Wednesday, March 25, 2020

CNN: Exterminators Of Hope

A few days back, I noticed a CNN "fact check" that was such an exemplar of entirely irresponsible and politicized journalism that I felt it meet to comment in this space about it. Recently, French doctors in a small-sample-size trial (n=20) summary wrote of their clinical success: "Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin."

This amounted to excellent news, at least for those of us who like actual good news about pandemics. (There is a recent report coming from China that another small sample randomized test does not show the same results.) Meantime, the CDC noted that "[b]ased upon limited in-vitro and anecdotal data, chloroquine or hydroxychloroquine are currently recommended for treatment of hospitalized COVID-19 patients in several countries." But you would not get that story from CNN, which downplayed the work being done elsewhere:
Chloroquine has not been approved by the FDA to treat the coronavirus -- and nor has any other drug, the FDA made clear in a post-briefing statement that said "there are no FDA-approved therapeutics or drugs to treat, cure or prevent COVID-19." Because chloroquine has been approved for other purposes, doctors are legally allowed to prescribe it for the unapproved or "off-label" use of treating the coronavirus if they want. But its safety and effectiveness has not been proven with regard to the coronavirus. FDA Commissioner Dr. Stephen Hahn, speaking after Trump at the briefing, said that chloroquine would be tested through a "large, pragmatic clinical trial" with coronavirus patients.
Here, the FDA and CDC speak in the same generalities one does when there aren't any pandemics involved, i.e. the same kind of thinking that delayed a US COVID-19 test by nearly a month. The combination is in fact going to those sorts of clinical trials, which are expected to conclude in 2022. But for now, CNN sees fit to omit the French work from their pretend "fact check" because it goes off narrative. Anything that gives people hope is disarming a weapon against Trump, and it must therefore be minimized if not eliminated. This foolish politicization will have consequences; we have already seen one in Nevada, where Democratic governor Steve Sisolak has barred physicians from using hydroxychloroquine to treat COVID-19 anywhere but in hospitals.

Update: It's important to note that Trump's initial comments were (mostly) comparatively anodyne (emboldening mine):
"It's shown very encouraging -- very, very encouraging early results. And we're going to be able to make that drug available almost immediately. And that's where the FDA has been so great. They -- they've gone through the approval process; it's been approved. And they did it -- they took it down from many, many months to immediate. So we're going to be able to make that drug available by prescription or states," Trump said.

He added: "Normally the FDA would take a long time to approve something like that, and it's -- it was approved very, very quickly and it's now approved, by prescription."
The approval speed was irrelevant for drugs already on the market. What was not forthcoming was whether this amounted to an on-label use, which, as stated above, won't be known for two years.

Wednesday, March 18, 2020

From The Virology Trenches: Squandered Chances By The FDA and CDC

A pretty good story from the trenches (written by someone at a local public health agency) regarding the early days of the CDC and FDA in the COVID-19 testing saga, and their role in fumbling the tests. The transcript begins at about 1:25:20; all errors are mine. Italics are what I assume is text from the letter's author; emboldened text is my emphasis, and anything in [square brackets] is my own commentary/editorial simplification as well.
Brenner writes: "Hi, TWIV team. Long-time listener. I started in academics after a PhD and a post-doc. I went into public health. I hear in the podcast that there isn't much information on the current COVID-19, or as I prefer to call it, SARS-2-CoV test [Ed. note: CDC seems to be calling it SARS-CoV-2], so let me give you the background. ... The CDC originally came out with a real-time reverse transcription PCR RTRTPCR. It had three targets, all in the N-gene. Why the N-gene when everybody else uses Spike? Your guess is as good as mine. And she gives a link. They sent out ... they sent the test out to 99 different public health labs. Of the 99, only five could make the assay work. 94 labs ... could have the N3 probe react to something in the HSC late in the reaction, causing a late positive CT for the HSC probe two [too?]. That's getting a little dense. Basically, ... test didn't work.  They got false positives. The CDC said they were gonna replace just the N3 primer probe set, but that the other two should be good to go.
A week passed. The CDC was still working on it. Were they going to change the sequence? No one knew what the problem was. However, in situations like this, laboratories cannot just adjust a protocol. We are required by CLIA, FDA, and just about every other alphabet soup agency to do the test as it is written.

A second week passed, and in a very surprising turn of events, the [Association] of Public Health Laboratories, who work very closely with the CDC getting a myriad of assays and programs up and running, wrote a harsh letter to the FDA asking them to loosen requirements for emergency authorized testing. Days afterwards, the CDC said, you only had to use the first two N-primer probe sets. They remanufactured and sent new lots out to the labs in about a week. Basically, we never speak of the N3 primer probe again....
Update 2020-03-21: Rereading this, I came to the incredible realization that there were not two but three weeks before the test could be properly performed. Insane.

Thursday, March 12, 2020

More On ICU Bed/100k Population Figures

One thing I missed in Sunday's post about ICU beds in various medical systems is that the underlying Clinicians' Biosecurity News paper says that "there are about 46,500 medical ICU beds in the United States and perhaps an equal number of other ICU beds that could be used in a crisis" (emboldening mine). (The paper was published February 27, 2020, so still hot off the presses.) If we double that figure, it means the US has 93,000 ICU beds (assuming it is possible to adequately staff each one), or
93,000 ICU beds/331M population = 28 ICU beds/100k population
This is notably better than all European countries save Germany. However, they don't say how they arrived at that figure. A 2013 summary in Current Opinion In Critical Care claims the US has from 20.0-31.7 ICU beds/100k population, pointing to a 2008 summary in Critical Care Medicine:

 It seemed more likely to me that the industry itself might have better statistics, and indeed they do: the American Hospital Association says that the US has 97,776 ICU beds, which would mean
97,776 ICU beds/331M population = 29.5 ICU beds/100k population
While impressive, it seems reasonable to subtract out the neonatal ICU beds (22,860) and pediatric ICU beds (5,131). This gives us
69,785 ICU beds/331M population = 21.1 ICU beds/100k population
Overall, very good news, considering, but still inadequate to the demands if coronavirus needs spike.

