Some of you may remember the interview I did with Ivor Cummins of the Fat Emperor podcast back in October, to talk about covid-19. We’ve now done a follow-up interview where we continue the discussion and talk about covid-19, my new book, and what’s been going on in Sweden these last few months. I think many of you might find it interesting. You can find the complete interview here.
Covid interview with Ivor Cummins
Delighted to see this notification in my inbox. Great for two heads like yourself and Ivor getting together to discuss matters. Thanks
I watched it an hour ago. Ivor are really good and this episode was great.
Dark times are ahead of us when we have to censor our own words in fear of being removed.
Keep up the great work.
I wish everyone read your book Sebastian. I bought it when it came out and speak about it with friends, co workers and family. Even then people still can’t take it in and fully accept the “new normal”. A new normal I refuse.
Great interview. I’ve ordered your book and can’t wait for it to arrive!
I just tried to find the book on Amazon, it does not turn up. I then talked to customer representative and got this answer:
“I understand you’d like to purchase this product. Unfortunately, it is not available on Amazon at the moment. However, we understand your interest in purchasing this and I’ll pass on the feedback to our order procurement team. Your feedback is valuable to us and we’ll try our level best to fulfill your request. ”
So in other words they have removed the book from their sales list. This is of course censorship.
I noticed the same thing earlier today. They appear to have removed books that discuss the covid vaccines in even a slightly critical way. Apart from my book, Alex Berensons book and Joe Mercolas book are also no longer searchable on Amazon. The direct link from my site still works though, so it appears they’ve only made it unavailable through their search function, rather than removing it completely.
Excellent interview, very enlightening.
I have a comment / suggestion to you both. I think a good thing with the “pandemic” is that we fonally have a lot of people focusing on health issues. Albeit very narrow with these Covid headlines wverywhere.
I mwan that this should be a great oppurtunity to talk about all the other big health issues such as diabetes, obesity, mental illness plus how to reduce spread of the usual colds, flus, stomach bugs and so on… Washing hands, good ventilation, stay at home when sick and even social distancing etc are great measures that should always be in place…
I remember reading somewhere that in Norway they will as last step in their easening strategy remove the signs on the streets for distancing, washing hands etc… Why? Keep them…
So you think people should abandon millions of years of history and never get close to each other again?
Life is short. Perhaps we need to live it and not spend all of it worrying about death.
What kind of response is that? Of course, we need to live life without fear… Is there no opportunity to learn something that will make our lives better and healthier in future?
Do you have the link to the non-Amazon bookstore for your book?
Thanks
https://www.bokus.com/bok/9789188729859/covid-why-most-of-what-you-know-is-wrong/
Please please please….. comment some studies on vaccine and pregnancy. Which trials recommend a pregnant young women in week 23 to take the vaccin, at the age of 36, no overweight or other complications or underlaying diseases? This young woman is so scared to get covid and be out of oxygen or a premature birth. Would you Sebastian recommend your own wife to take the vaccin under this circumstances? I am very very concerned grandmother, worried for future complications for the little baby. I know the trials is in fase 3 and will be ended 2023.
please don’t use youtube, vimeo works fine and is ad-free, please include closed captions, I have bad hearing problems
Hi, Dr. Rushworth!
I read your book last night and just watched your interview with Ivor Cummins. I’m sorry that you didn’t speak about the vaccine issue. As time goes on, the reports of injuries and deaths grow; but the censorship continues. People need to hear the truth, especially now that they’re pushing injections on children here in the US and elsewhere. FYI, I regularly post comments on Fakebook about the VAERS reports and the low risk of the virus to children. I have not been censored, although the “fact checkers” sometimes block my ability to post for a time. I have encountered many trolls. I suspect some are paid “influencers”. Others, perhaps, have been broken by the overreaction to the pandemic and are threatened by anyone who challenges their beliefs.
The reports to the VAERS, EudraVigilance, and the UK are shocking. Yes, I recognize they are preliminary and do keep in mind that correlation is not evidence of causation. But, these numbers are being suppressed in the US…and I suspect in other countries. It’s very hard to make sense of what has been happening in the world these past 15 months, but the willful silence about the reports of deaths and serious injuries is the hardest to explain. For me…hubris, stupidity, greed, and power are not enough to make sense of it.
I came across this factoid the other day. Mongolia had very little illness and death from Covid19. In fact, they didn’t record their first Covid19 death until December 28, 2020. And then they started “vaccinating” people on February 23, 2021. I believe they are using the AstraZeneca injections.
There are three oddities. First, they had very few C19 cases throughout the entire pandemic. Second, they had one recorded C19 death until about two weeks after the “vaccine” drive started. Third, they are now experiencing a large increase in cases and deaths at a time when you would expect the virus to be waning due to seasonality. None of this makes sense. It raises a lot of questions with no answers.
https://www.worldometers.info/coronavirus/country/mongolia/
https://mongolia.un.org/index.php/en/116082-mongolia-welcomes-first-batch-covid-19-vaccines-covax-facility?fbclid=IwAR0CYuwIfH9qMan2O_C3eM-cgImFLBazfkWDuJ5qUNpKdIRxBUhrfi9ORlY
I was also curious if your views about long Covid have altered in light of the Salk report, which states the spike protein alone can do damage to endothelial cells. I understand the MRI study you mentioned is deeply flawed on many levels, but is it possible people have experienced endothelial organ damage from the spike protein? It seems a reasonable hypothesis. The Salk study raises serious additional concerns about the “vaccines”, which the powers that be have ignored.
I would also mention that I developed two autoimmune conditions following my first and only influenza infection. The first symptoms started within three weeks. They were weird and seemingly unrelated: eyelid droop, heart palpitations, tingling in my lower legs, deep fatigue that didn’t improve with sleep, cold sensitivity, headaches, GI disturbances. I had these symptoms for about four years and made only a small attempt to find out what was wrong with me. Eventually, I was diagnosed by a recent med school grad. I went in to get a stronger cough medicine for a bad cough. He checked my thyroid and told me I had a goiter. I thought he was nuts, but I agreed to the blood tests. He was right. I have Hashimoto’s Thyroid. A few years later, I was diagnosed with another AI condition. As I’m sure you know, viral infections are a suspected trigger for AI disease. People who claim long covid may have anxiety or hypochondria, but they may also have emergent AI disease. Given my experience, I give them the benefit of the doubt. I might still be walking around sick but for that doctor. And I will take medications for the rest of my life to keep my immune system in check and to compensate for the damage done.
People with autoimmune disease usually spend years being mistreated and mocked before they are ultimately diagnosed. I was more fortunate than most.
Thank you for all you do! You’ve been a voice of reason and sanity during an insane year.
Fantastic! Is the book/will the book be available as a audiobook? Very useful for dyslexic people….
Yes, it is, but only in Swedish unfortunately.
Very good interview. Such a change from news reports to have two thinking people who actually know their subject and are not trying to push some hidden agenda.
I’ve ordered the book
Can I put a slightly different view of this.
Cummings, who did most of the talking, is a beguiling mix of facts, speculation, opinions, and prejudice. His use of data is pretty selective. He talked about the rising number of cases in Germany but a falling excess death rate. This is no longer correct (Our World in Data, latest data April 25th) The data for Europe is very variable with no consistent pattern. The majority of countries show an increase in overall excess deaths. A misleading impression was given in this part of the podcast. One statements really jarred with me “I am top of my field in problem solving data and myriad other fields..” There is no such thing as a self appointed expert.
I just do not buy into Cummings statements about all the influential world organisation, not mentioned, having a conspiracy to keep the pandemic going in their interests. If there is a choice between cock-up or conspiracy, cock-up is much more likely. I think the governments of the world have just blundered along firefighting day by day.
I read your posts as they assess and summarise the data and conclusions in a fair manner. If you hitch your wagon too much to any faction in the covid wars. you may loose your reputation for impartiality
I think what Ivor Cummins is suggesting is that various groups are seeking to use the situation in an opportunistic way to push their agendas, rather than some sort of grand conspiracy right from the start. Of course no one’s biases simply disappear when they start analysing data, and it can be difficult to judge at a particular time and place, whether a new virus has yet fallen into the endemic seasonal pattern of its close relations.
Data analysis is not my strong point to say the least, which makes Sebastian and Ivor’s clear explanations helpful. I never assume anyone is presenting the whole truth, or that there is no other interpretation. What I do know a bit about is logical reasoning and linguistics, so I can recognise logical fallacies and obfuscation when I see them. The mainstream narrative displays them relentlessly in spades.
