Brian, I just love your attitude, re: removing your tattoos, as I share that same attitude. I hope you'll give us an update on your 'self experiment'. 🤞👍
"The time to sustained alleviation of all signs and symptoms of Covid-19 did not differ significantly between participants who received nirmatrelvir–ritonavir and those who received placebo. (Supported by Pfizer; EPIC-SR ClinicalTrials.gov number, NCT05011513.)"
That was the standard risk trial - people who weren't going to have a lot of severe cases to begin with. Results were quite conclusive in the high risk trial. A whole pile of real-world studies as well...
The vaccine is for kids who haven't had it before. It's job isn't to boost adults and so this doesn't make sense as a context to say it does or doesn't "work." To begin with, in kids, all boosting achieves is to convert the fraction of first-dose-havers who experience primary vaccine failure (no abs). But this doesn't necessarily help the ones who reached normal titers after first dose, or inform who will experience secondary vaccine failure (get measles if exposed).
What is predictable for injecting an attenuated measles virus into people with antibodies already (either from one or two doses) - a very transient boost because some B/plasma cells say "here is measles antigen" and expand antibodies, these antibodies totally prevent the virus from replicating and clear the virus so the boost is self-limited and shouldn't still be around 150 days later. So that is what is shown here. You could still expect some "herd" effects if revaccinating during outbreaks which is what was done in a few colleges in 1980s.
But the study is interesting for the longitudinal pre-existing serosurvey. Definitely noticeable that the vaccine-era cohorts alive during the 80s resurgence still have higher antibodies, due to boosting from the live virus back in the resurgence.
The only way to have higher antibodies than what attenuated vaccine gives, and thereby to really be sure of no infection if exposed, is either to get measles breakthrough infection or some more aggressive type of vaccination e.g. mRNA antigen overload (and then possible IgG4 problem).
In a way, this is another example of "immunity is not antibodies". In a health human with prior immunity, it seems the normal response against measles would be quickly make some antibodies and activate some CD8+ T-cells, quickly clear the at that time still very small numbers of measles virus and then have the immunity system go back to dormant sleep. The obsession with having always high numbers of antibodies against any illness seems more misguided the more I read/learn.
For me a clear for instance a recent reason to stop further vaccinating my kids against aP (as in DTaP). It doesn't produce any meaningful long term immunity, doesn't stop colonization and is only there to boost antibodies so you have 2-3 year less severe illness at the expense of significant IgG4 conversion with each extra booster. In that sense covid awaked me to how poorly many vaccines truly protect. Surprisingly - to me at least - there seem to be only a handful of vaccines that truly provide long term robust cellular immunity as opposed to merely boosting antibodies.
Ultimately boosting presents extremely poor logic from an individual user perspective - encounter with the virus/bacteria/antigen, when it happens, will boost antibodies, there's a huge head start vs. the normal infection process of 'let this foreign gene do it's thing and react on the fly,' massive protection against true severe disease. If a kid still has severe disease somehow then their immune system was "NGMI" to begin with and they probably would fall to the common cold too.
It presents sound logic instead from a political and social perspective - it stops doctors from having to admit that one size fits all vaccination isn't valid, stops bad press about rare vaccine failures, etc. This is why you have more nuanced policy in UK - it reflects having a high trust society that can negotiate these nuances, whereas in the US we just have to have Vaccine Overkill shoved down our throat so no one questions the experts to begin with (and ostracize parents who do). That's why with the Covid vaccines the answer to every nuance was a perfunctory zoom call and "we decided you all should shoot up again," there's nothing else really going into the formula anymore.
The important question for me is: When a susceptible vaccinated person gets measles (whether the wild or vaccine strain), can they overcome the original miseducation of their immune system from the childhood shots, to develop true lifetime immunity after real measles infection?
I think that is the wrong way to phrase it. There is no miseducation of the immune system here. The measles vaccine is just a weaker version of the real thing. It is possible that it confers a weaker long term immunity of course, but there is no real evidence that it is like some protein-vaccines (e.g. DtaP vs DTwP vs natural) where immunity at cellular level is fundamentally different.
In fact, the angle that Brian describes here will also apply to natural immunity. People who got measles in childhood, now no longer get boosted by their children. It is hence almost certainly that their immunity also has waned to a level that makes them susceptible. Or the real conclusion is more: Is there long immunity even with natural infection, without constant boosting?
