Category: medicine

Jesse Singal: Science-Based Medicine has put its foot into it

July 16, 2021 • 9:45 am

The site Science-Based Medicine (SBM), renowned for debunking quackery and insisting on a firm evidential basis for medical treatments, has put its foot into it, and by “it” I mean the controversy about Abigail Shrier’s new book dealing with “rapid onset gender dysphoria”.

It started, as I’ve described before, with a favorable review on the site by physician (and SBM editor) Harriet Hall, assessing Abigail Shrier’s recent book Irreversible Damage: The Transgender Craze Seducing our Daughters. Shrier’s book, which I’ve now read, describes a phenomenon that she and others call “Rapid onset gender dyphoria” (ROGD). This is a phenomenon of recent origin in which young pre-puberty women (almost never boys) suddenly decide that they are really males, and, often with minimal advice and supervision, take hormone blockers to stave off puberty, followed by hormone treatment (and often surgery) to remove breasts and (rarely) construct surgical penises.

Shrier’s thesis was that these transitions are often motivated more by social pressure than innate feelings that one’s body doesn’t match one’s gender, and by transitioning, many of these girls gain affirmation and approbation from their peers, often on socia media. Further, Shrier maintains that these transitions are often poorly supervised and, if the girls weren’t given medical treatment but therapy, most would not transition but develop into adult women. Her book is largely a series of stories, largely because the ROGD is so recent that its origins—and whether medical treatment should be used (as well as the psychological and physiological outcomes)—haven’t been subject to rigorous scientific study. We know very little about how to deal with those who manifest ROGD.

Thus, rather than proving her thesis, which wasn’t Shrier’s intent, she wanted to raise red flags about a phenomenon that could have its origin in social pressure and lead to irreversible harm in adolescents who are often psychologically disturbed. The upshot is that we clearly need more research on this phenomenon before we start giving hormones to girls who, in their teens, decide that they’re actually boys. Hormonal and surgical treatment is, after all, irreversible.

Shrier doesn’t deal with the kind of gender dysphoria that manifests itself in early childhood and continues for a long period, or that is taken care of long after puberty in people like Caitlyn Jenner. She’s concerned with adolescent girls who suddenly declare that they’re boys and take immediate action to fix the situation. Their numbers have increased rapidly, raising the question about the origin of the phenomenon. Shrier’s book is neither shrill nor unempathic: she has deep sympathy for transsexual people who are heavily invested in being a member of their non-natal sex. Rather, she wants to call attention to the phenomenon of ROGD and to question whether surgery and hormones are the right answers for a temporary affliction, exacerbated by the climate of social media and physicians and parents who are told to do “the right thing” (facilitate transition), and who don’t hesitate before “affirming” gender change and supporting medical treatment.

I thought Shrier’s book, while not definitive, was well worth reading, and certainly not worthy of banning, a ban for which ACLU staff lawyer Chase Strangio has argued. It should start a conversations about the phenomenon and inspire the collection of data that don’t yet exist. But of course Shrier has been called a transphobe and has been widely demonized by the transsexual communty. One simply can’t question the Received Wisdom in this area.

Under the leadership of Steve Novella and David Gorski, SBM removed Hall’s review from their site, claiming that its egress was due not to social pressure but to Hall’s review (and Shrier’s book) being full of bad science and poor scientific judgment (you can still read Hall’s review at Skeptic Magazine). Novella and Gorski then posted a defense of the removal (replacing Hall’s review with three articles opposing Shrier’s view), citing several papers that I hadn’t read. Summarizing their defense, I listed six assertions by Gorski and Novella about why Shrier’s claims (and their defense by Hall) were bogus. Unable to evaluate them, as I wasn’t familiar with the literature, I just asked readers to judge for themselves.

Now, however, someone more qualified than myself, and more qualified than Gorski or Novella, has evaluated the data and their own claims. That person is Jesse Singal, who has read all the relevant literature cited by Shrier, Novella, and Gorski, and has published widely in respectable venues about transsexualism.  He concludes that not only should Hall’s review have been allowed to stay on the site, but that Gorski and Novella have behaved badly—indeed, unscientifically—in rushing to damn Shrier’s book and Hall’s review. One can conclude, if Singal be right, that Gorski and Novella are behaving in a woke-ish fashion, mis-citing data as well as accepting results that confirm their views and rejecting those that don’t—for no good reason. In fact, Singal’s indictment of Gorski and Novella’s reading of the literature is pretty damning, implying cherry-picking, confirmation bias, and distortion of the existing data, which is not about ROGD, which Gorski and Novella imply, but dysphoria that starts early in childhood or comes to fruition in adulthood.

Singal’s piece was 40 pages long when I printed it out in 12-point type, so it’s a long read. I’d still recommend it, especially if you’re interested in transgender issues or SBM in general. You can read Singal’s article for free by clicking on the screenshot below, though he would appreciate a donation for his work.

To my own credit, which isn’t substantial, I did pick out some of the same problems as Singal does with the Novella and Gorski piece—for example my asking, despite their claim that medical organizations had very high standards for facilitatating transition, whether those standards were actually used very often (it seems that they’re often flouted). And I questioned whether the change of gender dysphoria from a “disorder” in the DSM-IV to “not a disorder” in the DSM-V was meaningful.  Singal shows that it’s not.

But Singal’s analysis, or rather destruction, of Novella and Gorski’s defense is pretty damning. I urge you to read it for yourself. All I’ll do in this post is highlight, in Singal’s own words, the major problem with their claims. His words are in bold and indented, any comments I have are flush left.

