Article link: https://cardiovascular-research-and-innovation.reseaprojournals.com/Articles/myocarditis-after-sars-cov-2-infection-and-covid-19-vaccination-epidemiology-outcomes-and-new-perspectives

I’m a cardiologist too and this study has so many mistakes. Describing all of them would create an article longer than the linked article, so here I hit the highlights.

First off, if you are both on the board of your journal and a writer, there is a significant conflict of interest. Scientific journal articles are not like newspapers. In a newspaper, there is typically a dedication to journalistic integrity, but an editor or owner can write in his/ her newspaper. Normally, journal articles have a technique to peer review other authors by providing thoughtful and critical/ constructive feedback to make an article better prior to publication. If you are an author as well as a board member, you can get your article published no questions asked, which in the world of science publishing is basically the same as getting a job in politics by voting yourself in.

Next, given that there are theoretically two cardiologists in the panel, they should know that myocarditis incidence is going to depend on how strict your reporting criteria are. If your hospital does not have cardiac MRI, they are going to rely on other myocarditis criteria to diagnose myocarditis. The authors even contradict themselves in failing to report the results of meta-analyses of RCTs (e.g. Juan Gao et al 2022) which contradict their core arguments.

Next, the authors continue to insist that COVID-19 mRNA vaccination is a gene therapy product, while failing to rationally share which genes are changed and which peer reviewed experiments support those assertions. The work by McKernan et al on SV40 promoter contamination is deeply mistaken by a basic flaw: the DNA promoter from which the mRNA vaccines are made are chopped up prior to vaccine delivery. Never mind that the promoter cannot cause the whole SV40 virus to appear out of nowhere, since it wasn’t added in, in the first place.

Next the authors are not subtle in their data manipulation of COVID vaccine importance in chronic inflammation and comorbidities. They come out and say in their previous social media posts that COVID vaccines are mainly important in the medically complex, but still complain that they are unsafe in people with diabetes and arthritis in the face of abundant literature saying that the most medically complex amongst us are the most in need of these vaccinations. Never mind that professional societies relevant to diabetes and arthritis have come out and said that these vaccines are safe and effective in those populations (American Heart and American College of Rheumatology). The experiment they cite to say that, involves intravenous injection of vaccines. That should go without saying – vaccines are never supposed to be given in a big vein of the body.

Next, requesting clinicians perform a comprehensive arrhythmia and cardiomyopathy panel in serious vaccine myocarditis should always be accompanied by detailed genetic counseling due to the ability of these panels in identifying variants of unknown significance (and thus additional harm if formal genetic counseling is not given).

Next, it is inherently dishonest to complain about second mRNA dose vaccine myocarditis without saying that only a limited segment of the pediatric population is recommended to have two dose vaccines of the mRNA category for COVID. Adults have been recommended to get only 1 COVID vaccine at a time for several years now.

Next, they criticize batch dependent vaccine safety, while not thoughtfully explaining why the Australian TGA and a Danish population level study did not generate any significant safety concerns. There could be a small amount of batch variability, but this doesn’t hold across the board.

Next, it is inherently dishonest for the authors to quote an author that re-analyzed Pfizer and Moderna trial data while specifically designing a study to derive the result they are looking for. While I myself don’t hesitate to warn interested families about the risk of myocarditis with COVID vaccine, there is really no need to engage in data falsification to make this warning when there is already so much good other data available.

Next, it is a failure of simple fundamentals of cardiology to quote the Thai study by Mansanguan et al as evidence of myocarditis in a prospective study. Diagnostic criteria for myocarditis cannot be relaxed because you want to raise the number of myocarditis diagnoses as high as possible. When prospectively looking at a diagnosis, you are obligated to use the same diagnostic criteria throughout (there is no professional society that would diagnose myocarditis based upon chest pain and EKG changes alone). It becomes even more flimsy to quote the Taipei city study for its quote of “heart rate increased significantly after the vaccine”, when the actual heart rate increase is 2.6 beats a minute, a change that could be generated by brisk walking. Lastly in this section of the article, they quote Buergin et al’s study out of Switzerland that showed troponin changes; myocarditis was never diagnosed based upon troponin alone. This section of the article fails to diligently uphold basic diagnostic criteria of myocarditis.

The authors next demonstrate a failure to read the literature holistically on subclinical myocarditis – Ming-Yen Ng et al have shown that COVID vaccinations do not typically cause subclinical myocarditis. Yet another study says that when people are entirely symptom free, they should not have to worry about subclinical myocarditis.

Mainstream cardiologists can agree that some patients have lived through very serious myocarditis after COVID vaccination, but the authors of the paper are not able to come out and say that severe outcomes are a rare outcome, despite all the epidemiology saying otherwise. In addition, the authors of the paper do not thoughtfully analyze why some of the myocarditis they may have been seeing could have been generated from other sources. Discouraging autopsies is not a stance that is generalizable to any medical jurisdiction mainstream cardiologists are a part of. It is plausible there may be insufficient resources, but we aren’t seeing a consistent refusal of autopsies.

Next, the COVID insurance data is presented without any awareness that COVID deaths correlate strongly with COVID waves but not with vaccine waves (see Twitter/ X user @Jsm2334 for documentation of this).

Next, the authors complain about sudden deaths in athletes without realizing that the amount of sudden death in athletes has actually been coming down.

Next, the authors in “Misconception 1” directly come out and say they want to boost the number of myocarditis diagnoses when they are related to vaccination, but deboost the number when they are related to COVID disease. This is the equivalent of directly saying that they are going to lie. COVID viral myocarditis are always going to depend on the strictness of the diagnostic criteria. There are two former cardiologists in the list of authors; this factoid was taught during cardiology training program. The article authors do not thoughtfully discuss why their conclusions would be different from the Voleti meta analysis listed here.

In “Misconception 2”, the authors even contradict their own studies that they cited to complain about people who vaccine myocarditis is mild and transient. While they correctly quote the study out of South Korea, they fail to directly share with the audience that serious outcomes of vaccine myocarditis are exceedingly rare when compared across the entire planet. They also fail to come out and say that while myocarditis might be mild, it might be a severe outcome to the patient because they were hospitalized. Nobody enjoys the chest pain of myocarditis or being hospitalized, but the subjective experience to the patient (although important) is entirely different from the concept of medical severity which is explicitly spelled out in the 2024 myocarditis guidelines from the American College of Cardiology. This means the vast majority of vaccine myocarditis patients didn’t need machines to support their heart muscle strength. Mainstream cardiologists can acknowledge the significance of a diagnosis to the patient while still accurately assessing its medical severity.

In “Misconception 3”, the more up to date risk-benefit analysis is that the risks matter based upon the age and gender, and medical comorbidities. I don’t worry that much in 2025 if the general population mostly doesn’t want a COVID vaccine, but the risk/ benefit analysis still favors our oldest, youngest, and most medically complex patients (citation Infectious Disease Society of America). The benefit mostly comes in reducing the risk of long COVID and secondarily the risk of hospitalization. Again as a recurring theme in this article, it is not necessary to falsify COVID vaccine data when there is so much good data.