Ian, I have to say this. I have come across your comments in previous articles and my intuition tells me you are working on the side of Big Pharma or the Government or similar and have some stake in keeping this great lie going.
I am retired doctor, no stake in anything at all. I have not come across your comments before as far as I know, but do you work for David Icke? This idea that anyone who has an alternative viewpoint must be in the employ of the devil is rather childish.
I agree Ian. Dr Rushworth is only tarnishing his good reputation by associating with a quack like Cummins – the Feigl-Ding of the sceptics. I would have liked to see Rushworth push back against some of the baseless claims made in the interview (there were many), but I guess he’s too polite.
In what way precisely is he a “quack”.
What are your specific, factual points?
We can all label people with whom we disagree.
Matt,
You are right: poor doctor…
It is funny to see that are people who do not know what a ‘quack’ is. I advice them to buy a dictionary.
ian,
The incompetence theory is to be preferred over the conspiracy theory until the data doesn’t support the incompetence theory.
We have western governments and media and public health experts generally in lockstep, which they have practiced for in the past with pandemic wargaming seminars. We have panic mongering from those same entities aimed at spooking the sheep. Those same entities required that antivirals be given only as late treatment for covid, although as early treatment for influenza. We have the vaccine rollout just as the US reached herd immunity. The odds of all this coming together by accident is extremely improbable and the only way to avoid the conclusion of conspiracy is to place one’s hands over one’s eyes.
Only cowards worry about being labeled a “conspiracy theorist.” When the evidence of a conspiracy theory is overwhelming and people start yelling “conspiracy theory,” your rounds are on target.
Unfortunately, I increasingly agree with this view.
I did think this was 100% error.
Am less sure now.
Stephen,
For me, the pivotal moment was when I realized in June 2020 that the CDC in Jan. 2020 had advocated treating high risk flu patients early with antivirals. After seeing that I could no longer accept the incompetence hypothesis.
Just watched the video with Ivor Cummins. Sebastian I think you will go down in history for your excellent works.
And more important on the right side of history.
I recently came across an article that claimed the Sanger method for DNA sequencing was more accurate than PCR tests. The author suggested that to confirm PCR tests the Sanger method should be used. Is this an accurate claim? If so what would it reveal? Is it used for that purpose?
There are a host of questions but I will not try to list everyone.
Is their an article in this for you?
I’m not sure. Do you have any reference you can link to? From my perspective, if you want to be 100% sure that a positive PCR test represents an active infection, then the only way to confirm that is with viral culture.
Thank you Dr Rushworth
As someone who knew Fred, the question is essentially a misunderstanding. I think. I believe Sanger Dideoxy procedures are not used for PCR, but these are the sort of critical details that are so very hard to find. You do not use the Di deoxy ribose nucleotides. The process simply amplifies DNA based on two reciprocal primers, and the question is whether they anneal, (or recognise and so bind the DNA) at all. Then the result is purely quantitative, enough amplified DNA to give a recordable level of dye associated with the amplified DNA that is then measured automatically by a meter. consequently a binary result is given, and as I see it there are endless arguments out there in the DigiRama about this, and how many cycles of replication are used and so forth. Here I would say it is just another one of these endless pointless arguments that drains energy and misses the point. The critical issue is validation. Do you pick up the original viral RNA in the first place with your Reverse Transcriptase? And do your primers actually anneal? Does your sample treatment prepare the RNA and not degrade it. For example, RNAase is one of the toughest enzymes out there, it is ubiquitous, and your hands are fingers are covered with it. You have to remove the viral protein membrane coat and keep it RNAase free then the reverse transcriptase process will continue automatically and the resulting DNA can be amplified, and amplified proportionally. Thus 40 cycles would give 20 doublings more than 20 cycles, and you will find more virus, if you can find any at all in the first place. If so all well and good and the literature states, I believe, that as few as 10-20 molecules of viral RNA can be sensed sense, if they are there in the sample and not degraded. The notorious problem is contamination. If you can pick up so few viruses, how can you ensure virus or viral RNA does not enter your test system from another source. Then you may have a positive test result though the sampled patient was free of virus. “Now I don’t know but I’ve been told”, that this has been a significant problem, everywhere there was rapid scale up of the procedures. The sampling and analysis is a highly skilled procedure, especially with respect to keeping free of contamination. The Crick Institute for example were called in in London in the early winter, because of serious contamination problems consequent of poorly trained staff, giving rise to untold numbers of false positives. As you can imagine, that will give the impression of a lot of C19 and the panic will increase. One thing I have never seen, but perhaps is done, is to check for bursting. For example, 100 people are tested at a given site, or 100 tests are analysed in sequence, and 20 are positive. Were these randomly distributed throughout the 100, or were the positives for example 20 to 40. If so, you probably contaminated the procedures at patent 20 and the next however many are positives are simply. contaminants. The statement made to me was that it is simply ludicrous and in practice not possible to scale up such sensitive procedures to such an enormous extent, as you simply do not have the skilled personnel and it takes time to train them. So while it was seen in London, it presumably was the same everywhere there was rapid scale up and role out of PCR testing. The testing and particularly the sampling is treated well in this short video by Ferric Fang, a highly respected pathologist, about 21 minutes in.
COVID-19 Pathophysiology and diagnosis | Ferric C. Fang, MD • 20. mar. 2021
https://www.youtube.com/watch?v=-YSM-jIP5iA
The striking thing that Ferric Fang shows in the literature references he cites are absurdly low sensitivities of the PCR tests. Unusable sensitivities right down to the 30% level are reported. It is incomprehensible that such testing can be used. It is unviable. And I know of people who had highly suspicious symptoms of C19 where the tests were negative and an alternative diagnosis was given. This is absolutely inept medicine and I frankly have a hard time believing it. If true, the situation is beyond fiasco.
If what you are getting at is whether Sanger sequencing would be more sensitive, in the strict sense it would make no difference. But if you took the amplifying DNA and amplified further using DiDeoxy procedures you could run out the sequence and then the process would self validate. You would be able to see what you have, not just a colour dye, or a Yes/No binary result in your test equipment. This is where all the draining debate comes. It would be better to sequence the lot, then you know exactly what you have. You could identify bona fide C19. In that sense the test would be more specific.
What I do not understand from what has been reported is why even just part is not sequenced, you do not need necessarily to sequence the entire 30kb genome. Just part would be enough for unambiguous identification, particularly if you sequence areas of antigenic interest. Perhaps this is now done in the robing for variant of concern, but that is not clear in the literature I have read.
Depending on how much you sequence and the local mutation rate, you could then see if your samples are true viral infections or contaminations, for example if 20 to 40 of 100 for a theoretical test centre were exactly identical it would suggest contamination. If they were different you would be sure they were not. It would also obviate the whole problem of Variants of Concern, as you would have sequence identity of the actual viruses presenting. For example if you identified the exact variant in your patients and observed the outcome it would be readily clear if one variant was more infectious or virulent than another, and know where they were in your society and track their spread. I admit that it is confusing to me that this is not done. What is done seems to optimise the amount of confusion and societal panic in ratio to the actual useful medical information given.
From the extraordinary numbers cited in the literature (and also by “word on the street”) it is quite possible there was no real second wave of C19, just the annual seasonal cold and flu this time including any number of SARS CoV 2 variants, and by the end of March there were, according to the BMJ webinar on variants of concern, over a million different sequences in Genbank (which makes the debate around Variant of Concern untutored to say the least). Just a lot of false positives and staggering amounts of contamination in test sites, clinics and hospital wards could vastly over diagnose C19. Unless tests were also done to rule out the rest of the medley of viruses that come at that time of year. Was there a true second wave, or simply a traditional but severe cold and ‘flu season in the coldest winter we have had in years, unleashed on a population of totally immunocompromised people from 9 months of panic and anxiety and fear and endless and confusing “Lockdown Restriction” and an incessant media barrage.
Sorry with apologies, Dr Rushworth is quite correct, by the book. I just wrote about the sequencing of DNA/RNA.
But…. look through the Ferric Fang video, I believe he is a good resource. The traditional problem is low sensitivity of any form of pathogen culture. But how low do you have to be to compete with the absurdly low reported sensitivities of the PCR tests. They are simply not credible. If the reported values are correct, the mass PCR screening is just giving “Noise”.
In response for more information. I have lost the original article
Here is a study
https://wwwnc.cdc.gov/eid/article/26/10/20-1800_article
I – fucking – love you and the intelligent fight you are taking on behave of me, my children /family and all of humanity! THANK YOU!
