Bad arguments about the dangers of vaccines and the efficacy of snake-oil cures will kill many thousands and prolong the pandemic. Should YouTube censor them?
It has to be accepted, I think, that the real problem here is the collapse of confidence in many institutions, government prominent among them. It’s not a new phenomenon—radical distrust in this vein goes back to the Sixties. Polling indicates that around three-quarters of the American people repose little or no faith in either the honesty or competence of the federal government. Since most guidance and direction on the pandemic comes from government, it should surprise no one that skepticism and suspicion run rampant. And our truly despicable media only makes things worse: on the one hand retailing paranoid conspiracy theories about vaccines, on the other hand providing aid and comfort to the Chinese regime’s coverup of COVID-19’s origins.
Nor can it be said that our political overlords and elite experts have risen to the occasion. Their mendacity and hypocrisy only confirmed people’s low opinion of them.
I certainly agree that social media’s role has made a bad situation worse—but the misinformation and lies thus spread fall on fertile ground. It’s a fascinating study in doublethink, really: people clamoring for the very institutions that they most distrust to “do something.”
“ By the way, as far as ivermectin as a treatment for Covid; the idea is asinine. There is no plausible mechanism of action to suggest that it is efficacious.”
Thanks, Scott for the reference. The publications you linked to aren’t the gold standard, but they’re not even the silver or bronze standard. That doesn’t mean the analysis is wrong; just that it wasn’t published in a journal that most biomedical investigators have a lot of respect for. Also meta analyses can be very informative but they aren’t a substitute for an adequately powered randomized and blinded clinical trial.
I haven’t heard a single credible explanation of the mechanism of action through which ivermectin might improve the outcome in Covid. Does that mean it can’t possibly help? It doesn’t. But it raises the bar on the level of proof that’s needed.
At least with hydroxychloroquine (commonly referred to as Plaquenil) a plausible mechanism of action is present. The drug has immunosuppressant and anti-inflammatory properties. It is these properties which makes plaquenil a terrific go to option for many rheumatological disorders. Theoretically these properties can tone down a hyper responsive immune response to Covid infection that may lead to severe cases.
I really don’t believe that hydroxychloroquine is efficacious for Covid but at least there is a reasonable hypothesis for why it might help.
Re gold standard, double blind randomized clinical trials….a few days ago on Rogan’s podcast (forgive me, Claire, but I do find some — but certainly not all — of his stuff interesting) someone made the point that the gold standard evidence in a murder trial would be a Hi Def full face video of the perp shooting the victim, but 99% of murder convictions are won with “lower quality evidence” — a few even on circumstantial evidence. How many people would die during the months/years it would take to prove efficacy? Vs. how many people die from taking a med that has been safely dosed billions of times around the world? Our current state of knowledge seems to be “can’t hurt, might help”.
The Oxford trial will be underway shortly. We shall see.
PS. I had dinner tonight with a woman who because of immune system issues has been advised by her doctors not to take the vaccines. He has her on a prophylactic regime which includes invermectin as it seems the next best preventative out-patient treatment he believes might help. For all the poor people in the world let’s hope invermectin works. On véra.
It would be fantastic if ivermectin worked. The drug is remarkably safe. It’s given to children all the time to treat scabies that they pick up in school. Safe and cheap; if its efficacious for Covid nothing could be better.
One of the most dastardly lies told by the mainstream press at the beginning of the Covid crisis was the overwrought fear mongering about the dangers of hydroxychloroquine. When President Trump touted the drug (incorrectly) as potentially efficacious, the New York Times and Washington Post immediately exaggerated hydroxychloroquine’s side effects with one goal in mind; to make Trump look bad.
The argument they made is that hydroxychloroquine was potentially dangerous because it caused heart rhythm abnormalities. Like all drugs, hydroxychloroquine does have side-effects including in incredibly rare cases, arrhythmias.
But the safety profile of this medicine is so outstanding that prior to prescribing it, physicians virtually never require a patient to take an EKG.
Hydroxychloroquine is used routinely to treat malaria, rheumatological disorders and sometimes Lyme Disease. Ask tropical disease doctors or rheumatologists who have prescribed hydroxychloroquine thousands of times how many arythmias they’ve seen in their patients and the answer you will get from most of these doctors is that they’ve never seen this complication of the drug even once.
The press also lied about potential ocular complications of the drug. The implication was clear, hydroxychloroquine could make you blind.
Here’s the reality; after taking hydroxychloroquine for ten years there’s a one percent chance of eye issues. These issues are almost always detected early and if the drug is withdrawn, the ocular issues resolve. The chance of developing eye issues from taking the drug for the short period of time needed to treat Covid is zero. The reporters knew this; they didn’t care.
Patients who take hydroxychloroquine were hit with a double whammy. Because Trump recommended it, the drug was hoarded and thus patients who took it for years were unable to find it. Even worse, the press scared rheumatology patients to death. They thought they were taking a very safe drug (they were) that the Times and Post was now telling them could give them a heart attack or make them blind. After reading all of this, some patients stopped taking a perfectly safe and effective medicine and risked a worsening of their underlying disease.
The news media couldn’t have cared less. They cared about only one thing sticking it to Donald Trump. The media’s behavior was every bit as venal as the behavior of the social media platforms that are the subject of Claire’s ire.
Claire thinks social media’s insidious influence is slowly but surely destroying our democracy.
She’s probably right, but so is the insidious influence of the mainstream media.
Trump famously called the American press, the “enemy of the people.” Claire is claiming that the social media oligarchs are the enemy of the people.
Could it be that Donald Trump and Claire Berlinski are both on to something?
If on verra--and I am absolutely agnostic on this one; I'm waiting for the results of an RCT of sufficient rigor to settle the question--it won't be because of anything published in Trial Site News, which seems to be a vanity publication, from what I can tell.
Well written. It supports my instinctive decision long ago to not participate in social media. I've never been on Facebook, I followed a couple people on twitter to see what it was, and rejected it because a conversation of sentence fragments cannot communicate ideas in any meaningful way.