First, Singal’s disclaimer:

I should re-emphasize that I’ve said repeatedly I think banning youth gender medicine is a terribly bad idea. The evidence for those “positive outcomes of early medical interventions” come from research that, as we’ll see, leaves a lot to be desired. But it does suggest that for kids with intense, persistent dysphoria who have been well-evaluated, who have any other mental-health problems under control, and who have have good family support, puberty blockers and hormones are likely to lead to the amelioration of what would have been a great deal of suffering. (I include these conditions because we simply can’t say much about the effectiveness of these treatments under different circumstances.) I do not trust legislators to override doctors’ and psychologists’ decisions in a context like this. But again, the evidence here is thin and low-quality, so at the very least it is imperative that any truly ‘science-based’ outlet communicate this uncertainty to readers. Science-Based Medicine has failed to do so.

Having mental health problems “under control” is key here, for it could have significant bearing on the claim that transitioning by adolescents reduces suicide and suicidal ideation. This is frequent claim for which there appears to be almost no evidence. The correlation could work the other way around: only those adolescents who have had therapy and thus low suicidal ideation are the ones who are allowed to transition.

But let’s proceed to Singal’s beef against Gorski and Novella. Again, if you have the time, I’d urge you to read his piece for yourself. He cites a lot of data, something Gorski and Novella don’t do.

Below I summarize Singal’s paragraph headers; each of which is followed by a substantial explanation in the article.

Problems in “The Science of Transgender Treatment” by Steven Novella and David Gorski

1). Novella and Gorski misinform readers about the difference between the DSM-IV and the DSM-5 entries for “gender identity disorder” and “gender dysphoria,” respectively.

2) Novella and Gorski argue that there is widespread adherence to the standards of care for youth gender medicine without providing any evidence that this is the case, other than referencing ‘countless’ interviews they neither quote from nor link to. They also misrepresent the World Professional Association of Transgender Health’s Standards of Care for the administration of hormones to adolescents.

3) Novella and Gorski badly misunderstand the nature of the desistance debate [JAC: “desistance occurs when adolescents grow out of their transgender identity as they age] and communicate a great deal of misinformation and undue skepticism about the desistance literature to their readers.

4) Novella and Gorski badly misunderstand Hall’s concern about regret.

What they mean is that the data on whether transgender people regret transitioning comes from a different group from the one that Shrier and Hall consider (adolescent girls).

5) Novella and Gorski write off Lisa Littman’s study of rapid onset gender dysphoria as “bad science” without explaining why or engaging with Littman’s own rather credible defense of her work, and they engage in some methodological cherrypicking in order to do so.

6) Novella and Gorski falsely report the result of one study and ignore the fatal weaknesses in another.

These problems involve citing studies of gender-affirming outcomes in adults as if they had anything to say about gender affirming outcomes in adolescents with ROGD.

7) Novella and Gorski conclude their article with a profound exaggeration of the available evidence for youth gender medicine that is completely out of step with what the evidentiary reviews conducted by major medical institutions in multiple countries have found, and make no attempt to explain how they came to such a different, more optimistic conclusion.

So, according to Singal, who gives a lot of the data that contradict Gorski and Novella’s claims, there are problems with their analysis of data, with selective citation, and even with ignoring data they don’t like. Singal makes a compelling case, and he ends with these words:

When it comes to hormones for gender dysphoric youth, it’s pretty remarkable to compare the assessments of Steven Novella and David Gorski with those of NICE.

Novella and Gorski: “[T]here is copious evidence supporting the conclusion that the benefits of gender affirming interventions outweigh the risks.”

NICE [the NHS’s National Institute for Health and Care Excellence]: “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.”

What evidence are Novella and Gorski drawing upon that NICE missed? They should explain this striking discrepancy. And they should transparently correct their article where corrections are warranted, as well as add numerous points of elaboration and clarification. If they don’t, they will mortgage even more of their site’s long-term credibility than they already have.

This, of course, is not the end of the issue. Neither Gorski nor Novella are shrinking violets, and I’m sure they’ll defend themselves vigorously. But what they can’t do is produce data that don’t exist.

More on Abigail Shrier, Harriet Hall, Science-Based Medicine, Jesse Singal, and transitioning

July 3, 2021 • 11:00 am

Yesterday I reported on the site Science-Based Medicine’s defense of their “deplatforming” a book review written by one of their own editors, Dr. Harriet Hall. Hall had written a favorable review of Abigail Shrier’s book Irreversible Damage, itself about the dangers of transsexual adolescents undertaking medical treatment prematurely or without proper guidance. Hall approved the book, but the editors, including Steven Novella and David Gorski (N&G), summarily removed her review (it was reposted by Michael Shermer and Skeptic magagzine). N&G asserted said it was not removed because the review was ideologically impure or that there was a social-media pushback, but simply because Hall’s review was full of inaccurate statements and bad science.

I put up N&G’s response, and since I hadn’t yet read Shrier’s book (I am beginning it now), I simply reported that two well known skeptical scientists and doctors had objected to Hall’s review and to Shrier’s contentions. I still think that N&G should NOT have removed Hall’s review, but left it up with their own response. That, after all, is what free speech is about. But I’m not yet (and may never be) acquainted sufficiently with the data to pass judgement on these dueling views. But I will note further exchanges in this disparity of opinions.

