Sunday, August 30, 2020

Coronavirus - Sweden

Sweden Has Developed Herd Immunity After Refusing to Lock Down, Experts Claim. Others Point to its High Fatality Rate is an article in Barron's

Sweden's powers that be have been amply criticized for not imposing a severe lock-down by those who want severe lock-downs. The critics projected doom for Sweden. That has not been the case.

Of course, there is some evidence for either side. Sweden's experience is worse than its closest neighbors Norway, Finland, and Denmark, which had lock-downs. On the other hand, Sweden's experience is better than its European neighbors Belgium, Spain, Italy, United Kingdom, and France. Where Sweden's experience stands versus all of them or all countries is hard to say because there are so many relevant variables and differences -- time, ages in population, population density, extent of international travel, extent of testing, personal behavior, quality of health care, etc.

The article claims that Sweden's fatality rate is lower than four countries, France not one of them. It then claims Sweden's fatality rate is higher than France's. This is incorrect if fatality rate means deaths/cases. The following are the numbers from here thru 8/29/2020.

                     cases       deaths        pop.(mil.)     deaths/cases    deaths/pop.  tests/pop.
Sweden:       83,958       5,821         10.1                 6.9%                576          108,299
France:       272,530     30,602         65.4               11.2%                468            94,571

France's death/cases is about 1.63 times Sweden's. France's death/population (millions) is somewhat lower. However,  the article says Sweden's fatality rate is 6.8%, so it must be referring to deaths/cases.

A Market Watch article disagrees with Barron's and is critical of Sweden and its no lock-down approach. It says, "Sweden has an overall COVID-related death rate of 57.12 per 100,000 [571 per million], which is the ninth highest in the world, according to Johns Hopkins University." That's accurate. However, Belgium, Spain, UK, and Italy, all with severe lock-downs, had higher deaths/pop than Sweden.

France's daily new cases is surging again. Sweden's is not. The virus might be less virulent in this new surge. Time will time if France's deaths/pop surpasses Sweden's.

Update 9/1/2020: This article was first published by The Washington [Com]Post. It is highly critical of  Trump-appointed Dr. Scott Atlas, 'herd immunity' and mentions Sweden. "Sweden’s handling of the pandemic has been heavily criticized by public health officials and infectious-disease experts as reckless — the country has among the highest infection and death rates in the world."

Ignored are countries who had severe lock-downs, yet had infection and mortality rates higher than Sweden's. 

The article includes this quote: "The administration faces some pretty serious hurdles in making this argument. One is a lot of people will die, even if you can protect people in nursing homes.” The person quoted is an economist! Yet the next paragraph says, "Atlas, who does not have a background in infectious diseases or epidemiology[.]" How ironic! The Post authors regard an economist with no medical expertise as credible, but a medical doctor as not credible!

Friday, August 28, 2020

How Not to Be an Antiracist

The above title is the title of a Wall Street Journal opinion piece. It is the best thing I have read -- not a lot -- about the new meaning of racism. Since it is behind a paywall, the following in italics are some excerpts.

When properly conceived, antiracist programs can provide a powerful response to hate and bias incidents. The problem with much of today’s antiracism is that it doesn’t really oppose invidious discrimination and may even foment it.

The new antiracism is not, as its etymology suggests, opposition to racial discrimination. Ibram X. Kendi demonstrates this in his 2019 bestseller, “How to Be an Antiracist.” He defines “racism” as a combination of policies and ideas that “produces and normalizes racial inequities.” This racism has nothing to do with individual discrimination. Rather, it is support for institutions that yield disparities. Lest there be confusion, Mr. Kendi emphasizes that “focusing on ‘racial discrimination’ takes our eyes off” the policy goals he and other self-proclaimed antiracists support.

In other words, the new antiracism requires that we take our eyes off what antidiscrimination work is all about—combating invidious discrimination—and focus instead on social outcomes that arise in the absence of racial preferences.