Natural immunity is probably good without boosting. Otherwise adults who went long periods not around kids, like sailors, prisoners, would come back into society and get measles, this would have been noticed.
Sailors would often only leave for months to a few years, not many years and overseas trade posts and colonies had measles too for centuries, so they potentially got exposed overseas too. So I don't know if that is a strong argument. Prisoners might be better, but do we have good records of people getting released after years and not getting infected? Surviving in a prison for years may have been a challenge in itself for much of history.
More generic, how deep is our evidence of lifelong measles immunity let's say pre-World War 2, when measles was still endemic. Were there actual large documented groups that did not get boosted?
In fact we actually have records of adults getting measles dating back centuries. Are these all unvaccinated? The problem of course that often historical diagnosis was vague and various illnesses were frequently confused, so perhaps we should not trust these records too much. But also in light of your series on immunity over the last 3 years, it made me wonder if true life-long perfect'ish immunity is actually a thing at all for any illness.
As a fun fact, I looked at the 1982 article that wikipedia claims states "For people having had measles, it is rare to ever have a symptomatic reinfection", but as is so often the actual article doesn't make that claim itself. It only states that reinfection who have previously developed antibodies rarely appear. But this is from populations in which boosting was common. I wonder if a true dormant set of t-cells from decades ago is really enough to conquer a fresh inhale of measles.
Adult measles would imply isolation from childhood, obviously - as was the case with basically any island or arctic outpost, But the isolated-as-adult-no-reinfection is just my own instinct on the question. If not sailors, then mountain men, etc. - I think this would have been a curiosity that would have appeared in the lit. All these topics were frequently debated before modern vaccines; not only was it suspected that frequent boosting contributed to immunity (in measles and many other things), but in the case of smallpox it was thought that persistent latent infection was required. If you want a good snapshot of the zeitgeist there's Rivers (Rockefeller Inst.) 1927 https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/16559270/
But I think from a modern perspective there was too much emphasis on boosting, just given how much (unnecessary) control we've imposed on viruses with vaccines.
Actually, colonial America turns out to have been a long-term experiment in isolation and exposure, described in Caulfield 1943 https://pubmed.ncbi.nlm.nih.gov/21434087/
It was difficult to reimport measles from Europe because the virus would run out of hosts within a ship (high immunity in Europe) in the time it took to sail over (over a month).
So children born in the colonies never got measles, thus sporadic severe epidemics affecting all ages at once took place from 1657 to 1800, unlike in Europe where it was still a mild childhood disease (pre-urbanization). The virus couldn't be kept in circulation in the New World before 1795 when you finally have some yearly mild endemic measles take root in Philadelphia. If you scroll to p 552 there is a timeline for Boston showing epidemics starting from a 30 year interval and gradually becoming regular. Meanwhile, it was unusually common for newborns to be caught up in epidemics because mothers didn't have any antibodies to pass on like normally.
But are there second attacks in these all-ages epidemics or only first attacks from people who weren't infected in earlier epidemics? Caulfield doesn't directly mention any confirmation of observed immunity. However, he leans heavily on the standard presumption of lifelong immunity to account for the dynamics of the early epidemics. It is difficult to imagine he would do so if in any of the primary source accounts there was mention of second infections in adults. More parsimonious is to assume that second infections were not mentioned at any point during these colonial epidemics.
Thanks. It is indeed difficult to imagine he would do so if second infections in adults was common.
I personally always like to go back to biology. For measles perhaps there then is something like lifelong immunity as it is an illness of the body/blood, not throat or intestine. In the measles virus cannot replicate somewhere safe and create a large invasion force before the body had time to mount a better defense. As soon as measles lands on the bloodstreams beaches, the body will start to mount a defense.
But then why would vaccination not work just as well? Measles vaccine is after all a live-virus. The point I'm getting at is, why would a vaccine induce a different response then the real thing. Perhaps the vaccine induced infection is too mild to create a deep immunity, as in not the quality but quantity is the issue. A second shot should then resolve that as we seem to have indeed observed?
This as opposed for let's say things like DTaP vs DTwP. But also there is strong evidence DTwP immunity is not that different from real infection, but in terms of duration as biological response.