I agree that writing long form is the best way to organize, refine and communicate an argument. (See the length of my past comments. I was trying to keep them succinct.)
When I express a short response to an idea, the feedback I get almost always tells me the recipient has ascribed a meaning to my words I did not intend. This has taught me that if I'm not going to express an idea completely, there is no point to expressing it partially only to be misunderstood. Either go all the way or not at all. (I do forget and have to relearn this every so often)
Keep up the good work. In the past when new technology has changed the world, humanity had more time to react and adapt. Social media my be changing things faster than our ability to absorb and adjust.
Ken, don't blame yourself for brevity when somebody misses the point. You're not at fault when your interlocutor dodges difficult ideas. Cognitive dissonance isn't easy to handle, and we're all only human.
Surely social media has a role to play in the clusterfu$k that is the antivaxer movement, but it goes deeper than that.
All of the once trusted institutions that were ascendant in the western world have experienced a total collapse in credibility. It’s true of international institutions, it’s true of government, journalism and religious organizations. Why wouldn’t it also be true of science and public health authorities?
The bill of particulars against the expert class is damning indeed. William Galston writing in the “American Purpose” gets it exactly right when he enumerates the failures of this group of self appointed gurus,
“They believe claims to expertise are mostly bogus. Why did elites in both parties allow China to join the World Trade Organization on such favorable terms? Why did they plunge us into endless wars in the Middle East? Why did they cause the Great Recession and botch the recovery? Why have their medical experts changed their minds so often during the pandemic? President Trump was at his best, they say, when he ignored the experts and went his own way.”
Given not only the litany of failures that they refuse to accept accountability for, but also the callous disregard they have for everyone except for their over-educated brethren, can we really expect people to simply trust the experts yet again?
While it is self-evidently true that vaccines offer the only escape hatch from the calamity currently facing us; the horse is out of the barn. The experts have simply been wrong too often to expect anyone to believe them.
The list of errors made by governmental experts during the Covid crisis is mounting. First we were told not to mask up and then not only were masks required but people were thrown in jail for not wearing them. We now know that surgical masks are completely useless in preventing the spread of SARS-CoV-2. Then government experts encouraged us to wash our mail and groceries; now we know that the virus is only spread through an airborne route. How many experts arrogantly suggested that mass gatherings to excoriate the police were acceptable while celebrating Mass in a Roman Catholic Church was not? Weren’t we told that the adenovirus vector vaccines were the best thing since sliced bread until the government imposed a ridiculous moratorium that was lifted when it turned out that the chance of blood clots caused by the vaccine approximated the chance of being struck by lightening? Who remembers being told by the NIH leadership that only conspiracy theorists suggested the possibility that the virus leaked from a lab? Now we know it isn’t merely possible but very possible.
Given the remarkably poor track record of the expert class in general but also medical experts in particular, should we be surprised when people are skeptical about what the experts say about vaccines?
The venality of our expert overlords is hard to overstate and the chickens are now coming home to roost.
By the way, as far as ivermectin as a treatment for Covid; the idea is asinine. There is no plausible mechanism of action to suggest that it is efficacious.
I don't have time to reply to this at length today, but given the context, feel it would be appropriate to offer this disclaimer: Despite (implicitly) railing at length in this post about the value of editorial barricades--which prevent unjustified, untrue beliefs from gaining widespread acceptance--I neither edit the comments here nor do I have time to reply to every bad idea and offer a detailed counterargument that serves to drive my competitor out of the marketplace of ideas. I offer the following as assertions, not arguments; I hope someone else will take up the matter of arguing the points:
1. Surgical masks are not useless in preventing the spread of SARS-CoV-2
2. Given the state of our knowledge at the time, the government was correct to caution us of the risk the disease might be spread via fomites;
3. 1200 experts, by my count, suggested that mass gatherings to excoriate the police were acceptable while celebrating Mass in a Roman Catholic Church was not. This amounts to 0.01 percent of the total number of healthcare experts in America.
Nor are such claims epistemically equal: You are comparing errors of judgment with errors of fact with errors of interpretation The argument for the efficacy of the vaccines is independently confirmable to anyone who wishes independently to confirm it, unless said person has entered a state of radical skepticism such that he genuinely believes newspapers around the world are involved in a conspiracy that elaborateness of which is so inherently implausible that it is far easier to assume it isn't true. You would have to believe every media organ in the world is conspiring to manufacture the fabric of reality, really--you'd have to believe we live in a world where Israelis are secretly dying and hospitals in the US are *not* reporting that they see almost no vaccinated Covid19 patients. You'd even have to deny that the vaccinated people you know are strangely well, compared to those who aren't.
In the case of the lab leak hypothesis, the *reason* people lied, or distorted the picture, is relevant. So are the specific people involved. It is not Peter Daszak who has patiently sifted through the trial data and deemed the vaccines unsafe. That *an* expert has proved something less that authoritative does not mean *every* expert is not authoritative--even if, as I argue, you've failed in your responsibilities if you allow experts who tarnish your brand to babble on without contest.
“ 1200 experts, by my count, suggested that mass gatherings to excoriate the police were acceptable while celebrating Mass in a Roman Catholic Church was not. This amounts to 0.01 percent of the total number of healthcare experts in America.” (Claire Berlinski)
Do you really think that every health care worker is a health care expert? If you do, keep in mind that depending on which survey you believe somewhere between 15-30 percent of health care workers are refusing to be vaccinated. Should any of us take this as an indication that a substantial minority of health care “experts” consider the vaccines to be unsafe?
Of course not.
There are experts and then there are experts. Tony Fauci is one type of expert while a phlebotomist in a local hospital in Sheboygan is another type of expert. Obviously any one with a brain would take Fauci’s views far more seriously.
But here’s the problem; the government experts at CDC and NIH that the media usually genuflects to did a very poor job especially compared to experts working in Pharma.
If industry experts could develop vaccines for Covid from scratch in a manner of a few months and then operationalize clinical trials in a matter of weeks, you would think NIH could fund trials to determine the efficacy of different types of masks just as quickly.
If you thought that, you would be wrong. To this day, there are very few trials with published results providing convincing proof of the efficacy of the various types of masks.