I really hope there are many more Swedish doctors like you?…
Doctors are supposed to be educated and intelligent and we have an oath to follow…
First do no harm. Primum non nocere. I wish doctors could debate what this means during a time of Covid…and then start standing together in a fight for real science as opposed to pseudoscience – and a doctors right to follow science- not politicians who are actually violating the oath mentioned before – first do no harm!
I must say, I never heard of Ivor Cummins, by chance I noticed some articles of Sebastian. The one thing that I am really glad about, is that apparently I am not the only one who has lost the logic of this all. That is the only discussion I have with friends and family. How come we lost our capacity to think, how come we believe everything the media is presenting us, how come we are not allowed to think out loud and say out loud that we do not always agree. I was chocked about the use of masks outdoors and expressed myself and some responses were: it is just a piece of tissue, not so bad at all, just do it and keep your mouth shut, WTF. I am hurt every day, because my children have to endure this craziness. Do not get me wrong, a year ago we (my family of 5) all had the C and we were ill, some longer than others, some worse, some even longer and still in recovery, but that doesnot mean we have to stop living, because SURPRISE, there will be other diseases etc in our lifetime, and sorry to say this, we need them because the world is already to crowded. Nature will always find a way to be stronger. So accept, continue living, choose your way of living, healthy or not and keep on being critical, keep on educating where there is lack and misunderstanding and use your brains. That is what I try to learn my children, because the V is not always a solution.
I believe something went really bad and out of control completely, which explains the reaction we had in the world, it is the only logical explanation for me.
I am glad I found Sebastian Rushworth who has the capacity to try to ‘explain’ this weirdness and it helps me through this time.
The loss of ability to think is by design. Panic mongering leads to fear which paralyzes the thought process which is required for critical thinking and analysis. Sheep in panic play follow the leader and the public health authorities have been presented as the leaders of the sheep.
I think this is 100% correct.
Why would you even do this Dr Rushworth? Cummins is embarrassing: spends half the interview talking about how wonderful he is, and hardly lets you get a word in. Would love to see a conversation between you and Bret Weinstein of the Dark Horse podcast, Dr Vinay Prasad, or Freddie Sayers of Unherd.
Deep State and politicians are truly afraid of Ivor Cummins expert analysis and how he completely exposes them for what they are. Compromised liars.
Whatever Cummins’s faults, he is no foot-shuffling coward. Cummins calls a spade a spade and pokes the powers that be.
I tend to agree about Mr Cummings. His statements must be taken with a great pinch of salt.
That said, this is unfortunately the kind of rhetoric that is needed to breakthrough all the noise. So, I watch and listen to him with interest.
I also watch and listen to, for example, Dr John Campbell that is on the other end with his preachings in favour of restrictions, caution and vaccines. Combining the two, I think one can make pretty good conclusions… A brain needs two halves.
Hello Sebastian
After watching the interview, I bought your book and read it in a day and found it clear, calm and well thought out, all without any graphs and tables, which must have been a challenge in these times 🙂
I would highly recommend it to get it translated into other languages such as German, French, Italian etc. We now face “vaccine passports” and a lot of forthcoming legislation (e.g. Switzerland, referendum coming up in mid June 2021) that will restrict the free movement of people based on whether they have been vaccinated or not.
If I have one challenge for you, I think its worth further exploring the use of “anecdotal evidence” in scientific studies. A lot of doctors working at the frontlines in hospitals and clinics, do have valid stories to tell, yet just don’t have time or resources for balanced and double blind scientific studies. They just have the time to say “yes I did this, and it worked on my patients X, Y & but not patient B.” . With respect to this, if one looks at the introduction of Ivermectin as alternative or complementary treatment in countries such as Zimbabwe, Peru, India and others, doctors in these countries usually don’t have time or resources for scientific studies, they just get on with trying the treatment. As one example, take a look at the video interview with Dr. Jackie Stone on Youtube “The Impact of Ivermectin in Zimbabwe” and Dr. Paul Marik, Eastern Virginia Medical School “Fighting COVID 19. Ivermectin: Myth or Reality?” The irony is that the recoveries seen in these countries will be officially attributed to vaccines, not Ivermectin. I wonder how powerful it would be if someone or some organisation could collect thousands of short video interviews on their experience of such treatments vs vaccines?
That is the worst thing that could happen. If it is nonsense, it remains nonsense no matter how many times it is repeated.
The history of medicine is full of examples of well meaning doctors who were actually doing harm to the patients by following treatments that in their opinion were the best. Halstead’s radical mastectomy is one of the worst. Generally in the past, because of their social position and function, doctors either had or felt they had to project an air of infallibility, and there was little need or attempt to revise their opinions. Luckily these days are generally over, and evidence gathered by methods that reduce bias should underpin treatments. Individuals getting up on YouTube saying “I have done X, and it works in my opinion” will take us back to the Dark Ages.
Which seems to be exactly what is happening at the macro level: “look, we introduced a lock down, masks, vaccines etc. and the illness went away”.
Zero control study.
So why haven’t high quality RCT’s been done of early treatment with 200mg bid hydroxychloroquine x 5 days by pharma? What would happen to vaccine demand if an effective early treatment had been shown? Would “Warp Speed” have been done?
Why was hydroxychloroquine restricted to late treatment by the CDC? Why didn’t the CDC allow _early_ treatment where an antiviral might help? Why would the CDC suggest that early treatment with flu antivirals be given to high risk patients even before lab results were known back in Jan. 2020?
https://www.cdc.gov/flu/highrisk/index.htm
Where is the harm in a 5 day treatment course of HCQ at 200 mg bid? Show me the trial that demonstrates a harm at that dose.
I find it difficult to believe that any physician would say that anyone, including government entitities, ought to come between them and caring for their patients. Did you do clinical practice or just research?
Surgeons treat patients all the time with medical devices that haven’t gone through RCT’s and it is not possible for RCTs to occur for medical devices which are rarely used because the cost would be prohibitive. I agree that damage has been done by radical therapies and that physicians ought to tread cautiously when it comes to potential therapy. Show me the studies that show that clinical doses of ivermectin or hydroxychloroquine are not well-tolerated excepting a tiny fraction.
I think that we both know the answer to these questions.
“Where is the harm in a 5 day treatment course of HCQ at 200 mg bid? Show me the trial that demonstrates a harm at that dose.”
There is no trial at that dose that I know of, but that is not an argument that is is therefore harmless or useful. Would you do a trial of voodoo in this circumstance? If not, why not? There is as much reliable evidence in its favour as HCQ.
“I find it difficult to believe that any physician would say that anyone, including government entitities, ought to come between them and caring for their patients. Did you do clinical practice or just research?”
That is completely ludicrous and exactly the problem that occured in the past, when doctors could do pretty much anything they thought appropriate. There are a myriad of regulatory bodies now with specified professional standards. In the UK the General Medical Council is the registration body, but hospital trusts, responsible for the clinical standards of their employees have their own requirements, just to name two.
Ian,
It is on you to find the black swan regarding the alleged clinical dosage HCQ harm. I have looked and looked for such a swan and none is to be seen.
As regards HCQ usefulness for early treatment of covid, there are literally dozens of studies showing benefit. Even several that are high quality cohort studies. There has been a plethora of bad faith by “public health” authorities pointing at dodgy studies like RECOVERY and the VA study and the retracted Lancet article. If those authorities had been concerned about testing the early treatment hypothesis, they would have gotten some RCT projects underway. By ignoring this issue, they only confirm suspicions of their bad faith.
Then, when you consider the PCR overcycling question, you end up with even more evidence of bad faith by the “public health” authorities.
Now to the question of evidence. Are RCT studies necessary and sufficient for evidence? Certainly some RCT studies have found evidence of iatrogenic harm. They have also found evidence of benefit in other cases. Moreover, there is likely some group of medical interventions where studies show benefit which have not yet been confirmed by RCTs. And there is also likely some group of medical interventions where studies show no benefit which have not yet been confirmed by RCTs.
Do non-RCT studies tend to discover potential benefits? Of course. And are those benefits often confirmed by RCT studies? Quite often. So what sense does it make to restrict physicians from prescribing medications off label, which medications are almost universally described in the literature as “well-tolerated?”
When “public health” authorities prevent potential benefit, they are potentially doing harm. This likelihood is stronger when studies exist which show benefit–it’s not a coin toss. So restricting because of a lack of RCT confirmation is precisely the wrong tack. Let physicians weigh the risk/benefit for their particular patients. And let researchers go run their RCTs. And let public health authorities make their decisions based on science and not put their thumb on the scale.