Either way, I feel that vaccination against measles is not a bad thing. We seem to have eradicated it 'here' if not for those 'blasted migrants'. Most of us will now live without ever getting it at all. And if eventually vaccination in poorer areas of the world increases it is not impossible measles eventually dies off completely. Also - and I'm ducking - the measles vaccine seems to be fairly safe, unlike some other vaccines (DTwP, HPV, covid).
Your plea seems to be more applicable for other vaccines that are either less safe, and/or much less effective. (Of course I would agree that being non-vaxed does not warrant any panic let alone many of the existing measures unvaccinated. I never have nor will support such measures.)
There is no crisis today but one may be looming for older Adults whose immunity was dependent on vaccination. I think they are preparing us for ADULT BOOSTERS and require them for travel.
Anyways, here are measles cases reports going back to 2008. Notice the low numbers in 2020-2022?
As someone old enough to remember when every kid got the measles in the 50s and 60s, as my siblings and I did, I really appreciate what you wrote about the measles vaccine. You almost never see statistics about how many kids actually die of measles, which provides valuable context.
Forcing a vaccine on everybody which wanes as they get older so that they contract measles as adults, which I've always heard is worse than getting it as a kid, just sounds stupid.
In Hinman et al https://academic.oup.com/jid/article/189/Supplement_1/S17/821924 you can see the classic vaccine-free plunge in deaths for measles before 1962, while cases are steady. So it's very different case from diphtheria where definitely there was a role for antitoxin, maybe there was a role for the vaccine or maybe it was just less crowding, very hard to tell. Measles, definitely not especially deadly when you get rid of neglect and overcrowding.
One unique thing may be though that measles is an infection of the immune system. So people who go through a non-mild case will lose a large amount of immune memory cells. Various studies suggested that this makes you now more susceptible for other illnesses again that your previously gained (partial) immunity.
Of course these studies may also just look at correlation: poorer kids being less vaccinated, getting hence more frequent childhood measles, and then continuing to die at higher rates afterwards because they are still poor. I haven't looked at these studies in dept enough to rule either one out, but it seems not entirely illogical that killing a large part of your immune memory may have some additional risk in addition to direct mortality.
The real-world evidence for measles immunodeficiency having any relevance is all from post-vaccine contexts, e.g. Africa etc. So this isn't obviously translatable to a "measles in a healthy non-crowded society" context. We blew our chance to study this question, like many things with other vaccine-targeted illnesses.
On paper, it shouldn't be a big deal. The things that you need immunity for the most, you have many clones and many copies of the best-at-binding-to-last-encountered-variant clones, and if measles is killing B/T Cells randomly then the majority of killed cells are these ones with highest redundancy and most capacity to re-expand upon later challenge. Maybe you wind up aging some T Cells along the way but shouldn't be a big deal. For innate immune cells, these often tend to cycle and refresh from stem cells after infections in general. Whether that's good or bad, it's normal cost of doing business.
Plus, what if you have the same situation but the cells are self-targeting or allergen-targeting, maybe it is good to clean out the file bin in this way. Less auto-immunity. Who knows, again lost chance to study this.
Be nice in both cases if someone tried to synthesize a trial using UK health records from 1965-85.
And then historically, if immunosuppression after measles is actually relevant to pre-existing immunity, you would expect some noticeable oddities like pertussis and diphtheria re-attack since usually both preceded measles in timing. But this wasn't a thing as far as I have read in the old lit.
It sounds stupid because it is. But it’s all about ‘sell sell sell’. Whatever lies and propaganda work to scaremonger more people into getting jabbed…that’s what it’s all about. Nothing else.
Very interesting video on what is going on with SARS-CoV-2 and Covid:
https://www.youtube.com/watch?v=GmJTDN61JCc
Came across these around IgG4 class switching. Seems someone has done the research:
https://jitc.bmj.com/content/8/2/e000661
https://www.youtube.com/watch?v=liUg3eqyoZE
Brian, I just love your attitude, re: removing your tattoos, as I share that same attitude. I hope you'll give us an update on your 'self experiment'. 🤞👍
Thanks for the encouragement! Now that I can do it myself it is even more a test of patience to wait between zaps...
About Paxlovid. That was a waste of money.
