Powered by glolg
Display Preferences Most Recent Entries Chatterbox Blog Links Site Statistics Category Tags About Me, Myself and Gilbert XML RSS Feed
Friday, July 10, 2020 - 21:18 SGT
Posted By: Gilbert

We Interrupt For Basedness

As we await the Singaporean general election results, an update on last December's Warhammer 40k take on the American political situation, which has seen GEOTUS pulling out his latest trump card, in the form of ultrawoke artiste Kanye West:

  1. Kanye, one of the most prominent cultural icons of our generation, has of course been a longtime open GOD-EMPEROR supporter, going as far as to refer to TRUMP as his brother (which has earned him a warm welcome at The Donald's house); this places him in the company of courageous black uniters such as Terry Crews and Chance, in speaking against identity politics (complete with Jamaican accent for Vulkan, in the hilarious TTS series)
  2. In fact, Kanye has just declared that "it's racism and white supremacy to say all black people need to be Democrat", rightly declaring himself as a free-thinking person of colour who's not about to be corralled into staying on the Dem plantation
  3. His obvious 40k alter-ego is then of course Vulkan, total bro-tier fifteen-foot tall hulking ebony mass of barely-restrained muscle. Picture twenty gene-forged and warp-crafted superhuman demigods who tank plasma blasts and benchpress tanks, and there you have Vulkan holding back when sparring, so as not to hurt them.
  4. No, seriously, he's almost certainly the nicest of all the Primarchs, with his legion (later chapter) being about the only one to continue living amongst baseline humans. This is reflected by Vulkanye's staunch pro-life and yet pro-choice stance in our glorious reality
  5. Also, Kanye has always claimed to have "dragon energy" (like TRUMP), while Vulkan's totem-animal is the Dragon; happenstance? I think not.
  6. His declared candidacy has nervous "experts" from Newsweek predicting that he would barely get any votes. No disrespect intended, but as with my analyses in 2016, it doesn't seem like these people possess much political sense about them
  7. Despite Kanye initially indicating that he was breaking with TRUMP, this didn't fool many, with various subreddits quickly figuring that he would just siphon votes from Biden. Turns out, Kanye's not too good with keeping secrets (like Vulkan, unlike Lion El'Jonson)
  8. I love this timeline.

comments (0) - email - share - print - direct link
trackbacks (0) - trackback url

Back to top

Monday, July 06, 2020 - 21:53 SGT
Posted By: Gilbert

Politics & Fixes

Before delving into the local general elections, a brief round-up of purported advances in coronavirus treatment from these past couple of weeks: the pendulum appears to have swung all the way in the direction of some nose/mouth coverage - even if homebrewed - amongst public health authorities, because policies based on common sense and basic math apparently have to wait for large-scale retrospective observations nowadays (but for completeness, here's a contrary argument that I think not very valid). American states appear to be slowly coming around on mask politicization (more on this in a future post), for which the CDC is unfortunately (but probably correctly) coming under heavy criticism. On the bright side, a few hundred scientists have taken it upon themselves to keep hammering the WHO on aerosol transmission risks, and what with the WHO only now admitting that China had never reported the coronavirus outbreak on their own initiative, it's a relief that Europe appears to have fallen in with GEOTUS TRUMP's extremely firm call to restructure the agency, not a moment too soon.

There's no lack of anticipated revelations, by the way, with Gilead's pricing for Remdesivir now revealed. Recall when we were reporting a US$1,000++ cost? Well, a five-day course has been priced at about US$2,300, which comes out to over US$3,000 with insurance, for saving a day or two in the ICU. Anyway, this has instantly gotten Gilead US$1.2 billion for half a million courses, which appears to be the entire global stock for the next few months at least; about this, an immediate doubt might be why the American decision-makers didn't turn to the comparatively nearly-free Dexamethasone instead, given that it's been certified to perform comparably in much the same role on severely-ill patients, from the RECOVERY trial (which has been weathering quite the storm on Twitter)

That's also the next few months' rent, thankyew!
(Source: europeanpharmaceuticalreview.com)

As it is, the Dexamethasone alternative has already been credited with nearly halving Remdesivir's asking price [!], though portions of the public are quite understandably outraged at what looks like extortion by another name, especially given that it doesn't even work all that well. Additionally, The BMJ has now seen fit to release an editorial addressing the not-very-strong Remdesivir studies and clear commercial conflicts of interest involving the drug, in contrast with HCQ - so constantly maligned in the FAKE NEWS - aided by straight-up fraud and botched late-stage experiments.

Coincidentally as the money's in the bank, a flurry of studies suggesting benefits from early application of HCQ with conventional dosing (e.g. the U.K. COPCOV) has managed to see the light of day, and even if one discounts those from known supporters Raoult and Zelenko, you've got evidence from Michigan's Henry Ford Health System published in the International Journal of Infectious Diseases, NYC's Mount Sinai Health System acknowledging a similar ~50% decreased mortality in the Journal of General Internal Medicine, and a Lancet subjournal now admitting that rheumatic patients on long-term HCQ treatment appear to have around 90% reduced odds of coronavirus infection - and this is without mentioning the many other papers supporting HCQ, that have gotten next to no attention in the corrupt mainstream media.

Well, the tide seems strong enough that even CNN had to cover it - though near midnight, and later further modifying the headline to plant doubt; which might be fair enough, if they had applied the same standards to establishment-approved drugs (i.e. why was "'These improvements are not dramatic' and 'not a game changer'" a buried CNN subheader for "More evidence remdesivir helps some coronavirus patients", for example?). However, as analyzed early last month - what do you think will be the response, if it is established that HCQ actually can halve infection rates? Would the lying FAKE NEWS willingly admit that, whoops, we were mistaken, science now says that TRUMP had superior instincts on effective HCQ treatment, compared to the collective judgment of our medical elites?

No, as the old joke goes, I suspect that a lot of people who might otherwise have lived, would simply die from calculated inaction, and that the very science-worshipping parties now playing hardball on blanket face mask enforcement would turn out to be exceedingly reluctant to go on HCQ prophylaxis (bleach ahahahaha), given how the well has been poisoned (but a rushed vaccine, that's okay, of course!); I just hope to live long enough to read the post-mortem novel on this sorry affair.

Charting Singapore's Future

The pandemic has unavoidably entered our political sphere as well, with the co-chair of our official taskforce Pogba-ing SDP leader Paul Tambyah's critique that they had not followed scientific best practice, in discouraging prompt testing of foreign workers (it might be noted that Dr. Tambyah is president-elect of the International Society of Infectious Diseases). Now, I don't even think the taskforce has done that badly, and am quite ok with the government taichi-ing part of the blame to the WHO; however, it might be recognized given all the gleeful dumping on others' (i.e. mostly the U.S.) handling of the coronavirus in our controlled press, that our situation is hardly all that exemplary (now top ten in cases per capita). By the way, for all the chortling about the U.S. not being on Europe's safe travel list, Singapore's not on it either, to give some perspective.

Personally, I don't see much if any change to the status quo (see nice write-up about the goals for each party), all considered, with the biggest surprise being DPM Heng's assignment to East Coast GRC (indeed, he seemed as unprepared as anyone else); despite the overall calibre of opposition candidates (see summary) slowly improving (e.g. Andrew Yang expy "no blank cheque" Jamus Lim, who still got his credentials slammed by a salty Calvin Cheng), true external uncertainty does tend to favour the incumbents. I do understand the argument for a strong mandate in these times, especially for a small state - but again, I'd be a lot more sympathetic without all that gerrymandering nonsense with GRCs, and the complete fiasco of the Selected Presidency.

