Categories
Clinical trials Medicine Personal Politics Popular culture Skepticism/critical thinking

Henry Ford Hospital hydroxychloroquine trial: Not good evidence that the drug works for COVID-19

Recently, Henry Ford Hospital published a study of hydroxychloroquine for COVID-19 that showed a benefit. Unfortunately, it was a bias-prone retrospective study. That didn’t stop President Trump from touting the drug again.

And so it continues, the saga of hydroxychloroquine for COVID-19. It’s been a while since I’ve written about this particular drug. Indeed, it’s hard to believe that it’s been well over three months since I railed against the FDA’s premature issuance of an emergency use authorization (EUA) for hydroxychloroquine to treat coronavirus and over three weeks since I noted that the FDA had finally backtracked and revoked its EUA for hydroxychloroquine. In the age of the pandemic, weeks seem like months, and months seem like years. Be that as it may, there have been…developments…that have led me to conclude that an update is in order. The saga of hydroxychloroquine and chloroquine remain, as it has from the beginning, a cautionary tale about medical science in the age of a pandemic. The saga also reminded me how, in the context of this pandemic, not only has science become politicized, but narratives often not grounded in science saturate news coverage, which brings us to this Tweet from President Trump:

Yes, this is a study that comes from my neck of the woods, Henry Ford Hospital, and it’s not just Trump who is promoting it as vindication. It’s Peter Navarro:

Tuesday morning, economist and Trump advisor Peter Navarro walked onto the White House driveway and promptly brought a political cloud back onto the FDA.

Speaking to a White House pool reporter, Navarro said that four Detroit doctors were, based on a single disputed study, filing for the FDA to again issue an emergency authorization for hydroxychloroquine, the anti-malarial pill that President Trump hyped for months as a Covid-19 treatment over the objections of his own scientists. Then, while avoiding directly calling for the FDA to OK the drug, blasted the agency. He said its decision to pull an earlier authorization “was based on bad science” and “had a tremendously negative effect” on doctors and patients.

The question in the title of this article (“Can the FDA remain independent?”) is an excellent one, but let’s take a look at what’s going on here, which is very evident based on the Trump campaign website, where the copywriter is practically frothing at the mouth with glee over this study:

A new study from the Henry Ford Health System finds that hydroxychloroquine “significantly” decreased the death rate of patients with coronavirus. It also found that patients did not suffer heart-related side effects from the drug. “The data here is clear that there was a benefit to using the drug as a treatment for sick, hospitalized patients,” said Steven Kalkanis, CEO of the Henry Ford Medical Group.

This is fantastic news. Fortunately, the Trump Administration secured a massive supply of hydroxychloroquine for the national stockpile months ago. Yet this is the same drug that the media and the Biden campaign spent weeks trying to discredit and spread fear and doubt around because President Trump dared to mention it as a potential treatment for coronavirus.

Concluding with:

The media and the Democrats fear-mongering around hydroxychloroquine became so bad that doctors told NPR they were having a difficult time even recruiting patients to enlist in clinical trials to study it. “The fact that President Trump is touting this drug means some people are now invested in the idea that hydroxychloroquine won’t work,” one said. “We’re talking about a treatment. Who would be rooting for us not to find the therapy, for God’s sakes?” asked another.

The new study from the Henry Ford Health System should be a clear message to the media and the Democrats: stop the bizarre attempts to discredit hydroxychloroquine to satisfy your own anti-Trump agenda. It may be costing lives.

Yes, this is basically the same message that was being promoted three months ago, when I noted that science-based medicine has no chance against Donald Trump, Peter Navarro, and Dr. Oz (the last of whom was also promoting hydroxychloroquine as a panacea for COVID-19 at the time). During that time period, there was a drip-drip-drip of negative studies. True, they weren’t randomized, double-blind clinical trials, but rather observational studies (like the one being touted by Donald Trump and Peter Navarro, as you will see). Still, they were enough to lead me to conclude that it was unlikely that hydroxychloroquine would be found in randomized trials to have significant activity against COVID-19. This is starting to be confirmed with, for instance, the publication of a a randomized controlled clinical trial of the drug as post-exposure prophylaxis that was entirely negative. This was followed by two more, first, a Spanish post-exposure prophylaxis trial that was also negative. Then there was the Recovery Trial from the UK, which failed to find a benefit from hydroxychloroquine in hospitalized patients treated with the drug, leading to the revocation of the EUA.

