Covid-Lancet-PART-2 (002).doc
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Re: FW: Covid-Lancet-PART-2 (002).doc
 
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Good effort from your part, but not good enough for me. Everyone on earth makes honest mistakes, that's different from deliberate BS. I quote from the reference you gave: "Reading Gillespie's response, I don't think he was being deliberately misleading. I think he genuinely does not understand the article he co-authored" I quote further from your reference to support my view that there is no evidence that Gillespie is accused of deliberate BS: "Like I said, I obviously have different ideological preferences than Gillespie and other libertarians. But he isn't serving his audience very well. He's a pretty good writer, but he doesn't understand these issues at all. He thinks he can make up for his lack of understanding by relying on a co-author who, by dint of her total fealty to libertarian dogma and the ability to throw around a few numbers, has him convinced she knows what she's talking about. In reality she's a total hack. I really advise Gillespie to confine himself to subjects he understands (motorcycles? picking up chicks with a snap of the fingers?) and find a fiscal writer who is able to make the libertarian case from factual premises. " Accusing Gillespie of not understanding the issue is fair, but it's totally different from accusing him of deliberate BS. A bit off-topic, I find styles of arguments like the above annoying. Why accuse Gillespie of picking up chicks? Not wrong, it's obviously not meant seriously, but IMO it degrades the quality of the discourse. I like listening to the opinions of people with different world-views, but because there is so much information out there one can't listen to everyone. If a person uses a style like that I choose to ignore him. On Sat, 8 May 2021 at 00:22, uǝlƃ ↙↙↙ <[hidden email]> wrote: Yes, you're doing a good job of laying out why one's stance on some issue can be inertial, robust to perturbation. And it's useful to note that "trust" is a spectrum. I don't trust Reason, especially not Gillespie. But that doesn't mean I don't read it and, however, negligibly, fold what I read into my world view. Further, to be clear, I don't think anyone believes it's possible to persuade you out of trusting Reason/Gillespie. That's not the point of calling his assertion bullsh¡t. The purpose of calling bullsh¡t is to highlight biases. - .... . -..-. . -. -.. -..-. .. ... -..-. .... . .-. . FRIAM Applied Complexity Group listserv Zoom Fridays 9:30a-12p Mtn GMT-6 bit.ly/virtualfriam un/subscribe http://redfish.com/mailman/listinfo/friam_redfish.com FRIAM-COMIC http://friam-comic.blogspot.com/ archives: http://friam.471366.n2.nabble.com/ |
Re: FW: Covid-Lancet-PART-2 (002).doc
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In reply to this post by Pieter Steenekamp
I have a friend who did a long stint in Ghana with the Peace
Corps and contracted Malaria during that time and was quite
consumed by it by the time he chose to return to the states. He
reported (when Hydroxychloroquine came up as a possible remedy for
COVID) that he went through a number of high dose courses over
(many?) months and while it did help him significantly beat it
down, it was not without severe side effects (at those doses) and
he *personally* believed that while it was a likely candidate for
helping with a wild-card virus like COVID-19 that it was a risky
thing to prescribe/use indiscriminately, if not for the health of
the patient, for the squeeze on the supply for the myriad other
uses it IS highly vetted for in the third world. He seemed to
believe that if COVID-19 demand took more than a minimal number of
doses off the 3rd world supply (or raised the price), the net
result would be not-a-good-thing by humanitarian standards. If SoAfrica, for example, boosted Quercetin production to meet
your presumed need for broad use there, then it may well be a good
thing if not taken in the doses that my friend had to take
(apparently) to beat Malaria down. He believe he still has
residual effects from both Malaria (the illness) and
Hyrdorxychloroquine (the cure) and wants to believe that he is
overall better for having taken it, but mostly because he wants to
believe that the docs were "doing their best", even if the cure
did more damage than the illness. With that background I didn't have a problem with Trump taking
the drug or even acknowledging it *might* be helpful, but I
interpreted his endorsement as implying a "miracle cure" whilst
paradoxically trying to dismiss any worries about the Virus itself
and the lack of positive evidence the it was effective and the
lack of negative evidence that the side-effects may be worse than
the illness it was intended to relieve. His schtick on the topic
was, for lack of a better term, "very Trumpian". That does not
mean he was *dead wrong* about hydroxychloroquine... but imagine
if he'd decided to dump all the support that went to vaccines into
boosting production/delivery of hydroxychloroquine? Maybe South Africa will be a testbed for that strategy? Do you
have any idea how extensively Quercetin is being used for COVID in
South Africa? Do you know if it is also used as a
general-purpose anti-viral for other viruses (as it apparently is
in more equatorial regions) like Malaria. I just (re)read your
post and realized you said "natural, over the counter" so it
sounds like neither high-doses nor widely *prescribed* though
maybe widely heralded/promoted? In any case, I hope that your over-the-counter wards are helpful
to you and yours. I'm an anecdotal fan of Zinc/C for helping me
with at least the symptoms of cold/flu even though I generally
eschew all supplements/medication (my Luddite thing). I suppose
I might dose with those if I had COVID symptoms or exposure...
and assuming your Quercetin is low dose, maybe even that, as long
as it didn't line Donald Trump's pockets of course... As inefficient as it is for every country/region to have a
modesty different approach to a pandemic like this, I'm not
inclined to vilify those who ended up "guessing wrong". It is
easy to armchair quarterback (in hindsight) the decisions made in
other regions of the world with significantly different
circumstances. I'm guessing (but don't know) that South Africa's
infection and death rates may be closer to Australia than India?