I have not read Ibram X. Kendi's book, but I have seen him in videos and often referenced in articles. He is at the forefront of the new meaning of "racism" and the new term "anti-racism." The book was a #1 New York Times bestseller. It has 6,561 reviews on Amazon with 88% of them 5-star and a tiny percent of 1-star or 2-star reviews. The top of page 81 defines a cultural antiracist as "One who is rejecting cultural standards and equalizing cultural differences among racial groups."

Imagine a person with primary responsibility of selecting players for a professional NBA basketball team or NFL football team. About 80% of all NBA and NFL players are black, far exceeding their percentage of the U.S. population, which is about 13%. Imagine the person pursues all or nearly all white players in order to equalize this huge racial disparity. In other words, skin color outranks any other considerations like playing ability and improving the team's skill-set. 

Somebody might object. That's not what Mr. Kendi means. That person would decrease income for the blacks replaced and the wider goal of equalizing income for the black population. I would reply that objection doesn't follow. Other teams could pick up the black players replaced. What this brief exchange shows is how logically weak Kendi's meaning of "cultural antiracist" is.

An individual being color-blind is not good enough in Kendi's opinion. What counts instead is that society level statistics show no racial disparity.

Is there institutional racism in America? Walter Williams says 'yes', but it is not the kind that Kendi dislikes.

Tuesday, August 25, 2020

Coronavirus - convalescent plasma

The FDA has granted emergency use authorization (EUA) to convalescent plasma to treat hospitalized patients with Covid-19 (link). This is plasma containing antibodies drawn from persons who had Covid-19 and have fully recovered.

A Wall Street Journal op-ed calls the FDA's decision good. The op-ed being behind a paywall, some reading this may only be able to see the start of it. Hence, the following in italics are some excerpts. 

This is what occurred with the anti-malaria drug hydroxychloroquine and now is happening with convalescent plasma, which the FDA on Sunday granted “emergency use authorization” (EUA). Mr. Trump was wrong to tweet over the weekend that “the deep state” at the FDA was thwarting development of therapies and vaccines to sabotage his re-election.

There’s no evidence for his claim or that the FDA is making decisions based on anything but the science. There is, however, ample evidence that convalescent plasma may be effective and that the potential benefits outweigh the risks. This is the FDA standard for EUAs, and the agency was right to increase patient access to the potentially life-saving therapy.

But individuals produce varying levels and types of antibodies in response to viruses, so convalescent plasma from some recovered patients will be more effective. This makes it especially hard to do randomized trials with control groups. The two randomized placebo trials on convalescent plasma were inconclusive.

The evidence for convalescent plasma relies on more than a dozen observational studies and clinical trials that don’t meet the randomized placebo standard. 

Current evidence suggests that benefit is most likely in patients treated early in the course of the disease (e.g., prior to intubation). This make sense. Hospitalized patients in the early stages of the disease tend to have low levels of lymphocytes that produce antibodies. Infusing them with more antibodies probably helps. But patients who must be intubated may be suffering from a cytokine inflammatory storm, which mere antibodies won’t calm.

They [others, e.g. The New York Times] want evidence from gold-standard clinical trials, but these are hard to pull off in a pandemic and often yield conflicting results.

Thousands typically need to be enrolled to prove statistically significant benefits, and trial designs obscure benefits among patient subsets. It’s unlikely that any treatment will show an aggregate benefit among all sick patients because people suffer different symptoms at different stages of the disease.


Of course, and like the op-ed says, others have lambasted the decision, such as The New York Times. What else should one expect from that source? Again, the following in italics are excerpts.

F.D.A. ‘Grossly Misrepresented’ Blood Plasma Data, Scientists Say

But scientists were taken aback by the way the administration
[President Trump, Azar of HHS, Hahn of FDA] framed this data, which appeared to have been calculated based on a small subgroup of hospitalized Covid-19 patients in a Mayo Clinic study: those who were under 80 years old, not on ventilators and received plasma known to contain high levels of virus-fighting antibodies within three days of diagnosis. 