Before that, hydroxychloroquine was being relentlessly and shamelessly touted as a highly effective treatment—cure, even—for COVID-19 its promotion by a French “brave maverick scientist” and the President. How did this come about? I’ll repeat the story, because it’s clear if you know the real story just how flimsy the evidence base was. Based on an observation of 80 patients full of confirmation bias, Chinese doctors in Wuhan noted that no patients with lupus erythematosis became ill with COVID-19 and hypothesized that the chloroquine or hydroxychloroquine that they were taking might be the reason. (These drugs are also mildly immunosuppressive, hence their use to treat autoimmune diseases.) Of course, during a pandemic, it is people who are immunosuppressed are the very people who most rigorously obey orders to practice social distancing and self-quarantine and thereby protect themselves from infection. Be that as it may, the Chinese doctors started using the antimalarial drugs, and anecdotal evidence of success was reported, leading to randomized clinical trials that were announced by the Chinese government to have been “promising.” None of this stopped China from incorporating these drugs into its recommended regimen. The World Health Organization followed suit, as did several countries, and thus was born a new de facto standard of care for COVID-19 based on, in essence, no evidence other than some in vitro evidence that the drugs inhibit replication of SARS-CoV-2, the virus that causes COVID-19, anecdotes, and incredibly weak clinical trial evidence.

The evidence was basically as weak as this study from the Henry Ford Hospital System by the Henry Ford COVID-19 Task Force, by lead author Samia Arshad and corresponding author Marcus Zervos. Here is the text. Basically, it’s a retrospective observational study. It was not randomized. It was not double blind. The exposures studied included receipt of hydroxychloroquine alone, hydroxychloroquine in combination with azithromycin, azithromycin alone, or neither, and the primary outcome measure was in-hospital mortality. The study involved 2,541 patients with a median hospitalization time of 6 days (interquartile range, IQR 4-10 days) with a median age of 64 years (IQR 53-76 years). The subjects were 51% males, 56% African-American, and the median followup was 28.5 days (IQR: 3-53 days). Multivariable Cox regression models and Kaplan-Meier survival curves were used to compare survival among treatment groups while controlling for demographics (e.g., age, gender), preexisting medical conditions (e.g. CVD, lung disease) and clinical disease severity. The authors reported that in-hospital mortality was 18.1% (95% confidence interval:16.6%-19.7%); by treatment: hydroxychloroquine + azithromycin, 157/783 (20.1% [95% CI: 17.3%-23.0%]), hydroxychloroquine alone, 162/1202 (13.5% [95% CI: 11.6%-15.5%]), azithromycin alone, 33/147 (22.4% [95% CI: 16.0%-30.1%]), and neither drug, 108/409 (26.4% [95% CI: 22.2%-31.0%])​. Primary cause of mortality was respiratory failure (88%); no patient had documented torsades de pointes (a potentially fatal heart rhythm disturbance that can be caused by hydroxychloroquine). From Cox regression modeling, predictors of mortality were age >65 years (HR:2.6 [95% CI:1.9-3.3]), white race (HR:1.7 [95% CI:1.4-2.1]), CKD (HR:1.7 [95%CI:1.4-2.1]), reduced O2 saturation level on admission (HR:1.5 [95%CI:1.1-2.1]), and ventilator use during admission (HR: 2.2 [95%CI:1.4-3.3]). Hydroxychloroquine provided a 66% hazard ratio reduction, and hydroxychloroquine + azithromycin 71% compared to neither treatment (p < 0.001).

It didn’t take long for Twitter denizens to note that there were some huge potential biases in this study. First:

Yes, patients in the hydroxychloroquine and the hydroxychloroquine+azithromycin groups were twice as likely to be given a steroid. Why is this relevant? Simple. It was recently reported in a randomized clinical trial that a steroid, dexamethasone, resulted in improved survival in COVID-19 patients requiring oxygen support. At the time I wrote about it, the study hadn’t yet been published, but now it is on medRxiv.

There were also a number of other potential confounders. An accompanying editorial by Lauren J MacKenzie, Emily G. McDonald, and Steven Y.C. Tong on the Henry Ford Hospital study noted the potential confounding factor of the steroid use and discussed other problems with the trial as well. First, there was “immortal time bias,” which is a bias that can be introduced when some time-dependent variables are not modeled:

First, the precision of the results is impacted by immortal time bias, since several time-dependent covariates were not modelled in this manner. Fortunately, since the average time to receipt of treatment was only 1 day, this bias may be small; nonetheless, it favors treatment and should be taken into consideration.