One of these, pointed out by a reader, was a series of tweets by Jesse Singal, who writes for The Atlantic as well as New York Magazine and other outlets, and has some expertise in scientific and sociological studies of transgender transitioning (see here and here). He’s also written an article below in the July Spectator about how the media distorts what little good data exists about the psychological outcomes of transitioning. (The data appear to be far scantier than one would think from the vociferous claims of transgender advocates.)

First, though, Singal fired a fusillade of 16 tweets in response to N&G’s attack on Hall and Shrier, and I’ll reproduce these here. As always, judge for yourself, and dig further if you’re unclear or intrigued. I’ll reproduce them all as they’re a quick read, and they should be perused along with Singal’s Spectator piece at the bottom.

The Spectator piece mentioned in the next tweet is linked to and discussed at the bottom of this post.

Gorski’s tweet at Rowling above is clearly out of line here, and in fact is gratuitously nasty.

One gets the impression from these tweets, many of which are summarized in detail in Singal’s article below (click on screenshot), that N&G were firing from the hip, making unsubstantiated claims about the literature that verge on distortion. The problem with all of this is that everyone is so polarized on the issue, whether rightly so because of the data or because of ideological bias, that it’s hard to know whom to trust. However, Singal’s article below does show that he’s read many of the original studies questioning the supposed “safety” of puberty blockers and the claimed suicide-reducing effect of transitioning. Both claims are “problematic,” i.e., we really don’t have good data. Read and judge for yourself. I’ll give a few quotes from Singal:

Singal’s piece makes several points. First, although some U.S. gender clinics adhere to what we’d see as proper care for gender-dysphoric children and adolescents, many do not, and few seem to come close to the standards used in European countries.

Second, many of the studies cited by the media to show that transition is safe—beginning with the administration of puberty-blocking hormones, are flawed, and, in fact, we have no good information about the safety of these blocking hormones. Further, studies cited to show that transitioning reduces the risk of suicidality in transgender children are flawed to the point that we have no idea whether this is true. The patterns we see could have other explanations, like clinics not taking on children with serious mental problems.

Third, the mainstream media, which by and large adheres to the ideology of unreserved advocates for transitioning, generally refuses to report any of the incomplete data, false assertions, or problematic claims. That, says Singal, is because the media has an ideological bias on this issue, something I don’t doubt.

I’ll give a few quotes from Singal’s article, and. though it’s long (if your attention span is short), it’s well worth a read.

First, on the disparity of European versus American treatments:

In 2007, the Dutch Protocol, as it is known, was brought to the States, initially to Boston Children’s Hospital. These days, blockers and hormones are available in many more American youth clinics, though access varies considerably by geography.

There are some crucial distinctions between the Dutch approach and how some US youth-gender clinicians currently practice. For example, because, as the Dutch clinicians Annelou de Vries and Peggy Cohen-Kettenis wrote in a 2012 article describing their protocol, ‘most gender dysphoric children will not remain gender dysphoric through adolescence’ (a finding that has emerged at multiple clinics), the Dutch clinic has historically discouraged childhood social transition, while also discouraging parents from shaming children for gender-nonconforming behavior. Clinicians there promote the practice of ‘watchful waiting’ until the onset of puberty, at which point, if the GD persists, it is taken as a useful indicator that blockers might be the right choice.

Further reflecting the clinic’s cautious approach, youth with significant mental health problems or a lack of family support (or both) have not been eligible for physical transition. So when we look at the Dutch-protocol data, we’re looking at a subset of kids and teens who were carefully assessed, over a long period of time, to ensure they had clinically significant gender dysphoria and that other mental health problems could be ruled out as the primary drivers of their distress. They all had good family support when they began transitioning.

. . . The lack of outcome data for gender-dysphoric youth who physically transition is one reason there has been a steady drip of news, mostly out of Europe, reflecting growing unease about these treatments. The UK has seen a complicated, slow-boiling controversy at the National Health Service’s sole provider for youth transition services, the Gender Identity Development Service at the Tavistock Clinic in London. Staffers there raised concerns about the quality of care; some argued children were being fast-tracked toward blockers and hormones in part as a result of activist pressure. Complaints from a young detransitioner who insists that she was not properly assessed, and who had a double mastectomy she regrets, culminated in a High Court ruling declaring that under-16s are unlikely to be able to consent meaningfully to blockers or hormones, making it much harder for this group to access treatment. An appeal is underway; in the meantime a convoluted process will still allow some young people to access these services with parental permission.

This spring Sweden banned youth medical transition outright at a number of gender clinics, including one at the famed Karolinska Institute, except in approved research studies. And in June last year the body that recommends on treatment methods in the Finnish public healthcare system published guidelines that emphasized the need for thorough assessment prior to the administration of blockers or hormones — stating that blockers may only be given ‘on a case-by-case basis after careful consideration and appropriate diagnostic examinations’.

These steps seem to reflect a growing realization that the holes in the research on youth medical transition are too big to ignore. Three major reviews of the literature conducted by government agencies in Finland, Sweden and the UK found an alarming lack of data supporting early treatments.

On how the media distorts the data:

Journalistically, the proper response to this issue is to give the details in all their complexity — not to leap to some extreme in which we pretend, for the sake of our political agenda, that there are zero legitimate questions about youth transition. Unfortunately, though, that’s what just about every major American media outlet has been doing. To be fair, this trend started well before the GOP state laws were introduced, but it is getting worse. The threat posed by these laws is often deployed as an excuse to not ask too many questions about extremely unsettled areas of medical research centered on very vulnerable populations.

