Saturday, October 17, 2020

May WHO studies be trusted?

The Director-General of the World Health Organization is Tedros Adhanom Ghebreyesus, a veteran of the Ethiopian Marxist-Leninist League of Tigrai and a supporter of (the Chinese communists, obviously, but also) the dictator Robert Mugabe who "provided health care to all". I was rather persuaded by some videos claiming that he belongs to the Hague.

One man is not the only problem. The whole organization seems to have a truly radical left-wing flavor and there have been good reasons to think that China has a disproportionate influence on the organization. I think it was a great decision for the U.S. to withdraw. The Covid events have unmasked the useless or corrupt character of this organization. The WHO has been wrong about pretty much everything: it said that Covid couldn't be transmitted from a human to another human, face masks didn't change anything, borders shoudn't be closed, it has made a U-turn on all important drugs, and even on the desirability of the lockdown. And I don't need to mention all the wildly ludicrously overstated WHO projections of the numbers of fatalities etc.

When you look carefully, you may see that the primary problem is that the WHO is mainly a political or ideological organization, not an organization of impartial experts. The screaming "global equality and redistribution!" may be seen on pretty much everything that the WHO does or says.

At any rate, a preprint was posted two days ago by the WHO Solidarity Trial Consortium. Over 10,000 patients from 30 countries (mostly third world countries; there is none from the U.S., of course) were supposed to be included in one way or another and the excessively concise paper concludes that four drugs don't help at all to save Covid patients' lives: remdesivir, lopinavir, interferon, and HCQ.

Some mindless people immediately accept this paper – which has not been peer-reviewed – as the ultimate truth. Well, that's a very unwise attitude, I think.

A few days earlier, a NEJM paper on remdesivir compared 500+ patients with placebo and 500+ patients with remdesivir. The trial was randomized, double-blind, placebo-controlled, and peer-reviewed and it concluded that the recovery takes 15 days with placebo and 10 days with remdesivir, these two numbers are distinct at a 99.9% confidence level, and there's surely some difference. There are actually several similar papers with the same positive results.

About 1,000 Czech Covid patients have been given remdesivir and about 1,000 more are expected to get it in the rest of this month. Of course, the WHO study doesn't immediately change the protocol in the Czech hospitals – well, they rely on some European body that could change it but an EU decision that looks inconsistent with the facts could still be opposed at the national level, I think. Czech doctors have observed that the drug seems most efficient when it's served rather early, when the patient demands oxygen for the first time.

Various Czech news outlets have made it clear that leading Czech physicians disagree with the results of the WHO trial. Martin Balík is the Covid boss in a large hospital in Prague, VFN (General Faculty Hospital). He has treated a sufficient number of patients so that the aforementioned 5-day speedup of the recovery must have been rather obvious. Jan Máca of Ostrava Hospital offered his wisdom about how and when the drug works best. This guy doesn't really do scientific research. They've had positive results but they gave lots of things to the patients and they can't really attribute the success to particular drugs.

Tomáš Vymazal of Motol Prague, Czechia's largest hospital, said:
In the spring, the WHO offered us to participate in this trial. At the end, we refused to participate because the design of the trial seemed very obscure. It has included lots of cohorts and other parameters that were hard to be compared. If this paper refers to the trial that we were offered to join, then these results are not trustworthy.
In a discussion under another article about the WHO trial, most readers shared their view that the WHO has been discredited, some Czech readers were confused whom to believe, others demonstrated their own thinking:
Michal Mráz: Maybe the effectiveness of remdesivir would go up again if the U.S. started to fund the WHO again. ;-)
Tomáš Chrastný: I would wait for a day or two, Gilead gives them a slice of the profit and the WHO will praise remdesivir up to Heaven again.
Of course, I don't have a rigorous proof but I do share these suspicions. Gilead Sciences, the producer of remdesivir, is a U.S. company and the WHO is probably very upset about the U.S. that has ordered the withdrawal from the list of members and sponsors. Another commenter offered a list of some WHO blunders with an insightful political explanation:
Ondřej Sekera: The WHO = Organization for the Social Justice in the Healthcare Industry.

We can't say that a drug works unless it is available everywhere and for everyone. Incidentally, for the same reason, they (WHO) have been criticizing face masks, closure of borders, and basically everything else that the poor countries cannot afford (for many reasons).
Exactly. This way of looking at the WHO – and the real source of their possible lack of integrity – is consistent with all the previous data. Note that the main reason why the director of the WHO supported the terrible dictator Mugabe was that "he brought the health care to all". These ideological theses seem to stand above everything within the WHO. And it really looks like all the strange "failures to recommend things", like the face masks, are compatible with "we at the WHO will sabotage all these things because the poor nations cannot afford them". And yes, I think that even the recent WHO's statement that "lockdowns shouldn't be used as the main weapon" is politically motivated because the lockdowns started to affect especially the poor countries now (they recommended lockdowns when those were ruining especially the rich countries).