The WSJ op-ed compared the plasma treatment to the treatments dexamethasone and  remdesivir. The two drugs are for more serious cases, but they haven't clearly passed a gold standard either. The New York Times article said nothing about those drugs and them versus the gold standard. It seems the gold standard is for things the NYT doesn't like, but not for things the NYT does like.

Update 8/26: FDA Commissioner Stephen Hahn issues mea culpa for his plasma treatment claims, saying he had overstated the benefits of convalescent plasma as a treatment of coronavirus at a news conference last weekend with President Trump (link).

Update 8/29: A key person behind Stephen Hahn's apology was removed (reassigned, not fired) from her public relations position (link).

Saturday, August 22, 2020

Goodyear incoherence

Goodyear, the tire maker, has triggered controversy with policy rules about what political messages on attire its employees may wear in the workplace. President Trump has urged boycotting Goodyear for its policy rules. This article from a Topeka TV station is about the controversy. 

Another article about the controversy includes this statement: “Goodyear is committed to fostering an inclusive and respectful workplace where all of our associates can do their best in a spirit of teamwork. As part of this commitment, we do allow our associates to express their support on racial injustice and other equity issues but ask that they refrain from workplace expressions, verbal or otherwise, in support of political campaigning for any candidate or political party as well as other similar forms of advocacy that fall outside the scope of equity issues.” - Melissa Monaco, The Goodyear Tire & Rubber Company

How expressing "support on racial injustice and other equity issues" is non-political is incoherent. It's not overtly political, but it is de facto political. It urges political action, at least implicitly. Those who express such support to change government or society -- vocally, written, or worn -- are nearly always pro-Democrat, pro-progressive, or otherwise favor "left wing" politics. They are not pro-Trump, pro-Republicans, pro-conservative, or "right wing." Indeed, the Goodyear policy is specifically against expressions supporting views held by the latter.

Scott Adams -- of Dilbert fame -- talks about the Goodyear controversy here stating at 1:08:15. Regarding Goodyear's policy, he only called the details murky and it a misfired message. Part of his focus was on the potential reaction of voters to Trump calling for a boycott of Goodyear.

Wednesday, August 19, 2020

The Primary-Secondary Quality Distinction

This is another article (very lightly edited here) I wrote and posted on the Internet in 2009.

In the Appendix of the second edition of Introduction to Objectivist Epistemology Ayn Rand says the primary-secondary quality distinction (PSQD) is invalid. “The primary-secondary quality distinction is a long philosophical tradition which I deny totally. Because there isn't a single aspect, including length or spatial extension, which is perceived by us without means of perception. Everything we perceive is perceived by some means.” 

Of course, everything we perceive is perceived by some means, but the famous supporters of the PSQD, like Galileo Galilei and John Locke, did not deny this. Rand’s argument was against a straw man. 

Primary qualities are those of objects regarded as independent of any observer, such as solidity, extension, motion, number and figure (shape). They exist in the object self-contained and do not rely upon anything external. Secondary qualities are those that produce sensations in observers, such as color, taste, smell, and sound. A sensation or perception can differ due to different perceptual systems, e.g. color-blindness versus normal color vision, or what is external to the object, e.g. light conditions. The powers an object has to produce sensations in us depend on its primary qualities (John Locke, ECHU, II, VIII, 10). 

Rand says, “The primary-secondary distinction in fact starts from the idea that that which we perceive by some specific means is somehow not objective.” I disagree if “not objective” was intended to mean “subjective” in her vocabulary.  Using her intrinsic-objective-subjective trichotomy, the PSQD says that primary qualities are intrinsic rather than objective. Secondary qualities are objective in this regard. Indeed, next she says: “Now you can properly distinguish that which is in the object from the form in which you perceive that quality. But that isn't the same thing as saying color is a secondary quality but extension is a primary quality.” I agree it isn’t the “same thing”, but such distinguishing is what the PSQD does. 