I mean, what are you, anyway? One of those transphobic Trump supporters? This attitude underpins how these transition stories are framed and what news gets ignored entirely. Apart from the occasional fleeting reference neither CNN nor the New York Times nor the Washington Post nor Vox, all of which have offered near-blanket coverage of the proposed bans on youth medical transition, covered the NICE evidence review [the NHS’s National Institute for Health and Care Excellence] or any of the Tavistock controversy or the Karolinska decision. These outlets routinely repeat activist claims which should be given serious scrutiny and which sometimes defy basic, generally agreed-upon facts. ‘There is no consensus criteria for assigning sex at birth,’ explained CNN in a news article published in March, though editors there later struck that bizarre statement.

Mainstream coverage of this issue is a buffet of sanctimonious overclaiming. It says authoritatively that kids in the US can’t go on blockers or hormones prior to lengthy, in-depth assessment (false). That no one under 18 is getting surgery (false). That the worldwide rise in referrals to youth GD clinics is almost entirely the result of reduced stigmatization (no one knows). That GD [gender dysphoria], or the perception that one has GD, can’t spread through adolescent social networks (almost certainly false on the basis of anecdotal evidence and any familiarity with developmental psychology). That it’s a ‘myth’ that significant number of kids who believe themselves to be trans will later feel differently (false, according to all the existing data). That only a tiny percentage of people detransition (we have no data at all on this in the context of youth gender care in the States).

The last paragraph sums up in a nutshell what we don’t know but what is asserted to be true by liberal media.  I won’t go further except to say that Singal, who is no opponent of guided and informed transitioning, emphasizes our ignorance:

Most reporters don’t have much experience covering this issue.  When they take it up, they reach out early on to an activist organization, which in turn recommends media-friendly ‘experts’ who happen to be on the vanguard of this issue; i.e., seeking to break down the final vestiges of the ‘gatekeeping’ of trans youth. They will earnestly confide in the journalist that among real experts (like themselves), there are no legitimate concerns with the safety of medical treatment of very young trans youth. People who feel differently are transphobes. Simple.

This is a comfortable storyline, but it’s just not true. We desperately need better data on trans youth healthcare. But we don’t have it yet — in many ways, everyone is flying blind, especially families of kids with later-onset GD. Parents deserve every scrap of information that can help them understand not just the potentially profound benefits but also the risks and unknowns of blockers and hormones. American journalists, from an understandable but misguided desire to position themselves on the right side of an emotionally taxing and fraught issue, are hindering their ability to get it.

I’m well familiar with the ideological bias of liberal American journalists, and am prepared to believe that, since they’re not scientists, they want to be on the side of the angels. But this debate will continue, and it will continue until we have sufficient data to settle the medical issues. We appear to be a long way from that.

Jon Stewart gets pushback for dissing science and insisting on a lab-leak origin for Covid-19

June 23, 2021 • 11:00 am

On the first live Stephen Colbert show, he hosted his predecessor Jon Stewart, who went on a rant that partly dissed science (Stewart said, for instance, that the pandemic was more than likely caused by science”.)  More important, though was Stewart’s unwavering contention that the coronavirus, WITHOUT ANY DOUBT, came from the Wuhan Virology lab rather than transmission from an unknown host to humans. (Let me add that Stewart has worked for good causes: his testimony before Congress about getting more help from those exposed to toxins in the 9/11 incident was eloquent and moving.)

People have interpreted this rant, as I do, as Stewart’s being very serious about both science and the origins of the coronavirus. I remain agnostic about the latter, but do disagree with Stewart’s take that science itself has some inherently bad aspects to it. (I would argue that the scientific toolkit is amoral, but that the tools of science, since they’re used by humans, can be used to do bad things.)

Watch the piece below where it self starts (2:47) until it ends at 8:38 and listen for yourself.

The exchange is funny, as it would have to be given the participants (Stewart’s “chocolate” analogy is a chuckle), but several people, including two editorial writers from the Washington Post as well as journalist Dan Rather, have taken out after Stewart for a.) dissing science and arguing that science is inherently unreliable, and b.) making no bones about where the coronavirus came from.  Now the second question isn’t so important except for historical interest, but having Stewart, a role model from whom many young folk get their real news, make such unsubstantiated assertions about science and the virus has angered the writers (see below).

Here are three articles (the first two from WaPo, the other from Dan Rather’s Substack site) going after Stewart for his monologue above. I’ll give one quote from each (click on screenshots to read):

Quote:

The segment was practically tailor-made to blow up in the current debate over the lab leak. It’s funny and good viewing and features a guy who often lampooned conservatives promoting a theory they have warmed to more than the other side. Even Jon Stewart is saying the theory Donald Trump once (briefly) espoused but was dismissed by scientists and the media was right about the lab leak!

The conventional wisdom on the validity of the lab leak has changed in recent weeks, but Stewart goes even beyond that new conventional wisdom that holds the theory is suddenly more valid. Scientists still generally regard the theory that the virus emerged naturally as more plausible than a lab leak, although that thinking is definitely evolving.

But if there’s one thing Stewart was often criticized for — especially by conservatives — it’s in oversimplifying complex issues to land a joke. (He often shrugged off that criticism by saying he was a comedian, not a newsman. But his show was the news to many young people, and it clearly had a political bent to it.)

And his summation of the argument for the lab leak theory suffers from some of that. Stewart pitches it as an irreconcilably massive coincidence that that virus emerged from a place with a high-level virology lab, the Wuhan Institute of Virology, that worked on novel coronaviruses.

