to another regression discontinuity effort in England. There is no demential effect, but a shingles effect.