In the case of high quality early treatment HCQ RCTs, researchers have been quite lazy. Maybe a lack of profit is involved because pharma tends to fund RCTs and there is no money in repurposed drugs.
There have been some RCT trials on HCQ for prophylaxis, and no benefit was found (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013587.pub2/full). Dr Rushworth has reviewed the RCT trials on HCQ treatment, and found no evidence of benefit. This outweighs all the observational studies, anecdotal reports etc.
I was an anaesthetist/ICU consultant – for your information, i did clinical medicine and research. Every anaesthetic I gave usually consisted of about 8-10 drugs, and if the patient was a child or a pregnant woman, nearly all of them were outside their product licence. Drug companies do not test their products on these patients when getting a product licence. They rely on doctors extending the use into these other groups. Potentially I could be hauled up before the General Medical Council for this. My defence would be plenty of experts testifying this was established practice.
This would not be the case if I decided to try something totally off the wall.
The other problem I have with these ‘studies’ on unusual treatments is what was the consent procedures and had they been passed by a properly constituted Ethics Committee? We never hear what the patients were told, was written consent obtained that they understood the treatment had no established benefit and could have harmful side effects? In a proper RCT, this would all be documented.
Ian,
Thank you for explaining your experience. It makes a difference. I am nonmedical myself, although I have a bachelor’s degree in chemistry and a master’s degree in physics with thesis and some odd biology courses (intro, microbiology, biochemistry, cell biology, and evolution). I have access to medical people in my family on a daily basis and discuss issues with them. One of them prefers that I not give out any information about that person on the internet and I will comply. My classical optics research had implications for planetary study and for medical research. I have read more than 100 and likely more than 200 research articles on various topics surrounding covid (pathology reports, PCR articles, articles on coagulopathy, pulmonology articles, immunology articles, virology articles, ventilator articles, masking articles, vaccine studies, and various studies of antivirals used to treat covid).
Now I’ll discuss your article on “Chloroquine or hydroxychloroquine for prevention and treatment of COVID‐19”.
One good thing is that it looked at a broad section of humanity. The numbers looked good on the surface–it seemed to be a large dataset. Another is that the studies reviewed were RCTs, to limit bias and confounders.
Now I’ll look at the problems.
“Nine were in hospitalized patients, and three from ambulatory care.” Nine were late treatment. This is a mountain compared to anything else. Expecting antivirals to do any good in an inpatient setting is silly unless the inpatient caught the disease in the hospital and you treat it promptly, which looks to be within three days of symptom onset.
Viral clearance looks to be 8-9 days post symptom onset based on PCR with viral culturing. See
“Viral RNA load as determined by cell culture as a management tool for discharge of SARS-CoV-2 patients from infectious disease wards”
https://link.springer.com/article/10.1007/s10096-020-03913-9
From the article which I linked, “It was observed that SARS-CoV-2 was detected up to 20 days after onset of symptoms by PCR in infected patients but that the virus could not be isolated after day 8 in spite of ongoing high viral loads of approximately 105 RNA copies/mL of sample, using the RT-PCR system used in the present study.”
Back to my analysis of the article which you linked.
“Disease severity, prevalence of comorbidities, and use of co‐interventions varied substantially between trials.”
Severe disease and mortality risk are important factors to take into account when designing a study. Severe disease correlates with covid progression past the time to max viral load. These severely ill patients were given antiviral treatment past when it could help them.
“Severity of disease varied between trials. Whilst not all participants could be classified according to WHO severity grading, 3139/8569 (37%) of participants did not require oxygen or other respiratory support at enrolment; 5230/8569 (63%) were receiving oxygen or higher respiratory support.”
More evidence that the dice were loaded.
“The two largest trials (Horby 2020; Pan 2020), which mostly included participants requiring oxygen or higher respiratory support, contributed the majority of participants to the meta‐analysis of the outcome death due to any cause for the comparison of HCQ versus standard care or placebo.”
At least the authors were honest about loading the dice.
Loaded-dice RCTs versus observational studies? Observational studies _may_ have confounders that produce the positive results, but there’s at least a possibility that their results are valid.
From a few of the higher quality observational studies of hydroxychloroquine which I have seen, there looks to be about an 80% decrease in hospitalization relative to non-treatment. Put another way, non-treatment increases hospitalization 400% relative to early treatment with HCQ. Relative deaths track about the same as hospitalization.
I rate Derwand, Procter, and Mokhtari as pretty good, although I can find some molehills in those studies that I can nitpick.
I disagree:
To paraphrase Tim Noakes, who has done pioneering work on LCHF and reversing type 2 diabetes, and yes, using n=1 studies, on himself initially:
“The plural of anecdote is not evidence. But scientists ignore anecdotes at their peril. Since all new wisdom usually begins as anecdote”
I really do think the majority of doctors working in family practices, clinics and hospitals do follow ethical guidelines and “first, do no harm” principles. There are of course rogue elements, as in all professions. What is astounding are the “infallible” official government medical scientists and their recommendations, that get translated into very harmful policies.
Adsgamer
Good review. I used to peer review, and you can usually find holes to pick at in most papers. RCT evidence is better than other types of studies. As I am sure you know, you can amalgamate all sorts of evidence with meta-analysis, funnel plots to detect possible bias etc, and Dr Rushworth has done this, and so far, no evidence of benefit from HCQ.
What I am railing against is the degree of certainties expressed on all sides. You expect this from politicians of any stripe, but the ‘other side’ seems equally guilty. In any of these forums you can read fairly extreme viewpoints expressed with total certainty. You see similar entrenched positions on alternative cancer care. Could I point you in the direction of this BMJ paper you may already have seen; The more certain someone is about covid-19, the less you should trust them https://www.bmj.com/content/371/bmj.m3979
Scotty
Many scientific and medical discoveries occur serendipitously. This should generate the appropriate investigations to establish their properties before it becomes established practice. The story of Halstead’s radical mastectomy operation is a cautionary tale.
ian,
“There have been some RCT trials on HCQ for prophylaxis,”
Boulware? Wiseman showed Boulware to have a major error in data presentation caused by shipping delays and Boulware’s paper has yet to be corrected.
https://www.medrxiv.org/content/10.1101/2020.11.29.20235218v1
Was Boulware underpowered?
These are mountains. Or are you going to say that the treatment window is wide for antivirals?
As regards reviewing and finding holes in papers, I ignore mole hills and focus on mountains.
The key hypothesis to test is whether an antiviral reduces hospitalization of high risk patients when given early. The evidence so far is totally on the benefit side for this question. It’s not iron-clad, but it’s strong.
Although you might view this interview as a good book promotion opportunity, as others have also stated (or implied) the wisdom of appearing on Cummins’s podcast is highly questionable.
For one thing, I’m not sure why he bothers to invite guests on – he does the vast majority of the talking and the guest is often made to look like they agree with Cummins (perhaps that’s his aim). He should just make it a monologue as that appears to be more his style.
His knowledge of philosophy of science and – related to this – epistemology are extremely superficial. Drawing on my own knowledge of these subjects (including a Master’s degree in the history and philosophy of science), my appraisal of the way Cummins responds to quite reasonable methodological critiques suggests to me that he’s at worst a narrow-minded dogmatist, or at best a pseudoscientific grifter. Either way, you’re getting down in the mud by appearing on his podcast and some of it may stick to you as a result.
Take the simple doctrine of falsificationism (Karl Popper) which he seems to place so much focus on. Well, if he wants that to be the core scientific standard then he can’t claim the IFR for covid is 0.2% and/or enthusiastically endorse related analysis. For starters, about 0.4% of the population of some major cities have been killed by covid to-date (e.g. New York), and in some countries almost 0.2% of the country has died (e.g. UK) but far less than 100% of the country has been infected to-date. If we adopt a simplistic falsificationist approach, the hypothesis that “the IFR of covid is about 0.2%” is falsified by these observations. Various responses to this simple analysis are possible, but he’s certainly not being consistent in his approach and the way he handles knowledge claims.
As I watched this ‘interview’ and the somewhat smug discussion of Dr Rushworth’s diagnosis that “collective mass hysteria” has caused irrational policy-making during the pandemic my mind also turned to the humanitarian disaster unfolding in countries like India, and the emerging crises in countries which neighbour India.
Having followed the work of people like Ivor Cummins and Dr Rushworth during this pandemic something that stands out to me is that they don’t appear to have ever seriously questioned a single one of their beliefs about covid or the responses we’ve seen to it. Only other people are ever wrong (or fallible). They are unquestionably right – both scientifically and morally. It’s unambiguously the case that everyone else has gone mad. I might have expected that what’s unfolding in places like South Asia at that moment would have led to some reflection and greater questioning, but alas there was no discussion about this in the ‘interview’.