I also don't know if your lack of vaccines is a global supply
problem, a government policy to not pursue them as heavily, or
some unexplained coincidence? On 5/6/21 2:23 PM, Pieter Steenekamp
wrote:
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Re: FW: Covid-Lancet-PART-2 (002).doc
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In reply to this post by Pieter Steenekamp
On 5/6/21 3:02 PM, Pieter Steenekamp
wrote:
The inner-antagonist to my inner Luddite *wants* very much to
believe this could be true, the tech has been evolving so quickly
on this front I haven't even taken the time/effort to ask my
Virologist (Flavi not Corona) daughter about these
assertions/speculations. My growls about hypertechno-philic/utopian things are maybe
aggravated by the fact that I was once very much in that camp
(there is one more judgemental about smoking than a former
smoker?). I really did (want to?) believe that we could outrun
the crashing wave of unintended consequences collapsing behind us
(if we dared look in our rear view mirrors) from our *previous*
techno-solutions. I'm not trying to predict, for example, that there will be any
specific unintended consequences of widespread advanced mRNA
vaccines being developed maybe specifically *because* we had a
COVID pandemic in 2020 (did COVID do us a solid by threatening us
so relatively (existentially) mildly?). I DO accept Glen's point
(riffed off Dave's question) that techno-cultural evolution is a
valid way to adapt (and likely the dominant one?) to a (wildly?)
changing biosphere (and/or climate-sphere). I just can't let go
of my suspicion (bias, paranoia?) that it is so much easier to
ignore unknown risks than it is to accept/face the known ones,
that we are literally constantly Red Queening our way along,
thinking we are getting aheader and aheader when in some ways we
are doing perhaps just the opposite. I appreciate some of the quantitative facts that come with the
likes of Pinker or Kotler/Diamandis (Abundance) and have a hard
time not acknowledging the miracles of modern medicine, food
production, energy distribution HAVE raised the quality of life
for many if not most in this world. But I'm not sure that the
consequences (exponential population growth, widespread species
collapse, deforestation, ocean acidification, climate change) are
balanced by that good. I sense that the built in systemic delays
are such that by the time we notice a consequence of any one of
these things that we are too invested in the cause to acknowledge
the effect, and in some cases (Greenland Ice Sheet anyone?) we may
well be past tipping points *even if* we could abruptly blunt the
drivers acutely.
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Re: FW: Covid-Lancet-PART-2 (002).doc
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In reply to this post by gepr
> Well, FWIW, posts like this help me. I'm particularly susceptible to over-simplification, especially when it comes in an optimistic package. I need all 3 of realism, pessimism, and cynicism to keep my episodic forgetting in check. In particular, here, your remembering: > > • the complicated calculus in trusting agencies under cronyism, > • all the social chaos (BLM, right-wing rallies, etc.) coinciding with COVID-19, and > • that each attempt at expression should be as authentic and error-correcting as possible > > I need continual (not periodic, not discrete) reminders of that last one. Thanks. wow... "what HE said!". I so appreciate both of your superlative analytical/summarizing skills. By form Eric's rant here looks a lot more like my rants than any I've seen before, but the concise on-point aspect of the content is totally out of my range to generate. And Glen's skill at finding essences and summarizing succinctly is exemplified here! This is not to say that others don't achieve similar heights on a regular basis, but this just caught me as a one-two punch. And I know neither of you need my cheerleading. nevertheless "go team!" <channeling Nick?> - Steve > > On 5/6/21 3:38 PM, David Eric Smith wrote: >> Pieter, there is a good conversation to have here, but these bastards who seem committed to doing _everything_ in bad faith irritate me to the point where I spend time writing FRIAM posts instead of doing anything that will _ever_ benefit anyone or accomplish anything. >> >> Yes, the mRNA platform is great, and should be a geme-changer. Let’s pursue that topic. I’m fully with you on that. >> >> And? >> >> Oh, human challenge trials are an “innovative technique”. They also explicitly violate the Hippocratic oath. Do we fail to do them for no particular reason, or has someone thought about whether the Hippocratic oath is an important consideration? Dunno, hmmmm. How would one decide? >> >> Oh, public health people admonished Americans away from buying medical masks early on. Clearly just because those bureaucrats are so dead set against efficiency. We haven’t had that conversation ad nauseam on this channel already? We know why they did it; they are communicating to Americans, which is like communicating to a troupe of Tasmanian devils surrounding a roadkill. They know their words have consequences, and they feel the weight of that responsibility. Then, sometimes they also make mistakes. Do we criticize to correct, or exploit to destroy? >> >> And, just by the bye of things not mentioned. Let’s do a ballpark of what the best-case scenario might have been with very proactive response and people really trying to work together, like maybe some events in US society in WWII. Instead of having spent maybe USD5Tn by the end of the trump term, with — what was it at the time — something like 450k people dead, I could imagine that with a scaled-up S. Korea like response, the economic support could have been maybe USD 1Tn to 1.5Tn to achieve a similar backstop, and maybe 100k people dead. That would have been _really hard_ to pull off, but