As far as spread by fomites, this is an issue that could have been clarified by a well thought out and expeditious research program. It certainly is not as difficult a scientific question as the development of vaccines in record time. Yet the failure of NIH resulted in the sad spectacle of millions of Americans washing their mail. If only the government experts had been as competent as the pharmaceutical experts.
This is not to say that NIH got everything wrong; they certainly didn’t. The intramural division of NIAID played a critical role in the development of the vaccines, especially when it came to accruing primate data.
While there were important successes, there were important and preventable failures.
In a sane society, a free press would take up the mantle of chronicling and investigating both the successes and the failures.
Why hasn’t this happened? I think that a sense of class solidarity binds journalists to government scientists. Journalists see themselves as experts in their area and they are loathe to criticize experts in another area like science because their overriding loyalty is to protecting the hegemony of the expert class over the democracy once enjoyed by ordinary Americans.
Our society is increasingly bifurcated between the highly educated and everyone else.
The expert class or, if you prefer, the new American clerisy can’t stop telling everyone what to believe when it comes to race, sex, sexual preference, sexual identity, religion,culture, politics and now, even entertainment and sports. Is it any wonder that recommendations emanating from scientific experts are often dismissed as poppycock? Are ordinary Americans apt to listen to advice from a class of people who hold them in contempt?
Of course everyone should be vaccinated as soon as possible. Of course it’s an obligation we owe to our fellow citizens, our families and our selves.
While social media is certainly a villain, the real villain in vaccine hesitancy is the cult of expertise that has cried wolf once too often.
Just out of curiosity--and this isn't a gotcha question, just one I've actually been sitting here trying to figure out for myself--how would you design an ethical, randomized trial, with an adequate sample size, controlling for confounders, of mask efficacy? Is there any way it could be both observer-blinded and placebo controlled? Would that be ethical during a pandemic? Obviously, if you ask for volunteers, you have confounders and selection bias galore. Natural experiments (similar counties with similar populations but different mask requirements) do suggest efficacy, but it seems to me almost impossible to sort out the confounding variables during an infectious disease epidemic because the incidence of disease doesn't stay stable, and the initial conditions will to such a large degree determine the course of the outbreak. When you add the phenomenon of overdispersal to the calculation, it seems to me it would be all but impossible truly separate the signal from the noise. If you could design this experiment, how would you do it? It won't be perfect, but you want to do it so that you see the effect size and reduce as much as possible confirmation bias, population fallacy; controlling for regression to the mean, and somehow sorting out the noise of "how people behave when there's a mask requirement" from "actual effect of masking."
I can't think of a better way to do it than what we've done--and the way we've done it does favor masks--but I agree it's damned hard to study properly, unless I'm missing an idea.
I’ve thought about this and talked to investigators with an interest in infectious disease. There is published work on whether masks protect against infection with influenza. The results are all over the place. Some studies find masks in this context to be somewhat protective; other studies disagree.
None of the studies were done with cloth masks because cloth masks weren’t much of a thing before Covid. A major confounder is whether the masks are worn properly; often they’re not, even in a hospital setting.
Another approach would be too conduct animal experiments. Primates are hard to work with and they won’t willingly wear masks, but given sufficient motivation, these experiments could be done in primates. If you’ve ever visited a primate colony you know that these animals gesticulate vigorously. That’s advantageous to the experiment. Their tendency to gesticulate exceeds that of the average choir in a church.
Would data from primate experiments be dispositive? Nope.
Would it be very valuable? Yes.
Experiments on other animals like ferrets could also provide imperfect but valuable data.
Finally, bioengineers could develop mechanical means of testing the efficacy of masks in a laboratory setting. Again, the data would be imperfect but better than nothing.
If their had been a concerted effort to obtain this type of data, at least there would have been a more compelling argument than “trust us-we’re from the government.”
As far as contagion via fomites, that would certainly have been easier to test than, for example, developing and testing mRNA vaccines in a matter of a few months.
Do a literature search; see how many well designed studies of this funded by NIH that you find.
I don't know how valuable primate data would be. Our facial topography is so different from any primate's--the shape of our nasal cavity and nasopharynx is completely different. Our immune systems aren't the same: humans are more prone to certain infectious diseases than other primates; we don't exactly understand why. And the idea of getting chimps to replicate ordinary human social interactions with any precision--over a period of weeks, at that--is so absurd it could be the screenplay for a comedy. Bioengineers *have* been modelling this; they've been modelling their brains out. https://www.tandfonline.com/doi/full/10.1080/03091902.2020.1797198,Mamata Karmacharya, Sumit Kumar, Oleksandra Gulenko, Yoon-Kyoung Cho. Advances in Facemasks during the COVID-19 Pandemic Era. ACS Applied Bio Materials 2021, 4 (5) , 3891-3908. https://doi.org/10.1021/acsabm.0c01329
Hongchen Shen, Zhe Zhou, Haihuan Wang, Mengyang Zhang, Minghao Han, David P. Durkin, Danmeng Shuai, Yun Shen. Development of Electrospun Nanofibrous Filters for Controlling Coronavirus Aerosols. Environmental Science & Technology Letters 2021, Article ASAP.