"We could have written the same manifesto"
"Ho seh, PAP admit WP same standard, can compete on price liao"

(Source: asiaone.com)

The gradual levelling of the playing field in terms of candidate qualifications was perhaps best exemplified by another Lim - the PAP's Jurong GRC candidate, Ivan. To be frank, this posting was as good as a free ride into Parliament, and it would have taken some extraordinary circumstances to muck it up. That was exactly what happened, with his polytechnic classmates, army subordinates and shipyard employees emerging to whack him jialat jialat. Now, I understand that getting things done oft involves treading on toes, and we've probably all done stuff that we're not entirely proud of, but this solidarity from all periods of Ivan's life coming to rag on him together is something else.

Now, given that this fine chap was one of the PAP's rare humble-background-made-good stories, the party's who's who would initially come out in his defence, before eventually urging him to clarify matters as calls for his removal grew. This would come in the form of a terse press statement that didn't address the allegations fully, and moreover stated that he could not have been involved in an alleged bribery case in Brazil, because he was not involved in any Brazilian projects. To this, local netizens would duly dig up a Keppel newsletter interview purporting his management of at least one, and while this might be a case of unfortunate phrasing, it was evidently finally too much for the higher-ups, as he withdrew his candidacy.

The PM would put on a brave face at this, decrying the possibly-baseless allegations being unfair, to disbelief from certain quarters about which how the incumbents had treated - and are still treating - opposition party members such as Dr. Tambyah, compared to ownself check ownself. Well, at least one Regimental Sergeant Major has bravely put himself forward to the DPM, which appears to have gotten him threatened by a former colonel, surely a bad look. This was apparently followed by an attack on a WP candidate for racism, again directly as retaliation on the Ivan saga, which appears to have backfired as she put out a rather more convincing apology (it likely didn't hurt that she's a minority too); it then cumulated in the DPM having a police report filed against him for his recent assertion that "older Singaporeans are not ready for a non-Chinese prime minister", which I guess might be construed as indeed a teeny bit racist (and aren't minority elders, Singaporeans too)?

Poster design award for promoting active aging goes to the SDA
(Source: coconuts.co)

Anyhow, our rising star foreign affairs minister was pretty busy, as he went from implying that the WP was the PAP's equal on live TV, to whacking traditional scapegoat CSJ about plans for a 10M population, which would be followed by an official party statement likening CSJ's extraction of a denial to wife-beating. That brought a rebuke from AWARE, which had Redditors scratching their head as to whether the party's PR guy failed to get it renewed. Still on the 10M issue, our popular CS prof has again chipped in with a reasonable take, to which one unconvinced commentator responded that the S$100 billion earmarked for infrastructure planning must surely mean something in terms of intended population growth (interestingly, on his proposed AI bot to auto-generate a manifesto from kopitiam grievances, it's sort of been done for PAP messaging)

That said, I certainly don't envy Dr. Balakrishnan the job, nicely-crafted speeches and possibly much relationship-hustling aside; you thought poor Rear-Admiral Lui had it tough, when he got sunk by the transport portfolio earlier this decade (eventually tanked through by veteran fixer Khaw Boon Wan, who ultimately also buey tahan and retired)? I tell you, treacherous as Transport may be, I foresee it being child's play compared to what foreign affairs is going to become. I'll have to defer the full geopolitical analysis again, but let's just say that the State's Times cribbing entirely biased articles directly from the failing NYT aside, it'll almost certainly be a whole new ball game whoever triumphs in America, as explained last December.

On this front, Singapore seems to have fallen in with the U.S./U.K. alliance on shutting Huawei out of 5G (which might explain to some extent all those existing masts that got burned down), which has also seen India banning TikTok/WeChat, and Taiwan/America seeking to strangle their access to semiconductors in tandem. Local telcos have officially picked Nokia & Ericsson over the CCP subsidiary, which got Reddit buzzing for a bit, and apparently surprised some locals - but frankly, as expounded upon last October, "the sad and brutal truth is that there was ultimately no decision to be made". Do you think that the U.S. Department of Justice eyeing our money-laundering hub was simply a coincidence?!

Truly, modern Singapore has existed in an era where all the big powers that mattered could afford to play nice - America was more or less basking in the adulation of being undisputed King of the West World since the 1960s at least, and mainland China was busy going from just being happy not to starve, to having some more-equal comrades getting pretty rich in the meantime. Seriously, neither have gotten actually nasty in these parts yet - no, piddly stuff like not appointing a full ambassador or hacking the PM's health records don't count - and some of our wiser diplomats should be getting a familiar shiver up their spine when describing Hong Kong as "a pawn" in Cold War II...

comments (0) - email - share - print - direct link
trackbacks (0) - trackback url

Back to top

Friday, June 26, 2020 - 21:32 SGT
Posted By: Gilbert

Through Glasses Darkly

Paper submission deadlines and other projects are catching up again, so this will be a quickie; just had a new pair of spectacles made at OWNDAYS, and despite picking out their Transitions lenses as with my last pair about four years ago, the cost came out to less than a third of that. Now, I'm aware that one can rack up the price quickly with various additional options (e.g. high [refractive] index, anti-blue light, polarization etc), but the difference was still staggering. Not too sure how much of that went to the neighbourhood optician mark-up, but let's just say that I'm ordering backups online. It's not been great times for brick-and-mortar eyewear retail, so hopefully they manage to branch out to related services.

While my new glasses will take a bit of time to arrive, it wasn't hard to understand the popularity of the OWNDAYS price system and store ambience, which allowed free browsing of frames. Moreover, another point of inconvenience - lost prescriptions - has also been alleviated, what with the availability of a machine to recover one's prescription from one's existing spectacles. Comparing the recovered values with my own records, they got the Sphere and Cylinder for both eyes exactly right, while being only one or two degrees off for the Axes. In fact, there appears to be an FDA-listed app for prescription scanning with smartphones too, but alas for iOS only.

Since we're on computer vision for lifestyle purposes, there's also an app for face shape analysis, for those into matching hairstyles and accessories based on such; FaceApp for one doesn't appear to have much of a selection for the former for genderswap purposes, but yeah, there's no time to be commentating on that or the local elections in any depth.

Review Quiz: Can you spot any discrepancies in the presentation of the results, for HCQ & Dexamethasone?
(Source: twitter.com)

Returning to #Recoverygate, said trial has finally released a preprint justifying their HCQ doses... verified on five patients. This has done little to deflect critics of what's increasingly looking like possibly a flawed therapeutic approach, with the WHO now canning their SOLIDARITY trials for HCQ, as foreshadowed a couple of weeks ago. Anyhow, it has been reported that some 27 Brazilian researchers are now facing legal charges for fatally overdosing patients with chloroquine in their own study, but somehow I wholly expect it to get very quiet over in Great Britain, on this matter...

comments (0) - email - share - print - direct link
trackbacks (0) - trackback url

Back to top

Friday, June 19, 2020 - 23:06 SGT
Posted By: Gilbert

Of Logic, Looting, Twitter & Disinformation (Part 2.75)

This should be it on coronavirus cures for awhile, and so, first the good news: the RECOVERY trial has concluded that Dexamethasone can reduce deaths by a third to a fifth, in severely-ill hospitalized patients; the caveat, of course, is that by the time it's useful, the mortality rate is at least about 20%. Some badly-bitten scientists have seen fit to reserve judgment until more details are forthcoming (note no preprint yet, as far as is known), but that hasn't stopped the WHO and other mainstream outlets from hailing it as a "breakthrough lifesaver", with the U.K. already endorsing it as an authorized NHS treatment. As hoped for in the previous post, Dexamethasone is indeed cheap, though former users have hastened to warn of potential adverse effects. But more on this in particular later on.

