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11 Dec, 36 tweets, 6 min read
🧵 A comparison between hydroxychloroquine and lockdowns. ⤵️

Recently I compared lockdown proponents with crackpots who believe 5G causes covid: I admit I shouldn't have written this. But the comparison with HCQ proponents, on the other hand, works very well. Thread: •1/36
Ⓐ So, first, in both cases we have something which is supposed to work against covid for a simple and not completely idiotic reason (i.e., the idea is, at least, worth considering!). •2/36
In the case of hydroxychloroquine (“HCQ” henceafter), the theory is that HCQ could serve as a zinc ionophore, transporting Zn²⁺ into the cytoplasm where it serves to inhibit viral ARN-replicase. •3/36
In the case of lockdowns (“LD” henceafter), the theory is that LD serve to diminish the number of contacts between people and thus inhibit viral transmission on the population scale. •4/36
Ⓑ In both cases, this simple theory is borne out by simple models: for HCQ, we have in vitro evidence of its antiviral properties, for LD, we have SIR-like models that support their efficacy in reducing deaths. •5/36
Ⓒ In both cases, however, a great deal of complexity is being ignored: the difference between a simple model (cells in vitro, a mathematical model) and a complex system (a living body, a human society). •6/36
E.g., to defend LD on the basis of “reducing contacts” we are ignoring layer upon layer of complexity of human behavior: that making something forbidden may displace it elsewhere or elsewhen, for example, … •7/36
… or that reducing contacts for everyone uniformly may in fact increase mortality because we are preventing the less vulnerable from becoming immune. It's a bit like thinking “patient is loosing lots of blood, let's make them eat salt as this increases blood pressure!”. •8/36
Ⓓ We have a bigshot, multiply awarded, science guy standing behind these two approaches: Didier Raoult for HCQ, Neil Ferguson for LD. But in both cases, their reputation is put into doubt by erroneous predictions and past behavior, scientific and otherwise. •9/36
Didier Raoult has made claims so far about the covid pandemic that turned out to be very wrong, he has signed way too many publications to have even read them, he was even banned from an international journal. •10/36
In other matters, Raoult also expressed skepticism regarding climate change, and has been accused of turning a blind eye (or even favoring) various kinds of harassment in his lab. •11/36
Neil Ferguson has made some incredibly overpessimistic claims about both the present covid pandemic and several past pandemics (mad cow's disease, bird flu in 2005, swine flu in 2009…). •12/36
And he had to resign from the UK's “SAGE” group (Scientific Advisory Group for Emergency) for failing to abide by the rules of the LD he had himself advised and called for. •13/36
Ⓔ Independently of the bigshot guy's general reputation, the main paper used to justify the usefulness of HCQ resp. LD is borderline scientific fraud and should probably never have been published. •14/36
In the case of HCQ, Raoult's team's main paper on the subject is a non-blind non-randomized study in which they conveniently ignored differences between the two arms of the study. See… for more analysis. •15/36
In the case of LD, Ferguson's team's main paper on the subject conveniently postulates that only non-pharmaceutical interventions have an effect on epidemic dynamic, to arrive at the conclusion that lockdowns do. See… for more analysis. •16/36
Ⓕ On a broader level, the “evidence” we have in favor of HCQ and LD are based on the same kind of intellectual deception: “see, for this patient / country, it worked” conveniently ignoring the fact that the disease might have ebbed for other reasons. •17/36
Either a vague argument that this set of patients/countries was comparable to this other set, or some kind of timing argument (hmmm… how are we supposed to know that LD caused the epidemic to recede and not the general panic which also caused the LD to be decreed?). •18/36
Ⓖ In fact, both in the case of HCQ and LD, we now have some evidence that, in fact, they do not work as advertised (for HCQ this takes the form of counter-studies; for LD, by evidence from countries or regions which didn't have a timely LD and still had a similar peak). •19/36