it is the kind of hard that good countries aspire to and sometimes achieve. And the fact that _all_ that didn’t happen is clearly to the fault of some public health people who didn’t know early how much transmission was fomites and how much respiratory droplets? Or trying to redirect masks to hospitals? The public health people were _against_ testing? I believe that last claim is >> flatly false, and overwhelmingly documented to be so. There was nothing else going on at the time? Hmm, can’t recall. Or since? Or still, even worse? How would one tell? And Americans have a great record of really being supportive of each other, and using great reasoning based on all the best evidence, but were just thwarted again and again by the public health officials and agencies? >> >> And the vaccines were developed so rapidly, this time only because the agencies removed obstacles that they could have removed any time. Well, for the adenovirus vaccines (a largely established technology) there is a claim to that effect that can be made fairly. But of course the article puts up the mRNA vaccines as evidence of how, because the agencies got out of the way (is implied), BioNTech and Moderna had vaccines in a few days. That is deliberate BS, and I doubt the writer is such an idiot that he doesn’t know it. (cf. the very useful article in NYT a couple of weeks ago on Kariko and a little about the history of mRNA update and expression research.) They were done in a few days because of 30 years of work, much of it publicly funded, that was waiting in the wings, and had been postponed earlier, and only pushed through now, only because there hadn’t been a disease structure that enabled the (non-human-challenge) trial at a price the companies were willing to >> pay. The disinformation on that simple matter of fact has been wonderfully employed by those who will now ensure that we have an endemic, no longer just a pandemic. >> >> And now there is a fight on about suspending patent limits on vaccine production to open to more operators, and the companies argue that it wouldn’t make any difference because it is current capacity saturation that limits us (Jon’s DW news articles yesterday, which the Canadians say is false even now), deliberately bypassing the obvious intent of the suspension that capacity can be built by more actors in parallel, going forward from now. The company objection is that it would not be capacity _they own_, cf my rant from yesterday. But sure, now that the technology _exists_, clearly everyone will be fine. I find that foreshortening of the conversation harmful, because it is again anti-empirical. We are not distributing the technology we have well enough to evade an endemic — the needed and productive conversation is in large part WHY that is occurring, and what we want to change. These guys will tie themselves in any knot to distract from a real version of that discussion. >> >> So I don’t object to all the good points you raise about mRNA vaccines and their potential. I feel obliged to notice, however, the specific strategy by this klatch of writers, of using the techno-points to obstruct the conversation about human cooperation, which is immediately actionable, and responsible for a large part of the shortfall. Because the empirical discussion is in large part a discussion about the restraint of POWER. They live to prevent that discussion, and they will take us all down with them if they succeed. >> >> There is a thing we do, that they exploit. If they include a few statements that aren’t false in an overall framework that is deliberately distorted, we all bend over backward to grant them standing because a few things they say overlap with the truth. Maybe at first, a little. But conversations have a pragmatics and it is relevant. >> >> So, onward… >> >> Eric >> >> >> >>> On May 7, 2021, at 6:02 AM, Pieter Steenekamp <[hidden email] <mailto:[hidden email]>> wrote: >>> >>> I know I run the risk of responses like "it's Pollyanna, oh sorry I mean Pieter, again", but I'll take the risk and share the link with the speculation about technological progress with mRNA vaccines that will end pandemics like covid. >>> https://reason.com/video/2021/05/06/why-covid-19-may-be-the-last-pandemic/ <https://reason.com/video/2021/05/06/why-covid-19-may-be-the-last-pandemic/> >>> > - .... . -..-. . -. -.. -..-. .. ... -..-. .... . .-. . FRIAM Applied Complexity Group listserv Zoom Fridays 9:30a-12p Mtn GMT-6 bit.ly/virtualfriam un/subscribe http://redfish.com/mailman/listinfo/friam_redfish.com FRIAM-COMIC http://friam-comic.blogspot.com/ archives: http://friam.471366.n2.nabble.com/ |
Re: FW: Covid-Lancet-PART-2 (002).doc
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To answer above questions about Quercetin and vaccines in South Africa a) Quercetin is, to my best knowledge, not widely used in South Africa b) The lack of vaccines up to now seems to be just some South African botch up, I don't have the details, but the vaccines are coming Just some interesting facts. A friend of mine has three children who are married with children and living overseas. One in Sweden, one in Norway and one in Portland, USA. In December 2019 all the children and families visited him here in South Africa and some of them became very ill. The doctors could not diagnose them and they were hospitalized and recovered in full. My friend tells me that in hindsight, after details of covid emerged, he is convinced they had covid infections. On Sat, 8 May 2021 at 08:24, Steve Smith <[hidden email]> wrote:
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Re: FW: Covid-Lancet-PART-2 (002).doc
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Pieter - I have a LONG list of friends/family who think they had COVID as
early as December 2019. Being a Skeptic unto Cynic especially
about health matters, I suspect *most* of them of making it up for
one reason or another. None were hospitalized, several are
