Thread by @alexandrosM

The following is a 🧵on the Lex Fridman / Francis Collins podcast.

I haven't listened to it yet, so I'll be writing as I listen:
Episode #238 (Francis Collins: National Institutes of Health)

The pod is here if you want to listen along:

Fridman starts by stating the goal is to ask hard questions with empathy and humility "so that we may begin to regain a sense of trust in science, and it may once again become a source of hope". Francis says "he loves the goal" and so do I.

Off we go. Fridman's first question is "is there a chance the virus leaked from a lab" and Collins starts with the usual deflections. "I can't exclude that, I think it's unlikely".

Really? 3 labs in the world worked on modifying coronaviruses, only one has admitted to doing so in BSL2, a coronavirus pandemic starts at its doorstep, a thousand miles away from its most plausible zoonotic origin, and your answer is "I can't exclude that"?

He then gives a complicated explanation of how it may have arisen naturally, a set of assertions we have no evidence of, even though huge effort is being expended looking for said evidence, and when lex asks "will we ever know?", Collins talks as if zoonosis is the only scenario.

"there has not yet been a thorough enough investigation to say that that's not going to happen". A follow-up I'll never get an answer to: If the most extensive investigation of all time has not found the evidence you're looking for, what investigation is "thorough enough"?

False/Misleading claim #1:
"Remember, it takes a while to do this, with SARS it was 14 years before we figured out it was the civet cat".

Odd, because this article was published about 7 months after the original outbreak, and seems to be pretty specific.
cbsnews.com/news/sars-link…

False/Misleading claim #2:
"In MERS it was a little quicker (than 14 years), they discovered it was the camel".

"A little quicker" here means that in 1.5 year we had conclusive evidence published. I'm sure that's what the average listener will take away. eurosurveillance.org/content/10.280…

False/Misleading claim #3:
"If there's looking going on, we're not being told about it".

What?! Has he tried googling? This was published in March, I'm sure there's been a few more things done since. technologyreview.com/2021/03/26/102…

"My whole career, in genetics especially, has depended upon international collaboration between scientists as a way to make discoveries, get things done".

Francis, do you think your prior experience may have created some biases towards defending international colleagues?

Next up is the Gain of Function segment. I've listened ahead to this a bit now, and honestly, I think we're going to need a bigger boat. There is so much going on in there that it will take a while to untangle.

Let's start here: Fauci, Nabel, and Collins, in a 2011 WaPo op-ed wrote: "Given these uncertainties, important information and insights can come from generating a potentially dangerous virus in the laboratory". Call it what you want, I call it a Bad Idea. archive.md/8WPLN

Fridman asks Collins about "pros & cons of gain-of-function research".

Collins: "I need to take a minute and talk about what the common scientific usage of that term is". Promising us "scientific usage" he muddies the waters, talking about eyeglasses as "gain of function". 🤮

We don't need to go too far, just to our local Wikipedia, to see that Collins is throwing what Steve Bannon called "shit in the channel". Gain-of-function research is far FAR more specific than he makes it out to be. en.wikipedia.org/wiki/Gain-of-f…

Collins then gives his definition of ePPP: "Working with an established human pathogen, that is known to be potentially causing a pandemic, and you are potentialy enhancing its transmissibility or virulence"

Formal definition here: nih.gov/news-events/re…

"Only 3 times in the last 3 or 4 years have experiments been given permission to go forward, on influenza".

First, why focus on the last 3 years? Even 2018 funded work is arguably outside the scope of this statement. What purpose is it serving other than to mislead and CYA?