In Objectivism: The Philosophy of Ayn Rand Leonard Peikoff says the dominant view by philosophers gives only two possibilities in regard to sensory qualities: they are "in the object" or "in the mind." The former is taken to mean qualities independent of man's means of perception; the latter is taken to mean "subjective and/or unreal." Why he says this view is dominant is beyond me, and it isn’t the case for the major supporters. More accurately, the PSQD does not say secondary qualities are solely "in the mind", but that they are not solely “in the object.” 

Locke went on to say that our ideas of primary qualities resemble those qualities as they are in an object, but that is not true of our ideas of secondary qualities. He stated this as a conclusion without further explanation (ECHU II, VIII, 9). He did not use what I regard as a strong argument for the PSQD.  That is the nature of our various senses, something Aristotle noted long ago. According to Aristotle the “common sensibles” are motion, rest, shape, magnitude, number, and unity (De Anima III.1 425a16). (Different translations might use slightly different terms here.) They are apprehended by more than one sense – sight and touch. For example, extension and roundness can be perceived by both sight and touch. What Aristotle called the “special perceptibles” were those grasped by one sense only, e.g. warmth, color, taste, smell and sound. Aristotle did not make the PSQD. He treated all qualities of an object or body as belonging solely to the object or body. However, he gave one of the means to do it. 

Another argument in favor of the PSQD is that primary qualities are measurable or countable, but secondary qualities are not. Measuring decibels or sound wave frequency or amplitude is not measuring the sensation of sound. Measuring light wave frequency or amplitude is not measuring the sensation of color. 

In The Evidence of the Senses David Kelley makes a PSQD, but not in the same manner and for the same reasons as Locke did.  Kelley says primary qualities are macroscopic and extensive, while secondary qualities are microscopic and intensive (p. 114-15, hb). This macroscopic-microscopic difference is not about the qualities of an object intrinsically; it is about our knowledge. Primary qualities as physical attributes exist at the microscopic level, too. “[W]e find that certain dimensions can be explained by reference to the macroscopic attributes of objects. With other dimensions, however, we cannot find the intrinsic feature of the object itself, to which the senses are responding, unless we proceed to the microscopic level” (p. 116).  It may be a bit clearer to the reader to substitute “features” for “dimensions.”  

"The perception of size, shape, position, motion, and number seems to require enough perceptual integration to isolate as units the objects which possess these attributes.  …  Thus it seems that the awareness of secondary qualities first occurs at the level of sensations, but the awareness of primary qualities require the perceptual level and necessarily includes some awareness of secondary qualities" (p. 113) “Moreover, since the primary qualities are macroscopic, it is easy to measure them as they are apart from the forms in which we perceive them” (p. 117).  

Kelley also makes an intrinsic–relational distinction between primary and secondary qualities (p. 110, 111, 117, 231). At times Rand described the relationship of consciousness to existence as “objective.”  

Saturday, August 15, 2020

Aristotle on the Common Sense

The following is an article (very lightly edited here) that I wrote and put on the Internet in 2009. I wrote it while reading the book Aristotle on the Common Sense. I later wrote a review of the book for Amazon here

The book's introduction outlines the basic issue. Plato gives his position in his dialogue Thaeatetus. Each kind of sense -- vision, touch, taste, hearing, smell -- is autonomous. Something contains the senses, but cannot use them. Having the senses and being able to use them is another part of being an animal, which includes other capacities and a suitable body. To perceive by means of the eyes suggests there is a subject that uses the sense of sight localized in the eyes. Plato calls this subject 'soul', where each of the senses converge. The soul can integrate the senses and use the result. The soul uses the senses primarily to receive impressions of the basic sensory qualities. Also, the soul applies 'sameness' and 'difference' to sensory qualities. Such coordination of the senses seems to involve thinking. In Plato's view the senses are not integrated at the level of perception, but at the level of thought. It is compatible with Plato's wider philosophy to dissociate knowledge from perception.