borderline hypochondriacs, a couple wore their (potential) COVID
infection recovery as proof of their fitness/robustness. None got
COVID tests (not easily available at the time or not yet even
suspected, just in hindsight). Your anecdotal group is probably
drawn from a very different sampling than mine! Glad they all
came through. I haven't checked lately with my Swedish colleagues, I hope they are coming out of the woods they were wandering into with attempted low-key herd immunity. My UK colleagues are hunkered down but report it being semi-tragic there, my NZ friends are jeering at all of us, my AU friends are resenting the international travel limitations their low case numbers but low vaccine rates have lead to, and my Ukrainian friends have a lot more to worry about right now than a slow-rolling global pandemic (internal and external). I don't believe we have heard from our (one?) member here from the Indian Subcontinent (Sarbajit?) and hope that does not reflect anything dire for him. Mohammed E-B (retired from or passive on this list) in Egypt/Sweden hasn't reported recently. A friend expatriated to southern MX who is one who thinks she already had it and is "sure she is immune cuz she's tough as nails" says the incidents are low in her region. Glad to hear from Gary in Ecuador from time to time. When in history could most of us have this kind of spread of first hand reports so easily? I think it is going to be a long time before we can really say
"this Pandemic is Over" though the US (and much of EU?) is acting
as if it might be for us in the next few months. In the fullness of time... - Steve On 5/8/21 1:13 AM, Pieter Steenekamp
wrote:
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Re: FW: Covid-Lancet-PART-2 (002).doc
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In reply to this post by Pieter Steenekamp
Pieter, hi and thank you,
Yes, very good. Let me respond to your root post here, in parallel with whatever other branches may have grown from it. I want to note that the points in Glen’s first reply to the same post speak well for the things that animate me, and are better worded than mine. So I won’t recap them, but want to acknowledge and share endorsement of them.
So very good. I took hours thisAM writing a bunch of awful stuff, feeling stupider and stupider for having written a screed instead of a good argument yesterday, and realized I have to re-examine what I am responding to. I think my objection is to a salience structure of the article that I think grossly miss-apportions credit and fault, in a way that is not only unfair but that supports an anti-public and anti-institutional point of view that is harmful in many cases where it succeeds. So let me list for you what I experience as the salience structure, and what I would replace it with that I think would be more fair and also a better foundation for decisions. I am not complaining about any of Gillespie’s facts. Those he quotes that I know are consistent with what I understand from other sources, and I don’t doubt the veracity of those I didn’t know in detail. So here’s what I read in the paragraph you quote above: *. Natural timescales for production, accomplished by Companies, were very fast. **. What Government provided was a vastly longer and unnecessary gap, which didn’t have a good reason to exist. (Then, to adduce evidence) 1. Companies invented formula for vaccines (only the mRNA ones mentioned): pertinent timescale was 2 days. 2. Company partnered with other Company for production, Company produced a first human-injectable product; pertinent timescale was a bit under 2 months. 3. Government, Regulator, with Mandates, stepped in and 9 months were spent needlessly 4. Because of those 9 lost months (or some unspecified subset of them), some hundreds of thousands of people died needlessly. Here’s how I would have written a salience analysis for the first part — I will come back a bit later to the last two points, both their substance and how Gillespie renders them. -2. Government funds mRNA uptake and expression research, but just barely and precariously. Academic labs keep getting shut down, and their directors go to Companies, where that work is not in the portfolio. Somehow, remarkably, it does get pushed through to a working system; the outcome could easily have been quite different; pertinent timescale: 30 years, during which much of the cost and all of the long-horizon risk is carried in the public sector. (Could be, however, that Company grants do contribute at places, and perhaps fill in key steps that happen to fall on the timelines they can support. If so, note it.) -1. Government (Obama admin) seeds startup in thermostable lipid delivery systems for mRNA; pertinent timescale is 5-10 years. (I don’t know BioNTech’s history or who funded it, if it was Company funded as a venture, that matters and should be noted. If public, then that.) There are no products in either country, because the disease targets turn out to have either low enough severity and sales potential, or small enough coverage that it requires too-large clinical trials to get statistics, for any Company to be willing to foot that bill for an unproven technology. 0. Technology sits around and skowly gets more mature, but has no clinical trial testing history beyond basic safety of the delivery system. 1. mRNA vaccine Companies are finally able to pull the trigger on the gun that has been sitting loaded for years, and provide a formula in a couple of days. EXCELLENT — CREDIT TO ALL INVOLVED. Standard technologies, like adenovirus technologies (I think not mentioned in this article), were already ready and are fairly quick, though less so because of the inherent limits of the technology. STILL EXCELLENT. 2. Companies partnered with other Companies for production (GREAT — JUST WHAT THEY ARE SET UP TO DO). Some important Government regulatory protocols that normally are serialized get parallelized because of the singular circumstances. Potential testing timeline is shortened from typical 3-5 years to potentially less than 1 year if we get lucky. (We should come back to why they are normally serial, and whether even in light of what we have learned, they would be reset that way anyway because it costs less and is acceptable for many routine procedures. If not, and we want to go parallel, then that’s a great prod to innovation prompted by this pandemic.). In any case, first human clinical trial; pertinent timescale: a bit less than 2 months. ... etc. So, the way I responded yesterday, which you quote, is both needlessly rude and also unclear; thank you for pushing back. Let me be careful in the next, and reply to your exact words:
I wasn’t attributing that as a Gillespie claim; I was taking that as a factually roughly-correct description of what really happened. It is probably right that the “design of the formula” isn’t the same as “having the first vaccines”. However, RNA manufacturing is an off-the-shelf technology, which both these companies almost-certainly have in-house and don’t even need to go across town to get. Since the lipid delivery platforms are their product, the transition from sequence design to first injectable droplets was probably very fast; an assembly of components already on hand in their own shop. If they do get their RNA from a foundry, for a high-priority project they could probably get it made in a day, across town or via airmail. It probably took a bit longer to get enough production to run a clinical trial — that could have been weeks or even a month or more — but that is production scale-up and consistency checking, all exacting but established Pharma technical stuff.
What I was saying here was the I don’t think Gillespie is at all an idiot. Therefore I expect he understands well that the rapid delivery of the first mRNA vaccines (specifically) was putting the cherry on top of a sundae that had been a long time in the making, with the biggest foundation being public, and essential but timescale- and risk-limited roles for companies in partnership. My objection was the salience one above, putting up short timescales for that turnaround as if they were the natural timescales of the process, mentioning them only in association with Companies, which then only Big Regulatory Government with its Mandates came in and broke down. If he had talked _only_ about the adenovirus vaccines, already established in company production lines, rolled out unusually quickly (to their credit, in just the way he says generally), and with a history of clinical trial evaluation of essentially the same technology, then his discussion of regulatory roles would have indeed focused on the only remaining discretionary variable in affecting the time of the public availability. Everything else was more or less constrained. Only mentioning the adeno vaccines would have been a lot less compelling rhetorically, though, since J&J is a minor player in the US, Astra not yet at all (in the US, unless it has been approved and I haven’t kept up), both are slightly less-flashy by the efficacy numbers, may have more limited scope for use in boosters if there is immune response against the viral vectors that disables the delivery system in second doses before it can deposits its payload, and also have rare inflammatory side-effects that have been enough to give them some negative PR (though do not change the fact that they are excellent vaccines). Yet I think the only companies he mentions are the mRNA ones, for which the turnaround timescales are shortest and most impressive, and seem by comparison to make the Government Regulatory timescale look most blameworthy. That is what I felt is disingenuous. If you are going to use those as the standard for government responsiveness, why not mention that the most impressive timescale is that they exist at all, and which actor ultimately made the difference between now and never? But let me let that part go. You may still find my objection unjust as well as inept. I do want to respond to the points 3 and 4 above, though, because they are part of a tone that undoubtedly was what I was ranting against. The specific sentences are: "Had the agency been faster off the mark and used human-challenge trials and other innovative testing techniques, the vaccines could have been brought to market months earlier with no compromise in safety. That would have conceivably saved hundreds of thousands of lives globally” I want to flag where I think this is specifically manipulative, and suggest what I think would be a more correct and productive framing. Those two sentences are an assertion about constraint and causation, meaning that removal of a constraint would have caused a better outcome. Of course, they are not literally an “assertion", since everything is framed in conjectures or conditionals. That’s how lawyers and debaters talk. But with a clear intent to have the reader conclude what they only express as conditional. Let me give an ad absurdum for why I say it is a bogus assertion of causation. Not that the ad absurdum is a great literal model of the Gillespie language, but so I can be unambiguous about the structure of the argument I want to flag. Here: 1. This pig doesn’t have feathers. 2. Feathers have all these important functional roles in flight. 3. If this pig had features, he could fly. Why is that a bad argument? After all, each of the first two points is incontestably true. It is a bad argument because there is a complicated multi-factor relation behind any “true” concept of cause. The above not only leaves out things, it does so in a way that is designed to distort. There are probably many reasons this pig (and others) don’t fly. For instance, maybe they just don’t want to. A careful man might worry that, even if the pig had feathers, he still wouldn’t want to, which would keep us from concluding he “could fly”. So, if the FDA approvers had been faster off the mark “could” the vaccines have been brought to market faster? (Btw, great language; keeps our minds in the right frame: they are not “made available to people”; they are “brought to market”.) “Would” they then have saved hundreds of thousand of lives _worldwide_? So let’s go through some context-seeking questions. 