Then there were a number of other factors not taken into account:

Second, there is an important potential for residual confounding because there are a number of prognostic factors (e.g. frailty, residence in long term care, or “do not resuscitate” orders), potentially important markers of disease severity (e.g. ferritin, C-reactive protein (Zeng et al., 2020), troponins (Vrsalovic and Vrsalovic Presecki, 2020), and D-dimer (Zhang et al., 2020), and co-administration of potentially beneficial therapies (e.g. anticoagulants (Paranjpe et al., 2020) that were not included in the analysis.

This third confounder, however, is most likely the main bias that could well have produced a false positive result:

Third, confounding by severity or indication (Kyriacou and Lewis, 2016) is likely. While there was a hospital treatment protocol in place, unmeasured clinical factors likely influenced the decision not to treat 16.1% of patients, in a center where 78% received treatment. These factors are often difficult to capture in an observational study. Were the decision to withhold treatment related to poor prognosis (e.g. palliative intent), it stands to reason that patients receiving neither hydroxychloroquine nor azithromycin would have the highest mortality. Indeed, the non-treated group had an overall mortality that was higher than the rate of admission to the ICU (26.4% vs. 15.2%), suggesting that many patients were not considered appropriate for critical care. Such being the case, their care may have differed in other substantive ways that was also associated with death (e.g. terminal illness or advanced directives limiting invasive care). In the hydroxychloroquine treatment groups, the inverse was true with mortality lower than the rate of admission to the ICU (16.1% vs. 26.9%). While a propensity score analysis might further account for some differences between treatment groups, this approach is still limited to the information available in the dataset.

In this unrandomized study, confounding by severity or indication almost certainly at least significantly contributed to the observed result. Particularly telling is the observation that the mortality was higher than the rate of admission to the ICU; that almost certainly meant that there were a lot of patients who were considered so unlikely to survive that they weren’t admitted to the ICU and instead underwent only palliative care.

Finally:

Fourth, the chronological time point during the course of the pandemic whereby patients were managed was not included in the study. As the Henry Ford Health System became more experienced in treating patients with COVID-19, survival may have improved, regardless of the use of specific therapies. Hospital-specific guidelines regarding COVID-19 screening eligibility, as well as the availability of COVID-19 testing may have also changed over time, introducing additional chronological bias.

In other words, this study has a lot of issues, the sorts of issues that can plague retrospective studies of this sort, particularly retrospective studies in the fast-changing treatment milieu of a pandemic, where treatment protocols are evolving at a record pace, sometimes based on solid evidence but more often based on anecdote and clinical experience as more objective data are pending. I was also rather amused by this passage in the accompanying editorial:

Overall, the authors should be commended for rapidly compiling and analyzing data from a large cohort of COVID-19 patients. Clinicians worldwide ought to be acknowledged for their best effort to care for patients in uncertain times and in the absence of proven therapies. It is, however, very sobering to note that the number of patients in this single observational study would have made a substantive contribution to any randomized controlled trial. While all healthcare providers feel a clinical imperative to offer patients treatment, there was little evidence to justify a hydroxychloroquine protocol at the outset of the pandemic. It is a failing of healthcare systems and research infrastructure that the protocolization of unproven therapies is exponentially easier to execute than participation in pragmatic randomized controlled trials. Moving forward, we encourage academic centers to commit to participating in the necessary clinical trials that will establish high quality evidence for safe and effective therapies in the shortest possible time.

This is very similar to what I’ve been saying all along and more than a bit sarcastic. I like it. Yes, hydroxychloroquine became the de facto standard of care for COVID-19 patients based on a questionable anecdote about patients with rheumatoid arthritis taking the drug in Wuhan supposedly never becoming ill with coronavirus that led to clinical trials whose results were not published but reported verbally and led to the Chinese government to include hydroxychloroquine as a recommended treatment for coronavirus. This then led other governments, as the pandemic progressed, to take on this recommendation, thinking that the Chinese must have known what they were talking about. Then a “Brave Maverick” French doctor named Didier Raoult took up the banner and touted a combination of hydroxychloroquine and azithromycin as, in essence, a cure-all for COVID-19, leading other “brave maverick doctors” to do the same, leading to some tech bros to start touting it, which then brought it to Donald Trump’s attention. The rest, unfortunately, is history. The authors are exactly right. There was never any evidence sufficiently compelling to justify using hydroxychloroquine for COVID-19 outside of the auspices of a clinical trial. Unfortunately, that hasn’t stopped researchers from basically going hog wild on hydroxychloroquine:

The analysis, conducted in partnership with Applied XL, a Newlab Venture Studio company, found that one in every six trials was designed to study the malaria drugs hydroxychloroquine or chloroquine, which have been shown to have no benefit in hospitalized patients.