You may be right.
But the 0.2% comes from John Ioannidis in a paper on the WFO website.
Not Cummins.
WHO.
The other point is that the IFR is almost irrelevant from a policy perspective.
If lock downs do not make a difference, empirically, then the IFR is a given. It may as well be 5%.
The key thing is whether the response to Covid even works. That is far from clear. It may even be counter-productive.
Three quick comments:
1. For starters, the actual paper states that 0.23% is the median IFR in the dataset that he put together – for which the estimated IFR for covid in different locations “ranged from 0.00% to 1.63%” (which he corrected to 0.00% to 1.54%).
2. Therefore claiming that Ioannidis found that the IFR is about 0.2% is simply wrong, and perhaps deliberately misleading. It’s shameful to simplistically cite this figure.
3. Yes Ioannidis’s paper was published in a journal published by WHO but so what? Presumably it is a reputable journal which adopts good practices, but this doesn’t mean that WHO endorses Ioannidis’s analysis or whatever else people like to claim.
Additionally, it’s foolhardy to rely upon a single study, no matter who the author is or where it is published. What we typically need is a body of evidence (more than one paper) pointing to a shared conclusion, because all studies and the data they rely upon are limited.
Stephen and Mr. McGrail,
I don’t know if you are aware of Swiss Policy Research. I often find them helpful when I need a wide perspective.
https://swprs.org/studies-on-covid-19-lethality/
I watched the video and found it entertaining. I did not know that Dr. Rushworth had a section on how to read scientific papers. That alone would cause me to purchase his book.
As I have published on demarcation in philosophy of science, I read your comment with interest. The term “pseudoscience” is a word not commonly used by those who have studied philosophy of science beyond Popper.
Kuhn and Feyerabend must be laughing.
Your diatribe against Cummins reminds me more of a high school social justice warrior than of someone who has finished college.
This website is not the place for a detailed debate about philosophy of science, though I am of course well aware of the issues you are raising. But what I will say is that the fact you cite Kuhn and Feyerabend tells me a lot about where you’re coming from (intellectually) on these matters.
Mr. McGrail,
I don’t know if you are aware of Dr. Rushworth’s interest in philosophy of science questions. That interest includes how to read scientific papers and questions about methods, which we can find on this blog and in his book.
You introduced silly rhetoric (“pseudo-science”) while maintaining a philosophy of science pose. Now you no longer wish to play the game?
Yes, I find value in Kuhn and Feyerabend, especially in their analytical work, as well as some in Popper. Not so much the Rationalist project.
Charlatans wish to misuse science and philosophy of science in rhetorical attacks on their opponents. It’s up to us to expose this.
Ivor Cummins is an engineer, not a scientist, and I listen to him with that perspective in mind. Engineers tend to be less precise about the way they use science, but they invent such delightful toys, so we might give them a little benefit of the doubt. (I could point out that by comparison scientists benefit us only indirectly, which benefit is almost exclusively delivered by engineers, but that would be nasty.)
Let us remember the Bene Gesserit maxim, “Fear is the mind killer.” This should give us pause when we see that the public health authorities deliberately and admittedly mongered panic.
Theasdgamer,
Perhaps it would be useful if I briefly explained what I meant when I used the term “pseudoscientific grifter” to describe Ivor Cummins.
Whilst any implicit reference to the notion of pseudoscience will invoke in the mind of some the demarcation problem and unresolved issues regarding demarcation criteria (interested folk might want to read this article https://plato.stanford.edu/entries/pseudo-science/) I had a slightly different meaning in mind when I wrote “pseudoscientific grifter”.
I loosely had in mind someone who publicly presents themselves and/or their analysis as being ‘scientific’ (such as by invoking ideas from philosophy of science and claiming these ideas prove their claims are correct or that their approach is scientifically rigorous) but who actually, in reality, is just a self-appointed expert with no scientific training and who, in reality, has a tendency to make claims and use data in a highly misleading and speculative manner which bamboozles the ignorant… and leads many such people to financially support his work. Related to this, there’s a strong element of “confidence man” in Cummins.
My related sense (which may be wrong) is that Cummins has become increasingly financially invested in his covid project as his pontificating has increasingly become his main work and in order to continually receive money from his fan base he needs to defend his beliefs and claims (which his supporters tend to also share) and maintain the associated ideological fervour, or else the house of cards likely will collapse. His simplistic invoking of a few ideas from the philosophy of science is part of this project, and I feel this ought to be called out.
Mr. McGrail,
I wish to reply to the following statement of yours, “If we adopt a simplistic falsificationist approach, the hypothesis that “the IFR of covid is about 0.2%” is falsified by these observations.”
The IFR cited by Ioannidis is a mean value, isn’t it? You cannot falsify a mean value with a single data point, can you?
When you have data points outside of a standard deviation from the mean, there are likely confounders involved.
I agree that Cummins is imprecise with his technical language from a scientific perspective, but Cummins is very accurate from an engineering perspective. It’s easy for readers to confuse the two and Cummins attempted to clarify by referring to his engineering experience which some uncharitable listeners took to be self-aggrandizement.
Theasdgamer,
That IFR number is the median value in the dataset, not the mean.
I was specifically responding to how both Dr Rushworth and Ivor Cummins simplistically cited that study as finding that the IFR of covid is “about 0.2%”. Given what we’ve seen around the world in terms of mortality from covid, I don’t understand how they can continue to assert this and expect to be taken seriously.
Furthermore, as I commented above in response to another commenter, the way they cite the study is incorrect and perhaps deliberately misleading. Such practices don’t fill me with much confidence regarding the rest of their analysis.
Regarding Ivor Cummins’s perspective, perhaps you could elaborate what you mean by his ‘engineering perspective’ on covid and what this specifically contributes? I’m aware of his professional background from his continual boasting about his former career in the private sector (prior to becoming a self-appointed covid expert), but what exactly do you mean when you assert that “Cummins is very accurate from an engineering perspective”?
0,23% is the best overall global estimate (or at least it was until Ioannidis revised his numbers down). It has been established that countries with a higher proportion of elderly people and a higher proportion of metabolically unhealthy people will be hit harder, while those with younger, less metabolically unhealthy populations will be hit less hard. Thus it is not even remotely hard to see how some countries, like the UK and US, can have significantly higher infection fatality rates than the global average. Both countries have very high rates of obesity and type 2 diabetes. Apart from that, both are generous with what they define as a covid death, which likely leads to overcounting.
Mr. McGrail,
From Ioannidis’ paper on ifr, “Average values of 0.15%‐0.20% for the whole global population….” Looks like a mean to me.
https://onlinelibrary.wiley.com/doi/10.1111/eci.13423
I don’t think that mean ifr means very much. Distribution varies considerably based on age, especially. For those under 40, the risk of covid mortality is as significant as the likelihood of dying in a car wreck on the way to work.
‘what exactly do you mean when you assert that “Cummins is very accurate from an engineering perspective”?’
Engineers look at significance–typically something has to reach about 10% of the total to be significant from an engineering perspective. This is what I mean. You won’t find many engineers who will argue with Cummins’ analysis because he is speaking their language and focusing on what they find to be important.
Where I have a problem with Cummins is when he glosses over the mortality risk to those over 80 y.o. Even from an engineering perspective, that risk is significant. Cummins might say that half of those people would likely die in 6 months from something anyway and he would be correct. Protecting them from covid may do some good for half of the 80+ y.o.’s who might otherwise die from covid.
They were referring to this paper which is Ioannidis’s main study of the covid IFR: https://www.who.int/bulletin/online_first/BLT.20.265892.pdf.
Later in the discussion Dr Rushworth noted Ioannidis’s most recent paper – this is the link: https://onlinelibrary.wiley.com/doi/10.1111/eci.13554 – which does introduce the notion of an “average global IFR”. This notion has been simplistically and misleadingly cited by those who wish to downplay covid.
Dr Rushworth,
re: the claim that 0.23% “is the best overall global estimate”, and your related comments, a few related thoughts and suggestions come to mind:
1. Perhaps the chief issue is that such an estimate papers over important variability – Ioannidis himself clearly stated that it is the median value in his dataset, but this detail seems to have become lost overtime.
2. Assuming it is an accurate “global estimate”, which is doubtful, what is the value in citing/stating it given that the IFR in most closely studied countries is significantly higher than this. For example, the Public Health Agency of Sweden has itself published studies indicating the overall IFR is around 0.6% in Sweden (they studied Stockholm) and they further state that this estimate is likely to be a conservative estimate when excess mortality is taken into account. I’m only aware of one major study of a Western country that is in the ballpark of 0.23% which is a study of Iceland which found that the IFR was about 0.3% (see https://www.nejm.org/doi/full/10.1056/NEJMoa2026116).
