Showing posts with label hydroxychloroquine. Show all posts
Showing posts with label hydroxychloroquine. Show all posts

You're being duped. Here's how to spot it.

It struck me recently that anti-vaxxers, quacks, dictators, populists, and other would-be autocrats all follow the same playbook. They all want to sell you something for their own personal gain, and all of them are willing to lie to get what they want.

These lies have a purpose, and it’s rarely good.

Let's look at a few of the most damaging lies from recent events, starting with medicine and then moving on to politics. (Lies are in italics.)

If you believe that vaccines don't work, you've been duped.

If you believe that vaccines cause autism, you've been duped.

Vaccines are the greatest invention in the history of medicine. They've saved billions of lives, dramatically increased human life expectancy, and in many ways enabled the growth of civilization itself. The Covid-19 vaccines are more than 90% effective, and without them we'd have no chance to end the pandemic.

And yet many anti-vaxxers claim that vaccines don't work. They also claim there's a massive conspiracy to hide the (extremely rare) harms caused by vaccines. 

The anti-vax movement is led by people like Andrew Wakefield, Robert F. Kennedy Jr, Joe Mercola (whom I wrote about  in 2010, in 2014, and last year), and other members of the Disinformation Dozen who use social media to spread vaccine misinformation. They make a great deal of money selling books, seminars, and (in the case of Mercola) bogus treatments for the diseases that vaccines prevent. These people simply make stuff up and then demand that scientists devote time to disproving it. 

Science doesn’t work that way. If you make a claim, you first have to prove it, by producing evidence and rigorously-done studies that go through peer review. You can't just throw out garbage claims and insist that other people do the work of disproving them. Nope.

If you believe that ivermectin is a cure for Covid-19, you've been duped. 

As I’ve explained in this column, ivermectin doesn’t help at all in treating Covid-19, and it’s dangerous if you take too much of it. But if you prefer to get medical advice from right-wing zealots like Tucker Carlson, go ahead.

If you believe that hydroxychloroquine is a cure for Covid-19, you've been duped.

The misinformation about hydroxychloroquine started with an egocentric French microbiologist, who posted an over-the-top video claiming he had the solution to Covid-19, a claim that was quickly debunked. That didn’t stop politicians and right-wing television pundits from promoting it, even as evidence emerged that it was nonsense.

Hawkers of ivermectin, hydroxychloroquine, and other fake Covid-19 cures have profited by claiming, first, that the government is lying and that vaccines don't work, and second, that they have a truly effective treatment that they can sell you. This is a double lie, but a necessary one, because if they can't convince you that vaccines don't work, then they won't be able to sell your their snake oil. 

For instance, a sketchy right-wing group called America’s Frontline Doctors (which is not, despite the name, a group of doctors working on the front lines of any disease) was selling $90 online “consultations” where they provided prescriptions for ivermectin. The $90 didn’t include the cost of the drug: it’s just a fee that went straight into their pockets.

By the way, if you've been duped about a Covid-19 cure, you’re in good company. Early in the pandemic, doctors at Yale Medical School were duped into believing that hydroxychloroquine was an effective Covid-19 treatment, as I explained at the time. They figured out their error eventually, but not before they boldly advertised their treatment protocol on their website and via Twitter.

Now let’s look at a few examples in the political realm.

If you believe that Trump won the 2020 election, you've been duped.

This is utterly false, of course: Biden won by over 7 million votes, and he won the Electoral College 306-232. Trump is a loser, and his Big Lie is possibly the worst case of being a sore loser in the history of politics. And yet, according to some polls, 60% of Republicans believe his latest lie (or at least that's what they tell pollsters). They’ve been duped.

Trump lied over 30,000 times during the course of his presidency, as was documented, painfully, by the Washington Post, and he's still doing it. This frequent lying is part of a strategy to "flood the zone with shit," as Trump minion Steve Bannon openly boasted a couple of years ago. The idea is to make up lies far faster than the opposition can shoot them down. After all, it's easy to make up a claim when you don't have to produce any evidence, and it takes much longer to disprove it. If you take these people seriously and try to play their game, they will always win–because by the time you debunk one lie, they've produced ten more.

If you believe that Ukraine is threatening war against Russia, you've been duped. 

As I write this, Vladimir Putin is flooding his own citizens with a huge lie, trying to convince them that Ukraine is threatening war against Russia, when just the opposite is true: Russia has sent over 100,000 troops to its border with Ukraine, while Ukraine has done nothing of the sort.

If you don't believe that Russians helped shoot down Malaysia Air flight MH17 in 2010, you've been duped.