"The time to sustained alleviation of all signs and symptoms of Covid-19 did not differ significantly between participants who received nirmatrelvir–ritonavir and those who received placebo. (Supported by Pfizer; EPIC-SR ClinicalTrials.gov number, NCT05011513.)"
https://www.nejm.org/doi/full/10.1056/NEJMoa2309003
That was the standard risk trial - people who weren't going to have a lot of severe cases to begin with. Results were quite conclusive in the high risk trial. A whole pile of real-world studies as well...
I suspect that if they keep their D3 levels up, they will be fine:
https://www.sciencedirect.com/science/article/pii/S2772829323000243
https://onlinelibrary.wiley.com/doi/10.1002/eji.200838216
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052476/
Curiously, it seems like the Measles vaccine does not work:
https://academic.oup.com/jid/article/216/8/977/4084678?login=false
This seems like strong evidence.
The vaccine is for kids who haven't had it before. It's job isn't to boost adults and so this doesn't make sense as a context to say it does or doesn't "work." To begin with, in kids, all boosting achieves is to convert the fraction of first-dose-havers who experience primary vaccine failure (no abs). But this doesn't necessarily help the ones who reached normal titers after first dose, or inform who will experience secondary vaccine failure (get measles if exposed).
What is predictable for injecting an attenuated measles virus into people with antibodies already (either from one or two doses) - a very transient boost because some B/plasma cells say "here is measles antigen" and expand antibodies, these antibodies totally prevent the virus from replicating and clear the virus so the boost is self-limited and shouldn't still be around 150 days later. So that is what is shown here. You could still expect some "herd" effects if revaccinating during outbreaks which is what was done in a few colleges in 1980s.
But the study is interesting for the longitudinal pre-existing serosurvey. Definitely noticeable that the vaccine-era cohorts alive during the 80s resurgence still have higher antibodies, due to boosting from the live virus back in the resurgence.
The only way to have higher antibodies than what attenuated vaccine gives, and thereby to really be sure of no infection if exposed, is either to get measles breakthrough infection or some more aggressive type of vaccination e.g. mRNA antigen overload (and then possible IgG4 problem).
In a way, this is another example of "immunity is not antibodies". In a health human with prior immunity, it seems the normal response against measles would be quickly make some antibodies and activate some CD8+ T-cells, quickly clear the at that time still very small numbers of measles virus and then have the immunity system go back to dormant sleep. The obsession with having always high numbers of antibodies against any illness seems more misguided the more I read/learn.
For me a clear for instance a recent reason to stop further vaccinating my kids against aP (as in DTaP). It doesn't produce any meaningful long term immunity, doesn't stop colonization and is only there to boost antibodies so you have 2-3 year less severe illness at the expense of significant IgG4 conversion with each extra booster. In that sense covid awaked me to how poorly many vaccines truly protect. Surprisingly - to me at least - there seem to be only a handful of vaccines that truly provide long term robust cellular immunity as opposed to merely boosting antibodies.
Ultimately boosting presents extremely poor logic from an individual user perspective - encounter with the virus/bacteria/antigen, when it happens, will boost antibodies, there's a huge head start vs. the normal infection process of 'let this foreign gene do it's thing and react on the fly,' massive protection against true severe disease. If a kid still has severe disease somehow then their immune system was "NGMI" to begin with and they probably would fall to the common cold too.
It presents sound logic instead from a political and social perspective - it stops doctors from having to admit that one size fits all vaccination isn't valid, stops bad press about rare vaccine failures, etc. This is why you have more nuanced policy in UK - it reflects having a high trust society that can negotiate these nuances, whereas in the US we just have to have Vaccine Overkill shoved down our throat so no one questions the experts to begin with (and ostracize parents who do). That's why with the Covid vaccines the answer to every nuance was a perfunctory zoom call and "we decided you all should shoot up again," there's nothing else really going into the formula anymore.
The important question for me is: When a susceptible vaccinated person gets measles (whether the wild or vaccine strain), can they overcome the original miseducation of their immune system from the childhood shots, to develop true lifetime immunity after real measles infection?
I think that is the wrong way to phrase it. There is no miseducation of the immune system here. The measles vaccine is just a weaker version of the real thing. It is possible that it confers a weaker long term immunity of course, but there is no real evidence that it is like some protein-vaccines (e.g. DtaP vs DTwP vs natural) where immunity at cellular level is fundamentally different.