“If the goal was to optimize the likelihood of figuring out the best treatment options, the system is off course,” said Robert Califf, the head of clinical policy and strategy at Verily Life Sciences and Google Health and a former commissioner of the Food and Drug Administration. The findings show, he said, that too often studies are too small to answer questions, lack real control groups, and put too much emphasis on a few potential treatments, as occurred with hydroxychloroquine.

Indeed, the analysis found many of the studies are so small — 39% are enrolling or plan to enroll fewer than 100 patients — that they are unlikely to yield clear results. About 38% of the studies have not actually begun enrolling patients.

The amount of resources and effort expended on hydroxychloroquine based on so little data and prior plausibility has been staggering. One wonders what other avenues of research far more likely to result in effective treatments have been delayed or foregone because of all the attention lavished on hydroxychloroquine.

The hydroxychloroquine cultists very much remind me of acupuncturists. Just as acupuncture believers do when rigorous randomized, double-blind, sham acupuncture-controlled clinical trials fail to show an effect of acupuncture greater than placebo, hydroxychloroquine cultists retreat to studies with less rigor when randomized controlled trials don’t show what they want. In this case, they’re ignoring the at least two negative randomized trials, one for prophylaxis and one for hospitalized patients, that failed to find a beneficial effect due to hydroxychloroquine and latching on to this bias-prone retrospective study from Henry Ford Hospital as “proof” that Donald Trump was right all along. Unfortunately, once we have randomized clinical trial results, studies like the Henry Ford Hospital study really don’t tell us much of anything worthwhile any more.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

62 replies on “Henry Ford Hospital hydroxychloroquine trial: Not good evidence that the drug works for COVID-19”

So essentially the trial was principally flawed because it included in the untreated comparison those possibly too far gone or with other complications that they were excluded from treatment and of those treated twice as many received steroids, which is a known effective treatment.

So essentially the trial principally fails because the untreated in the comparison includes those with complications or too far gone to be treated and because twice as many of those treated were given steroids a known effective treatment.

PS – To use as a to the point rebuttal.
PPS – Repost because my first effort seems to have disappeared.

So were the flaws in the study deliberate – ie designed to suit a particular agenda, or the result of not thinking through/incompetence/accident etc?

I think part of the problem is that in retrospective studies, you take your population as is.
But aren’t there ways to control for that?

You can set up the mathematical models to include those additional parameters, but there is no guarantee that the resulting model will be statistically sound. You may end up with a model too flawed to be useful. It’s an issue with retrospective studies because you aren’t able to control the confounding variables and when they are highly correlated with the variables of interest (as in this case), the effects may not be mathematically separable.

Apart from the things already mentioned, Elisabeth Bik also noted something odd about the last two columns in Table 3 of the report (characteristics of patients): it would appear that the researchers succeeded in finding an exact ‘untreated’ match for 190 patients treated with HCQ, on no less than 18 separate characteristics. Is this kind of perfect matching normal in observational studies this small?

Marlon (answering to Raoult. I detect some insolence)

Du coup … Maintenant ça marche pour les patients en état grave, admis aux urgences ? Je comprends plus là.

For non-Frenchies: “So… Now, it works for patients in a severe state, admitted in the emergency unit? I don’t understand nothing anymore.”

in the latest episode (the Discovery result, if I’m tracking it correctly), proponents of the Raoult protocol argued that HCQ obviously wasn’t working with severe patients, because it has to be given as early as possible after infection.

I’m trying very hard to keep an open mind on the possibility that, in certain specific conditions, HCQ could provide some benefits, but it’s getting past ridiculous.

Weird how you try to claim that you think autism is caused by very specific genetic variations (and that you have all of them) and that’s your only issue with vaccines, and then turn around and make willy-nilly claims about vaccines causing random issues. It’s almost like what you claim can’t be trusted.

@ Terrie,

Oh, was I being Vewy Mean about Vaccines ?

I mean, how silly of me, just look at Australia! If the flu vaccine was actually causing increased susceptibility to COVID, we would start seeing a case surge from their seasonal flu vaccine campaign that started in April-May and … oh …

@CK, So are you admitting you think all vaccines are bad, rather than just being concerned about individual genetic vulnerabilities?

Because there’s no OTHER possible cause for an uptick in cases……

None so blind as those who will not see.

@CK, And Alzheimers, and learning disabilities and CP and the list goes on and on. You couldn’t name a single antivax claim about vaccine injury you didn’t believe. You want to pretend you’re better than other antivaxxers, but you’re just the same run of the mill quackery.

There are no flu season on northern hemisphere, yet covid pandemic is still here. If you were right, there would be no pandemic on northern hemisphere.