The mainstream media has meanwhile finally seen fit to commentate on #Lancetgate, with articles from our State's Times and The New York Times coming out within a day of each other. Both agreed that the fraud was unacceptable, before devoting most of their column space to pinning the fault on the sloppiness/difficulty of the peer-review process, and the NYT did at least mention possible politicization... in the final paragraph; readers who followed the saga through the last few blog posts here might consider some quick discourse analysis, as to what perspectives were not raised, despite their significance. On this, I'd recommend the curious to occasionally peruse sites like AllSides to receive different points of view, even if only to prepare improved counterarguments for one's stand (was actually planning a side-project about this, but eh)

The battle over HCQ has continued in the alternative media, despite some poor monkeys and hamsters biting it (the same group are saying Remdesivir works, by the way), with various reports on pre-exposure efficacy still going nowhere fast. Giuliani, Zelenko and Him in the White House have quite rightly torn into the relevant journals and media on this deception. Nevertheless, the FDA has revoked the Emergency Use Authorization for HCQ (though this paradoxically makes its prescription more accessible, so it seems), apparently based at least in part on the RECOVERY trial's largely data-and-analysis-free headlines. We'll have quite a bit to discuss about that, but one can't help but imagine some ready parallels between this and the sorry WHO/#Lancetgate affair (on which Internet investigators have kept on prying into possible links)...

But before that, more quick go-overs of other preventive measures. Our local DSO has come up with a number of antibodies, but most of the talk has probably been swirling around vaccines, with Italy, Germany and France having already signed up with AstraZeneca/Oxford. There may be some very cautious optimism to be had here, with experts warning that the first vaccine candidates might not actually protect fully against the coronavirus, and instead settle for a partial prophylactic effect. Hmm. And then there's the joint China-U.S. study suggesting that humans aren't producing long-lasting antibodies against the coronavirus, which has clear negative implications for vaccines, but that's enough bad news for today.

Returning to face masks, Dr. Fauci has now openly admitted that the advice against them was due to shortages for medical staff, which really doesn't do much for trust in authorities, their interpretation of science (with recent research now somehow all pointing the way of masking up), and their future advisories - as the Governor of New York, among others, might be belatedly discovering. The ever-quotable Taleb has chipped in on just how all of the world's top bureaucrats and medical minds combined managed to come up with reasoning that is so blatantly wrong, which seems to boil down into poor intuition on probabilities, once again. For some historical context, consider that folks had advanced breathable mask designs (a tad creepy, fine) during the 1918 Spanish flu pandemic, more than a century ago; nothing new under the sun, indeed.

1918 or 2020?
(Original source: auburnpub.com, colorized by deepai.org)

Prosecution & Defence

And now the main course - #Recoverygate, yea or nay? But first, a pretty comprehensive timeline of the happenings involved, some of which have not been covered here (note that Surgisphere's HCQ paper in The Lancet was so egregious, that multiple observers were calling foul within a day of its publication). Now, to pick up where we left off, the France-Soir interview with RECOVERY trial co-head Prof. Landray seems entirely genuine, with the French online newspaper releasing raw audio of Landray's very Brit pronouncements, with further confirmation of his assertions reportedly sought (wouldn't be a proper -gate without audio evidence, would it?)

Given that another RECOVERY trial head has tried to clear the air on another French site, instead of outright denying the charge, one has to suppose that the event did take place. Prof. Horby would describe the initial 2400mg loading dose as having low associated risks, an angle also explored by Dr. Watson, whom recall was behind the open letters that carried #Lancetgate (and that were, ironically, probably at least partly instigated by Oxford researchers unhappy at The Lancet's HCQ paper putting a stop to their RECOVERY trial)

Now batting for the other side, Watson would offer a paper from 1949 that describes the treatment of hepatic amebiasis with chloroquine (HCQ had barely been invented then), while also mentioning "quite a few other papers from the 50s-70s". He went on to describe the 1949 dosings as a loading dose of 600mg for the first two days, and then 300mg for two to three weeks, which seems curiously similar to modern-day recommendations. Watson then says that RECOVERY was giving these 600mg/300mg doses, but just twice daily (and actually, closer to 2.5 times than twice), for the same peak concentration by the end of treatment (10 days versus up to three weeks)

This largely repeats the more-detailed reasoning provided in the official trial protocol, although one suspects that at least some curious reviewers would find the correlation drawn with amoebic liver abscess seemingly coming out of the blue, and moreover at increased dosages. The argument appears to run as follows:
  • The WHO has recommended a treatment regimen for amoebic liver abscess [ALA] (fair enough?)
  • Our loading doses are the same as the regimen for ALA (wait, how does suitable dosages for the coronavirus relate to those for ALA in the first place?)
  • Only, we double these dosages again (okay...)
  • This is such that the total dose over 10 days is the same as standard treatment for ALA over 20 days (clearly, the risks aren't automatically going to be "standard" here...)
  • The seriousness of COVID-19 (~20% in-hospital mortality) justifies testing these higher doses

On that final point, it certainly hardly seems immediately evident that relatively high mortalities necessarily imply that (unprecedentedly) high doses are appropriate. Obviously, there has to be some trade-off between expected detriment to patient health directly from the high dosage of HCQ applied, and the expected benefit gained. Notably, while the trial heads have repeatedly made references to "careful pharmacokinetic modelling" and the like, the exact details on just this risk-benefit modelling appear to be exactly what's missing (and what a proper reviewer would ask for). In particular, statements like "ensure the necessary blood concentrations are achieved rapidly" should be qualified - for example, what would be the delay were a more common regime (e.g. 600mg/day) to be applied? If it is a matter of a few days, is the rush actually imperative, especially given that a recent study in Brazil has already suggested danger for such high doses? And if no happy middle ground could be found for a safe yet effective dosing regime, why go ahead with the trial only to vacillate between calling it toxic and not?

One hopes that the Oxford dons eventually engage in an open dissection of the full reasoning behind the dosage calculations, as befits the university's storied history, instead of rehashing explanations of the following forms (some as seen on Twitter), none of which are actual scientific explanations:
  • Look at our shiny ISO certifications!
  • It's similar to the WHO's SOLIDARITY trial (which may turn out to be a circular argument; also, there is talk that Singapore had been hesitant to participate in the SOLIDARITY trial for HCQ due to the dosages involved, which if true, makes me proud of our health system)
  • Any disagreement suggests that the U.K.'s regulatory processes are inadequate
  • Our ethics committee would have blocked the trial if there were any real concerns
  • Hundreds of Very Important People have been involved in the trial design, and tens of thousands of patients have been recruited for this big national project

As one wise statistician has it, with #Lancetgate, the fraud was perhaps the least of it. Instead, the real scandal was that the prestigious journal (or ethics committee, or governing body, etc) "aids and abets in poor research practices by serving as a kind of shield for the authors of a questionable paper, by acting as if secret pre-publication review has more validity than open post-publication review".