When later Aristotle considers perception, he tries to give an account of nonhuman animals as well. The often very complex behavior of animals might be explained on Plato's framework, provided one attributes some level of thought to nonhuman animals. It seems Aristotle would not, that his position was that nonhuman animals cannot think or form opinions. An animal's survival depends on the ability to differentiate and associate sensible qualities (e.g. cold and hard versus soft and warm, smell and taste). The animal seems to apply 'same' and 'different' to them. Aristotle agreed with Plato that integration occurs and the subject is able to use the result, but he disagreed about where or how. Per Aristotle the senses are not integrated at the same level as thinking, but by what he calls the 'common sense'. He wrote very little about it, but held such integration to be perceptual. It could thus be attributed to nonhuman animals.

An interesting aside is where each philosopher believed sensory integration to occur. Plato thought it was the brain, where he believed the rational soul was (in his dialogue Timaeus). Aristotle located the common sense to be in the heart. We can discount both views given the paucity of knowledge about anatomy when they lived, but it is fascinating to see Aristotle rationalize his position.

According to Aristotle the 'common sensibles', or 'common perceptibles', are motion, rest, shape, magnitude, number, and unity (De Anima III.1 425a16). (Different translations might use slightly different terms here.) Common perceptibles are those apprehended by more than one sense. For example, extension is perceived by both touch and sight. Would the reader consider time a common perceptible? What Aristotle called the 'special perceptibles' were those attributable to one sense only, e.g. warmth, color, taste, smell and sound.

This concludes my presenting the views of Plato and Aristotle. What does Ayn Rand say about this? It did not surprise me that her view better aligns with Aristotle. However, she said so little about it. "A percept is a group of sensations automatically retained and integrated by the brain of a living organism. It is in the form of percepts that man grasps the evidence of his senses and apprehends reality" (ITOE2, p. 5). "Similarity is grasped perceptually" (p. 14). That is about all -- various sensory data is automatically integrated into percepts. Her published works barely reach beyond that. We could add that her view of thinking and consciousness being under volitional control buttresses her view that perceptual integration is automatic.

To some extent our sensory apparatus is under volitional control. For example, we can choose where to look or direct our attention to specific sounds. This, of course, raises the question of volition in nonhuman animals, a topic on which I venture no further here.

To conclude I present this short essay as food for thought. Often in philosophy more questions are raised than can be answered. This is a hazard of philosophy. On the other hand, such food is the nourishment of the soul.

Friday, August 14, 2020

The stock market and the economy

Barry Ritholtz writes about why stock prices are high while the economy stinks in this article.

Me: Stock prices plummeted between February 20 and March 23, during which news about the coronavirus grew rapidly, but have since recovered most of the drop.

The following are excerpts, especially for any reader who can't access the article.

“The economy many people experience, while bleak, is local, personal and, for the most part, either not publicly traded or plays only a small part in the stock market’s moves.”

“The most visible and economically vulnerable industries are also among the smallest, based on their market-capitalization weight in major indexes such as the S&P 500. Markets, it turns out, are not especially vulnerable to highly visible but relatively tiny industries. The 30 most economically damaged industry categories could be de-listed before tomorrow’s market open, and it would hardly shave more than a few percentage points off the S&P 500.”

“But the U.S. economy is not the stock market and vice versa. As we discussed before, ignoring overseas strength is a major oversight. The so-called FAANGs [Facebook, Apple, Amazon, Netflix, Google] (along with Microsoft) derive about half -- and in some cases even more -- of their revenue from abroad. Beyond that, the pandemic lockdown in the U.S. has benefitted the giant tech companies’ sales and profits. No wonder the Nasdaq Composite 100 Index, which is dominated by big tech companies, is up about 26% this year.