@ Aarno

You misunderstood Christine.
It’s not the actual flu she is worried about.
She thinks the flu vaccine is making things worse, regardless of the presence of any flu virus.

“I mean, how silly of me, just look at Australia! If the flu vaccine was actually causing increased susceptibility to COVID, we would start seeing a case surge from their seasonal flu vaccine campaign that started in April-May and … oh …”

So, you think that Australia has a crocked flu vaccine strategy, one that only involves giving it only to residents of Melbourne?

Can’t be. Had my flu vaccine in mid April. Haven’t been to Victoria since the end of March as we have been banned from travelling there. Flu vaccines don’t cause Melbourne.

In fact, South Australia had its highest rate of influenza vaccine uptake ever. There is currently 1, almost active, case of COVID-19 in the state.

More usefully: “There have been 1,537 cases of influenza notified year-to-date, compared with 20,677 cases reported for the same period last year.”

A combination of increased vaccination and social distancing.

I am much inclined to believe that hydroxychloroquine doesn’t have any dramatic curing effect against Covid 19, but what about studies like this one : https://www.medrxiv.org/content/10.1101/2020.04.18.20063875v2
that shows a rather sharp and clear-cut difference in fatality rates between countries where hudroxychloroquine has been widely used and those where it hasn’t ?
It has been pointed to me that data in France, for example, corroborates this, as the ICU of Marseille (whose head director is Professor Didier Raoult) registers the lowest casefatality rates in the whole country.
What do you make of it ?

This study is basically correlating countries’ fatality rates with their HCQ use and production.

Several questions I as a layman have are:
1) This is a limited group of 16 countries. There is no evidence that they were randomly selected. Wouldn’t this introduce extremely strong bias to the results?
2) Considering thar the group that used more HCQ was able to ramp up production of HCQ much more rapidly than the non HCQ using group, wouldn’t that indicate the HCQ using group of countries also had significantly better manufacturing and pharmaceutical capabilities, all of which are probably more strongly correlated with mortality than anything else.
3) Considering that HCQ was unproven, any mass adoption of HCQ likely followed increases in fatalities and cases, and almost certainly was a step that was taken after other steps such as lockdowns, greatly increased testing, social distancing, etc. Wouldn’t it be likely that the HCQ adoption increases after countries’ deaths/cases peaked and after they had taken other known steps that reduced measures mortality rates (such as increases and broader testing).

In a nutshell, there are probably thousands of other factors that correlate with “country starts manufacturing and administering HCQ to COVID patients in great numbers”, so attributing any resultant changes in measured mortalities and mortality rates to HCQ is almost certainly foolhardy.

Brand new!

Podcast/ transcript interview with Anne Rothschild/ 538.com

How Dr Fauci thinks partisanship delays containment of Covid-19
AND how anti-vaxxers affect reaction to vaccine development

Why do people listen when he speaks? And rate him over 70% trust ( like governors of NY, NJ, CA) and Trump NOT?

Fauci lacks a lot of insight. HE is the reason their is a negative response to vaccine development.

Nobody wants to follow him down the yellow brick road just to see him do yet another about-face on the issue.

Christine. Fauchi was in a tough spot. He admitted to being misleading. Of course, the ‘right’ thing to do was to recommend a covering. Any covering. But we uncensored ‘mericuns were seeing horrific things on YouRube. And when you see guys in full hazmat dragging out a family mearly because their phone location revealed one family member had been around someone identified as positive — As I’ve said before, “there would have been blood in the streets” when people thought they needed real protection (as I actually do*) and there was none to be had.

It must have been a tough lying, but consider what would have happened if all the healthcare workers dropped dead? Of course, I wanted any kind of masking from day one but seeing a video like this… It was all fucked. Bad science. China is brutal (they are). You’ll touch your face (you will; less of a concern, maybe). That is the narrative he, and much of the rest of the world had to run with. Once we hear we need something to protect life, we want the best we can come up with.

All forsight and preparedness was squandered. For months. There are even PPE shortages, testing reagent, staff, and machine shortages again. AFTER shutdown to prepare.

I note that the very first day It was acceptable/allowed to appear with a mask that Fauchi was the lone man standing at that briefing and he had a good’n.

And I note that Fauchi has a certain someone above him that still is against masks.