The countries that have been found to have a low IFR often have poor quality data, so the low IFR estimate for such countries may be unreliable.
3. Related to this the variability issue you cite the issue of the proportion of metabolically unhealthy people and the proportion of elderly people in a population. OK, that’s fair enough. But let’s play this out a bit for a moment and consider the UK as an example.
In the UK, back in early January around 20% of the population was estimated to have been infected to-date by one study (see https://www.theguardian.com/world/ng-interactive/2021/jan/10/one-in-five-have-had-coronavirus-in-england-new-modelling-says) and at this point in time around 80,000-85,000 had died from covid. A simple calculation can therefore be made which estimates that the covid IFR in the UK is around 0.6%. (80,000 / 20% of 68,000,000 x 100 = 0.6%).
This estimate of 0.6% is the same as what was estimated by the Public Health Agency of Sweden (in their study of Stockholm done in 2020).
You may be better off stating that the IFR is likely to be in the ballpark of around 0.6% (as per Swedish and UK data) for a lot of countries, particularly Western ones, but for some countries with favourable demographics and population health, etc, it may be lower than this. This seems preferable to stating a simple “global estimate” which is inconsistent with most studies and countries.
I should also add that detailed studies of places like New York City have found that the IFR is almost 1% in those locations, so you ought to also acknowledge that an IFR of much higher than 0.6% is also possible (e.g. this study of New York City estimated the IFR to be 0.97% https://www.nature.com/articles/s41586-020-2912-6)
McGrail,
Yes, I initially misread Ioannidis’ paper as saying that the data was based on a mean. Ioannidis’ _opinion_ is that the covid cases are overcounted, which is likely in the US and Britain with their very high cycling thresholds (I’ve seen variations of 37, 40, 42, and 45) and using a very wide covid-death-definition basket.
I think that it is helpful to look at comparisons of deaths per million in the contiguous 48 US states to draw conclusions as well as deaths per million in the countries on the Isle of Britain for comparison purposes, paying attention to median age and latitude.
I looked for low deaths per million at https://www.realclearpolitics.com/coronavirus/country/united-states/
Maine is one of the lowest five and has the highest median age of the US states and is at the northmost latitude. Maine’s cases per million is very low in line with deaths per million. I expect at some point Maine will get hit hard by covid.
Utah is interesting. It has the lowest median age at 31 and is at a median latitude. Utah has triple the cases of Maine and about the same deaths per million.
Compare Utah with Washington DC. DC has a median age of 34, just 3 years above that of Utah and is about at the same latitude as Utah. DC has triple the deaths per million as Utah, but only about half the cases per million.
Florida has an old population and its deaths per million are about level with DC. Florida has 80% more cases per million than DC, tho, so Florida’s ifr is likely far below the ifr of DC.
The data from US states is difficult to fathom based on age and latitude. Maybe there’s a lot of difference in the reporting by different states. Likely some don’t report deaths _with_ covid, only deaths _from_ covid.
This is a mess to figure out. What would help would be to normalize the numbers based on a consistent definition of a covid death, a consistent cycle threshold, a median age, and cases per million. But if the public health authorities don’t want their numbers to be understood–perhaps inflated by design in some cases, it’s unlikely that this will happen.
McGrail,
New York has several factors arguing against a high ifr.
1. Ventilator-induced lung injury was in the thousands in New York City and New Jersey. Those numbers belong in the iatrogenic column rather than in the covid column. I recall watching the Kyle-Sidell video about this topic in April.
2. New York experienced most of its deaths from March thru May 2020 and numbers from that time frame are especially suspect because the cause of death was so uncertain.
3. New York was under extreme political pressure to inflate its “covid” deaths during this period. Remember the scare that there supposedly weren’t enough ventilators? New York has a democrat governor who was a political opponent of Trump and the focus was to blame Trump for all covid deaths. Northern New Jersey similarly.
4. New York’s numbers are an extreme outlier and are extremely suspect. If you examine the data at corona.help, you can see that there are a couple days in April where _huge_ covid death numbers were dumped several standard deviations above any other numbers of that time and may simply be constructed out of whole cloth.
I cannot buy your book via amazon and the youtube interview is erased.Apparently something dangerous is reported.Could you send me the English version ? I will prepay.
Dr S Rushorth and Mr I Cummings,
having watched your video, could you please be so kind as to clarify who is doing the censoring, at what level, and by what right or law.
Please be so kind as to spell it out precisely as I am not very bright.
thank you
There is a lot of censoring being carried out by media and social media companies at the moment. Interviews I have done have for example been removed from Youtube. Articles by respected scientists like Carl Heneghan have been removed from Facebook. A well referenced debate article I wrote along with over 20 other doctors here in Sweden was refused for publication in the Swedish medical journal. If we had been arguing the opposite side (vaccinate everyone!), there is no doubt in my mind it would have been published.
You can buy the book from Adlibris.
https://www.adlibris.com/se/sok?q=sebastian+rushworth
ian,
Your point about uncertainty is well taken. I have frequently said that it is important to be certain about your uncertainties and to look carefully for systematic error which may be adjusted for. Using PCR tests clinically is an example of systematic error which may be adjusted for using viral culturing. The failure to do viral culturing to adjust for systematic error shows widespread incompetence.
Community PCR positives may be used to tell you where your pandemic is on the Gompertz curve as well as for nucleic acid research (of course).
Back to HCQ. Because retrospective studies are notorious for bias and confounders, they have a very large obstacle to overcome before their results can be recommended. RCTs are quite useful for chronic problems affecting large numbers of people where a potentially small relative benefit due to improved effect or improved safety or reduced side effects needs to be measured accurately. Frequently the relative improvement is around 10%.
The situation with covid is acute, not chronic. The repurposed drugs’ safety profile is well understood and they are well-tolerated. A 10% benefit for a repurposed antiviral might be due to bias or confounders or placebo effect. When someone with an engineering mindset sees a consistent benefit of 80% reduction in hospitalization relative to non-treatment across multiple retrospective studies, this is seen as a powerful signal of benefit which is unlikely to be due to bias or confounders. These studies rely on PCR, but so does the comparison group, so with high enough numbers the results achieve significance.
Now let’s consider vaccine studies. Vaccine efficacy studies uniformly rely on PCR without viral culturing confirmation to decide in favor of vaccine efficacy. One person in the treatment group contracted covid and 19 in the control group, supposedly. (Half or more of the control group might have been exposed and been asymptomatic for covid, but developed symptoms due to the flu.) Who can take vaccine efficacy studies seriously?
One thing I am certain about. Didier Raoult was quite correct in suggesting that viral culturing ought to be done as a check for PCR. He said this back in April 2020 and was studiously ignored. It took until December 2020 for Heneghan to back up Raoult. Raoult was roasted for “cherry-picking” the data by excluding severely ill patients from his initial HCQ study. Those roasting Raoult revealed their own incompetence rather than showing him to be incompetent or corrupt.
I feel I have to reply to this.
There are methodological problems with the PCR test. This is not my field, but I would think that viral cultures are slow, difficult and expensive and just not a practical tool in management. I am sure you will know that part of the success of Taiwan in initial control was getting results quickly (within 24hr, not 2-4 days as in UK) and acting on them to isolate people.
I am sure you have read the original vaccine papers in the NEJM and Lancet. The results between the 2 groups are too large to be explained by PCR noise.
Raoult is a charlatan, and nothing he says can be believed until confirmed otherwise. He epitomises all that is wrong in the medical research community: ghost authorship in the extreme (it is not possible to be publishing 120 papers of original research per year, year on year.) The number of publications of an institute is often used for funding allocation, so this sort of publication inflation is grossly unethical. He was banned for publishing in the journal of the American Society for Microbiology for submitting papers with identical results while claiming they were separate experiments. His original claims about HCQ were on 24 patients! That is all you need to know.
Interestingly, this episode brings up the issue of ‘Big Pharma’ scuppering trials of cheap medicines that may undermine their profit models. After Raoult announced his ‘results’, Sanofi offered millions of doses to the French authorities: it was not scuppered by ‘Big Pharma’, as seems to be a shibboleth of the ‘dissidents’.
PCR is not my field, either, but I have taken a look at it because it is so essential to understanding my limits of certainty.
Unless you have a consistent handle on systematic error, you will not have any idea how wrong you may be.