Marius Rutkevičius, Tahira Pirzada, Mackenzie Geiger, Saad A. Khan. Creating superhydrophobic, abrasion-resistant and breathable coatings from water-borne polydimethylsiloxane-polyurethane Co-polymer and fumed silica. Journal of Colloid and Interface Science 2021, 596 , 479-492. https://doi.org/10.1016/j.jcis.2021.02.072
Susan R. Reutman, Tiina Reponen, Michel Yermakov, Sergey A. Grinshpun. Homemade facemasks: particle filtration, breathability, fit, and other performance characteristics. Journal of Occupational and Environmental Hygiene 2021, 18 (7) , 334-344. https://doi.org/10.1080/15459624.2021.1925124
David A. Rothamer, Scott Sanders, Douglas Reindl, Timothy H. Bertram. Strategies to minimize SARS-CoV-2 transmission in classroom settings: Combined impacts of ventilation and mask effective filtration efficiency. Science and Technology for the Built Environment 2021, , 1-50. https://doi.org/10.1080/23744731.2021.1944665
Weidong He, Yinghe Guo, Jingxian Liu, Yang Yue, Jing Wang. Filtration Performance Degradation of In‐Use Masks by Vapors from Alcohol‐Based Hand Sanitizers and the Mitigation Solutions. Global Challenges 2021, 81 , 2100015. https://doi.org/10.1002/gch2.202100015
Leigh R. Crilley, Andrea A. Angelucci, Brian Malile, Cora J. Young, Trevor C. VandenBoer, Jennifer I. L. Chen. Non-woven materials for cloth-based face masks inserts: relationship between material properties and sub-micron aerosol filtration. Environmental Science: Nano 2021, 8 (6) , 1603-1613. https://doi.org/10.1039/D1EN00277E
Ebuka A. Ogbuoji, Amr M. Zaky, Isabel C. Escobar. Advanced Research and Development of Face Masks and Respirators Pre and Post the Coronavirus Disease 2019 (COVID-19) Pandemic: A Critical Review. Polymers 2021, 13 (12) , 1998. https://doi.org/10.3390/polym13121998
Kyeongeun Lee, Jungtaek Oh, Dongwhan Kim, Jinbok Yoo, Gun Jin Yun, Jooyoun Kim. Effects of the filter microstructure and ambient air condition on the aerodynamic dispersion of sneezing droplets: A multiscale and multiphysics simulation study. Physics of Fluids 2021, 33 (6) , 063317. https://doi.org/10.1063/5.0053449
Christian M. Sterr, Inga-Lena Nickel, Christina Stranzinger, Claudia I. Nonnenmacher-Winter, Frank Günther, . Medical face masks offer self-protection against aerosols: An evaluation using a practical in vitro approach on a dummy head. PLOS ONE 2021, 16 (3) , e0248099. https://doi.org/10.1371/journal.pone.0248099 ...
None of this is conclusive, because this is hard to figure out, but all of it suggests to me that yes, masks are an additional layer of protection in what needs to be a Swiss-Cheese defense.
It’s true that primate social interaction doesn’t mimic human interaction but I’m not sure how critical that is. Indian-origin rhesus macaques, the animals used in most Covid studies gesticulate vigorously when in social settings. While imperfect, for the type of experiments we’re talking about, it’s pretty good.
To be fair, though, they won’t wear masks willingly so they may need to be bound or even anesthetized which could seriously confound the results.
While the respiratory tracks of these animals differs from humans, they do have transient viral replication in the upper and lower respiratory track and the do get modest inflammation in the lung.
Its far from a perfect model but I don’t think it’s useless either.
In terms of immunology, most investigators would say they are a very reasonable model for human disease. The more typically used mouse models (whether humanized or not) are not as similar as the maques in terms of the innate or adaptive immune systems especially in terms of
B-cell and T-cell repertoires.
It’s for this reason that the mRNA vaccines were tested in the primates before clinical trials commenced. In fact, the primate immune system is similar enough to the human immune system that all vaccines are tested in primates first.
When human trials are unethical or impractical which is frequently the case, we routinely rely on animal experiments for lack of an alternative way to accrue data.
We can’t let the perfect be the enemy of the good.
I encourage paying attention. But if one investigates like Sherlock Holmes for anyone with a master's degree, and turns in to Mr Magoo the instant political allies need to me questioned, I really have to call out motivations.
Apologies, Claire, those posts were directed at WigWag, who seems to have had enough of my shenanigans. The man will parade the errors of 100 well-educated subject matter experts, but not be interested in the fact that subject matter experts are the best chance we have of knowing technical details in most fields. (No, this is not a claim that they are above question or some sort of clergy, so put the strawman away) Then he will somehow miss the errors of his preferred class of (honestly I'm not even sure) people who lack technical education and are making good choices by accident and intuition?
I admire your tenacity in trying to fight this with counter examples, but I believe this is the sort of conversation that is impervious to facts. As long as there are 100 examples of failure, 1000 examples of success are irrelevant.
A relevant example of this is something I read recently regarding trying to deprogram antivaxers. You could list off dozens of reasons why their claims about vaccines are incorrect, and they'll actually become further entrenched in their beliefs. Show them pictures of children suffering with the measles, strike them in the fear that motivates your reasoning, and you'll have a higher success rate. Reading that broke my heart, as it took a slice out of my trust in human reason. This is about the heart, not the head. Perhaps you enjoy the intellectual exercise of data sparring, but I think I've heard enough about this phenomenon to become jaded.
Unless we can think of a way to appeal to someone's resentment?
I hope y’all address the “it isn’t that bad, they cooked the numbers” crud as well. I’m seeing way too many otherwise well educated folks falling for a lot of this malarkey.
I think we've seen one of the great weaknesses of liberal society ahead in the road, and the Internet has caused us to slam on the gas. We're not trying to fight bad reasons people have for believing things. We're fighting human desire to belong, since the reasons we're appealing to are all post hoc.
There is a giant social benefit to shouting the accepted tenets of the antivax movement, and that is the accolades and support of your group. And there is a terrible cost to changing your mind, as you'll be exiled and mocked for following the evidence. There's a reason "No evidence can change my mind" will be met with cheers, thanks Jenny for that haunting example.
I used to be somewhat aligned with what I now call the Cult of Freedom, youthful days of borderline anarchism. Eventually I dialed that back to, "as much freedom as we can stand." Reading Popper helped me refine that further. But now, knowing that AI, tailored diseases, and illiberal Americans are cresting over the horizon, I'm scared that the American project is self defeating. Reactive safety in future tech is very likely too little, too late.
Claire, whomever you nominate to debunk ivermectin should be willing to debate Bret Weinstein in a three hour session moderated by Joe Rogan. Now, that would be interesting and most likely very informative.
I have volunteered myself, and I sent him a 60-page essay explaining my thoughts, which thus far he's dismissed as "bad faith." But I hope perhaps he'll come around.