1. [dumb and annoying: worldwide?]. FDA is a US agency. How much do we think that US FDA approval of vaccines made in the US could have saved lives worldwide in 2020? (Is Moderna even used outside the US? Have any vaccines originally bought by the US government from either Pfizer or Moderna been distributed outside the US?) Does Astra's use in any country besides the US depend on US approval? So the “worldwide” looks to me like a red herring, put there to allow bigger numbers who “would conceivably have” been saved, but not real. 2. So let’s be a bit more conservative. It could/would have saved how many lives in the US then? Hundreds of thousands? That is a reasonable number to have been saved. Do we think vaccine approval on any achievable timeframe is the major, or even an eligible, factor in their not having been saved? In my email yesterday, I used the snarky language “There was nothing else going on at the time? Hmm, can’t recall. Or since? Or still, even worse?” Glen, in his reply late-night US, I think was reminded of BLM and other social upheavals, perhaps by that comment. Those are true and also relevant, but had not been in my thought at the time of writing. I was referring, rather, to two HUGE things going on at the time: A. Almost every federal agency had had its chief offices staffed by people who were either out of their depth or incompetent, or put there as deliberate saboteurs. I would class Redfield at CDC as out of his depth and incompetent, but not a saboteur. Azar was a kind of flatly-unqualified lackey, though probably less than a pure saboteur. Giroir may have been tolerably competent, and in any case did some things okay. I forget now exactly what I thought of people like Stephen Hahn heading FDA at the time, when news was more immediate. We do have names of various others who were harassing, interfering in, and distorting the output of, multiple officers within CDC. Again, I forget which people and which news articles, but all that can be dug up. Anyway, to get to what matters: I think it is fair to say that FDA and CDC committed a couple of important errors early on (CDC in not allowing tests to be used just bypassing a superficial third screen that wasn’t essential, or accepting early German designs), FDA (maybe, though I want to revisit their reasoning) in blocking universities or others from participating on various things (was it testing?) Some of that could have been creeping incompetence within the agencies; it’s fair to ask. Maybe some of the choices were actually hard, given standing rules and available information. But I think it is sure that all of them were operating crippled, internally disrupted, I believe on cut funding and cut staffing in many cases, and certainly not by any means in their best form. We saw the same people, under good leadership, do much better, for instance under Tom Frieden on the ebola response, so I think we know they can. To criticize agencies while they are under attack by a government whose goal is to make them fail so it can eliminate them — not mentioning that any of that is going on — while suggesting that if they could be moved aside either the same government would save lots of lives, or that the lives would somehow get saved by other means not relying on the government (a question on which we have good data from the current administration’s role), was one thing I was calling a BS move. B. In parallel with the undermining of institutional function officially within the administration, there was an active and full-time campaign to amplify conflict and dysfunction in the public. It was in place at a kind of baseline from the US right-wing media before the last presidency started, added a whole new circus show starting with trump for the first six months of 2020, and then propagated down through the whole republican apparatus as the year went on, becoming even more fanatical and destructive now that he is out of office. We now have the vaccines and 30% of the country won’t use them; I am comfortable suggesting that those people were the same in 2020 as they are in 2021. Once masks were being advocated (after the early-year mess about how to handle that, as we discussed), during the long period when public health measures were _all_ we had under the best conceivable vaccine outcome, and when every country in the Eastern Hemisphere was using them to good effect, we still had half the country refusing to wear them, and all but a few right-wing politicians pouring fuel on that fire as fast as they could carry it. So it is not idle of me to say that the political effort had a strong causal role in what could or could not have been done, or what lives would have been saved by vaccines “because" there weren’t other ways to save them before. and “because” they would have been used afterward. Not only not admitting, but indeed choosing not to mention, the constant and committed role of the political right in sowing confusion, mistrust, belligerence, and sociopathic behavior as an important factor in what could/would happen in the US, is what I call a second deliberate BS move in the Gillespie presentation. (Note: I do understand that not every bad behavior in the US came from right-wing political forces. No country in the West did well, compared to many in the East, presumably because the East had experienced SARS and MERS and took these things seriously. Likewise, we learned since that the trump government didn’t have much of a plan for distribution in place beyond shipments to states; that, together with states limited by budget crises, also affected availability post-approval. So, many factors go into how much difference in mortality really turned on some number of months’ difference in FDA approval time.) Next, let’s come back to the wording “ with no compromise in safety.”