In fact, the angle that Brian describes here will also apply to natural immunity. People who got measles in childhood, now no longer get boosted by their children. It is hence almost certainly that their immunity also has waned to a level that makes them susceptible. Or the real conclusion is more: Is there long immunity even with natural infection, without constant boosting?
Natural immunity is probably good without boosting. Otherwise adults who went long periods not around kids, like sailors, prisoners, would come back into society and get measles, this would have been noticed.
Sailors would often only leave for months to a few years, not many years and overseas trade posts and colonies had measles too for centuries, so they potentially got exposed overseas too. So I don't know if that is a strong argument. Prisoners might be better, but do we have good records of people getting released after years and not getting infected? Surviving in a prison for years may have been a challenge in itself for much of history.
More generic, how deep is our evidence of lifelong measles immunity let's say pre-World War 2, when measles was still endemic. Were there actual large documented groups that did not get boosted?
In fact we actually have records of adults getting measles dating back centuries. Are these all unvaccinated? The problem of course that often historical diagnosis was vague and various illnesses were frequently confused, so perhaps we should not trust these records too much. But also in light of your series on immunity over the last 3 years, it made me wonder if true life-long perfect'ish immunity is actually a thing at all for any illness.
As a fun fact, I looked at the 1982 article that wikipedia claims states "For people having had measles, it is rare to ever have a symptomatic reinfection", but as is so often the actual article doesn't make that claim itself. It only states that reinfection who have previously developed antibodies rarely appear. But this is from populations in which boosting was common. I wonder if a true dormant set of t-cells from decades ago is really enough to conquer a fresh inhale of measles.
Adult measles would imply isolation from childhood, obviously - as was the case with basically any island or arctic outpost, But the isolated-as-adult-no-reinfection is just my own instinct on the question. If not sailors, then mountain men, etc. - I think this would have been a curiosity that would have appeared in the lit. All these topics were frequently debated before modern vaccines; not only was it suspected that frequent boosting contributed to immunity (in measles and many other things), but in the case of smallpox it was thought that persistent latent infection was required. If you want a good snapshot of the zeitgeist there's Rivers (Rockefeller Inst.) 1927 https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/16559270/
But I think from a modern perspective there was too much emphasis on boosting, just given how much (unnecessary) control we've imposed on viruses with vaccines.
Actually, colonial America turns out to have been a long-term experiment in isolation and exposure, described in Caulfield 1943 https://pubmed.ncbi.nlm.nih.gov/21434087/
It was difficult to reimport measles from Europe because the virus would run out of hosts within a ship (high immunity in Europe) in the time it took to sail over (over a month).
So children born in the colonies never got measles, thus sporadic severe epidemics affecting all ages at once took place from 1657 to 1800, unlike in Europe where it was still a mild childhood disease (pre-urbanization). The virus couldn't be kept in circulation in the New World before 1795 when you finally have some yearly mild endemic measles take root in Philadelphia. If you scroll to p 552 there is a timeline for Boston showing epidemics starting from a 30 year interval and gradually becoming regular. Meanwhile, it was unusually common for newborns to be caught up in epidemics because mothers didn't have any antibodies to pass on like normally.
But are there second attacks in these all-ages epidemics or only first attacks from people who weren't infected in earlier epidemics? Caulfield doesn't directly mention any confirmation of observed immunity. However, he leans heavily on the standard presumption of lifelong immunity to account for the dynamics of the early epidemics. It is difficult to imagine he would do so if in any of the primary source accounts there was mention of second infections in adults. More parsimonious is to assume that second infections were not mentioned at any point during these colonial epidemics.
Thanks. It is indeed difficult to imagine he would do so if second infections in adults was common.
I personally always like to go back to biology. For measles perhaps there then is something like lifelong immunity as it is an illness of the body/blood, not throat or intestine. In the measles virus cannot replicate somewhere safe and create a large invasion force before the body had time to mount a better defense. As soon as measles lands on the bloodstreams beaches, the body will start to mount a defense.
But then why would vaccination not work just as well? Measles vaccine is after all a live-virus. The point I'm getting at is, why would a vaccine induce a different response then the real thing. Perhaps the vaccine induced infection is too mild to create a deep immunity, as in not the quality but quantity is the issue. A second shot should then resolve that as we seem to have indeed observed?