Well, that’s not such a biting critique, but the next one is a bit more critical, concentrating on why we shouldn’t trust celebrities’ opinions on Covid-19 (or, for that matter, the opinions of politicians. Remember Trump and his “bleach our insides” theory of cures?). This piece, and the article by Dan Rather below it, emphasize that science is not a one-way street to the truth, and opinions about what’s true or best to do can change as the data change, as they did during the pandemic. The alterations about how we should behave changed over time, leading some people to reject the science altogether.

Some excerpts:

But these days, [Stewart] is retired and only emerges from time to time, and because he always delighted more in skewering Republicans, it was a bit shocking to see him go on an extended rant on “The Late Show with Stephen Colbert” about the coronavirus lab leak theory.

This theory has become associated with conservatives trying to prove that former president Donald Trump was right about everything. Yet Stewart apparently thinks it’s the only plausible explanation for the source of the virus.

This provides an important lesson about celebrities: You shouldn’t get your political opinions from them, or your scientific opinions either

. . .Even though Trump briefly claimed in 2020 (a claim he quickly dropped) that he had lots of evidence that the lab leak theory was true, what did it change? Had we had definitive proof from the get-go that it came from a lab, would Trump’s response to the pandemic, and the resulting death toll, have been less disastrous? Once the pandemic was here, it was here.

But set that aside for the moment, and consider Stewart.

Yes, he has every right to go on as many talk shows as he wants and explain his coronavirus theories. But his attack on expertise reminds us why expertise is so important.

The world is full of amateurs who think they’ve stumbled across some piece of information or logical connection that the people who know a lot more about the subject at hand have missed. There are a thousand unpublished manuscripts titled “Einstein Was Wrong About Relativity” stored on the home computers of people with no formal training in physics.

That’s not to say that experts don’t often have biases or blind spots, because they do. Sometimes, they can be catastrophic. But it’s not because experts can’t be trusted, it’s because something kept them from seeing what they should have, or — perhaps more often — they just didn’t have enough information to arrive at the best judgment.

. . .As long as they’re “raising awareness,” no one gets upset; it’s when they take stances on controversial issues that people decide that if that athlete or singer doesn’t agree with them, then he should shut up and stick to the thing that got him famous in the first place.

. . . But they’re not experts, and the reason we listen to experts is that they know more than we do. And if they know more about some things than others, then we have to understand where we shouldn’t listen to them and where the limits of their knowledge are.

That’s why it’s problematic when liberals say “I believe in science” as though science always shows you exactly which political decisions to make. Sometimes it does, and sometimes it has gaps that can lead you in the wrong direction. That’s why we need elected leaders who’ll listen to scientists, then make judgments built on a broad range of considerations.

The nature of human existence is that we have to outsource much of what we learn about the world to people we trust. But if a celebrity agrees with you today about one thing, it doesn’t make them any more trustworthy than they will be tomorrow when they disagree with you about something else.

Well, I’m not sure how many people will now adhere to the lab-leak theory just because of Stewart’s rant. After all, the truth or falsity of that theory isn’t all that important. What is important is the point that Dan Rather makes in the next article: science is our best (and, in this case, only) weapon to defeat such a deadly pandemic. And yet science is a set of tools, and must be wielded by fallible humans.

In many important ways Rather’s commentary is the most trenchant, as it defends the enterprise of science against those who think that it is either inherently unreliable or contains some elements that motivate people to do bad things. No, bad people do bad things. As I’ve said before, blaming science for the spread of the coronavirus is like blaming architecture for the Nazis’ gas chambers.

Here are a few excerpts from Rather’s piece:

All this underscores a simple truth: science, nature, the universe, is complicated. What we have seen in this pandemic is the public witnessing scientific research in real time. Scientists will be the first to tell you that a lot of what they initially think, their hypotheses, turn out to be wrong. That is what experimentation is for. That is what data is for. We learn from our failures as well as our successes. At first we got guidance that COVID was spread largely on surfaces, even as some scientists were warning early on about it being aerosolized. We eventually got mask mandates. Many researchers felt that that came too late. This is not a sign of good faith or bad faith. Science isn’t faith. It’s about teasing out what we know, and pivoting our thinking when we learn something new. Scientists, especially in the early stages of examining a phenomenon (like a deadly virus they haven’t seen before), often disagree.

. . .On The Late Show, Stewart didn’t leave his criticism of science and scientists at COVID and lab leaks. He extrapolated. “Can I say this about scientists?” he added. “I love them and they do such good work but they are going to kill us all.” Let that sink in. Scientists are going to “kill us all?” And he finished up by predicting how the world would end. “The last words man utters are somewhere in a lab a guy goes, ‘Huhuh! It worked.’”

I cannot overemphasize how dangerous this line of thinking is. It is true that some scientists have done some bad things in the name of research — such as the Tuskegee experiments. Scientists have been wrong. Science and technology have been tools that supported colonialism and oppression. Science does not release us from our moral responsibilities. All of this is the case because science is a human endeavor and scientists are human, subject to the same frailties and base instincts as any member of our species. But science is also a way of thinking, where we challenge our own dogmas and beliefs, whe

. . .I am old enough to remember when childhood was plagued by horrible diseases that have now been almost completely eliminated by vaccines. I remember when cancer was an automatic death sentence. I remember when we couldn’t imagine going to distant planets. I remember when we didn’t understand how our climate worked. I remember times when we were less knowledgeable and prepared, until science helped open our eyes. At the same time, I know that science itself is not a substitute for morality or public policy. It is a method for us to understand the choices we might have to make.