. That was my point in the Hippocratic oath. I believe that is bogus several ways. Here again is the ad absurdum: I ran across the highway and didn’t get hit by a car, so clearly there wasn’t any risk in running across the highway. Nobody thinks that’s how risk assessment works, so insinuations that because some particular thing is found ex post not to have gone wrong, that shows that there would have been no compromise in not checking for it ex ante, looks to me like deliberate distortion. Please recall that when the mRNA vaccines were first found to have 90-95% efficacy, people were floored. They were hoping to get above 50% for symptomatic disease. If the vaccines had been in that expected performance range, and human challenge clinical trials had been done, how many people would have been expected to get sick, possibly severely, possibly with long-term problems, or possibly dying? Some. Not none. If a human-challenge trial had been designed to get comparable statistics to those delivered by the 66,000 people in the non-challenge clinical trials for Pfizer and Moderna taken together, maybe quite a few. Medical risk assessment is hard. There are lots of occasional but very consequential troubles that arise with such mundane things as flu vaccines — cytokine storms and crippling encephalitises, etc. (I happen to know a woman, since deceased, who lived for decades with brain damage from a flu vaccine that just happened to hit her the wrong way.) This is why approvers are careful. Yes, lots of people died in the months before a vaccine was available. How do we assess that fact, when other public health measures that could (as we know with certainty) have saved some of them were not used? Glen did mention another thing, about trust in institutions, that is dead center to this question. If I wanted to do the unpleasant thing that debaters do, I would trot out Media Trope #15 that is currently going around every outlet: Black Americans say they don’t want to get vaccinated because they don’t trust the government because of the Tuskegee syphilis trials. Good reason, but of course it is embedded in a fabric of institutional distrust that is a tilted playing field for _everything_ a government agency has to do, with every constituency for one or another reason. And that is the center of the Hippocratic oath. The reason doctors won’t do things, even if the patients are desperate and would approve them, is partly because doctors are trying to preserve medicine as a practice that can be trusted. One thing that did or didn’t go wrong in one vaccine roll-out — called after the fact — is not the relevant context for a decision structure. One could go on and on about threads in that fabric. The awful Harvard psych experiments that get trotted out because they were used on Ted Kaczynski, the LSD experiments on US servicemen, all of anatomy that was written using data from Nazi doctor dissections, for which reason it was withheld from use in medical schools for decades even though ti was the most complete data available. I don’t even know how much else across countries and wars, because I am not informed on that topic. All these together make up the decision context these agencies work under, and I think to be fair one must grapple with the difficulties that result. That brings us back to whether the FDA approval timeline, which would have been the major available expediting variable for the adeno vaccines Gillespie doesn’t mention, really had the same relation to the mRNA vaccines he does mention. I don’t think it does. Precisely because nothing had been through full clinical trial, and because mRNA is a rather different insertion than viral DNA, I think the standard for caution with the mRNA vaccines had to be much higher. We appear to have got very lucky (on the shoulders of much good design), and they seem likely be even safer with fewer side effects than viral vectors, as well as better for boosters, faster roll-out, greater mass-production scale, etc. But before 100M people got vaccinated, that wasn’t known. Anyway, I’ll stop. I have probably driven you mad with tedium if you have read this far. It’s shocking and appalling how much better a writer Gillespie is than I am, isn’t it. Eric - .... . -..-. . -. -.. -..-. .. ... -..-. .... . .-. . 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Re: FW: Covid-Lancet-PART-2 (002).doc
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Eric, Thanks very much for this reply, I really appreciate it. To be honest, I admit I was probably a bit *naughty* in referencing Reason in my comment about the mRNA technology. I could just as well have summarised the technology and my enthusiasm for the potential benefit for humanity in having this to fight viruses in future, without referencing Reason. If my son in law was part of the discussion he would have done what he often does when I do something like this - he would have handed me a spoon, indicating that I'm just stirring. To emphasise the key point I wanted to make, I'm quoting your description of mRNA vaccinations: " they seem likely be even safer with fewer side effects than viral vectors, as well as better for boosters, faster roll-out, greater mass-production scale, etc." So, on my original key point you and I seem to be in some sort of agreement. (Note to self: be more careful to use the spoon in future) Pieter On Sat, 8 May 2021 at 09:50, David Eric Smith <[hidden email]> wrote:
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Re: FW: Covid-Lancet-PART-2 (002).doc
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Hi Pieter,