Sure, all this worry could be over nothing - the trial investigators might eventually release sufficient evidence supporting their choice of dosages. However, it might also be noted that policies have already shifted without the public release of data & analysis (note that the WHO at least waited for The Lancet to publish). I don't expect this to be over yet, what with many critics emboldened by #Lancetgate (which didn't directly involve real patients in treatment, remember), and spurred on by AstraZeneca - in collaboration with Oxford on their vaccine - apparently seeking to merge with Gilead. As it is, France-Soir has just alleged that the very pharmacokinetic analysis of interest had been cut from the trial's HCQ info sheet, leaving it a mere three pages for version 3, down from 25 in version 2 (which appears to have been entirely disappeared). Much more drama ahead, then?

Kengan Omega Singapore Represent!

Distant relative of you-know-which-clan?
[N.B. Belle Delphine also back for the simps, after a long layoff following her kidnapped hamster rescue!]
(Source: r/singapore)

I was pleasantly surprised when Thursday's scheduled instalment of Kengan Omega revealed the first known Singaporean fighter in that comicverse; not so much when he turned out to be a massive weeb (then again, Singapore does have our fair share of those...). Can't lie, he was fairly cool in his initial appearance, only to turn out to be the cringiest Sasuke-cosplaying banana magic poseur spouting phrases like "have at thee!". In my estimation, the only way to salvage this would be to go the whole hog with the Merlion green mist. Oh, and his favourite dish is chicken rice. Did the Tourism Board slip the mangaka a couple of bucks under the table here?

comments (0) - email - share - print - direct link
trackbacks (0) - trackback url

Back to top

Friday, June 12, 2020 - 23:50 SGT
Posted By: Gilbert

Of Logic, Looting, Twitter & Disinformation (Part 2.5)

It seems that we just can't get away from HCQ and related commentary yet, not when The State's Times has just announced on its front page, a day or two back, that Remdesivir is now approved for treating late-stage coronavirus patients in Singapore, thanks to a breaking paper showing that it reduces recovery by about four days (note similar study in The Lancet showing no improvement ignored). Eh, I do hope it helps, but more on that later.

Meanwhile, more confusion reigned at the WHO, as they somehow asserted that asymptomatic transmission is "very rare", before the paint dried on their new face mask guidelines, which seemed to have been driven by concerns over this modality of transmission (and right as local researchers declared that half of Singapore's new coronavirus cases were symptomless). It would have to be clarified that true asymptomatic carriers - who never develop any symptoms throughout their infection period - are indeed rare, but presymptomatic folks who do not manifest symptoms early on are common, and can indeed spread the virus during that early period; which was, like, how almost everyone interpreted "asymptomatic spread"? Anyway, the WHO has backtracked on the statement, but yeah, not really listening anymore.

Retraction Aftermath

As we said, the outcomes are predetermined
(Source: dilbert.com)

As the unwinding of #Lancetgate continues, the most staggering observation was just how paltry the attention it had received in the mainstream FAKE NEWS. Despite its extremely far-reaching and incomparably-relevant implications, there was only mild coverage in a handful of relatively fringe outlets, because why would anybody at all be interested in a coordinated effort to discredit a potential coronavirus remedy?

There would be more pointed outrage on Twitter and other social media, but the visibility of such in the English-reading world has probably been somewhat dampened, due to many of the anti-HCQ mafia's most ardent critics residing outside the Anglosphere - a reminder of just how much one's language proficiencies can colour one's perspective of reality. Raoult's French believers (we'll be relying on their analysis for much of the next section) have been particularly loud, such as in pointing out that some fifty-over countries have been quietly dosing their populations with HCQ, to what one suspects is some success in early prevention. Coincidentally, none of Lebanon, Costa Rica, Saudi Arabia, Malaysia, India and Italy etc appear to have English as their dominant language, so it's perhaps not too surprising that the news and meta-analyses aren't getting through to the U.K. and U.S. in particular.

On this, a Yale epidemiologist's call for early outpatient treatment with HCQ in the American Journal of Epidemiology appears to have been outright ignored in the mainstream media, as they preferred instead to rehash the old much-critiqued Veterans paper, just-published in Med. Seeing as how some states have apparently been continuing with HCQ, however, and how others are suing for the right to prescribe it, we might or might not get some real answers in the future.

And on the mysterious Surgisphere magic firm, they have basically erased their online presence, as dazed observers from the medical community slowly came around to just why nobody at The Lancet or the NEJM or any number of other big-name journals, bothered to question as to just how what was essentially a one-man company making outright fantastic claims, could have assembled the wealth of data they claimed to have. At least some consequences were to be had, as one of the authors just had his adjunct appointment terminated by the University of Utah; it seems that this worthy was related to Surgisphere's CEO by marriage, which may make for some slightly-awkward upcoming family reunions.

HCQ Dosage Debate

#Lancetgate appears to be old news, though, what with the French Twittersphere now pushing #Recoverygate & #Oxfordgate, targeting the slightly-sketchy HCQ dosages employed in Oxford's RECOVERY trial, as discussed in the previous post. This new hashtag push owed much to an exclusive interview by French online newspaper France-Soir (who had notably previously snagged an interview with one of the #Lancetgate authors, too), of the honorable Prof. Landray, who was co-head of said trial.

The questioning of the high-seeming dosages had begun immediately once and even well before the results were revealed, with India's ICMR going as far as to write to the WHO in protest, but yeah, it's the WHO. Frankly, I'm not even sure I want the France-Soir interview to be legit - though it seems to be - from the answers given. Landray would first affirm that the high doses were chosen to ensure that the HCQ blood levels were high enough to have a chance at killing the virus, which I guess most can't verify independently; the kicker however came when it was then revealed that the dose was decided to be "in line with the sort of doses that you used for other diseases such as amoebic dysentery", and that he wasn't sure about the max HCQ dose in the U.K., but that "it is much larger than the 2400mg, something like six or 10 times that".

Well, these statements prompted an absolute outroar amongst horrified mostly-French commentators, beginning with the observation that 24000mg of HCQ was so obviously not okay (some defenders have trotted out a case where a teen survived a 22000mg dose, but I hope it self-evident why this is not an ideal direction to argue from). The horror then intensified, when a French M.D. mused that HCQ isn't generally prescribed for amoebic dysentery, and the usual cure is hydroxyquinoline, for which the stated dosages do make sense. Raoult himself couldn't resist chipping in on the unthinkable, no doubt after much pinging from his many followers.

It was further noted that the 2400mg dose was indicated for kids weighing just 40kg too, which did not exactly inspire additional confidence in the study protocol, as gleefully reported in several French publications, none of which will likely gain much currency in the world of English propaganda. Indeed, the RECOVERY trial's heads seem to be wavering from their initial messaging of HCQ being "quite toxic" (this presumption apparently backed by their Evidence Service Team, who stated that "[Safety of HCQ]... is an unjustifiable assumption... there is no guarantee that, because a drug is safe at one dose, it will be safe at a higher dose"), to insisting that the doses were not toxic, because there were no additional deaths - well, so which is it? Can't have it both ways, surely?

I'm not sure whether #Recoverygate is going to get as much traction, although it's not looking too good on the transparency end, with involved professors seemingly going around shutting down informed opinion and analysis on Twitter. Finally, there had been some muttering about the strange timing of the RECOVERY trial's shutdown of their HCQ arm - right on time to smother #Lancetgate - which had been explained as a mere coincidence. Well, as an intelligent Twitter user has noted, this seems to imply that all the other treatments ongoing in the other five arms of the study, must be working rather better; do forgive me if I'm not buying into that explanation just yet...