I would not, even if invited, debate this on Joe Rogin. Anything else, gladly. But debating the effect of the demise of written culture on a *talk* show is like debating the evils of prostitution in a brothel. The arguments I make--about ivermectin and vaccines--require the apparatus of the written word. I could, I'm sure, make them out loud, but when people see them on a page, and spend real time in the literature, they will feel secure in them. An oral debate serves only to encourage people to weigh my charisma and authority against Weinstein's. I'd win: A pretty woman who has facts on her side and can deploy a few charming and witty rejoinders--and who is defending a mainstream view--will always have the audience's sympathy. But it wouldn't do what I want this series to do, which is guide people through this problem and show them how to reach these conclusions for themselves.
It has to be accepted, I think, that the real problem here is the collapse of confidence in many institutions, government prominent among them. It’s not a new phenomenon—radical distrust in this vein goes back to the Sixties. Polling indicates that around three-quarters of the American people repose little or no faith in either the honesty or competence of the federal government. Since most guidance and direction on the pandemic comes from government, it should surprise no one that skepticism and suspicion run rampant. And our truly despicable media only makes things worse: on the one hand retailing paranoid conspiracy theories about vaccines, on the other hand providing aid and comfort to the Chinese regime’s coverup of COVID-19’s origins.
Nor can it be said that our political overlords and elite experts have risen to the occasion. Their mendacity and hypocrisy only confirmed people’s low opinion of them.
I certainly agree that social media’s role has made a bad situation worse—but the misinformation and lies thus spread fall on fertile ground. It’s a fascinating study in doublethink, really: people clamoring for the very institutions that they most distrust to “do something.”
WigWag:
“ By the way, as far as ivermectin as a treatment for Covid; the idea is asinine. There is no plausible mechanism of action to suggest that it is efficacious.”
On véra:
https://www.clinicaltrialsarena.com/news/ivermectin-principle-trial-covid/
https://trialsitenews.com/uk-based-meta-analysis-peer-reviewed-published-suggests-ivermectin-a-key-public-health-weapon-in-the-war-against-covid-19/
Thanks, Scott for the reference. The publications you linked to aren’t the gold standard, but they’re not even the silver or bronze standard. That doesn’t mean the analysis is wrong; just that it wasn’t published in a journal that most biomedical investigators have a lot of respect for. Also meta analyses can be very informative but they aren’t a substitute for an adequately powered randomized and blinded clinical trial.
I haven’t heard a single credible explanation of the mechanism of action through which ivermectin might improve the outcome in Covid. Does that mean it can’t possibly help? It doesn’t. But it raises the bar on the level of proof that’s needed.
At least with hydroxychloroquine (commonly referred to as Plaquenil) a plausible mechanism of action is present. The drug has immunosuppressant and anti-inflammatory properties. It is these properties which makes plaquenil a terrific go to option for many rheumatological disorders. Theoretically these properties can tone down a hyper responsive immune response to Covid infection that may lead to severe cases.
I really don’t believe that hydroxychloroquine is efficacious for Covid but at least there is a reasonable hypothesis for why it might help.
Got it. As I said, we’ll see.
Re gold standard, double blind randomized clinical trials….a few days ago on Rogan’s podcast (forgive me, Claire, but I do find some — but certainly not all — of his stuff interesting) someone made the point that the gold standard evidence in a murder trial would be a Hi Def full face video of the perp shooting the victim, but 99% of murder convictions are won with “lower quality evidence” — a few even on circumstantial evidence. How many people would die during the months/years it would take to prove efficacy? Vs. how many people die from taking a med that has been safely dosed billions of times around the world? Our current state of knowledge seems to be “can’t hurt, might help”.
The Oxford trial will be underway shortly. We shall see.
PS. I had dinner tonight with a woman who because of immune system issues has been advised by her doctors not to take the vaccines. He has her on a prophylactic regime which includes invermectin as it seems the next best preventative out-patient treatment he believes might help. For all the poor people in the world let’s hope invermectin works. On véra.
It would be fantastic if ivermectin worked. The drug is remarkably safe. It’s given to children all the time to treat scabies that they pick up in school. Safe and cheap; if its efficacious for Covid nothing could be better.
One of the most dastardly lies told by the mainstream press at the beginning of the Covid crisis was the overwrought fear mongering about the dangers of hydroxychloroquine. When President Trump touted the drug (incorrectly) as potentially efficacious, the New York Times and Washington Post immediately exaggerated hydroxychloroquine’s side effects with one goal in mind; to make Trump look bad.
The argument they made is that hydroxychloroquine was potentially dangerous because it caused heart rhythm abnormalities. Like all drugs, hydroxychloroquine does have side-effects including in incredibly rare cases, arrhythmias.
But the safety profile of this medicine is so outstanding that prior to prescribing it, physicians virtually never require a patient to take an EKG.
Hydroxychloroquine is used routinely to treat malaria, rheumatological disorders and sometimes Lyme Disease. Ask tropical disease doctors or rheumatologists who have prescribed hydroxychloroquine thousands of times how many arythmias they’ve seen in their patients and the answer you will get from most of these doctors is that they’ve never seen this complication of the drug even once.
The press also lied about potential ocular complications of the drug. The implication was clear, hydroxychloroquine could make you blind.
Here’s the reality; after taking hydroxychloroquine for ten years there’s a one percent chance of eye issues. These issues are almost always detected early and if the drug is withdrawn, the ocular issues resolve. The chance of developing eye issues from taking the drug for the short period of time needed to treat Covid is zero. The reporters knew this; they didn’t care.
Patients who take hydroxychloroquine were hit with a double whammy. Because Trump recommended it, the drug was hoarded and thus patients who took it for years were unable to find it. Even worse, the press scared rheumatology patients to death. They thought they were taking a very safe drug (they were) that the Times and Post was now telling them could give them a heart attack or make them blind. After reading all of this, some patients stopped taking a perfectly safe and effective medicine and risked a worsening of their underlying disease.
The news media couldn’t have cared less. They cared about only one thing sticking it to Donald Trump. The media’s behavior was every bit as venal as the behavior of the social media platforms that are the subject of Claire’s ire.