Fauchi has not done an “about-face”. He has been walking backwards all along speaking to the people with only derriere aimed squarly at Dumbp. He looks at him and asks, “why is this talking asshole more popular than me?”

droplets, SPAT, aerosolized, airborn… there is considerable debate about that but not on the science that any covering is better.

https://arstechnica.com/science/2020/07/is-sars-cov-2-airborne-questions-abound-but-heres-what-we-know/

ps. I went to the vitamine store today. I needed choline, because I drink, valerian (because Publix does not carry it anymore) for sleep, and p-5-p, riboflaven, magnesium, and zinc (support for nitric oxide production). There was no zinc to be had. An entire empty shelf. there were two bottles of worthless elemental mineral zinc/copper. So thx, HQers. I really doubt ya’ll care about nitric oxide production but sure know what Dead Leader recommends. Nobody else in the store but me and the cachier, no zinc, she was caughing.

christine kincaid

HE is the reason their is a negative response to vaccine development.

Huh?
Dr Fauci has been the director of NIAID since the Reagan administration.
The reservations I have with the current COVID-19 vaccine development in the US right now is directly related to the incompetent Trump-appointed leadership of the FDA which issued contaminated test kits, derailing the US’s response to this global pandemic.
It has absolutely nothing to do with your misunderstanding of the fact that we acquire knowledge over time, and sometimes recommendations that were appropriate under one set of conditions are not longer adequate—i.e., consumers in areas not yet even affected by the virus hoarding PPE needed by the medical personal involved in treating the actual outbreaks in the US back in March—and as circumstances change, recommendations change.

@ Tim,

I still think the ppe could have been intercepted at the source & diverted away from retail, if supply was the concern. He’s blaming an easy scapegoat but most people know how they made their own minds up.

It is actually going to insult them, for someone to suggest it was the evil antivaxxers.

And there was something wrong with the retail supply in January, when the few people even concerned with COVID in the US were still calling it “the Wuhan virus”. Retail was already wiped out. And I think Fauci knows this. Maybe he knows why? I sure don’t.

Well, in Europe, it was the Chinese who were buying out all sorts of healthcare supplies. I hear they had a bit of public health problem there.

“I still think the ppe could have been intercepted at the source & diverted away from retail,”

It was. All our production is in China (3M). And ‘the administration’ would not sweat a dime to stand up already existing production lines here. Trump said he though hospitals were hording it and selling it on the black market:

https://www.veteranstoday.com/2020/03/30/disgraced-president-trump-healthcare-workers-stealing-and-selling-face-masks/

Timmah had a heart problem, fifty years old
Timmah worked the record store, spinning out the old
Bobby didn’t wanna wear a mask, as he was asked
Bobby shouted out “no Cure or King Crimson? or Tears for Fears?”
Bobby made a yo mamma joke in little Timmah’s face.
Bobby spit on the floor as he left the place,

Timmah died. He was a friend of mine.

Retail was already wiped out. And I think Fauci knows this. Maybe he knows why? I sure don’t.

I thought you had already figured out that it was a Chinaman who was always just one step ahead of you in Colorado Springs.

Foiild again! <– I’m pretty sure that is spelled most wronglyl {because I’m ujsing a Logitech keyboard}

Annnd there is something going on here. I was looking for the clip of Monty Python Queen Victoria’s racing but it is not to be foud?

I’ll have to settle for this, then:

Thank you, Harold. That is the one. Could you maybe find season 1 episode 6 It’s the Arts : sketch, Twentieth-century vole for me? ( “yes men”, “did he say “splunge”?, writer’s sketch)

I can’t acess DM with any of my browsers without a direct link. YouRube has the clip but it has been claimed by… Believe Entertainment Group?? All Flying Circus is there but says “not in your country”.

@ RI minions:

You may have noticed that two important commenters, Joel PhD, MPH and F.68.10 are absent of late and sorely missed
Hopefully, all is well and they are busy pursuing other activities. They are great fun.. Even when they argue. Their intelligence and reality based stances are necessary foils for woo, alt med, anti-vax and diverse crap which can rapidly accumulate around here in an unsavoury fashion. And who wants that!

Come out, come out wherever you are, guys.

-btw-the infamous PRN woo-meister continues to broadcast misinformation about how dangerous Covid is and how vitamins etc can affect its course. To mostly elderly listeners.

@ Denice Walter

“You may have noticed that two important commenters, Joel PhD, MPH and F.68.10 are absent of late and sorely missed”

I’m waiting for Joel to comment. I feel I’ve been a bit rough with him, and would feel guilty if I commented without him being back. I do not intend arguments to have the effect of silencing someone else. So I’m waiting for him to come back.

Antivaxers must be gnashing their teeth over the public’s continued high level of trust in medical experts as the pandemic continues. A N.Y. Times/Siena College poll from late June is evidence of that.