This as opposed for let's say things like DTaP vs DTwP. But also there is strong evidence DTwP immunity is not that different from real infection, but in terms of duration as biological response.
Either way, I feel that vaccination against measles is not a bad thing. We seem to have eradicated it 'here' if not for those 'blasted migrants'. Most of us will now live without ever getting it at all. And if eventually vaccination in poorer areas of the world increases it is not impossible measles eventually dies off completely. Also - and I'm ducking - the measles vaccine seems to be fairly safe, unlike some other vaccines (DTwP, HPV, covid).
Your plea seems to be more applicable for other vaccines that are either less safe, and/or much less effective. (Of course I would agree that being non-vaxed does not warrant any panic let alone many of the existing measures unvaccinated. I never have nor will support such measures.)
There were thousands of breakthrough cases in the 1980s resurgence, no mention of reinfections afterward as far as I know.
There is no crisis today but one may be looming for older Adults whose immunity was dependent on vaccination. I think they are preparing us for ADULT BOOSTERS and require them for travel.
Anyways, here are measles cases reports going back to 2008. Notice the low numbers in 2020-2022?
Measles
2008-140
2009-71
2010-63
2011-220
2012-55
2013-187
2014-667
2015-188
2016-86
2017-120
2018-375
2019-1274
2020-13
2021-49
2022-13
2023-58
2024-97 ytd
A ‘crisis may be looming for older adults…’ No. That’s a load of crap.
As someone old enough to remember when every kid got the measles in the 50s and 60s, as my siblings and I did, I really appreciate what you wrote about the measles vaccine. You almost never see statistics about how many kids actually die of measles, which provides valuable context.
Forcing a vaccine on everybody which wanes as they get older so that they contract measles as adults, which I've always heard is worse than getting it as a kid, just sounds stupid.
In Hinman et al https://academic.oup.com/jid/article/189/Supplement_1/S17/821924 you can see the classic vaccine-free plunge in deaths for measles before 1962, while cases are steady. So it's very different case from diphtheria where definitely there was a role for antitoxin, maybe there was a role for the vaccine or maybe it was just less crowding, very hard to tell. Measles, definitely not especially deadly when you get rid of neglect and overcrowding.
One unique thing may be though that measles is an infection of the immune system. So people who go through a non-mild case will lose a large amount of immune memory cells. Various studies suggested that this makes you now more susceptible for other illnesses again that your previously gained (partial) immunity.
Of course these studies may also just look at correlation: poorer kids being less vaccinated, getting hence more frequent childhood measles, and then continuing to die at higher rates afterwards because they are still poor. I haven't looked at these studies in dept enough to rule either one out, but it seems not entirely illogical that killing a large part of your immune memory may have some additional risk in addition to direct mortality.
The real-world evidence for measles immunodeficiency having any relevance is all from post-vaccine contexts, e.g. Africa etc. So this isn't obviously translatable to a "measles in a healthy non-crowded society" context. We blew our chance to study this question, like many things with other vaccine-targeted illnesses.
On paper, it shouldn't be a big deal. The things that you need immunity for the most, you have many clones and many copies of the best-at-binding-to-last-encountered-variant clones, and if measles is killing B/T Cells randomly then the majority of killed cells are these ones with highest redundancy and most capacity to re-expand upon later challenge. Maybe you wind up aging some T Cells along the way but shouldn't be a big deal. For innate immune cells, these often tend to cycle and refresh from stem cells after infections in general. Whether that's good or bad, it's normal cost of doing business.
Plus, what if you have the same situation but the cells are self-targeting or allergen-targeting, maybe it is good to clean out the file bin in this way. Less auto-immunity. Who knows, again lost chance to study this.
Be nice in both cases if someone tried to synthesize a trial using UK health records from 1965-85.
And then historically, if immunosuppression after measles is actually relevant to pre-existing immunity, you would expect some noticeable oddities like pertussis and diphtheria re-attack since usually both preceded measles in timing. But this wasn't a thing as far as I have read in the old lit.
It sounds stupid because it is. But it’s all about ‘sell sell sell’. Whatever lies and propaganda work to scaremonger more people into getting jabbed…that’s what it’s all about. Nothing else.