But a reasonable person might argue that GDP fell by about a third in the second quarter and the S&P 500 should be in synch with that. What’s more, of the 500 companies in the S&P 500, about 450 of them are doing terribly. Industries such as retail, travel, energy, entertainment, dining have seen sales evaporate. Bankruptcies are piling up -- legendary retailer Lord & Taylor is just the latest-- and more are surely coming. Yet, the S&P 500, after a huge plunge in March, is up 2% this year.

Market capitalization explains why.”

“So although high visibility industries may be of considerable significance to the economy, they are not very significant to the capitalization-weighted stock market indexes.”

“Consider how little these beaten-up sectors mentioned above affect the indexes. Department stores may have fallen 62.3%, but on a market-cap basis they are a mere 0.01% of the S&P 500. Airlines are larger, but not much: They weigh in at 0.18% of the index. The story is the same for travel services, hotel and motel REITs, and resorts and casinos.”

“Both before and especially since the pandemic, those six stocks [FAANG plus Microsoft] have been the biggest drivers of the market-cap weighted indexes like the Nasdaq 100 or the S&P 500. If your only frame of reference is a domestic economy, this is easy to miss.”

Tuesday, August 11, 2020

Coronavirus - how much infected?

Since maybe early April when the number of new cases in the U.S. began rapidly rising, I have wondered: Doesn't it matter to what extent a person is infected by the coronavirus? Mildly infected likely means no or mild symptoms. Severely infected likely means severe symptoms, maybe hospitalization or worse. Of course, the strength of the person's immune system can constrain the severity of symptoms.

I finally saw an article that has some answers to my question.

40% of people with coronavirus have no symptoms. Might they be the key to ending the pandemic?

The article taught me another word, inoculum, the amount of virus someone is exposed to. It also says that wearing a mask might constrain the degree of infection.

A different article includes the following.

“When we looked in the setting of Covid disease, we found that people who had prior vaccinations with a variety of vaccines — for pneumococcus, influenza, hepatitis and others — appeared to have a lower risk of getting Covid disease,” Dr. Andrew Badley, an infectious disease specialist at Mayo Clinic told CNN’s Anderson Cooper on Monday night.

It’s what immunologists call immune training: how your immune system creates an effective response to fight off infections, Badley says.

This article has more about the immune response.

This article has more about potential immunity to the coronavirus.

Sunday, August 9, 2020

Website about Wokeness

Three days ago I became aware of the website New Discourses. I have read only two articles from it but found them interesting. 

1. The Complex Relationship between Marxism and Wokeness.

2. No, the Woke Won’t Debate You. Here’s Why.

The first title is self-explanatory. The second isn't. Much of the article is about the philosophical mindset of a typical "Woke" person. It includes the Woke view of racism, oppression, and truth.

The author of both articles is James Lindsay, co-author of the soon-to-be-released book Cynical Theories. 

Friday, August 7, 2020

Coronavirus – clinical trials #4

If an experiment or clinical trial were to show that a drug treatment could cure Covid-19 or block it from making the patient sicker, then Mill’s Method of Difference only identifies that the drug treatment works. A more complete causal explanation would include explaining why the drug treatment works. I have not seen any such explanation why regarding hydroxychloroquine (HCQ) or HCQ + zinc. Maybe somebody can explain why, but I can't. The only drug treatment I have read about that plausibly explains why it works is RLF-100, i.e. aviptadil (Coronavirus - drug news).


Yesterday Yahoo News reported that the FDA granted Investigational New Drug (IND) permission to test the use of RLF-100, i.e. aviptadil, for patients with moderate and severe Covid-19 in order to prevent progression to respiratory failure (Yahoo News). 

Also yesterday President Trump signed an executive order requiring U.S. government agencies to purchase “all essential medicines” from American sources (NBC News). The patent for RLF-100 is owned by a Swiss company. On the other hand, it is partnering with NeuroRx, a USA-Israel company, to produce and sell the drug in the USA. I won't try to predict how the executive order will affect RLF-100's future. 