What we need is to teach people what science is, and what it is not. We need to show how the process of discovery works, how ideas are tested and sometimes found to be wrong. We need to investigate such stories like the origins of the virus. But we need to put that into the context of life on the planet, our interconnectedness, and all the other factors that shaped this pandemic. We need to embrace science as a quintessentially human endeavor, our instinct as a species to cross horizons of knowledge and experience. Like all of our actions there is a fine line between benefit and harm. So we must strive to create structures and systems of government and society that promote the former and minimize the latter. That does not include fanning the flames of ignorance or demonizing scientists who are dedicating themselves to opening our collective minds to information and data and have done so much to lessen the suffering of the human condition.

I know people think Rather is superannuated, a has-been with little to say. But his piece, as in the words above, is a far better take on science than that of any non-scientist journalist I’ve seen. The man understand how science works, and how it’s intertwined with human wants and desires. Jon Stewart, on the other hand, doesn’t seem to have a clue.

And you could argue that Stewart is just making an extended joke. Indeed, his line about the “last words man utters” is funny. But also misguided. And I don’t think for a second that Stewart is just joking here.

But I’ll grant you this: Stewart has a good sense of humor.

Did the Covid-19 virus come from a Wuhan lab? It’s looking increasingly likely.

June 4, 2021 • 1:15 pm

You surely remember last year when the “conspiracy theory” was broached that the coronavirus, which was thought by nearly all the media to have come from a Wuhan wet market, might have actually come from a virology lab in Wuhan, with some even suggesting that it might have been released on purpose.

Well the “deliberate release” scenario is dumb, since how could one contain an easily-spread virus targeted at an enemy? But the “accidental release” theory is gaining more and more credibility, with the Biden administration deciding to launch its own investigation. The story below, from Newsweek (yes, a conservative site), recounts how a group of amateur Internet sleuths pieced together from publicly available data what is the most likely story: an accidental release of a virus stored in the Wuhan Institute of Virology (WIV). That virus seems to have come from a Chinese cave in which 3 men shoveling bat guano died in 2012, and died from a virus that was remarkably similar to the coronavirus responsible for the pandemic.

It’s thus likely that the Chinese repeatedly lied about the origins of the virus and the U.S. government, suckered in, didn’t do due diligence in following up. After all, if a bunch of amateurs can piece together this tale (and I emphasize that we don’t know if it’s true for sure), why couldn’t the government?

Click screenshot to read the story:

It was a group of amateurs, following the lead of an young Indian called “The Seeker,” who determined that the sequence of the pandemic virus was almost identical to that of the virus stored in the WIV (they managed to get the latter sequence), and that that virus was likely the one who killed the three men nine years ago. They also found out, through diligent labor, that the WIV was actually studying the virus despite their denial, and had made seven trips to the guano mine to collect samples. The amateurs found grant proposals from the WIV, which was apparently testing the infectivity of the collected viruses, possibly with the hope of producing a vaccine against them.

As Newsweek notes, “The ongoing effort to cover this up implies that something may have gone wrong.” What went wrong, if the story is indeed true, might never be known, as the Chinese either might not know themselves and at any rate haven’t been exactly forthcoming about what they do know. Now professional journalists and epidemiologists are on the case, so we should get some answers—at least about whether the virus came from the WIV.

The episode of course makes China look bad (the article is replete with the WIV’s and Chinese government’s lies), but it also makes the U.S. look bad. It makes the press look bad: newspapers and websites had to go back and change months-old headlines that the lab-escape theory had been debunked. And it makes science look bad. To dismiss a theory without having investigated it first, and dismiss it so, well, dismissively, is only going to make people trust scientists less.  It’s even worse when you realize that had the Chinese been open about what they were doing, and were studying the sequences of viruses related to the pandemic organism, a vaccination might have been developed—or at least been in the works years before the outbreak.

Again, this is just a theory, but it’s a theory that’s become so plausible that nobody dismisses it as lunacy any more, and our own government is taking it seriously. If it turns out to be true, what will be the upshot? We’ll know to trust Chinese assurances even less (apparently the U.S. government was too credulous), and perhaps this can ensure more cooperation with the Chinese in future cases. But I wouldn’t count on it. At least we know that science works best when it’s at its most open.

At any rate, you owe it to yourself to read this fascinating amateur detective story.

h/t: Luana

Effectiveness of coronavirus vaccines

May 2, 2021 • 11:00 am

My doctor, Alex Lickerman, has put up post #13 in his continuing series on the medical science of coronavirus and the pandemic. This short but informative post (click on screenshot below) deals with a question we all have:

First, the effectiveness. Alex summarizes numerous studies showing how effective a vaccine is. Remember, though, what that number, expressed as a percentage, means. If a vaccine is 95% effective, it means that in a situation in which a certain percentage of people get infected, say 30%, then the chance you will get in infected is (100% – 95%) X 30%, or 1.7%.  Note that this does not mean that your chance of getting infected is 5%: it’s lower than that because not everybody gets infected when they’re not vaccinated.