Let's take a small break here, back in the times where definitions meant things, mostly. On the 17th of October 2014, the NIH announced a pause in "certain types of Gain-of-Function" research. Already-funded research was asked to pause only *voluntarily*. nexus.od.nih.gov/all/2014/10/17…

Guess when the Emerging Pandemic Threats PREDICT project run by EcoHealth and involving WIV was funded? Well, October 2014. If it was funded even one day before the 17th, the pause only applied to it "voluntarily". Are these dates really a coincidence?!

https://twitter.com/alexandrosM/status/1417084424726843393?s=20

So why does Collins deflect, talking about a far more narrowly defined concept (ePPP), instead of Gain-of-Function, which was clear enough in 2014 to appear on the title of the federal funding pause, but somehow in 2021 it's a disinformation term used by the enemies of science?

Collins continues: "the more you know about the coming enemy, the better chance you have to recognize when trouble is starting".

But ePPP research only covers *established* human pathogens, not viruses that *might* jump to humans. This justification for the banned GoF, not ePPP.

He then talks about the 2014 PREDICT-2 project I linked above: "Was it GoF? Well, in the *standard* use of that term, that you would use in science in general, you might say it was. But in the use of that term that applies to this very specific example of ePPP, absolutely not".

In an alt-universe, where Collins was not trying to throw every possible distraction at us, this answer would be something like: "Did we fund WIV/EcoHealth to do GoF? Yes. Today we have a new definition that's tighter than that, but of course it didn't apply when we funded them".

He also acknowledges that EcoHealth performed GoF research that it did not alert NIH of, "but it was *not* ePPP"

Francis -- nobody asked about ePPP. The fact that this 2017 concept keeps getting brought up over and over again, invites hypotheses of ulterior motive.

Collins: "these were all bat viruses, collected in the wild, not shown to be infectious to humans, just looking what would happen if you took 4 diff. bat viruses and moved the spike gene from one into one of the others to see whether it would bind better to the ACE receptor"

Let's work on this statement a bit: First, here's a 2015 paper, funded by 13 separate NIH grants, with Zhengli-Shi (WIV) and Ralph Baric (UNC) as most senior authors. pubmed.ncbi.nlm.nih.gov/26552008/

Let's read closely, keep your eyes on the "ACE2 receptor" that Collins is talking about, aka the *Human* Angiotensin Converting Enzyme II.

It appears that they showed it can replicate in human airway cells, and caused "in vitro titers equivalent to epidemic strains of SARS-CoV".

And by *it*, I mean the novel coronavirus they were writing in that paper, combining the spike from one coronavirus (SHC014-CoV), and the backbone from another "mouse-adapted" coronavirus. I think this is enough for me to name this False/Misleading claim #4.

Folks, We're 10 minutes and 14 seconds in, including the intro that Lex made, and the amount of untangling I'm having to do has needed almost 3 hours so far. I'm going to take a break now, but this is not looking good. I'll continue on this later today.

If you've reached this far, please consider liking the tweet linked here, which is a reply to Lex's original thread, to increase the chance that lex might possibly see this thread:

https://twitter.com/alexandrosM/status/1457365910134530056?t=u9t8AQt236FmbM5SPrCpHA&s=19

Collins then connects these experiments, which led to the creation of WIV1-CoV published in the paper above, to the pandemic, saying some people are saying that these viruses were further modified into SARS-CoV-2. This is False/Misleading claim #5: Strawman, not the actual claim.

On Fauci being attacked by Rand Paul, Collins says that Fauci is "the epitome of a dedicated public servant" that "certain figures are trying to discredit, perhaps to distract from their own failings. This never should've happened". It's unclear which failings he's referring to.

What really bothers me here is that Collins is offended at the *idea* of criticism, and considers it fair to counterattack an elected representative, for doing what, in a representative democracy, is his job: Holding the executive branch to account.

"Here's a person who's dedicated his whole life to trying to prevent illnesses from infectious diseases, including HIV, in the 80's and 90's". This is a bit much to pass by. Fauci is known for handling HIV by first freaking everyone out that HIV may be transmissible by fomites...

...then promising a vaccine in 2 years. When physicians begged him to advise using Bactrim, a *repurposed generic*, he advised against it initially, because of "risks", until relenting 2y later, eliminating one of the most severe early side-effects of HIV. He then pushed AZT...