The C-word

That bad, huh?
(Source: twitter.com)

This cynical stand was only bolstered by a leak from a French former health minister, of a Chatham House discussion; for those not in the know, such talks are supposed to be under Chatham House rule, in which anyone who comes to the meeting is free to use information from the discussion, but is not allowed to reveal who made any comment, so as to increase openness of discussion (from this, we expect Dr. Douste-Blazy not to be invited back, unless the leak was prearranged). Anyway, the big revelation was that the editors of both The Lancet and the NEJM (yep, probably prearranged) had bemoaned the huge pressure placed upon them by Big Pharma, with The Lancet's Dr. Horton going as far as to state that: "If this continues, we are not going to be able to publish any more clinical research data because pharmaceutical companies are so financially powerful; they are able to pressure us to accept papers that are apparently methodologically perfect, but their conclusion is what pharmaceutical companies want" (hardly new, granted)

I'm not sure how sympathetic I can get, given that Dr. Horton had just insisted much the opposite in a public tweet barely a week before that, and it has to be said that the circumstantial evidence is suggesting business as usual for Big Pharma here. The incentives are very clear here, with Remdesivir likely to cost orders of magnitude more than HCQ, before mentioning a supposed correlation of close to one between funding received from Gilead by physicians, and their public opinions expressed against HCQ. Raoult probably isn't going to win many establishment friends with that paper, nor for his digging into why data favourable to HCQ was somehow elided between preprint and publication (not that he likely cares)

Personally, I expect this to be yet so much song and dance, once again; it's not like these elite journals are gonna stop publishing shoddy papers espousing whatever expensive shitty drug Big Daddy Pharma wants, and it's not like the WHO isn't going to suddenly drop their supposed double-blind RCT standards when the leash is yanked. If it's any consolation, twenty-six U.S. states are suing pharma firms for price-fixing of generic drugs, but I ain't holding out much hope of anything but a damp squib of a tame settlement on that either.

Sadly, academic tribalism and fraud hardly seems limited to medicine, with a Purdue professor sounding out on potential organized fraud in ACM and IEEE computer science conferences lately. The mechanism is pretty straightforward: allegedly, a few dozen authors would collude via private chat group, to arrange for their submitted papers to be assigned to fellow conspirators for peer-review. Obviously, these papers would be scored high, outsiders scored low, and all this isn't even that hard to justify even under scrutiny. It is times like this, when I wonder whether I should just retire and take up farming.

All Solutions Matter

Just to clarify again, for all the space I've given HCQ on this blog, I don't actually have that much of a dog in this fight - I'm open to anything that can be shown to work (robot overseers in dorms gave a slight pause, though). The Germans have evidently scrounged up evidence for face masks, and the Japanese are designing cooler and more comfortable ones, excellent! Ivermectin has been getting some good press, as have Antabuse, Canakinumab, Tocilizumab and possibly a host of other existing drugs, more power to them; however, it should be noted that many of these aren't exactly affordable, and let's be honest, a 99% reliable cure at US$100/dose is no cure at all, to the vast majority of the world's population. I hope this explains why I remain rooting for something simple and cheap, even if it's only 50%, heck, 20%, effective.

It goes without saying that a true vaccine would be best of all, but a realistic view would be that no coronavirus vaccine has ever been developed - so why the sudden confidence? Somehow, you have players such as Moderna and Oxford seemingly ready to pump out billions of doses by the end of the year, a timeline I believe is quite unprecedented in vaccine development, if economically tantalizing. Various highly-placed politicians and doctors somehow appear all for it, despite that, moreover preemptively warning that they "shouldn't force drug companies to lower the costs of Covid-19 vaccines and treatments but should encourage fair pricing". Honestly, I'm pinning my last hopes on the virus dying out by itself now.

comments (0) - email - share - print - direct link
trackbacks (0) - trackback url

Back to top

Sunday, June 07, 2020 - 02:31 SGT
Posted By: Gilbert

Of Logic, Looting, Twitter & Disinformation (Part II)

The relevance of this shall become apparent later in this blog post
(Source: dilbert.com)

At least it took only about twelve days, and not twelve years, this time around; the Lancet has retracted their super-shady HCQ BAD paper, as have the NEJM for their paper by much the same authors, on cardiovascular disease.

I had originally been planning to get to the next part of this series - on the American domestic situation - but there's been just too much coming in on the #Lancetgate scandal front. But before diving deep into that, we might note yet another retraction, this one from the Annals of Internal Medicine, often seen as comparable to the Big Four medical journals in prestige. This relates to an April paper on the effectiveness of face masks against the coronavirus, that demonstrated on four [!] patients that both surgical and cotton masks were ineffective. On this, one can only muse that it might be rather easier to publish in high places, if you're spouting the same "wisdom" as the establishment...

Anyway, it appears that this retraction was to make way for the latest establishment (i.e. WHO) stand, as newly canonized in... The Lancet: that face masks actually were effective (along with physical distancing & eye protection). Not a few unimpressed souls would thank Mr. Obvious there, with observations that medical staff weren't striking for the right to wear them for fun, and that perhaps it just makes sense that exhalations would be impeded by a mask, or why did the powers that be recommend coughing into a crooked arm? By the way, the WHO has also resumed HCQ trials based on the Lancet retraction, since that was their original justification - but I won't be expecting any positive results, for reasons that shall soon be clear.

Consequences Of Fraud (i.e. Next To None)

As it should, to all good doctors
(Source: twitter.com)

The previous post has, I hope, explained just how serious this #Lancetgate fraud was - on the back of unverifiable data from an unknown company, the WHO made it global health policy to discontinue investigations into one of the most accessible potential treatments on the reputation of The Lancet (The WHO chief scientist admitted to simply trusting the authors, in pulling the plug within days). It might also be noted that none of the very well-credentialed Harvard-laundering clinicians that "authored" the paper apparently ever had any access to the underlying data (wow); I guess the science fiction writer under their employ had been very busy.

Of course, retractions - even those rightly described as "one of the biggest... in modern history" seldom tend to make nearly as much of a splash as the original scoop. Notably, none of the NYT, CNN or WaPo thought fit to even mention HCQ in their headlines on the scandal, although one would think this hugely more newsworthy than the initial declaration. No indication of the scandal's significance, or analysis as to what might have caused the unthinkable, was forthcoming from these doyens of the mainstream media either, and it was left to the Wall Street Journal, National Review and The Hill to diagnose the malady: that medicine has regrettably become politicized.

It should be emphasized here that the relevant journals and the WHO deserve very little credit for the retractions - the legwork and necessary evidence had been tirelessly compiled by various amateur sleuths, who turned out to be far more competent peer-reviewers, than the actual ones. In other words, were it not for their investigations, the potential of HCQ for treating similar conditions - whether ultimately tenable or not - would have been almost entirely shut down, and those reponsible would have been happily mucking about collecting fat paycheques (with a couple of top-tier publications to boot)

Some of these doughty hero sleuths have been pressing for information on any of the "data" behind the Lancet paper, all the more after their esteemed editor expressed hope for only "lessons, not consequences". I wouldn't hold out too much hope on this, since I fully expect Surgisphere's CEO (who seems the only one on Earth to have ever had access to it) to soon disappear from public life (and perhaps re-emerge some months later with a new name and nip-and-tucked face). Still, Dr. Horton shouldn't worry overmuch, since as one Twitter wit has it: "China has the iron rice bowl; academia's got tenure, but what I really want in terms of job security is to edit The Lancet!"

More Incoming HCQ Research!