Here are some effectiveness estimates taken by Alex from the literature:

Single dose Pfizer: 70%
Double dose Pfizer: 85%
Single dose Pfizer and Modern considered together, single dose: 80%
Double dose   ”            ”                   ”                 ”            double dose: 90%
The two above figures are also the same in another study not specifying vaccination

The 80%-90% holds for both symptomatic and asymptomatic infections; this means that yes, you can be an asymptomatic carrier if you have been fully vaccinated, but the chances are very small.

 Pfizer and Moderna combined (both mRNA vaccines): effectiveness: over 96%

Now remember again what these figures mean, because people get that meaning wrong all the time. Here’s one example I quote from the article:

A CNN article was skeptical of this data, arguing that “real-world studies of the Pfizer-BioNTech and Moderna vaccines show they are only 90% protective against the coronavirus, not 95% as reported in clinical trials. Translated into reality, that means for every million fully vaccinated people who fly, some 100,000 could still become infected.” Importantly, this is not what 90 percent effectiveness means! Ninety percent effectiveness means the vaccines reduce the rate of infection by 90%. To calculate a person’s absolute risk of getting infected after having been vaccinated, you have to start with the base rate of infection, which is different in different contexts. It would be true that “for every million fully vaccinated people who fly, some 100,000 could still become infected” if the base rate of infection for those million people was 100 percent. Yet the highest rate of infection we’ve seen in published contact tracing studies was around 30 percent (for spouses of infected people). This means that post-vaccination rates of COVID-19 infection in the vaccinated population are at most 90 percent less than 30 percent, or 3 percent. And that only if everyone who’s been vaccinated has an infected spouse.

In fact, the CDC reported that, as of April 20, 2021, out of 87 million fully vaccinated people there were only 7,157 breakthrough infections (0.008 percent), only 498 hospitalizations (0.0006 percent) related to COVID-19, and only 88 deaths (0.0001 percent) related to COVID-19.

Alex’s bottom line:

The mRNA vaccines are extraordinarily effective at preventing both symptomatic and asymptomatic infection and therefore at preventing transmission of SARS-CoV-2. Most importantly, if you’re fully vaccinated, your risk of dying from COVID-19 is 0.0001 percent.

What about the variants?. In answer to the question of whether the vaccines work against the variants, Alex says “yes”, at least for variants currently circulating. He adds that more data are to come.

Here’s Alex’s conclusion, which happens to echo the same conclusions reached by Bari Weiss in a piece published on her site this morning:

CONCLUSION: Given the incredible effectiveness of the vaccines at preventing both symptomatic and asymptomatic disease, and therefore disease transmission, and given that the rates of death from COVID-19 in vaccinated people is 0.0001 percent among all vaccinated people in the U.S. (an analysis that also included the J&J vaccine), if you’ve been vaccinated, we consider it reasonably safe to dine indoors, travel, and gather with even unvaccinated people. Living in the world has, of course, never been risk-free. Yet we can now say that with the advent of effective vaccines against SARS-CoV-2, the risk of living as you did before the pandemic has returned to what it was before the pandemic.

Here’s Weiss’s piece, which I think is free, though I’ve now subscribed. Click on the screenshot:

Harvard issues most self-abasing antiracist statement ever

April 10, 2021 • 12:00 pm

Not enough time has passed for us to understand why the tide of “progressive” political excess has risen so quickly. Yes, it accelerated after the death of George Floyd, but there are reasons why Floyd’s death unleashed what was already waiting to happen. I myself don’t really understand the phenomenon of “Wokeness”, and why so many people seem to have been driven mad.

Nobody wants to think of themselves as racist, but now we are told that not only are we all racists, but that we’re unconscious of that fact, and that the very structures of government, politics, and universities have racism embedded in their bones and sinews. And in this we’re all complicit. Some of this is true, as the voting rights bills suggest, and it behooves us to find the truth in all the shouting around us.

But the excesses—the shaming, the demonization, the self-abasement, the rush to judgment in every act, the drive to efface the past—often make me despair of the whole enterprise of antiracism, at least as conducted according to the Tenets of Critical Race Theory. It’s not so easy to separate the genuine inequalities that need to be fixed with the cries of the “progressive” left that we need to tear down the whole system and hand over political power to them.

But we can pretty much brush off extreme cases of self-abasement, so common in university “declarations” like the following. Harvard’s Medical School has a Program in Global Surgery and Social Change, and its goals are admirable: to extend what progress the “first world” countries have made in surgery to what they now call “the global South”: those countries with lower standards of living and insufficient medical care. Here are the program’s goals:

The Program in Global Surgery and Social Change (PGSSC) is a collaborative effort between Harvard Teaching Hospitals, the Department of Global Health and Social Medicine at Harvard Medical School, Boston Children’s Hospital and Partners In Health (PIH).

Our strategy is two-fold:

  1. Global surgical systems strengthening through Research, Advocacy, and Implementation Science, using the framework of the Lancet Commission on global surgery. You can learn more about the Lancet Commission on global surgery on the PGSSC Resources page.
  2.  To produce leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery. Through the Paul Farmer Global Surgery Fellowships and research associate positions, it aims to empower surgeons, surgical trainees and medical students around the world with the skills they need to improve the health of some of the world’s most impoverished people.

That is all well and good, but then the Program got mixed up in the anti-racism business, and in a pretty strident way, and issued this statement, which I reproduce only in part.

Racism murders. Racism destroys. Racism dehumanizes. We live in a racist world and all play active and passive roles in perpetuating racism: the system of prejudice and discrimination based on the ambiguous social construct of race backed by unequal and unjust power dynamics. Racism is inherent to every aspect of our lives; it is woven into the fabric of society and consequently its effects interface with our work as the research associates, fellows, and faculty at the Program in Global Surgery and Social Change. Therefore, the absence of conspicuous racist actions is not enough. We must be actively anti-racist. We absolutely, unapologetically denounce our wretched racist system and its proponents without exception.