A few years ago, after Putin's soldiers near the Ukrainian border shot down a civilian Malaysian Airlines plane, killing hundreds of innocent civilians, he used the Russian media to publish multiple confusing theories, all of them simply made up, to convince his audience that Russian soldiers had nothing to do with it. An independent investigation concluded that a Russian missile, shot from a base in Russia, downed the plane. And yet many Russians today are still unaware of this.

If you believe any of Putin’s claims about Ukraine, you've been duped. 

And yet because Putin controls all the media in Russia, it is likely that many Russians do believe him. He's also claiming, falsely, that many Ukrainians actually want Russia to take over their country.

Politicians, quacks, and pseudoscientists are all con artists. They lie to gain money, power, and fame. Some of them lie without any sign of discomfort whatsoever, a trait that is characteristic of sociopaths. To people who find lying uncomfortable–which is most people–the boldness of these lies in itself is convincing.

In skeptical circles, this strategy is called the "Gish gallop," named after a creationist who used this strategy in debates where he challenged the theory of evolution. His idea was to put out so many lies and half-truths that his opponent would simply be overwhelmed. In a live debate, this tactic can be particularly effective when the audience doesn't know the topic well. 

One way to combat con artists is to expose how much they’ve gained at other people’s expense. Vladimir Putin is not only powerful, but he’s also incredibly wealthy, as a result of stealing many of his own country's assets. Putin’s biggest political foe, Alexey Navalny, released a video that showed a $1.35 billion palace that Putin built for himself, paid for with money that Putin had stolen from his own people:

Navalny got very popular in Russia. Putin first poisoned and nearly killed him, and now is holding Navalny in prison. It’s not likely Navalny will survive.

Here in the U.S., Donald Trump profited in countless ways, documented in excruciating detail by the Washington Post and the New York Times, by using the tools of government to direct business to his hotels and resorts. As just one example, hundreds of companies and foreign officials stayed at the Trump Hotel in D.C. during Trump’s presidency, in what was essentially an open bribe to the sitting President.

How can one avoid being duped?

First, always ask what the person has to gain. If they’re making money or gaining power from their claims, we should be skeptical.

Second, look at the reliability of the source. When someone lies constantly, we really can’t believe anything they say. At this point, virtually nothing claimed by some of the people I’ve highlighted in this column (Trump, Putin, Wakefield, Mercola) can be trusted.

Third, question the expertise of the source. When Tucker Carlson spews out claims about ivermectin, you shouldn't believe a word of it. When politicians make claims about science and medicine, they rarely know what they're talking about. (There are exceptions, but they are infrequent.) 

Even when the claims come from a scientists, there are plenty of reasons to be skeptical. Modern science has thousands of specializations, for good reason: biology, medicine, physics, chemistry, and other disciplines are amazingly complex. So if you want to know about global warming, don't ask a doctor. If you want to know about vaccines, don’t ask a biophysicist, even if he has a Nobel Prize, and certainly don’t ask a surgeon who’s running for political office. And for answers to any of these questions, don't ask a politician.

What do Trump and Yale Medical School have in common? Both were duped about hydroxychloroquine

Hydroxychloroquine, promoted just a few short weeks ago as a cure for COVID-19, is useless.

Actually, it's worse than that. Hydroxychloroquine causes heart arrythmias, which can be fatal. Data from early trials of hydroxychloroquine show that it is killing people, not saving them.

Why, then, are so many people talking about hydroxychloroquine? The answer is a tale of scientific hubris and incompetence bordering on fraud. It's also a tale of how Yale Medical School and the Trump administration both fell for it.

Part 1: the hubris of a French "science star."
Last week, the New York Times ran a lengthy profile of Didier Raoult, a French microbiologist who the Times lauded as a "science star." Raoult vaulted into the public eye in March, when he published a very small study claiming that a combination of hydroxychloroquine, an anti-malarial drug, and the antibiotic azithromycin could cure COVID-19. Claimed Raoult:
"We know how to cure the disease" (Didier Raoult, quoted in the NY Times)
Actually, Raoult's proclamations began earlier, on February 25, when he posted a video on YouTube called "Coronavirus, game over." Not surprisingly, the world took notice. (Note that as the evidence for his so-called treatment evaporated, he re-titled the video "Coronavirus, towards a way out of the crisis.")

Raoult's study was deeply flawed, and it has been taken apart by multiple scientists, so I won't repeat all their points here. A good summary of many of the flaws was written by Elisabeth Bik, first on Twitter and then in a blog article, back in late March. Among other flaws, the study dropped 6 of the 26 patients who were given hydroxychloroquine without explaining why. One of those patients died. “My results always look amazing if I leave out the patients who died,” Bik commented.