Yes, as I also said in the earlier post. From what we can tell so far, these mRNA/lipid vaccines look like a technology that really matters. Earlier in 2020, I wasn’t paying close attention to the technology (attention in other areas, and I didn’t know that there was a big technology deal in the offing). A colleague who works in academic/research partnerships, and is a close associate of my boss at the time (a microbial molecular biologist), was emphasizing that this is a big deal. That was what got me to start paying attention. I believe the following thing is correct to say, but it is outside my daily work (though bread and butter for a lab I work in, so I should know it), and I could be wrong: I think custom RNA production these days is done by chemical assembly, and doesn’t require a living cell for manufacture (which always used to be the case). If that is correct, then _all_ components of the new vaccine are chemical. One of the slowest and hardest to scale of bio-based vaccines is the gene editing and growth of the cells or viruses or whatever. To eliminate that step and move to an all-chemical platform changes both the cost and the timescale of production. I believe that is also why monoclonal antibodies are slow and expensive. They are proteins, and we have no other ways to manufacture proteins at scale. In labs, custom RNAs are a commodity item; proteins are still expensive. Two weeks ago, I was in a conversation with two younger colleagues who work full-time in cancer biology, where the problem is that even if a known mutation is the source of the problem, there is no direct way to eliminate the cells with that mutation; you always end up doing something at the phenotype level that misses some of what you are after and causes a lot of collateral damage. I was asking them whether there were important techniques in view for using CRISPR on these delivery vehicles to get directly at the relevant mutations. Their opinions is, not anywhere close anytime soon, because there are too many other difficulties that just having a delivery system will not address. But given the nature of technology and technologists, I feel certain those pursuing this area are looking at it as a general-purpose platform, and not one defined by its introductory role in vaccines. I don’t have a context-free desire either to pursue or to avoid any of this, but I would like to be able to understand what exists and what is possible, not only decades after it has become common. We’ll see what happens. Take care, Eric
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Re: FW: Covid-Lancet-PART-2 (002).doc
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There is a story about a frog and a scorpion trapped on an island that's going to explode or something and they both will die unless they get off the island. The frog got ready to swim to safety and the scorpion asked him for a lift. After the scorpion promised that he's not going to kill the frog, the frog conceded to give him a lift. Half way towards safety the scorpion stung the frog and both were about to die. Just before he died the frog asked the scorpion why he did that. His answer was, it's in my nature to kill frogs. Although I promised not to stir, it's in my nature to do so, so here we go again. I know many of you are probably against the Intellectual Dark Web (IDW), so a reference to a card carrying member Bret Weinstein is probably stirring? My knowledge of biology is very poor, but I found the discussion by Bret Weinstain and his wife Heather Heying on mRNA vaccination technology very informing for a lay person like me: https://www.youtube.com/watch?v=ifPjaVL_1yw&t=3s If you can for a moment ignore their political views and listen to their explanation of mRNA you might just find it very informative. On Sat, 8 May 2021 at 12:25, David Eric Smith <[hidden email]> wrote:
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Re: FW: Covid-Lancet-PART-2 (002).doc
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Sirry, I couldn't get two minutes into their chatter before I fled to google. https://www.nature.com/articles/nrd.2017.243.pdf is a Nature Review article on mRNA vaccines from 2018, so a snapshot of a technology prior to covid-19. The mRNAs are synthesized in vitro using phage RNA polymerase, ribonucleotides, and template DNA, products purified using high performance liquid chromatography or something similar to remove double stranded RNA, and packaged into lipid balls. The Moderna specifies modified nucleosides, meaning not the common RNA bases, which reduces immune response to the RNA itself. The Pfizer-BioNTech didn't specify. (Apparently there are mRNA treatments which package viral RNA amplifier enzymes on the mRNA, not relevant to these vaccines, though.) Note that "2 days to vaccine" is comparing the final step in vaccine manufacture. There are months or years of work before that step to develop the virology, molecular biology, immunology, mRNA and protein engineering to the point where you have a template DNA for any vaccine. And some of those precursor steps will involve filtering out mRNAs that don't transcribe well and protein fragments that don't fold well or fail to have the desired antigenicity, steps which might not be necessary if you were developing a vaccine with another technology. -- rec -- On Sat, May 8, 2021 at 9:08 AM Pieter Steenekamp <[hidden email]> wrote:
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Re: FW: Covid-Lancet-PART-2 (002).doc
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"I couldn't get two minutes into their chatter before I fled to google." I did like, "Your confirmation bias is not my pronlem." --- Frank C. Wimberly 140 Calle Ojo Feliz, Santa Fe, NM 87505 505 670-9918 Santa Fe, NM On Sat, May 8, 2021, 10:45 AM Roger Critchlow <[hidden email]> wrote:
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