As it is, the blatant political hit job has done quite some damage, with recruitment for HCQ trials already impacted in Australia. Here, I will attempt to summarize the most relevant recent releases on HCQ efficacy, that I know of. Before we begin, it might be helpful to note that HCQ can be considered to have four possible broad areas of application:
  • Pre-exposure of coronavirus
  • Post-exposure of coronavirus
  • Early community treatment
  • Hospitalized patients

It seems mostly accepted that there are very few really high-quality results for any of the above (a notable exception being the retracted Lancet paper, for how large and diverse its surveyed population was touted to be). I'll survey the prominent ones supporting HCQ use first, since it seems that the media somehow doesn't cover them: there's the NYU Langone study by Carlucci et al., which suggests that HCQ+AZ+Zinc resulted in a 1.5 times greater likelihood of recovering enough to be discharged, and being 44% less likely to die, with the understanding that HCQ was best applied to early-stage patients.

Internationally, Didier Raoult - the French infectious diseases specialist who arguably kicked the whole HCQ fad off - has just put out a preprint claiming that "early diagnosis, early isolation and early treatment with at least 3 days of HCQ-AZ result in a significantly better clinical outcome and contagiosity in patients with COVID-19 than other treatments"; the Indian Council of Medical Research has published in the Indian Journal of Medicine, proclaiming that six weeks of HCQ prophylaxis - yes, early treatment again, since this makes the most sense with anti-virals like HCQ - reduced infection likelihood by 80% amongst symptomatic health care workers (with PPE)

In the interests of some objectivity, I shall try to provide some critique of these studies. None of them follow the "gold standard" randomized controlled trial (RCT) format, that every public health head honcho is insisting upon as proof (well, it has to be said that the retracted Lancet study wasn't one either, but it was big, so...); Raoult for one is philosophically opposed to RCTs, as he explains with the parachute paradigm: we tend to accept the claim that parachutes reduce injury among people who leap from airplanes, but this effect has never been proved in a randomized study that compares an experimental parachute group to an unlucky parachuteless control. In other words, he doesn't like to sacrifice a control group, for purposes of research (of course, the counter is that there would probably be subjects who are against the intended treatment in any large trial)

The not-being-a-RCT was one of the main objections in an open statistical review of Raoult's original HCQ paper from March, along with lack of covariate-adjusted analysis, the dropping out of six patients, and choice of outcome (viral load); Raoult has also apparently come under some criticism, in particular that he churns out "an extraordinary number of publications but few of great quality" (as to this, it's kinda hard to argue with a h-index of 179, for those that care about this sort of thing). It should also be said that Raoult is at least an actual infectious disease researcher with a track record in successfully applying HCQ to new diseases such as Q Fever, unlike the three cardiologists who somehow became viral experts (likely on their NEJM high)

First Do No Harm

And we come to the "HCQ is rat poison" new publications, two of which have exploded across the corporate mainstream media these few days, right as #Lancetgate broke. First up, fresh from the NEJM, there's a trial from the University of Minnesota, that claims no benefit for HCQ post-exposure, from 821 enrolled subjects; the relief immediately expressed by a collection of big names supposedly dedicated to healing felt... oddly off. This was swiftly followed by a tweet from the United Kingdom's much-awaited RECOVERY trial: no clinical benefit from HCQ in hospitalized patients. I'll quote our own State's Times on this: "This is not a treatment for Covid-19. It doesn't work." Martin Landray, an Oxford University professor who is co-leading the Recovery trial, told reporters. "This result should change medical practice worldwide. We can now stop using a drug that is useless."; he further added that HCQ was "quite toxic", so halting the trials would be of benefit to patients.

Now, these are some pretty definitive proclamations for a scientist, and given the world's experience with various supposed-authoritative medical journals and organizations of late, I hope that readers will indulge in a bit of ad-hoc review of the above papers/claims here. For the Minnesota trial, it was noted that 85% of participants didn't even test for coronavirus, and the trial somehow tested for symptoms (instead of, say, PCR) from assumed existing infections despite that saying little about viral load (comment: "Please tell me this is a joke. So a study on a treatment for covid-19 didn't test for covid-19???"). Not only that, patients self-reported data, and one-fifth didn't even take their assigned doses. But well, this seems good enough for the NEJM, so what can we say?

An even more interesting observation would be made in the discussion on Science Translational Medicine's post on the paper, which was that the Minnesota study was powered to detect a 50% difference in symptoms (which it failed). This meant that despite an actual observed improvement with HCQ (11.8% with symptoms) versus placebo (14.3%), the authors (correctly) claimed that HCQ could not statistically be claimed to have worked (or not worked), because it didn't hit the (kinda optimistic?) bar set initially, essentially due to not having enough subjects. Here, it might also be possible to add that Surgisphere had initially claimed a partnership with researchers from Minnesota on their website, now scrubbed, and that the first author Boulware receives funding from Gilead.

The Oxford study is even more intriguing, despite the above. First off, it might be noted that unfortunately, about 25% of the patients died (25.7% with HCQ, 23.5% usual care), from which it might be reasonably surmised that these were largely ICU-level patients, or close to that. As stated in a previous blog post, HCQ - or indeed most anything else, as far as known - is kind of a toss-up by this point. Indeed, I am inclined to agree that for moderately-to-very sick hospitalized patients, HCQ is unlikely to do much if anything, from many previous retrospective studies.

From the U.S. CDC advisory on HCQ

This is a good time to take a small detour. Recall that the #Lancetgate fraud had kicked off not because the investigators checked out their LinkedIn page and found a camgirl, but from the data - and, in particular, that "...the big finding is that when controlling for age, sex, race, co-morbidities and disease severity, the mortality is double in the HCQ/CQ groups (16-24% versus 9% in controls). This is a huge effect size! Not many drugs are that good at killing people." Of course, this is exactly the sort of outcome you'd want, if you wanted to sell "HCQ is arsenic/bleach/cyanide combined!" (which the editor of a certain journal might have liked), but critical thinking and some sanity checks should come in here: can this be true?

The problem with this message was that, as with face masks, the claim of HCQ being dangerous didn't have much face validity to begin with. As various common folks all over the Internet noted, HCQ is, like, amongst the boringest of boring medications. It's been around for so long, that it's outlived many great-grandfathers; while we're on authority, the CDC has it generally safe for pregnant women and nursing mothers; it's on the WHO's Model List of Essential Medicines, that are considered the "most effective and safe". It's a customary long-term malaria prophylaxis in many tropical countries, been prescribed in the millions of doses for various chronic diseases - surely some indication that it was terribly unsafe, would have rung the bell after over 65 years? And suddenly, just because a certain political leader mentioned it and went on a course, you have a Fox News host screaming that it'll kill you?

Of course, it's not untrue that HCQ can kill; but so can Panadol, or cough syrup, or heck, plain water. As the National Review clarifies, the dose makes the poison. Let's consider the example of aspirin. Most everyone's taken it before, it's not very exciting, but most people should also recognize the dangers of an overdose from low-budget drama serials - the kind where a heartbroken silly girl cups a handful of pills, swallows them all, and either achieves a fairytale ending through reconcilling with her lover in the hospital, or gets written out of the show. Some guidelines have 300mg per kg of bodyweight of aspirin as a mildly toxic amount, with 500mg/kg as potentially fatal.