Claire thinks social media’s insidious influence is slowly but surely destroying our democracy.
She’s probably right, but so is the insidious influence of the mainstream media.
Trump famously called the American press, the “enemy of the people.” Claire is claiming that the social media oligarchs are the enemy of the people.
Could it be that Donald Trump and Claire Berlinski are both on to something?
I’m not sure Claire could manage that :-)
If on verra--and I am absolutely agnostic on this one; I'm waiting for the results of an RCT of sufficient rigor to settle the question--it won't be because of anything published in Trial Site News, which seems to be a vanity publication, from what I can tell.
Claire,
Well written. It supports my instinctive decision long ago to not participate in social media. I've never been on Facebook, I followed a couple people on twitter to see what it was, and rejected it because a conversation of sentence fragments cannot communicate ideas in any meaningful way.
I agree that writing long form is the best way to organize, refine and communicate an argument. (See the length of my past comments. I was trying to keep them succinct.)
When I express a short response to an idea, the feedback I get almost always tells me the recipient has ascribed a meaning to my words I did not intend. This has taught me that if I'm not going to express an idea completely, there is no point to expressing it partially only to be misunderstood. Either go all the way or not at all. (I do forget and have to relearn this every so often)
Keep up the good work. In the past when new technology has changed the world, humanity had more time to react and adapt. Social media my be changing things faster than our ability to absorb and adjust.
Ken, don't blame yourself for brevity when somebody misses the point. You're not at fault when your interlocutor dodges difficult ideas. Cognitive dissonance isn't easy to handle, and we're all only human.
Surely social media has a role to play in the clusterfu$k that is the antivaxer movement, but it goes deeper than that.
All of the once trusted institutions that were ascendant in the western world have experienced a total collapse in credibility. It’s true of international institutions, it’s true of government, journalism and religious organizations. Why wouldn’t it also be true of science and public health authorities?
The bill of particulars against the expert class is damning indeed. William Galston writing in the “American Purpose” gets it exactly right when he enumerates the failures of this group of self appointed gurus,
“They believe claims to expertise are mostly bogus. Why did elites in both parties allow China to join the World Trade Organization on such favorable terms? Why did they plunge us into endless wars in the Middle East? Why did they cause the Great Recession and botch the recovery? Why have their medical experts changed their minds so often during the pandemic? President Trump was at his best, they say, when he ignored the experts and went his own way.”
See,
https://www.americanpurpose.com/articles/the-bitter-heartland/
Given not only the litany of failures that they refuse to accept accountability for, but also the callous disregard they have for everyone except for their over-educated brethren, can we really expect people to simply trust the experts yet again?
While it is self-evidently true that vaccines offer the only escape hatch from the calamity currently facing us; the horse is out of the barn. The experts have simply been wrong too often to expect anyone to believe them.
The list of errors made by governmental experts during the Covid crisis is mounting. First we were told not to mask up and then not only were masks required but people were thrown in jail for not wearing them. We now know that surgical masks are completely useless in preventing the spread of SARS-CoV-2. Then government experts encouraged us to wash our mail and groceries; now we know that the virus is only spread through an airborne route. How many experts arrogantly suggested that mass gatherings to excoriate the police were acceptable while celebrating Mass in a Roman Catholic Church was not? Weren’t we told that the adenovirus vector vaccines were the best thing since sliced bread until the government imposed a ridiculous moratorium that was lifted when it turned out that the chance of blood clots caused by the vaccine approximated the chance of being struck by lightening? Who remembers being told by the NIH leadership that only conspiracy theorists suggested the possibility that the virus leaked from a lab? Now we know it isn’t merely possible but very possible.
Given the remarkably poor track record of the expert class in general but also medical experts in particular, should we be surprised when people are skeptical about what the experts say about vaccines?
The venality of our expert overlords is hard to overstate and the chickens are now coming home to roost.
By the way, as far as ivermectin as a treatment for Covid; the idea is asinine. There is no plausible mechanism of action to suggest that it is efficacious.
I don't have time to reply to this at length today, but given the context, feel it would be appropriate to offer this disclaimer: Despite (implicitly) railing at length in this post about the value of editorial barricades--which prevent unjustified, untrue beliefs from gaining widespread acceptance--I neither edit the comments here nor do I have time to reply to every bad idea and offer a detailed counterargument that serves to drive my competitor out of the marketplace of ideas. I offer the following as assertions, not arguments; I hope someone else will take up the matter of arguing the points:
1. Surgical masks are not useless in preventing the spread of SARS-CoV-2
2. Given the state of our knowledge at the time, the government was correct to caution us of the risk the disease might be spread via fomites;
3. 1200 experts, by my count, suggested that mass gatherings to excoriate the police were acceptable while celebrating Mass in a Roman Catholic Church was not. This amounts to 0.01 percent of the total number of healthcare experts in America.
Nor are such claims epistemically equal: You are comparing errors of judgment with errors of fact with errors of interpretation The argument for the efficacy of the vaccines is independently confirmable to anyone who wishes independently to confirm it, unless said person has entered a state of radical skepticism such that he genuinely believes newspapers around the world are involved in a conspiracy that elaborateness of which is so inherently implausible that it is far easier to assume it isn't true. You would have to believe every media organ in the world is conspiring to manufacture the fabric of reality, really--you'd have to believe we live in a world where Israelis are secretly dying and hospitals in the US are *not* reporting that they see almost no vaccinated Covid19 patients. You'd even have to deny that the vaccinated people you know are strangely well, compared to those who aren't.
In the case of the lab leak hypothesis, the *reason* people lied, or distorted the picture, is relevant. So are the specific people involved. It is not Peter Daszak who has patiently sifted through the trial data and deemed the vaccines unsafe. That *an* expert has proved something less that authoritative does not mean *every* expert is not authoritative--even if, as I argue, you've failed in your responsibilities if you allow experts who tarnish your brand to babble on without contest.