A failed cancer drug, at the initial dosing it was arguably worse than HIV itself. Today, we don't use AZT in our drug cocktail in the west, and is only used in a very small amount in the developing world. Read more here in the right-wing Huffington Post. huffpost.com/entry/whitewas…

BTW, the FDA was strong-armed in approving AZT, being reassured it would be used in extreme cases. Instead, using that authorization, it was expanded even to pregnant women, and even prophylactically. Tell me if any of this is sounding familiar. More here: archive.md/jbj7N

Fridman: "When you're do these experiments, unexpected results may be achieved, and that's the gray area of science. [...] I'm very uncomfortable that we can't discuss the uncertainty and the gray area of this."

Collins: "What I'm uncomfortable with is people deciding to define for themselves what that threshold is based on some political argument. The threshold was very explicitly laid out. Everybody agreed to that on the basis of these 3 years of deliberation. If that threshold needs..

...to be reconsidered, let's reconsider it, but let's not take an experiment that's already been done, and decide that the threshold isn't what it was".

So the experiment done in 2015, during the pause, was subject to a threshold announced in 2017?

False/Misleading claim #6.

They then discuss if GoF should ever be done, and Collins appears open to this kind of research being banned. I must say I'm torn here: On the one hand I wish it were banned forever, and on the other, I know the rules seem to only apply to the good guys: taibbi.substack.com/p/meet-josiah-…

Next up: Bioterrorism. In particular, as GoF becomes easier and cheaper, what happens when everyone is doing it?

Collins' only answer seems to be that we need more collaboration and regulation. Nobody seems to be planning for a world where this stuff is commonplace.

"Should Fauci be fired, seeing as he's lost the trust of many?" (paraphrased)

Collins: "Absolutely not. To do that would be to give the opportunity for those who want to make up stories about anybody, to destroy them".

Well, that's that then. 37 years in his post, going strong.

"I think the best way you give people trust is to tell them the truth, and so they recognize that when you're sharing information, it's the best you've got at that point. And that's something Tony Fauci does at every moment". Gotcha. Tony Fauci is Jesus Christ, basically. 🙄

Hearing Collins fawn over Fauci like this makes me wonder if Collins has been really bad for Fauci, coddling him and telling him this stuff in private, enabling his worst impulses. It can't be that he can't even see any issues whatsoever. It.. Just can't. So he's dissembling?

Lex makes a nuanced point: mRNA vaccines are a huge scientific accomplishment, and the fact they're not appreciated as such, is a failure of leadership. Yes. Because like any beta technology, they should be rolled out with humility. And Fauci has none. @lexfridman nails it here.

This stands out: "I think you have more confidence in our ability to get past our current divisions, after seeing how deep and dark they've become". I fear the public health mind doesn't trust humans. If Collins thinks divisions can't be overcome, he's got no place leading us.

Fridman asks Collins to empathize with parents not wanting to vaccinate their kids, Collins *immediately* blames "information coming from all sides". He then acknowledges that the speed of development is a concern, and waves his hands frantically about "good answers to that".

What about long-term effects? "This hasn't been seen with other vaccines". So, two things here: first, yes it has. The GSK H1N1 vaccine took 2 years to be recognized as causing narcolepsy, with Sweden leading the charge. And there's more of these. en.m.wikipedia.org/wiki/Pandemrix

Second, even if that was true, you can't just piggyback two completely new immunization techniques (LNP/mRNA and adenovirus vectors) on the very different vaccine technology of old. That's irresponsible and arrogant. False/misleading claim #7 here, well earned.

I wonder what Sweden is doing now with these new vaccines? Much like the rest of Scandinavia, it's taking a long hard look at the adverse events profile. And it doesn't like what it's seeing with Moderna. cbsnews.com/news/covid-vac…

"I'm not sympathetic with people who continue to distribute information that's demonstrably false, and continue to do so. They're taking lives."