Thursday, August 6, 2020

Coronavirus – clinical trials #3

Yesterday’s post was about a clinical trial for a coronavirus vaccine and Mill’s Method of Difference. In this post I consider a clinical trial for a Covid-19 cure and Mill’s Method of Difference.

A clinical trial for a cure for Covid-19 would enroll patients who already have Covid-19. There is no contingency analogous to becoming infected like there is for a coronavirus vaccine clinical trial. On the other hand, there are a lot more variables – a variety of patients’ ages, each patient’s health status, degree of infection, and so forth. Dosage amounts may also differ, for which the logic is also Mill’s Method of Concomitant Variation.

Dr. Anthony Fauci often invokes the “gold standard” for clinical trials (randomized double blind placebo control studies) when he comments on any drug doctors might prescribe to treat patients. This standard is mainly for new drugs, but may also be used for already FDA approved medications for treating medical conditions outside the scope of prior approval, e.g. remdesivir for Covid-19. These are often called “off label” uses. It is also called repurposing. The FDA has relaxed its standards for drugs to treat Covid-19 patients. The FDA has made emergency use authorizations (EUA). The FDA may grant Investigational New Drug (IND) permission to test a drug. To my knowledge no drugs – even Remdesivir, which Fauci personally approves -- have passed the “gold standard” for treating Covid-19.

The following are the NIH guidelines for the treatment of Covid-19 with four different drug therapies.  Remdesivir.  Chloroquine and Hydroxychloroquine.  Hydroxychloroquine Plus AzithromycinDexamethasone.

Conspicuously non-existent are web-pages for (1) Hydroxychloroquine (HCQ) Plus Zinc and (2) HCQ Plus Zinc Plus Azithromycin, especially with outpatients. Several doctors who recommend using HCQ for Covid-19, mainly with outpatients, have said zinc is a necessary enabler and without zinc the HCQ is minimally effective. Note that the NIH's web-page for HCQ + Azithromycin page concerns only trials with inpatients (hospitalized).

Dr. Anthony Fauci still approves using remdesivir. Regardless, it falls far short of a cure for Covid-19. Like the above web-page shows, some clinical trials have shown at best that remdesivir reduced  recovery time compared to a placebo. Other trials have shown no observed improvement or the data is insufficient. I would not call that passing the “gold standard.”

Dr. Fauci and the NIH recommend dexamethasone for some patients. The web-page above says clinical trials have shown significant mortality reduction in patients requiring supplemental oxygen, with or without a ventilator. On the other hand, no benefit of dexamethasone was observed in patients who did not require supplemental oxygen. Does this mean that dexamethasone passed the “gold standard”? Arguably 'yes' in some cases, but a cure? Many who got the drug still died during the trial.

Despite the many unknowns about the coronavirus and Covid-19 and the long time frame of clinical trials, Dr. Fauci often appeals to the “gold standard” as an argument against anything that doesn’t meet his or the FDA’s approval. In effect, he has little regard for individual judgments of practicing physicians to prescribe drugs absent his or the FDA’s approval, despite the lack of “gold standard” drugs for curing Covid-19 or halting its progress.

Dr. Fauci also consequently has shown little regard for giving placebos to patients who are seriously ill with Covid-19. Assume such patients participate in a clinical trial hoping to be cured and they later learn – if they survive – they were given a placebo and other patients in the trial who got the drug benefited. I suspect they would not be content.

Wednesday, August 5, 2020

Coronavirus – clinical trials #2

My previous post posited that the logical basis of clinical trials is Mill’s Method of Difference. The following is a simple example of a clinical trial based on Mill’s Method of Difference. Suppose there are N patients with disease D and the clinical trial is to treat some, e.g. two-thirds, of the N patients with medicine M and give the other one-third a placebo. Assume the later result is that the patients who are given M are cured of D, but the patients who are given the placebo are no better off than at the start. Then one could conclude that M is a cure for D. Call this the SDMT (for simple disease medicine trial).