Racism systemically places higher value and opportunity in the hands of a specific race, and as a direct consequence disadvantages another racial group. It is this benefiting of one group to the detriment of another that has led us to focus on anti-racism. The work of antiracism is allied to that of anti-discrimination and the evaluation of inequities based on gender, sexual orientation, caste, religion, ability, tribal affiliation or socioeconomic status. However, given the distinct relationship of racism, colonialism, and global health, we in the global health community have a moral imperative to shine a bright light specifically on racism within our sphere.​

Racism is inherently linked with colonialism. Our work in global health is rooted in colonialism, which provided power to white Europeans through subjugation and exploitation of others. Colonialism subsequently allowed for the creation of the construct of race to justify the dehumanization of those the colonizers exploited. This practice has lived on in global health through the racist belief that those same colonial powers possess medical knowledge that is superior to that of the cultures they denigrated. Consequently, global health is built on a foundation that, at its core, is antithetical to the principle of shared human dignity and respect. Affirming our commitment to anti-racism also affirms our commitment to being anti-colonial.

Academic institutions in high income countries are complicit in and the product of centuries of historic institutional colonialism and racism with over-representation of white voices that are heard on a global scale. We interact with a diverse group of international partners, but cannot truly be equitable partners until we acknowledge and address the place of power and privilege from which we operate.

Here we see the familiar denouncement of racism (seriously, is there any rational person who doesn’t already denounce it?), the chest-beating and self-abasement, and the accusations that all of us are complicit in perpetuating systemic racism. And, like Ibram Kendi, it argues that it’s not enough to refrain from being racist, but we must all actively work, and work in a certain way, to be “antiracists”. Whoever is not antiracist, says Kendi, is racist. It is as if there is only one issue in the world on which we should be working.

Now eliminating global inequality in medical care is an excellent goal, but I fail to see how these kinds of statements will help solve the problem. What we need is the kind of recognition of moral deserts that got Dr. King and his associates the civil rights laws they sought. Why shouldn’t we be helping others who are human and suffer in ways we understand? What we get instead is annoying hectoring, coupled with the strange declaration that promoting global health in Harvard’s way is racist because the practice of medicine in First World Countries is more advanced than in underdeveloped countries. (The fellowships given out by Harvard’s programs are, after all, spent learning at Harvard.)  I call your attention to goal #2 of the program given above:

To produce leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery. Through the Paul Farmer Global Surgery Fellowships and research associate positions, it aims to empower surgeons, surgical trainees and medical students around the world with the skills they need to improve the health of some of the world’s most impoverished people.

This is the exportation of Harvard-style medicine to other countries. Isn’t that the conscious promulgation of “superior medical knowledge”?

This is, of course, a species of medical colonization, for who determines what skills medical workers in poorer countries need? It’s not colonization in the sense of taking advantage of poorer nations, but it’s colonization in the sense of believing that one indeed has “medical knowledge superior to that of the countries they  [once] denigrated.”

There’s a lot more, as well as three subsections swearing what Harvard will do to promote antiracism in various areas, including “People,” “Culture”, and “Civic Engagement”, which itself has two sub-subsections, “Academia” and “Economic Injustice”.  Here’s the Academia part.  I reproduce it because I think it’s misleading about the degree of racism in academia, at least in my experience:

Academia: We acknowledge the role that academia plays in perpetuating structural racism. Academic excellence requires equity, yet despite statements denouncing prejudice, many academic systems are fraught with biases. Notably, it is often Black, Indigenous, and People of Color who are expected to be, and inevitably are, the most engaged in issues of structural racism in academia. This engagement results in activities and efforts leading “diversity, equity and inclusion” initiatives that are not traditionally valued in academic promotion criteria. This reality highlights the need for a paradigm shift in two ways – who shoulders anti-racism efforts, and how anti-racism work is valued and supported institutionally to ensure that personal and professional goals are being met. We will engage in the broader academic system, outside of our specific purview of global health, to catalyze meaningful change in the culture of academia.

Anybody familiar with academia will sense the tension in this statement.  And I’ll finish by adding that inequities (differential representation of groups) in academia does not constitute prima facie evidence for structural racism present in academia now.

New post by Dr. Alex Lickerman: Should you get the Johnson & Johnson vaccine?

April 2, 2021 • 10:00 am

Dr. Alex Lickerman, my GP, has a new post on his website about the coronavirus and vaccines, the twelfth since he began posting during the pandemic. Click on the screenshot below to read it (it’s free).

The short answer to the title question is “yes”, but there are lots of other questions answered (and some raised without known answers). One is whether you can be an asymptomatic carrier if you’ve been vaccinated. Alex’s answer:

The study didn’t present enough data to prove the vaccine prevents asymptomatic infection. Nor did it assess whether subjects who developed COVID-19 despite vaccination are less likely to transmit the virus. Thus, it’s not yet clear how effective the vaccine will be in containing the spread of the infection. (A recent study from the CDC, however, strongly suggests that both mRNA vaccines—Pfizer’s and Moderna’s—do indeed prevent even asymptomatic COVID-19 infection by 90 percent in real-world circumstances, which is great news. We need more studies to learn if this is also the case for J & J’s vaccine.)