Vaccine results are too large to be obscured by PCR noise?
Influenza is cycled around 27 times. Covid is cycled around 37 times (a low estimate). What are the chances for a misdiagnosis of mild covid relative to influenza? I leave it to you to do the math. And I haven’t even begun to discuss unculturable positives. When you are doing research, you must often do things that are expensive and inconvenient, which the vaccine studies failed to do. The studies were unblinded, besides, iirc. There was no regular testing–only if patients presented with ILI symptoms. And what were the “suspected cases” all about??? “With 20 times more suspected than confirmed cases, this category of disease cannot be ignored simply because there was no positive PCR test result” That might put vaccine efficacy as low as 0.5%.
There’s no getting around the conclusion that the vaccine research was dodgy.
If Raoult is a charlatan, how much worse are his detractors who use less reliable methods than he does and have no clue about the uncertainty of their results?
No doubt viral culturing is too slow for pre-treatment diagnostic purposes, but it is essential for clinical research that involves viral transmission.
I have to say I find your logic and reasoning unfathomable.
If you get slung out of a professional medical organisation for attempted publication fraud, and grossly abuse authorship ethics, you have no credibility even before attempting to claim results on an observational study of 24 patients.
I notice you do not give any examples of the incompetence of his critics but it is irrelevant anyway. Raoult’s behaviour has to stand or fall on its own merits. It is not a game of competitive transgressions.
Ian,
My focus is on accuracy, good methods, systematic error, and degrees of certitude. Credibility is not high on my list of things to focus on. Raoult may well have employed tricks in past–certainly nothing as abominable as what we have seen from the CDC with its hydroxychloroquine smear campaign that has likely cost thousands of lives. Restricting HCQ to late treatment may well lead those in the CDC to appear before a Nuremberg-like tribunal. They ought to be called to account.
“Upon no man’s word.” That was the motto of the Royal Society and was emblematic of their commitment to data and doing their own due diligence. That is also my motto. I looked at Raoult’s data and the data from others as well for confirmation. Ad hominems and science are strange bedfellows.
Sanofi stops supplying free well water after pharma has poisoned the well. Recall the withdrawn Lancet article by Mehra, et. al., which was the justification for withdrawing hydroxychloroquine?
https://www.fool.com/investing/2020/05/29/sanofi-stops-supplying-hydroxychloroquine-to-covid.aspx
Trials were stopped after publication of this article and so was the EUA.
So much misdirection (the restriction to late treatment) and control over the research, restricting it to late treatment RCTs. Fools fell for the misdirection and fake research because the research were RCTs, the “gold standard” of science!!! Never mind that they were late treatment studies of an antiviral, which is absurd on its face. This should be a lesson. Retrospective studies that examine a possibly effective treatment are superior to prospective studies that examine a treatment that cannot possibly be effective.
I knew by June that antivirals had to be given early and I have no medical training. Shortly after that I realized the scam that pharma had perpetrated. As I said above in a comment to another commenter, the key point for me was when I saw the CDC recommendation posted in Jan. 2020 to treat high risk flu patients early with antivirals, even before the viral panel results had come back. Then it was obvious that incompetence wasn’t the issue.
Pharma stopped early trials of hydroxychloroquine after the Lancet smear of hydroxychloroquine and didn’t restart early treatment trials when the article was retracted. Instead pharma pushed RECOVERY and SOLIDARITY, which were late treatment trials, poisoning the well further. The CDC never admitted its “mistake” in limiting hydroxychloroquine to late treatment. More evidence of bad faith. And the CDC obviously is in collusion with pharma.
The whole point of all this was to remove competition for vaccines–especially the EUA for hydroxychloroquine–and to drive consumers towards vaccines with governments paying for vaccines. The inexpensive antivirals were potentially strong competition for vaccines.
Recall the load of tripe about how unsafe hydroxychloroquine was supposed to be? Not a single death due to HCQ has been reported when HCQ was used to treat covid early at normal clinical doses. Now we have thousands of deaths likely from inadequately-tested vaccines and pharma is off the hook for liability.
How did the public get snookered? There is a saying from the Bene Gesserit of Dune: “Fear is the mind-killer.”
I can only point you to Dr Rushworth’s review of HCQ, which would reflect the opinion of the vast majority of those in medicine. He does briefly discuss a paper by Raoult, dismissing it as a “mountain of nonsense”. Luckily the rest of the world does value credibility.
If you have been caught attempting research fraud before, your results will not be taken seriously even if you did do a decent study.
ian,
I have seen Dr. Rushworth’s review and he _seemed_ to be coming around to my point of view that the evidence looks to favor the theory of bad faith by pharma.
Most of the medical world doesn’t see value in HCQ? I have looked carefully and have seen value in early treatment with HCQ. As have quite a few doctors. I would hypothesize that most of the medical world either a) can’t tell the difference between early treatment and late treatment with antivirals, b) practices eminence-based medicine, c) are cowed, or d) put more stock in RCTs of late treatment than retrospective studies of early treatment. None of those options speaks well of the medical community. I would remind you that most of the medical community for years believed that ulcers were produced by stress despite research that showed that H. pylori was responsible. It took over a decade for the medical community to accept that research and _begin_ to put it in medical textbooks. “July 31 [, 1984]: The New York Times publishes an article by its medical correspondent Dr. Lawrence K. Altman on the possible link between H. pylori and PUD.[42] He states in 2002, “I’ve never seen the medical community more defensive or more critical of a story” since he joined the newspaper in 1969″ https://en.wikipedia.org/wiki/Timeline_of_peptic_ulcer_disease_and_Helicobacter_pylori
RCTs are a “nice to have”. Who is set up to fund them? Are outpatient clinic doctors set up to do research and fund RCTs? Would you expect an outpatient clinic doctor to treat his patients with placebos if he had confidence in an antiviral? Would you consider that ethical if he did that?
There is consistent, preliminary, retrospective evidence in favor of early treatment with HCQ. See https://c19hcq.com/#early There are links to the original studies and the site manager has been kind enough to review the studies and correspond with authors. (I always ignore the meta-analysis at the top which looks bogus.) You have to do your due diligence and sift the baby from the bathwater, just like anywhere.
Which of the public health authorities even acknowledges that evidence? Whose responsibility is it to look for the black swan via RCTs? Outpatient clinic doctors? Pharma? The public health authorities?
“Luckily the rest of the world does value credibility.”
The old eminence based medicine idea. With that, we can totally dispense with research, can’t we? And we can smear people in order to diminish the value of their research in our pursuit of politically correct science. Is the value of Raoult’s research diminished by his reputation? I would say that the intelligent reaction to Raoult as the source is simply to scrutinize his research very carefully.
Inveterate liars tell the truth frequently, although they lie more commonly than average. An intelligent person looks for confirmation from any source to compare. Peter may tell me that a wolf is near the city and I may not believe him because he’s a liar. If a city guard says that he saw a wolf, too, should I ignore the evidence simply because Peter lies frequently? In the story, Peter lied twice, but did tell the truth once. This illustrates the principle of confirmation, which triumphs over reputation.
In criminal court, attorneys frequently rely on the testimony of habitual liars because the attorneys examine the witnesses and because even liars frequently tell the truth–which is found by confirmation–and attorneys rule out cooked testimony by careful scrutiny.
People who deceive in research ought to be punished. No question about that. Cherry-picking data is done in about 1/3 of research from what I have read, and researchers mostly don’t get punished for it. And that is far from the only fraud in research. Raoult just had the bad fortune to get caught because he has some powerful enemies. Has Raoult done some good work? I think that many people might allow that he has done a fair amount, although they might not want to credit him.
I would accuse those authors of late treatment studies of antivirals of perpetrating fraud that resulted in smearing antivirals that might have prevented millions of deaths. Raoult looks quite decent compared with them, imo.
Have followed your work and Ivor Cummings over the lock down and have been impressed with your diligence in giving out accurate information .
Until this interview when you just roll over ME, CFS and long Covid.
You are misinformed if you think these conditions do not exist.
Very disappointing
It just undermines all that you have done.
Here are your Black Swans using your own terminology. To do with Long Covid, CFS, and ME.
Long Covid
Long serving PSCO Officer got Covid-19 on the 22nd September 2020. Was giving antibodies on trials for people in ICU.
Is still suffering today with lack of energy to do what she did before she had COVID-19.