“In the Times survey, 84 percent of voters said they trusted medical scientists to provide reliable information about the virus, with 90 percent of Democrats and 75 percent of Republicans trusting the experts. Overall trust in the C.D.C. was 77 percent — 71 percent among Republicans and 83 percent among Democrats.”

Even after “Plandemic”‘s mudslinging, the poll found that Dr. Fauci still had the confidence of two thirds of voters.

I think there may be too much pessimism about the influence of pseudoscience types, antivaxers and other cultists. Once a good vaccine becomes available, people’s longing to get back to normal will override the rantings of conspiracy theorists.

Of course Bill Gates and Pharma paid me to say that. $20 a word isn’t chump change.

It’s particularly sad that Christine is now offering poorly extracted Tincture of Beth:

Fauci lacks a lot of insight. HE is the reason their is a negative response to vaccine development.

Nobody wants to follow him down the yellow brick road just to see him do yet another about-face on the issue.

I would volunteer, when someone is recruiting. Trials accept limited number of people, you know

@ DB:

You only get 20?

I notice that since the crisis, Dr Fauci has become an object of scorn amongst woo-meisters, supplement entrepreneurs, anti-vax internet/ social media stars and whosoever trolls sceptics like Orac. Tales of his life long malfeasance have emerged as well including his hiv/aids SBM : I’m rather surprised that his origins as an Italian-American from Brooklyn have not led to the obvious conclusion of ties to the Genovese, Gatti or Soprano crime families.

This is prep work for when vaccines arrive: they are trying to poison the well about any vaccine available. If they question Fauci, maybe they’ll question vaccines and avoid them. HOWEVER suppose jobs or schools require vaccination. What I observed recently is that businesses are trying very hard to make safer venues for customers and employees, using the internet to explain their specific actions: vaccines will assist them in doing so .It will be the New Normal. It’s on its way.

Woo meisters and anti-vaxxers can be quite cavalier whilst transmitting misinformation including factitious tales of woe following vaccination because if their ideas harm anyone there is little one can do legally as followers chose this rather than SBM, no one forced them and you cannot prove which woo influenced them when there is so much. As Prof Dorit revealed public misinformation that is more wide spread created by anti-vaxxers may actually protect them from legal actions!

So if the anti-vaxxer has a website, facebook page or broadcast which has thousands of
followers or spouts nonsense on a sceptic’s site which thousands read, they can
rest assured that they probably won’t be in trouble legally

Over the past decade, I’ve seen how anti-vaxxers use the internet and live public actions like protests, stopping young mothers/ pregnant women in shopping areas or leaving literature in doctors’ offices to scare vulnerable women. Or they post horror stories of devastation caused by vaccines on websites. While they won’t be prosecuted, they can be called out or ridiculed. .

@ Denice / DB

You only get 20?

Current standard rate for entry-level minion.
As you know, it takes some courage and more than a little luck to go ask Lord Draconis for a rise. First you should get into the Glaxxon PharmaCOM orbital station (and Musk is not very helpful nowadays, he used to allow minions into his cars before launching them into space), then you reach His Lordship’s office by walking across the feeding pits in the hatchling nursery, and you are only allowed a pair of rubber boots to protect yourself…

Moreover, it’s a flat 20, in the minion’s country’s currency. That’s actually why we Europeans pushed to replace our old currencies by the Euro. We almost bankrupted Bill Gates that day.
I have this Italian colleague. Man, he threw such a party when Italy joined the European Union and his PharmaLucre(tm) wages increased a thousand times. There was this thimerosal fountain to dip fruits into, forty-two different flavored aluminium oxide spreads (including lutefisk-flavored)…

@ Aarno,

Yes I know we are not having the flu vaccine campaign in the northern hemisphere.

We were in January & experienced our highest death rates in March-April. In January it had been 7 months since flu vaccine campaign in Australia & their initial new death rate peaked at 8, on April 6. And then it literally fizzled away. New cases less than 10 per day on many days.

Meanwhile in the US the virus had blanketed the country; from the ski towns to the beach towns. It went everywhere; too much virus. We are now having record high new case rates because we reopened after the virus was everywhere & people participated in mass gatherings & general poor behavior.

Australia’s measures were more severe than ours, the compliance was better, as a one country continent they were able to close borders & even travel between states was curtailed but they started getting flu vaccines in March & now new cases are surging. I understand it’s early. Doubt anyone is looking into the influenza vaccine factor.