Now consider a scenario where aspirin has become a candidate drug for treating sharp head pains. Somehow, you have researchers gathering emergency room patients with severe head injuries from car crashes, and feeding them inordinately-high doses of aspirin - say, sixteen pills a day. It doesn't seem to help, and some of these patients (expectedly) suffer the side effects such as nausea and ulcers. A reasonable person might figure that this might not prove much. No problem, more researchers continue running similar studies on severely-injured patients from bicycle/bus/Roomba crashes instead. The same reasonable person might say, fine, we get it, aspirin doesn't help when it's come to this. But what about preventing headaches?

Instead, all the mainstream media sites propagate the same headlines: "Aspirin very dangerous. Do not use for headache."


Another little detail not explored by the mainstream media
(Source: twitter.com)

This seems suspiciously like what may be happening with HCQ. It might be noted that Oxford's RECOVERY trial had its HCQ results spread by the mainstream news despite the lack of even a preprint, but fortunately, there are some details about their study protocol. In particular, the HCQ dosage used over ten days was revealed on Page 9: 800mg initial, another 800mg after 6 hours, 400mg after 12 & 24 hours, and 400mg every 12 hours thereafter. Understandably, not a few observers were shocked at the 2400mg dose within the first 24 hours (and 800mg/day afterwards), which appears rather... excessive, to say the least.

To put it into perspective: common HCQ dosing guidelines for malaria prophylaxis is 400mg weekly; acute treatment is admittedly up to 1600mg in the first 24 hours, but with no indication of continued application for long. Treatment for chronic conditions involves 200-600mg/day. For coronavirus application, Raoult's protocol involves 600mg/day (which does seem the maximum limit recommended by French guidelines); Zelenko, if you've heard of him, advocated for just 200mg twice a day (with Azithromycin & Zinc). The Indian ICMR advisory calls for 800mg for the first 24 hours, and then a 400mg maintenance dose weekly. In summary, the maximum first-day dosage of the major HCQ proponents appears barely a third of what was used in the RECOVERY trial; it is quite difficult to imagine what inspired these Oxford investigators to begin with such an exceptional dose, although it might be mentioned that the university is developing a vaccine, that might be somewhat less critically-needed were a good prophylaxis to be discovered.

Like, "first do no harm", right?

Astoundingly, this doesn't even appear to be the beginning of it. A Redditor claimed to be one of the principal investigators of the RECOVERY trial on the Medicine subreddit (his comment history appears at least plausible as to that), and said that "We didn't suspend our HCQ arm, partly because the doses we used were lower than some of the other trials' protocols."

What in the absolute fuck is this?!

Let's return to the investigators that exposed the #Lancetgate fraud: one of them mentions FDA guidelines of 800mg on the first day, and then 400mg/day for up to a week. I really, really hope to stumble upon a good explanation for these trial dosage decisions in the coming days, or my faith in the medical profession will be extremely severely shaken. I mean, you might expect this sort of hanky-panky with casino money laundering, or oil/gas bunkering, or drug/gun/avocado smuggling, but medicine?! Say it ain't so, Joe!

The outcomes have been determined;
Trial investigator: *applies toxic dose of drug*
Trial investigator: "This drug is quite toxic"
World: *pikachu face*

(Source: twitter.com)

Unfortunately, the way I'm seeing it, there's no way out now. I don't think that the rational response of, well, HCQ doesn't work with severely-ill patients, but maybe it can help all of us to an extent in prevention (like with face masks), is gonna fly here. Above and beyond the billions and billions of dollars that are at stake for Big Pharma and their allies in medical journals and the WHO, and possibly American pride in wanting a home-grown drug, it's gotten too up close and personal for a lot of bigwigs. Do you know what it means, if it is shown that HCQ kind-of-works prophylactically? Yes, a lot of people would be saved, but I don't think that's at the top of certain fellas' minds now. This would mean that, after defeating first the entire Republican establishment, and then the entire Democratic establishment, a certain slightly-orange former reality TV star would demonstrate his Ultra Instinct on epidemiology, to be superior to essentially the entire (Anglo-American) medical establishment.

Now, if I know anything at all about the type of guy that's managed to claw themselves up the establishment, they are gonna pull in every favour they can, and pull out every dirty trick in the book, to destroy HCQ now. Like, how did it come to this?! The early TRUMP mention of HCQ was more or less in passing, and moreover with a request to defer to one's physician! Somehow, you have the greatest and goodest of America's health professionals now basically forced to hammer down a prospective solution, because the reaction if it actually comes to pass that HCQ could actually have helped - which really isn't that far-fetched - would be disastrous to them?

They can't buy stuff quite like he can, after all

[N.B. For those getting depressed at the flood of negativity and/in politics, may I recommend... r/PoliticalCompassMemes! All sides of the political spectrum take the mickey out of each other there, and one might learn some new stuff too!]

comments (0) - email - share - print - direct link
trackbacks (0) - trackback url

Back to top

Wednesday, June 03, 2020 - 17:35 SGT
Posted By: Gilbert

Of Logic, Looting, Twitter & Disinformation (Part I)

"There are decades where nothing happens;
and there are weeks where decades happen.

- Vladimir Ilyich Lenin

That there's been a lot going on these days, has to be a bit of an understatement, and it's nearly a full-time job just attempting to keep on top of events. But first, some updates on the local situation, and the developing #Lancetgate scandal. First up, in local news, the gahment has committed to building new and better dorms for migrant workers, which should probably have been done earlier, but late better than never. Alongside this, our Second Lady has come out with one of her more lucid Facebook posts, on how mask adherence and mask efficacy factors combine to reduce effective coronavirus R0. Hopefully somebody forwards this research to the WHO, who are by some reports "on the verge of doing a U-turn on its mask advisory", or perhaps on the brink of the verge thereof.

As noted in the previous post, the WHO certainly wasted no time at all in shuttering their HCQ trials based on a hot-off-the-press Lancet publication, and let's just say that it's not looking very good for either The Lancet's or the WHO's reputation, as Nature has picked up on. As the number of signatories to the open letter demanding clarification and transparency grows, a number of statisticians and clinicians have been moved to speak out on the incongruity of it all, with one particularly-pointed accusation of outright data fabrication gaining traction.

The main thesis of this statistician is fairly direct: how would a single, by all accounts quite-new and not-very-large company, have access to privileged patient health data from nearly 700 hospitals from all around the globe?! He points out that an entity capable of such a feat would require a veritable army of managers, liaisons, trainers, researchers, in-house lawyers, software developers, database engineers etc, merely to get off the ground. By all accounts, they should be easily a billion-dollar unicorn, if not close to that; instead, one estimate of its revenue has it at barely US$50,000 - which as the statistician notes, is not enough for "the discovery stage of an EHR integration project at a single hospital, never mind deploying anything" (on this, you might be surprised at just how varied and incompatible the EHR systems at different Singapore healthcare clusters alone can get, from my own experience)

These guys would have to be the greatest EHR integration specialists I have ever seen in my career
(Source: twitter.com)

It is then noted that the QuartzClinical software involved is heavy on platitudes and misattributed awards, and a parallel investigation by an M.D. from Columbia University turned out many more tasty tidbits about the firm - basically, there's no evidence of any research chops, and of the anywhere from five to eleven employees, only the founder (and second author) seems to have any medical credentials. Other than that, only a General Manager, a VP of Sales, a Science Editor and a "Scoence Editor" [sic] are listed on LinkedIn, which might not bode well for attention to detail. Apparently, QuartzClinical's Director of Sales Marketing might also be an event hostess and model, but if true this is one of the few details that would actually add to Surgisphere/QuartzClinical's credibility, IMHO.