CFS
Captain of the Rugby team, Hockey and Cricket teams during prep and senior school, 5 mile swimming medal. Bronze, Silver has not completed Gold Duke of Edinburgh award final expedition due to onset of CFS
Suffers with lack of energy to do what he did before the onset of CFS
ME
Long term condition of Megsays can be found on Instagram and You tube has all the details in her blogs
Between these three individuals they must have had, most, if not all medical tests available today with no outcome which explains why they suffer as they do
I am sure they would all be happy to meet and discuss all the medical tests they have had
Your reply to this will be interesting to read.
Note that I never said that long covid doesn’t exist, nor did I say that CFS doesn’t exist. I wrote an article a few months ago that discusses the evidence on long covid, which you can read here: https://sebastianrushworth.com/2020/11/17/what-is-long-covid/
Thank you for your reply
Though your article is very much your opinion and no data.
None the less I have and can produce these three individuals which are yours and mr I Cummings Black Swans
You and Mr I Cummings are as bad as lockdown zealots
You deny the other side if it does not fit your narrative
Very poor as until now I thought you were both above this and open to debate and a black swan is a black swan no matter what you say
Thanks again for keeping me interested in the other side to lockdown
I don’t think you get the concept of a black swan. A black swan is a thing that if you find it disproves a hypothesis on its own. For example the hypothesis ”all swans are white” is disproved by the existence of one black swan. Your anecdotal stories do not constitue black swans. They don’t disprove any of what I’ve said or written. And like I wrote above, I never said that long covid wasn’t real. What I questioned was that it is a distinct new entity, different for example from the post-viral syndrome sometimes seen after other respiratory viral infections.
Thanks for the reply
I totally get what a black swan is.
In your interview with Mr Cummings he mentioned ME and called it Yuppy flue. You and he belittle this.
Then you try to belittle long Covid in the same manner
I agree it is only affecting a very small minority and is no real concern to the greater population but why belittle something that has a huge effect on the people that suffer from it
Today they label ME as CFS
and now some long Covid is producing the same outcome.
This may be due to the viral issue I am an engineer not a doctor
My point being
As a medical practitioner to have Possible links to each condition that are similar would have raised some questions
The black swan is you and he do not want to see the other side
Of the reported adverse advents from Covid gene therapy injections Läkemedelsverket has reviewed so far (051121) the rate of death stands as follows:
Pfizer 6.9% (180 deceased, 2608 reports)
Moderna 4,9% (13 deceased, 265 reports)
Astra Zeneca 2% (21 deceased, 1041 reports)
https://www.lakemedelsverket.se/en/coronavirus/covid-19-vaccine/reported-suspected-adverse-reactions-corona-vaccines
As I understand, the concept “black swan” is mainly applied to “lockdown” as a measure to limit the spread of airborne disease. A dozen regions that do lockdowns cannot prove that lockdowns “work”. However, a single region that does nothing or not much and has a similar epidemic curve that a comparable regeion that does lockdowns disproves that lockdowns work.
In the USA we now have numerous states that ended lockdowns sometime a go or never had them at the first place. Yet, the curves are just the same as those in lockdown states.
This is what falsifies the lockdown narrative.
See the interactive map of the NYT for an overiew on the US.
https://www.nytimes.com/interactive/2020/us/states-reopen-map-coronavirus.html
Dr Rushworth: I downloaded your book to my Kindle from Amazon no problem a couple of days ago and have now read it. It is very readable, and concise, and helped clarify a few things for me, particularly about vaccines -so thank you.
UK (England): I was looking at EUROMOMO recently and noticed in the 15 – 44 age group, a significant spike in excess mortality during the epidemic, and increase in the subsequent months. No other reported Country shows this. Another big spike too in the Winter season unique to England, except for Hungry.
Since this age group is hardly affected by CoVid, to what do we attribute the spike in excess deaths? Why would CoVid be so serious in this age group in England uniquely, or are the excess deaths due to some other cause? Any thoughts?
Thanks. I’m not sure what’s responsible.
John,
Possibly suicides and other lockdown-related deaths are responsible. Inquests were put on hold because of the lockdowns, so numbers _appear_ lower than actuality.
Let’s look at a couple of pro-HCQ early treatment studies and see if we can find problems with them.
First up, Derwand.
https://www.sciencedirect.com/science/article/pii/S0924857920304258
The method was to triage symptomatic patients based on comorbidities and send low risk patients to recover at home while treating high risk patients early with HCQ/zinc/azithromycin. Claimed followup was 100%. Patients were sequential. Comparison was to an untreated community control group. The retrospective study claimed a 79% reduction in hospitalization–2.8% (treated) v. 15.4% (control)…p-value < 0.0001
100% followup is very unusual in a clinic setting. Combine that with sequential patients and it looks like cherry picking, which it undoubtedly was. The desire was 100% followup with sequential patients and the largest treated group that the authors could find was 141 high risk patients, interspersed with low risk untreated patients.
15.4% hospitalization looks quite high for the community control group, but this was early in the pandemic. Mortality began higher in the pandemic, which is normal. Hospitalization would follow suit. So the hospitalization numbers don't look high for early March.
Let's consider those hospitalization numbers relative to today. Hospitalization due to covid runs about 2% of cases today. That includes asymptomatic and mild cases. The Derwand study looked at high risk patients. They comprise about 30% of the population. We'd expect to see 6% hospitalization for high risk, symptomatic covid patients today, assuming that they represent the bulk of hospitalized covid patients. So even worst case, the reduction looks significant.
Maybe we can attack the study from a diagnostic perspective. The study was from early march when testing was dilatory and new. Maybe some false positives occurred because the lab personnel were inadequately trained. Probably the lab backlog resulted in a lot of false negatives. In any case, the error from misdiagnosis should work against the study, presuming that other ILIs are less deadly and should be as frequent in the control group as in the treatment group.
Next up, Procter.
https://rcm.imrpress.com/article/2020/2153-8174/RCM2020260.shtml
The Procter study is similar to the Derwand study in that it triaged patients for treatment based on comorbidities and it found about the same % hospitalized results as the Derwand study. It also claimed 100% followup. The Procter study compared its results with Houston Methodist. (https://jamanetwork.com/journals/jama/article-abstract/2769610)
Can you confirm this?
“They haven’t seen lasting immunity from survival. Sweden tried that and they didn’t even get 7% immunity. People who have survived covid have caught the first strain twice.”
Hey, was just looking at this paper which shows previous infection giving 84% immunity. This would allow for people getting it twice of course.
SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN)
From Findings
“A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals.”
from Discussion
“We believe this is the minimum probable effect because the curve in the positive cohort was gradual throughout, indicating some of these potential reinfections were probably residual RNA detection at low population prevalence rather than true reinfections”
correction, first extract is from iNterpretation, not findings.
Brilliant an utterly congenial. I enjoyed watching every minute.
Dear Sebastian,
We would like to publish your review of the vaccine book.
Would that be OK with you ? .
Many thanks,
Maggie
Hi, absolutely, go ahead!
Dear Dr Rushworth,
I’ve just finished your book on the dreaded covid (kindle version purchased from Amazon Oz for $AU 11.99). Thanks, it was enjoyable read and I especially appreciated the overview of what has happened in Sweden.
The discussion of the v-word was interesting too. I’m ensconced in near outback Queensland, Australia, and blessed with abundant sunshine induced vitamin D and trying not to worry too much, but I am of an age and portliness that I should consider a shot and, unfortunately AZ is what is most likely to be on offer. If you learn something about the Novavax, I hope you will make a posting. I’m partial to arthropods and if I am going to be an experimental animal, then something cultured in army worm cells sounds the most interesting.
I have one comment and one question. The discussion of statistics, experimental protocols, and their abuses was generally good, but I didn’t notice anything on effect size. ‘Gold standard’ has been much bandied about, and there are many reasons to prefer double-blind randomised control trials in many instances and absolutely so when the effect size is not very impressive. However, I’m quite happy to use observational data when the effect size is large.
My question is about asymptomatic (as opposed to pre-symptomatic) transmission. You seem to think it more likely than I do, although I realise that these seasonal respiratory viruses must have some way of surviving the summers and a persistent low rate of mild infection is probably it. My hypothesis is seasonally resurgent infections in carriers, but perhaps most infected people may be potential carriers as with chicken pox and shingles. The ‘unexplained’ community outbreaks now occurring in cold, dreary Melbourne as the winter comes on may be an example of endemic covid.
Do you have a model of asymptomatic transmission that would produce reasonable levels of virus that you think likely? I am very much confused by what has been published on transmission – it seems very hit or miss.
Cheers,
Dave
A question rather than a reply
What’s the difference between the standard vaccines all children get and which mostly give very long protection and these CV ‘vaccines’ which apparently only last 6 months?
Howard Dewhirst