But in a sense, this is irrelevant: it's for the proponent of a measure to offer clear evidence that the measure works, not for its detractors to offer evidence that it does not. And this is again something common between HCQ and LD: … •20/36
… their proponents are subtly trying to shift the burden of proof: having offered crappy evidence, they say “if you don't like our evidence, please provide some counter-evidence”. But this is not how science is supposed to work: it is up to them to demonstrate efficacy. •21/36
Ⓗ Another common theme between HCQ and LD is the insistence on early treatment. Faced with evidence that HCQ provides no benefit, Raoult retreated by explaining that it only works if administered sufficiently early in the disease. •22/36
Similarly, LD fanatics insist that not only should countries be given strong doses of their treatment, but it should also be administered very early. Various countries have had debates not on whether lockdown was beneficial but whether it was started early enough! •23/36
Ⓘ Perhaps the most important point of all: proponents of both HCQ and LD choose to ignore, dismiss or deny all the negative side effects of their “cure”. •24/36
HCQ can cause long QT syndrome and ventricular arrhythmia, but this has been variously dismissed as well-known, irrelevant, exaggerated, or manageable by HCQ proponents. Dying patients have been excluded from studies! •25/36
Similarly, LD proponents are very keen to ignore all the negative consequences of lockdowns (be they social, psychological, medical, economical or otherwise), and retreat behind the injunction that they need to save lives, as if these consequences didn't also cost lives. •26/36
Basically, HCQ and LD proponents are ignoring one of the cardinal rules of medicine, “primum non nocere” (“first do no harm”) which commands that we fully investigate the negative consequences of any intervention before undertaking it. •27/36
Ⓙ And this breach of medical ethics probably stems, in both cases, from the overwhelming desire to do something in what looks like a hopeless situation. Basically, “we have do do something! (so let's do anything!)”. •28/36
It's really hard to admit that sometimes the best course of action is to do nothing — or rather, that is to say, to stick with basic things which are proven to do no harm even if they provide only limited benefit. •29/36
So individuals are keen to place their hopes on whatever miracle drug they hear about, or governments on miracle measures, thinking that limited evidence (see Ⓐ&Ⓑ) is better than no evidence at all, and that “we have do do something!”. •30/36
This is particularly true in a situation where all available remedies (medical: anti-inflammatory drugs and respirators; or epidemiological: hand-washing and masks) seem grossly insufficient. We don't like to feel hopeless, so we prefer the illusion of control. •31/36
This is the reason, I think, why so many people have jumped on the HCQ or LD bandwagon (but very rarely on both: once you place your hopes in one place, you don't really need a second). •32/36
Ⓚ But there's another reason, which is the political push they got, in opposite sides, from authoritarians. HCQ was pushed by Donald Trump, because it was a way to deflect guilt from his utterly damning failure to act under the “it's just a flu” slogan. •33/36
LD, on the other hand, were pushed by different authoritarian governments, who saw it as a convenient pretext to crack down on civil liberties and gain new powers under the pretext of saving lives and public health. •34/36
✱ Now I'm not saying, of course, that there aren't also significant differences between HCQ and LD. But in both cases we have quack remedies hat have been pushed aggressively, despite lack of serious evidence, and in abandonment of the “primum non nocere” principle. •35/36
And what disturbs me is how many people are able to see the light on one side and not on the other, despite the high level of parallel. (In fact, that people tend to believe in HCQ or LD but rarely both is circumstantial evidence of bad faith!) •36/36

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More from @gro_tsen

10 Dec
A claim has been brought to my attention that covid has cut life expectancy in England and Wales by a year. I think this is EXTRAORDINARILY misleading, so it deserves some clarification. •1/9…