Raoult is not happy with Dr. Bik. He recently called her a "witch hunter" on Twitter. This apparently is not unusual for Raoult; the NY Times compares his psychology to that of Napoleon. I wonder what he'll call me after this article appears.

In addition to its serious flaws, the paper was published in a journal whose editor-in-chief, Jean-Marc Rolain, was also a co-author on the paper. Even worse is the fact that, as the journal itself notes, the paper was accepted just one day after being submitted. Clearly, this paper did not undergo careful peer review, and it reeks of extremely sloppy science.

Since then, several larger, better-run studies have either found no benefit for hydroxychloroquine, or found actual harm. To be specific, a study of 368 patients in US Veterans Administration hospitals found that the mortality rate in patients given hydroxychloroquine was 27.8%. Patients who received both hydroxychloroquine and the antibiotic azythromycin had a mortality rate of 22.1%. But patients who did received neither one had a mortality rate of 11.4%.

In other words, giving patients hydroxychloroquine doubled their risk of dying.

One final note about Didier Raoult: he has a truly unbelievable number of scientific publications, over 2,800 according to PubMed. From 2012-2019, he averaged 176 papers per year, or about one paper every two days. Speaking as a scientist, it simply isn't possible that he made any real contribution to the vast majority of these papers. The NY Times explained that Raoult puts his name on every paper published by his institute, which employs hundreds of scientists. Again, speaking as a scientist, this is grossly unethical. No scientist should put his/her name on a paper unless they made a genuine scientific contribution to it. At many universities, Raoult's behavior would be grounds for dismissal.

Part 2: Trump and Yale Medical School fall for it.
As the NY Times reported, and as most of the U.S. knows, Trump began touting the benefits of hydroxychloroquine at a news conference on March 19:
“I think it’s going to be very exciting. I think it could be a game changer and maybe not. And maybe not," Trump said.
Right. Soon after that, the FDA, "under what appears to have been strong pressure from the Trump administration," issued an emergency use authorization for hydroxychloroquine.

Medical experts, including NIAID director Anthony Fauci, quickly injected a note of caution, pointing out that the evidence was very preliminary, and that we needed better studies. Nonetheless, Trump and his political allies ran with the news that a "cure" was available. They were wrong.

Perhaps most disturbing, though, was the behavior of some highly regarded doctors, who also fell for Didier Raoult's hype. One might excuse politicians for being fooled–they don't have the training–but the same excuse doesn't work for a medical expert.

And yet on March 26, Yale Medical School boldly tweeted out its "Treatment algorithm for COVID19," promoted with two megaphone icons:
Attached to the tweet was a graphic of a flowchart, showing that the first steps in their treatment algorithm were hydroxychloroquine and atazanavir. At the time, I replied to their tweet and warned them that there was no good evidence for their recommendations. Their response:
"While there are no FDA approved treatments for COVID19, this protocol is based on available knowledge, personal observations & communications from other institutions. In the absence of firm evidence for best treatments, this is intended as a working document & subject to change."
Well, at least they responded. But in their response, they admit that their protocol is based on anecdotal evidence and little else. This is seriously disappointing, coming as it does from one of the nation's top medical schools. It also displays hubris not that dissimilar from Didier Raoult's.

Now that more evidence has emerged, and we know that hydroxychloroquine doesn't help and probably harms COVID19 patients, has Yale updated its treatment protocol? Well yes: they tweeted out a new algorithm on May 15. Now it says:
"Consider hydroxychloroquine x 5 days with close cardiac monitoring."
This is truly appalling. The only evidence of efficacy was the small, badly-run study promoted by Didier Raoult, which has now been contradicted by much larger, better run studies. We now know that hydroxychloroquine is harmful. Others on Twitter quickly questioned the new Yale recommendation, but it's still there as of this writing.

So there you have it. As of this writing, many so-called experts are still pushing the use of an ineffective, dangerous drug that doesn't help, and may harm, people infected with the SARS-CoV-2 coronavirus. A bogus claim promoted by a self-important, egotistical scientist who published a sloppy study in a journal run by one of his co-authors turned into millions of doses of medication wrongfully prescribed.

And for now, Yale Medical School still hasn't admitted any error. I'm waiting.

[Note: I am an alumnus of Yale University, and I have long been one of its biggest fans. I did not attend medical school there, but their unscientific behavior is nonetheless especially disappointing to me as an alum.]