“ 1200 experts, by my count, suggested that mass gatherings to excoriate the police were acceptable while celebrating Mass in a Roman Catholic Church was not. This amounts to 0.01 percent of the total number of healthcare experts in America.” (Claire Berlinski)
Do you really think that every health care worker is a health care expert? If you do, keep in mind that depending on which survey you believe somewhere between 15-30 percent of health care workers are refusing to be vaccinated. Should any of us take this as an indication that a substantial minority of health care “experts” consider the vaccines to be unsafe?
Of course not.
There are experts and then there are experts. Tony Fauci is one type of expert while a phlebotomist in a local hospital in Sheboygan is another type of expert. Obviously any one with a brain would take Fauci’s views far more seriously.
But here’s the problem; the government experts at CDC and NIH that the media usually genuflects to did a very poor job especially compared to experts working in Pharma.
If industry experts could develop vaccines for Covid from scratch in a manner of a few months and then operationalize clinical trials in a matter of weeks, you would think NIH could fund trials to determine the efficacy of different types of masks just as quickly.
If you thought that, you would be wrong. To this day, there are very few trials with published results providing convincing proof of the efficacy of the various types of masks.
As far as spread by fomites, this is an issue that could have been clarified by a well thought out and expeditious research program. It certainly is not as difficult a scientific question as the development of vaccines in record time. Yet the failure of NIH resulted in the sad spectacle of millions of Americans washing their mail. If only the government experts had been as competent as the pharmaceutical experts.
This is not to say that NIH got everything wrong; they certainly didn’t. The intramural division of NIAID played a critical role in the development of the vaccines, especially when it came to accruing primate data.
While there were important successes, there were important and preventable failures.
In a sane society, a free press would take up the mantle of chronicling and investigating both the successes and the failures.
Why hasn’t this happened? I think that a sense of class solidarity binds journalists to government scientists. Journalists see themselves as experts in their area and they are loathe to criticize experts in another area like science because their overriding loyalty is to protecting the hegemony of the expert class over the democracy once enjoyed by ordinary Americans.
Our society is increasingly bifurcated between the highly educated and everyone else.
The expert class or, if you prefer, the new American clerisy can’t stop telling everyone what to believe when it comes to race, sex, sexual preference, sexual identity, religion,culture, politics and now, even entertainment and sports. Is it any wonder that recommendations emanating from scientific experts are often dismissed as poppycock? Are ordinary Americans apt to listen to advice from a class of people who hold them in contempt?
Of course everyone should be vaccinated as soon as possible. Of course it’s an obligation we owe to our fellow citizens, our families and our selves.
While social media is certainly a villain, the real villain in vaccine hesitancy is the cult of expertise that has cried wolf once too often.
Just out of curiosity--and this isn't a gotcha question, just one I've actually been sitting here trying to figure out for myself--how would you design an ethical, randomized trial, with an adequate sample size, controlling for confounders, of mask efficacy? Is there any way it could be both observer-blinded and placebo controlled? Would that be ethical during a pandemic? Obviously, if you ask for volunteers, you have confounders and selection bias galore. Natural experiments (similar counties with similar populations but different mask requirements) do suggest efficacy, but it seems to me almost impossible to sort out the confounding variables during an infectious disease epidemic because the incidence of disease doesn't stay stable, and the initial conditions will to such a large degree determine the course of the outbreak. When you add the phenomenon of overdispersal to the calculation, it seems to me it would be all but impossible truly separate the signal from the noise. If you could design this experiment, how would you do it? It won't be perfect, but you want to do it so that you see the effect size and reduce as much as possible confirmation bias, population fallacy; controlling for regression to the mean, and somehow sorting out the noise of "how people behave when there's a mask requirement" from "actual effect of masking."
I can't think of a better way to do it than what we've done--and the way we've done it does favor masks--but I agree it's damned hard to study properly, unless I'm missing an idea.
I’ve thought about this and talked to investigators with an interest in infectious disease. There is published work on whether masks protect against infection with influenza. The results are all over the place. Some studies find masks in this context to be somewhat protective; other studies disagree.
None of the studies were done with cloth masks because cloth masks weren’t much of a thing before Covid. A major confounder is whether the masks are worn properly; often they’re not, even in a hospital setting.
Another approach would be too conduct animal experiments. Primates are hard to work with and they won’t willingly wear masks, but given sufficient motivation, these experiments could be done in primates. If you’ve ever visited a primate colony you know that these animals gesticulate vigorously. That’s advantageous to the experiment. Their tendency to gesticulate exceeds that of the average choir in a church.
Would data from primate experiments be dispositive? Nope.
Would it be very valuable? Yes.
Experiments on other animals like ferrets could also provide imperfect but valuable data.
Finally, bioengineers could develop mechanical means of testing the efficacy of masks in a laboratory setting. Again, the data would be imperfect but better than nothing.
If their had been a concerted effort to obtain this type of data, at least there would have been a more compelling argument than “trust us-we’re from the government.”
As far as contagion via fomites, that would certainly have been easier to test than, for example, developing and testing mRNA vaccines in a matter of a few months.
Do a literature search; see how many well designed studies of this funded by NIH that you find.
I don't know how valuable primate data would be. Our facial topography is so different from any primate's--the shape of our nasal cavity and nasopharynx is completely different. Our immune systems aren't the same: humans are more prone to certain infectious diseases than other primates; we don't exactly understand why. And the idea of getting chimps to replicate ordinary human social interactions with any precision--over a period of weeks, at that--is so absurd it could be the screenplay for a comedy. Bioengineers *have* been modelling this; they've been modelling their brains out. https://www.tandfonline.com/doi/full/10.1080/03091902.2020.1797198,Mamata Karmacharya, Sumit Kumar, Oleksandra Gulenko, Yoon-Kyoung Cho. Advances in Facemasks during the COVID-19 Pandemic Era. ACS Applied Bio Materials 2021, 4 (5) , 3891-3908. https://doi.org/10.1021/acsabm.0c01329
Hongchen Shen, Zhe Zhou, Haihuan Wang, Mengyang Zhang, Minghao Han, David P. Durkin, Danmeng Shuai, Yun Shen. Development of Electrospun Nanofibrous Filters for Controlling Coronavirus Aerosols. Environmental Science & Technology Letters 2021, Article ASAP.