Now, even if one were to discount entirely the company's shrouded history, possible links to Gilead (which is pushing the HCQ competitor, Remdesivir), and that their founder has seemingly been named in three medical malpractice lawsuits just last year, their purported data alone remains quite unbelievable, according to not a few practitioners. On the African data alone (since they've divided it by continent, for some reason), a professor from the London School of Hygiene & Tropical Medicine reckons it essentially impossible for some 40% of their coronavirus deaths to have been captured in hospitals with cardiac monitoring & comprehensive EHRs, from his group's extensive experience in southern Africa; reported smoking rates seem weirdly homogeneous across continents, and bear little resemblance to known rates; the American data appears infeasibly complete. Now, it's one thing if a paper has a discrepancy or oddity or two, I've seen plenty in my time, but the sheer amount of questionables here defies comprehension.

To top it off, it has moreover been noted that it could even be worse if all this data were in fact real and non-fabricated, since this would suggest that the hundreds of hospitals involved had somehow surrendered their precious confidential health records to a no-name startup - including cases where particular demographic data is outright illegal to maintain, as with ethnicity in France. In the first case, only the authors get canned for dishonesty; in the second, one gathers that there would possibly be a lot of interested lawyers circling about.

The public response was as expected
(Source: twitter.com)

In the face of this flood of justified doubt and sniff-test-failing, the company has put out a response, starting by asserting that their findings were consistent with previous retrospective studies in the other Big Four journals (which, note, say next to nothing about prophylactic potential), that their research was completely unfunded (another red flag), and concluded with what amounted to a repeated flaunting of their ISO certifications. On the actual substance of the criticisms raised in the open letter from the scientists, the authors first admitted to the mistake of wrongly labelling an Asian hospital in an official correction, with no acknowledgement of the many other salient points raised in the open letter, or promise of any further clarifications, while insisting that their findings stand.

Unfortunately, these ain't the bad old days of medical research, and I highly doubt that the 201 and counting scientists who put their names behind the challenge would be mollified by such a non-response - and nor should they. Fortuitously, the authors of the Lancet HCQ paper turned out to have published on the less-controversial topic of cardiovascular disease on a subset of the same dodgy data in NEJM, earlier this month. The signatories would send out a similar open letter to the NEJM on June 2nd. Credit to the NEJM, they appeared to have taken a second, closer look at the supplementary data (which could somehow be stratified by country, this time round), gulped, realised there was no way out, and put out an official Expression of Concern by the next day. Their hand now forced, The Lancet had little option but to belatedly follow with a similar statement of their own, and that they would... have the authors independently audit themselves. I suppose that settles it, then.

One senses that some fairly highly-placed heads are going to have to roll over this, as the enormity of this absolute abortion of the scientific process and medical hierarchy unwinds; but first, to put the entire clusterf**k in proper perspective here:
  1. You had a virtually-unknown company, claiming access to unverifiable proprietary patient information supposedly from many hundreds of hospitals throughout the world (that established consortiums helmed by renowned physicians would sweat to obtain a fraction of), write up a couple of papers presenting aggregate data that was wholly improbable, at least to those in the know

  2. Two medical journals widely acclaimed as the two most prestigious anywhere, The Lancet and the NEJM, went on to publish these articles and enshrine them in the topmost shelf of medical literature, after peer-review

  3. The World Health Organization then swiftly latched onto the Lancet paper on HCQ as definitive evidence, to halt their HCQ trials, and signal HCQ's inefficacy

  4. This recommendation from the WHO - who had been regarded as the foremost authority on public health internationally - causes several European countries to follow suit in abandoning their own investigations on HCQ; this, together with other disruptions, clearly impacted millions of lives in the middle of a pandemic

Now, there was no way that this could have gone from Point 1 to Point 4 directly; had Surgisphere and partners published in a third-rate journal, there would have been no possibility that their "findings" on HCQ could have driven global scientific direction. Instead, they had to borrow The Lancet's prestige, that in turn bought them (what remains of) the WHO's heft, which was used to demonize research into what is, to the best of my knowledge, the most practical, accessible and at least mechanically-plausible prophylactic treatment that has been in widespread application for the coronavirus. I don't think The Lancet, the WHO or their many mainstream media supporters can pin this on racists or rightists or "the Russians", for once.

Luckily, a number of countries have begun to follow Taiwan's lead on not trusting the WHO in earnest, with Indian health leaders quickly figuring that the Lancet study was incredibly sloppy, and various African nations continuing with their use of HCQ all along, because can one expect them to wait for a US$1,000++ course of Remdesivir? Meanwhile, the White House - so often at the cutting edge of scientific research - has okayed the delivery of two million doses of HCQ to longtime friend Brazil, over the outdated advice of Dr. Fauci (who has disappointingly been talking Remdesivir up despite scarce better evidence, which is probably why he's beginning to get ignored) on CNN. Retrograde Democrats in the House Foreign Affairs Committee and various congressional campaigns have only escalated their attacks on HCQ, because it's not like these people keep up with breaking exposés from Science.

To me, there remain two major "whys" - first, why did The Lancet have to print an egregiously-substandard piece of work, to further discredit HCQ? The various other big journals have already done their part, with technically-valid-if-inherently-biased retrospective studies, which generally compared the outcomes of particularly-sick patients that had been given sometimes strangely-high doses of HCQ as a Hail Mary, against generally-healthier controls; certainly, mainstream newspapers wouldn't bother to explain such subtleties; look at the New York Times not bothering to mention HCQ anywhere in the headline of their "report" on #Lancetgate, while being happy enough to scream "HCQ!" on negative articles. It wouldn't have been difficult to manipulate the public into being wholly against HCQ, had the corrupt corporate media simply kept this tack up.

So, it has come down to this?
(Source: twitter.com)

Some have suggested that it was down to ego, perhaps some CCP influence, and a desire to validate left-wing views (including past controversies where they seemed to loosen standards where surveys/papers concerned the Iraq War, and U.S. gun control) and discredit TRUMP, at least in The Lancet's case. A prominent statistics professor from Columbia has ironically pinpointed the most damning criticism, which came from a certain British activist editor. Which brings us to the second why - why stack the deck to this extent, against an approach that might well help? Heck, I am hardly certain that HCQ plus whatever is a steel-plated prophylactic/cure, but isn't it the point of science to give it a fair go?

Look, it's one thing if politicos shitpost "stout man morbidly obese", "ugly woman sick" or "black people ain't black if they don't vote for me"; but this is supposed to be science, and not only that, public health. One really shouldn't politicize it, whatever moral high ground they think they occupy, because everyone deserves the same opportunity to medical care, however ludicrous and unfounded their political inclinations are. There was simply no call for The Lancet and other prominent medical journals to put their grubby thumbs on the scale. I'm watching if the various medical celebrities playing up the Lancet study do the right thing here (but a brief glance suggests not, given they're popularizing statistics without even normalizing for total population here), but one expects that, in a responsible world, The Lancet and the WHO are going to take a yuge hit.

Now, I could be entirely wrong here, of course, and Surgisphere etc. could indeed produce convincing evidence that the data from their 671 hospitals are real to the satisfaction of the open letter signatories, in which case I would gladly make a grovelling apology. However, if I were a betting man - and I can be one, under the right circumstances, such as this one - I'd bet not. Let's just hope The Lancet doesn't take twelve years for this retraction, then.

comments (0) - email - share - print - direct link
trackbacks (0) - trackback url

Back to top

Copyright © 2006-2020 GLYS. All Rights Reserved.