Dr Collins, these are your words, and if some internet rando catches you red handed 7 times in 30 min, you need to look at the mirror.

"Lex, if there's something I'm really worried about, [...] it's an epidemic of the loss of the anchor of truth."

I fear the epidemic of using the word epidemic for every problem imaginable. As for his moralizing, the reader of this thread can ascribe the blame.

Collins goes on about how social media posts replace "objective truth" i.e. his truth. It's revolting. Sometimes I think our biggest problem is the broken epistemology of prior generations. They don't get that saying you're objective is actually relativism.

https://twitter.com/alexandrosM/status/1425989100780154889?s=20

Lex nails it again here. In the battle of ideas, love and humility wins, not authoritarian tone, not through having "truth". I must say he does a lot better in this segment than the previous.

https://twitter.com/alexandrosM/status/1419712533594710027?s=20

We get to Rogan, and Collins criticizes him for "being fairly publicly against vaccines, at a time when people are dying". Stop and consider this: An opinion that Collins disagrees with makes you a bad person. We can't get to truth this way, shutting down one side of the debate.

And by the way, if Collins condemns Rogan "at a time when people are dying", he must condemn Iceland and other Nordics for fairly publicly halting Moderna vaccination in certain age groups or entirely. This is not the way to discuss. bloomberg.com/news/articles/…

He continues to tar Joe with "unnecessary deaths of unvaccinated people [...] It's simply irresponsible". That last word is a trigger for me. That's how adults talk about children. As if they know better. In a pandemic, you MUST be more humble than that.

https://twitter.com/alexandrosM/status/1435339589518983170?s=20

He continues with ivermectin, people getting "pretty sick" with "doses intended for livestock". No mention of pharmacies not fulfilling doctors' prescriptions for human ivermectin, pushing some to unrestricted alternates. Or a disinfo campaign by the FDA.

https://twitter.com/alexandrosM/status/1429515761815474177?s=20

https://twitter.com/la_smartine/status/1457487136731672576?t=HoRJXgVqcsYR_Tqt3JNwjw&s=19

"There's a recent review that looks at all of the studies around ivermectin and basically concludes that it probably doesn't work". I haven't seen such a meta-analysis, but I've seen one that balkanized the data until it could reach no conclusion at all. *very different*.

I've also seen "living reviews" that remove *all contested studies*, still reaching robust results. Controversial? Sure. If NIH wanted to use this to recommend ivermectin, would they be covered? Hell yeah! So call it what it is: a choice not to recommend. ivmmeta.com/#exc

False/misleading claim #8:"This virus doesn't care, how healthy you are. How much you exercise". If someone hears this and decides that it's not worth getting healthy, talk about irresponsible. The COVID severity correlation with BMI and other health indicators is clear as day.

He then goes on to standard talking points about the vaccine being "really safe and really effective", and saying that the risk for children "is not zero". But I guess EUA technology risk "is zero"? What am I listening to.. Where did my day go writing this thread...

Then they talk Delta, and of course not a word about how variants started gaining ground about the time we started the mass vaccination campaign, and within a year, Delta had sweeped all other strains to dominate.

He then tells us that to end the pandemic, we have to vaccinate every last adult, and the children. And that the variants arrive in the unvaccinated populations. There's so much to say here, but I'm running out of energy. I'll link this 🧵for the brave:

https://twitter.com/alexandrosM/status/1443032755244126220?s=20

Folks, I'm really out of steam here. The rest of the sections seem out of my general scope, and by now, this thread is being read by only the bravest, so I'll leave it at this, I think.

Conclusion: 50 minutes of podcast covered, many false statements, much grandstanding. I revise my opinion of @lexfridman -- he did a better job exposing Collins than I imagined, like the Brazilian jiu-jitsu blackbelt that he is.