So I am not officially accusing anyone of anything but this is my impression about the WHO, too. I have just seen too many people who were placing the left-wing ideology and Marxist politics above the scientific integrity. In fact, I am convinced that the people who place the integrity above some politics are extremely rare and the WHO just doesn't have too many of these people. Also, I think that the researchers from most countries in this trial just shouldn't be considered trustworthy when it comes to their competence as well as their resistance to bribes. So yes, I think that this study is (almost?) completely fabricated. Some people in random countries participated, pretty much invented their data, and these data were combined and edited in some way to confirm predetermined conclusions. And I would actually bet that if someone checks Benford's law (about the frequency of digits in the paper), the conclusion will scream "fraud".

Aside from the general character of the WHO, I have lots of other reasons to think that this trial is an example of a political fabrication, not proper science. One extra reason is the very name "solidarity trial". Why solidarity? What does the research into the effectiveness of 4 drugs have to do with solidarity? When the word "solidarity" gets to such a prominent yet completely illogical place, it just screams that the goal isn't "to find the truth" but to "hurt the U.S. and/or achieve some global redistribution". The word "solidarity" really is a codeword for "redistribution", isn't it?

And I just have a problem with the concise format of the paper. It contains an abstract which you can make up, some graphs, tables, lists of institutions etc. but almost no comments about the methodology and how they were getting all the relevant data. It simply looks like a brutally inferior piece of science (in comparison with the NEJM paper, for example) or even non-science. And in fact, I find it hard to imagine that the physicians in the 30 countries (who surely had enough work with saving lives at the same moment) could have been trained to follow the unified protocol even if everyone had the desire and integrity. It's just nontrivial to make faraway doctors in 30 countries (doctors who have probably never met in person) follow procedures that are consistent with an extremely subtle yet complex statistical exercise.

One more comment. When I was at Rutgers in 1997-2001, I saw some first petition against the commercial scientific journals, especially those operated by Elsevier. I was supposed to sign an anti-Elsevier petition. Of course I didn't sign it. For the first time, I saw how insanely and extremely left-wing some of my colleagues were. Elsevier really had to be liquidated, they were convinced, because the journals are too expensive for Ethiopia's college libraries and others. I am sorry. While it sucks for most buyers and potential buyers, the journal is mostly expensive because it contains important and valuable stuff. If and when things become free, they unavoidably become less valuable and lose their weight and quality. There are good reasons why Ethiopians can't afford all the luxurious things we have in the West – and that includes some scientific papers that cost something. On top of that, I obviously never believed that the power of theoretical physics in Ethiopia is primarily weakened by the limited access of that country to Elsevier-style papers. This idea looks utterly ludicrous to me and it always did. For a similar reason, I just don't expect a piece of good science to be a survey-style research covering assorted folks in 30, mostly poor, countries. In contrast with the deceitful PC clichés, good science is simply created almost entirely in the first world and even if we deal with exceptions, some centralization and tight communication between members seems necessary for good science, too. These traits were absent in the WHO trial.

So for 20 years, I have known very well that even many people who can do lots of nontrivial things and who are competent in a field of science may still place the extreme left-wing ideological delusions above their scientific integrity. I find it extremely likely that the attachment of the doctors to the scientific integrity is (even) lower than in the case of the high-energy physicists – and that is doubly the case when we talk about politically organized doctors; and triply the case when we talk about politically engaged doctors who hate the U.S. after the U.S. told them "FU". So yes, it seems more likely that this preprint is a complete joke designed to hurt someone whom they don't like for political or financial reasons. Remdesivir looks like a most natural target because it is both American and very expensive.

The widespread, straightforward faith in the conclusions of the WHO trial is another thing that greatly bothers me. Lots of people take this preprint as a fact – including tons of people who think that they are capable of critical thinking (e.g. Alex Berenson, holy cow). I don't think that you are capable of critical thinking if you instinctively embrace the results of such a paper as a fact and you immediately start to invent stories how to spin these results. It is bad if you make it clear that at the end, you believe that some brute political power – like the power that the WHO possesses, even after the departure of the U.S. – just trumps the characteristics of a good science (including checks be reviewers etc.). When the political brute force trumps the scientific criteria, the scientific character and accuracy of the results unavoidably evaporates.

And that's the memo.

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