The thing is, life expectancy (at birth, or at any other age) is a bizarre notion. It is obtained by taking observed death rates by age at a given time (generally averaged over several years), assuming these rates stay constant, and computing expectancy from that. •2/9
So it's a concept which basically embeds the assumption that death rates hold constant over time. Which isn't true, of course. When they vary slowly (e.g., due to medical progress), it still makes sense. But in the face of an extraordinary even like covid? •3/9
Read 9 tweets
8 Dec
I should probably write a preventive thread about this, because I feel I'm going to get a few comments of the kind “more than 60% in place <X> have been infected by covid, and infections are still taking place! this proves that herd immunity DOES NOT WORK! ChEcKmAtE!!!”. •1/24
So yes, I've claimed a number of times, and I still do, that the trivial estimation of the collective immunity threshold given by the formula 1 − 1/R, which gives 60% for R=2.5, is pessimistic (but that it's hard to figure out the true value). •2/24
This is essentially because the reasoning behind this formula assumes a homogeneous population (everyone is equally likely to get infected) with perfect mixing (everyone is equally likely to infect anyone) and deviations from this lower the threshold. •3/24
Read 24 tweets
7 Dec
Extremely disappointed by this move of Dylan's. As a recipient of the Nobel Prize in literature, he should understand what value his songs have for humanity as a whole, and consider giving them to mankind by emancipating them into the Public Domain.…
Instead, he preferred to keep them locked under copyright for many decades to come, by selling them in exchange for a large sum of money to a predatory company. What cultural, artistic or social values was Dylan supposed to stand for, again? The times they aren't a-changin'!
This is particularly disappointing given that D. himself recognized the value of imitating others (and was criticized for doing so). From his Nobel speech: “By listening to all the early folk artists and singing the songs yourself, you pick up the vernacular. You internalize it.”
Read 4 tweets
29 Nov
Je viens de regarder l'épisode de la série “Quand l'Histoire fait dates” consacré à la bataille de Talas en 751:… — je dois avouer mon inculture (et/ou mon européo-centrisme) en ce que je n'avais pas entendu parler de la bataille de Talas… •1/6
… Du moins jusqu'à la semaine dernière, parce que j'ai appris son importance justement avant-hier, ce qui m'a permis de dire à mon poussinet «quoi? tu ne connaissais pas la bataille de Talas‽ j'en parlais justement avant-hier avec ta mère». 😅 •2/6
Ceci dit, l'importance de la bataille semble un peu disputée. Patrick Boucheron, dans cette émission, en fait une date-clé dans le développement des deux empires musulman et chinois et dans l'histoire de l'Asie centrale, et même dans la conversion des Turcs à l'Islam. •3/6
Read 6 tweets
28 Nov
Je viens de regarder la troisième partie, qui est aussi très intéressante (quoique un peu moins que la deuxième). •1/10
Il y est question des langues qui ont changé d'alphabet, à commencer par le turc, par décision d'Atatürk, mais aussi l'Ouzbek (arabe traditionnellement, puis latinisation à partir de 1928, puis cyrillique à partir de 1940, et maintenant retour à l'alphabet latin). •2/10
Mais aussi des tentatives de latiniser le chinois, avec le «Latinxua Sin Wenz» dans les années 1930 (je n'en avais jamais entendu parler). Par contre, bizarrement, le documentaire parle peu de la simplification des idéogrammes chinois. •3/10
Read 10 tweets
27 Nov
Très intéressant documentaire diffusé par @ARTEfr, ‘L'Odyssée de l'écriture’, sur l'histoire de l'écriture, en trois parties (1 “Les origines”, 2 “L'Empreinte des civilisations” et 3 “Une nouvelle ère”), visible sur leur site jusqu'au 19 janvier:… •1/17
J'ai vu la première partie hier, qui est intéressante et très bien expliquée, sur les origines de l'écriture d'une part, et de l'alphabet de l'autre. Mais je n'y ai pas appris grand-chose de plus que ce que je savais déjà. Je n'ai pas encore vu la troisième partie. •2/17
Par contre, j'ai trouvé la deuxième partie absolument fascinante. Elle se penche sur les supports et techniques d'écriture entre l'antiquité et le développement de l'imprimerie à caractères mobiles et sur l'impact que ceux-ci ont eu. J'essaie de résumer: •3/17
Read 18 tweets

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