@ DB,

Poor Brazil. No wonder they started doing so pitifully; after making it to the second week of April with about 25,000 cases & only 1,200 deaths! Now they are the 2nd worst in the world. Second only to us, of course. That was a quick catch up, guess now I know why. Oh & from your link:

"They also adjusted for multiple health variables and for socioeconomic
variables but found that this did not change the magnitude of the positive
association significantly"

Do tell (well they don’t). Those are very important variables in Brazil. Why didn’t they publish this? Multiple health variables? Key during COVID. Socioeconomic can swing a study by 50%. I’d like to see what “not significantly” actually means.

Do you actually buy this?

As far as polls on who would get an (as yet) nonexistent Covid-19 vaccine, one-fifth to one-third of Americans are so far saying no. Here’s one recent poll showing two-thirds saying they definitely or probably will get a vaccine.

https://www.wivb.com/news/national/poll-third-of-americans-wont-get-a-covid-19-vaccine/

I suspect many of the up to one third of prospective refusers will change their tune, especially if they’re employed in health care or other jobs with a lot of person to person contacts. Many businesses i.e. restaurants are very unlikely to hire the unvaccinated once a vaccine becomes available. Currently in central Ohio a number of restaurants that had reopened have shut down again because one or more employees became sick, and they’ve announced closures for “deep cleaning”.

In many if not most cases, if you’re unvaccinated and can’t work from home you’ll be SOL.*

*and whining ineffectually about “violations of bodily autonomy”. Try telling that to parents of elementary school students if you’re a teacher.

@ DB,

Cool story, maybe they will remove the Act to facilitate public confidence & ensure higher uptake metrics?

The prosecutors say the men willfully violated a federal order made in April that they stop selling and distributing the product. The family also allegedly sent letters threatening violence to the federal judge who issued the order and warned that they may stage “a Waco.”

All along, a special agent with the Food and Drug Administration made undercover purchases of their MMS and exchanged emails with the men, according to an affidavit. In some of those emails, one of the defendants advised the agent on how many drops of bleach per hour the agent’s (fictional) wife should drink to treat her bladder cancer.

After a federal judge ordered them to stop selling the bleach, the men allegedly moved their online orders to email and required customers to fill out a survey, asking customers if they worked for the government or “fake news.”
.
.
.
Genesis was co-founded in 2010 by Mark Grenon, the father of the three other defendants, and Jim Humble, who is referred to in the criminal complaint as “Co-Conspirator 1.” In a February 2020 interview, when Mark Grenon was asked why he formed the church, he responded: “Because everything you do commercially is under the Universal Commercial code, OK? A church is completely separate from that code, statutes, and laws. That’s why a priest can give a kid wine in church publicly and not get arrested. Because it’s a sacrament… You can’t arrest us from doing one of our sacraments, and I knew this. So that’s why… I said let’s do a church.”

The affidavit notes that Genesis’ own website says it’s a “non-religious church,” and Mark Grenon, who calls himself an archbishop, has acknowledged that the church “has nothing to do with religion.”
.
.
.
In an April 21 letter to Judge Williams, the Grenons wrote, “We are practicing ‘civil disobedience’ against this unjust order! Civil disobedience is permitted in the US Constitution, peaceably of course at first, if possible,” adding, “NOTE: The 2nd Amendment is there in case it can’t be done peaceably.”

“The Genesis II Church of Health and Healing will not stop… providing our sacraments to the world! The DOJ and FDA have NO authority over our Church,” the letter said.

In subsequent Genesis podcasts, the Grenons continued to make threats, saying, “You’ve got the 2nd [Amendment]. Right? When Congress does immoral things, passes immoral laws, that’s when you pick up guns, right? You want a Waco? Do they want a Waco?”

They also accused Judge Williams of committing treason and said, “You think we’re afraid of some Obama-appointed judge that broke their oath? You’re no judge. You could be taken out, Ms. Williams. [W]e’re not obeying [the order]. Don’t care what you do.”

https://arstechnica.com/science/2020/07/florida-men-charged-with-selling-bleach-as-covid-19-cure-threatening-a-waco/

PSA:

SpaceX is expected to have a launch soon. Idk why they can not get their Starlink off (with two rideshare sats) And it is still standing on the other pad.This one is notable because the booster was the one that delvered those astronaughts ( Robert Behnken and Douglas Hurley) to the ISS 45 days ago. Rapid turn around, And they will be able to view the launch of that booster that delivered them there in first place.

The payload is a South Korean comminications satelite that Lockheed produced for them in exchange for buying up a lot of really ugly F35-A. Pig of a plane. So, there is that.

https://old.reddit.com/r/spacex/comments/hkbhqo/anasisii_launch_campaign_thread/

Want to respond to Orac? Here's your chance. Leave a reply!

This site uses Akismet to reduce spam. Learn how your comment data is processed.