Marius Rutkevičius, Tahira Pirzada, Mackenzie Geiger, Saad A. Khan. Creating superhydrophobic, abrasion-resistant and breathable coatings from water-borne polydimethylsiloxane-polyurethane Co-polymer and fumed silica. Journal of Colloid and Interface Science 2021, 596 , 479-492. https://doi.org/10.1016/j.jcis.2021.02.072
Susan R. Reutman, Tiina Reponen, Michel Yermakov, Sergey A. Grinshpun. Homemade facemasks: particle filtration, breathability, fit, and other performance characteristics. Journal of Occupational and Environmental Hygiene 2021, 18 (7) , 334-344. https://doi.org/10.1080/15459624.2021.1925124
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None of this is conclusive, because this is hard to figure out, but all of it suggests to me that yes, masks are an additional layer of protection in what needs to be a Swiss-Cheese defense.
It’s true that primate social interaction doesn’t mimic human interaction but I’m not sure how critical that is. Indian-origin rhesus macaques, the animals used in most Covid studies gesticulate vigorously when in social settings. While imperfect, for the type of experiments we’re talking about, it’s pretty good.
To be fair, though, they won’t wear masks willingly so they may need to be bound or even anesthetized which could seriously confound the results.
While the respiratory tracks of these animals differs from humans, they do have transient viral replication in the upper and lower respiratory track and the do get modest inflammation in the lung.
Its far from a perfect model but I don’t think it’s useless either.
In terms of immunology, most investigators would say they are a very reasonable model for human disease. The more typically used mouse models (whether humanized or not) are not as similar as the maques in terms of the innate or adaptive immune systems especially in terms of
B-cell and T-cell repertoires.
It’s for this reason that the mRNA vaccines were tested in the primates before clinical trials commenced. In fact, the primate immune system is similar enough to the human immune system that all vaccines are tested in primates first.
For more information on this see,
https://www.nejm.org/doi/full/10.1056/nejmoa2024671
When human trials are unethical or impractical which is frequently the case, we routinely rely on animal experiments for lack of an alternative way to accrue data.
We can’t let the perfect be the enemy of the good.
"Population variance," I meant.
I cannot imagine what inspired you to be so keen to count misses.
How else would you know how many there have been?
I encourage paying attention. But if one investigates like Sherlock Holmes for anyone with a master's degree, and turns in to Mr Magoo the instant political allies need to me questioned, I really have to call out motivations.
Are we talking about the same thing? What did you mean by "misses?" I meant "near-catastrophic accidents involving nuclear weapons."
Apologies, Claire, those posts were directed at WigWag, who seems to have had enough of my shenanigans. The man will parade the errors of 100 well-educated subject matter experts, but not be interested in the fact that subject matter experts are the best chance we have of knowing technical details in most fields. (No, this is not a claim that they are above question or some sort of clergy, so put the strawman away) Then he will somehow miss the errors of his preferred class of (honestly I'm not even sure) people who lack technical education and are making good choices by accident and intuition?
I admire your tenacity in trying to fight this with counter examples, but I believe this is the sort of conversation that is impervious to facts. As long as there are 100 examples of failure, 1000 examples of success are irrelevant.
A relevant example of this is something I read recently regarding trying to deprogram antivaxers. You could list off dozens of reasons why their claims about vaccines are incorrect, and they'll actually become further entrenched in their beliefs. Show them pictures of children suffering with the measles, strike them in the fear that motivates your reasoning, and you'll have a higher success rate. Reading that broke my heart, as it took a slice out of my trust in human reason. This is about the heart, not the head. Perhaps you enjoy the intellectual exercise of data sparring, but I think I've heard enough about this phenomenon to become jaded.
Unless we can think of a way to appeal to someone's resentment?
I hope y’all address the “it isn’t that bad, they cooked the numbers” crud as well. I’m seeing way too many otherwise well educated folks falling for a lot of this malarkey.
I think we've seen one of the great weaknesses of liberal society ahead in the road, and the Internet has caused us to slam on the gas. We're not trying to fight bad reasons people have for believing things. We're fighting human desire to belong, since the reasons we're appealing to are all post hoc.
There is a giant social benefit to shouting the accepted tenets of the antivax movement, and that is the accolades and support of your group. And there is a terrible cost to changing your mind, as you'll be exiled and mocked for following the evidence. There's a reason "No evidence can change my mind" will be met with cheers, thanks Jenny for that haunting example.
I used to be somewhat aligned with what I now call the Cult of Freedom, youthful days of borderline anarchism. Eventually I dialed that back to, "as much freedom as we can stand." Reading Popper helped me refine that further. But now, knowing that AI, tailored diseases, and illiberal Americans are cresting over the horizon, I'm scared that the American project is self defeating. Reactive safety in future tech is very likely too little, too late.
Claire, whomever you nominate to debunk ivermectin should be willing to debate Bret Weinstein in a three hour session moderated by Joe Rogan. Now, that would be interesting and most likely very informative.
I have volunteered myself, and I sent him a 60-page essay explaining my thoughts, which thus far he's dismissed as "bad faith." But I hope perhaps he'll come around.
Keep trying. Weinstein seems like a reasonable person. And think of the audience Rogan can provide.
I would not, even if invited, debate this on Joe Rogin. Anything else, gladly. But debating the effect of the demise of written culture on a *talk* show is like debating the evils of prostitution in a brothel. The arguments I make--about ivermectin and vaccines--require the apparatus of the written word. I could, I'm sure, make them out loud, but when people see them on a page, and spend real time in the literature, they will feel secure in them. An oral debate serves only to encourage people to weigh my charisma and authority against Weinstein's. I'd win: A pretty woman who has facts on her side and can deploy a few charming and witty rejoinders--and who is defending a mainstream view--will always have the audience's sympathy. But it wouldn't do what I want this series to do, which is guide people through this problem and show them how to reach these conclusions for themselves.
Go where the sinner is, Claire, don't expect the sinner to come to you.
Eric Hines