A real world clinical trial is probably rarely as clear-cut as SDMT. It also seems to me that a clinical trial for a vaccine against the coronavirus would be far less clear-cut, for at least the following reasons.

1. The SDMT has a huge advantage over the coronavirus vaccine trial at the start. The participants at the start of the vaccine trial presumably have all tested negative for the coronavirus.* Some get the vaccine and the rest get a placebo. Then they wait to see if they do become infected by the virus to some degree. If they do become infected, and the vaccine protects against Covid-19, whereas those given the placebo get Covid-19, then the vaccine justifiably worked. However, many of the participants may not become infected any by the virus. They provide no basis for any conclusion about the efficacy of the vaccine. Presumably, such a vaccine trial must have many, many more participants than a SDMT kind of trial to make up for the probability of not becoming infected.

2. Those given the placebo might get infected, but their natural immune system might protect them from testing positive for the coronavirus or getting very ill from Covid-19 anyway.

3. Some participants may become only mildly infected and others far more so. This might come about due to the extent of precautions they take while in the trial, such as wearing a mask, keeping a safe distance from others, and washing hands. 

4. Some given the vaccine may be infected and the vaccine works. Others given the vaccine may be infected and the vaccine doesn't work or works poorly.

For all these reasons, and more not stated, a clinical trial for a coronavirus vaccine falls far short of all factors being the same except for one key difference for ideally applying Mill’s Method of Difference. It makes me quite skeptical about achieving a “gold standard” vaccine clinical trial per the wishful Dr. Anthony Fauci.

*The trial might also include groups of people who tested positive and are (a) asymptomatic or (b) have mild symptoms. They should be considered as separate trials.

Tuesday, August 4, 2020

Coronavirus – clinical trials #1

The coronavirus pandemic has pushed the concept and use of clinical trials into the mainstream media. Searching the Internet for {coronavirus clinical trials news} or {coronavirus clinical trials method} or {clinical trials logic} yields many results about clinical trials underway, but very little about the logic behind such trials. For example, this web-page is about clinical trials for a Covid-19 vaccine. The title says “here’s what you need to know”, but none of it is about the logic behind such trials.

When I became aware of clinical trials, I supposed that such trials are an application of John Stuart Mill’s Method of Difference. Researching it very recently, I found this web-page which supports the supposition. Despite that, it doesn’t link the logic of clinical trials directly to the influence of John Stuart Mill himself. Another web-page addresses the direct influence of Mill, but such influence is sketchy.

Monday, August 3, 2020

Coronavirus - drug news

A Reuters article says: "Critically ill COVID-19 patients recovered rapidly from respiratory failure after three days of treatment with RLF-100, a therapy granted fast-track designation in the United States, two drug companies said on Sunday."

The drug plausibly blocks replication of the SARS-CoV-2 virus in human lung cells and monocytes (white blood cells).
The article also appeared in the New York Post and Jerusalem Post.

A Science Alert article says: "A paper came out in Nature on July 22 that further underscores earlier studies that show that neither the malaria drug hydroxychloroquine nor chloroquine prevents SARS-CoV-2 – the virus that causes COVID-19 – from replicating in lung cells."

Zinc was used with hydroxychloroquine in some cases, but the article doesn't mention zinc.

RLF-100 was used to treat critically ill patients, whereas earlier alleged successes with hydroxychloroquine were mainly with early-stage mildly infected patients or as prevention. The blocking versus not blocking replication of the virus is a big difference, too. 

Update August 4 

This page shows a transcript of Dr. Anthony Fauci testifying about hydroxychloroquine. He is acutely asked about using zinc with hydroxychloroquine, and he evades the question. (He refers to corticosteroids, which contain no zinc.) He clings to the "gold standard" despite its very long time frame and requiring giving very ill patients a placebo, and the urgency of finding a cure.