Actual Intersex People: Forgotten Pawns In The Trans Wars

I recently had cause to read something from Intersex Human Rights Australia which struck me, at least at first glance, as entirely sensible and a subtle rebuke to the trans activists who wish to define away biological sex into some kind of nonexistent spectrum (emboldening mine):
After fielding a few phone calls it is clear that many people can’t grasp our position in opposing the creation of a third sex while supporting X sex descriptors on birth certificates and passports.

To be clear, intersex is not an arbitrary third sex category, but rather a spectrum of possibilities, and nor is it an arbitrary third gender.

Even though some intersex people define their identity as intersex, this is a political statement, and not necessarily anything about their gender or preference for sex classification. Identity is not what defines intersex: intersex is contingent on innate physical bodily characteristics. Intersex is not a gender identity because it is a matter of sex. ...
We say we should have that right in the same way we have the right to remain silent on our gender identity, our sexual orientation, our race, our religion and our political affiliation. None of those things are marked on birth certificates or passports, though they are in some ways more indicative of who a person is than sex anatomy. 
This strikes me as entirely reasonable. The trans activists have tried to conflate biological intersex individuals (such as people with Kleinefelter syndrome) with people having gender dysphoria, but the former get almost no air time.

Wednesday, March 11, 2020

Women's Soccer And "Equal Pay": Clutching Pearls At Obvious Biological Truths

ESPN has a predictably horrified article about a motion to dismiss the frivolous US Women's National Soccer pay imbalance lawsuit, which raises important (and one would hope, obvious) points about difficulty of skill required to play in those leagues:
The motion filed on behalf of U.S. Soccer on Monday reiterated a number of objections made throughout the lawsuit. But among the most stark were repeated assertions that, regardless of any other consideration, players from the two teams do not perform equal work -- either in terms of revenue potential or the actual physical labor required.

As a result, U.S. Soccer said, women's players do not qualify for relief under the Equal Pay Act or Title VII of the 1964 Civil Rights Act.

"The overall soccer-playing ability required to compete at the senior men's national team level is materially influenced by the level of certain physical attributes," the defense motion stated at one point, "such as speed and strength, required for the job."

That followed the original motion for summary judgment, in which U.S. Soccer stated that women's players did not perform jobs requiring "equal skill, effort and responsibility under similar working conditions."
That the lawsuit got this far is really astonishing, but that these things need to be pointed out is absurd:
  1. We already have pay in athletics distributed by ability, not just in the major leagues (starters generally make more money than relief pitchers) but in the overall professional leagues (MLB players make more than minor leaguers). So the principle is not, on its face, absurd, despite attorney Molly Levison's sneering at it as the product of a "Paleolithic era" mentality.
  2. Female soccer players get routinely beaten by high school boys in the rare cases where they scrimmage together. This is of a piece with high school boys in track and field commonly breaking world record times by females.
  3. The USWNT exists entirely because of subsidies from MLS, which in turn is driven by the male game:

    Professional soccer players are also paid by privately owned club teams. Megan Rapinoe, for example, plays for Seattle Reign FC, one of nine teams in the National Women's Soccer League (NWSL). Player's salaries in the NWSL range from about $16,000 to $46,000 annually, according to NPR. That's not a lot, and it's certainly less than even the lowest-paid players in Major League Soccer (MLS; the top North American men's pro soccer league), who earn a mandatory minimum salary of $60,000.

    That pay gap isn't the result of sexism. It's what the market allows. Major League Soccer teams drew an average of 21,000 fans last year, while NWSL games drew about 6,000. The TV contract MLS has with ESPN and other broadcasters generates $90 million a year. While neither league discloses revenue figures, it's a safe bet MLS earns considerably more—and, thus, its players do too.
    For women to earn what men do, it's clear they need to get butts in the seats and watching on TV. So far, that hasn't happened. (Given some of the women's teams' fans, maybe there's a reason.)
  4.  Those subsidies in fact are a big reason that the US women's team has won four World Cup titles, more than the US men's team ever (zero). Only a handful of countries pay their female soccer players, and this makes a huge difference in the quality and quantity of training the players can undertake. It puts the players in the interesting position of asking for more subsidy because they already get some.
It's hard to look at this situation and wonder what self-serving snake oil the women's team attorney offered her clients. The bottom line is still the bottom line, and at least one member of the women's team understands this:
"Fans can come to games," [Seattle Reign FC player Megan] Rapinoe said. "Obviously, the national team games will be a hot ticket, but we have nine teams in the NWSL. You can go to your league games, you can support that way. You can buy players' jerseys, you can lend support in that way, you can tell your friends about it, you can become season ticket-holders."
And that's it.

And Now A Warren-Sexism Corrective From Cathy Young

Some new links therein about more silly postmortems (Ella Nilsen and Li Zhou at Vox, and Connie Schultz), and good reminders about how all personalized criticism and bashing isn't a sign of sexism (Ted Cruz particularly seems to attract this sort of thing). As ever, excellent work from Cathy Young.

Sunday, March 8, 2020

Nancy Pelosi Joins The Sexism-Scuttled-Warren Bandwagon

Nancy Pelosi has at times impressed me as one of the less crazy Democrats, particularly in her handling of loose cannon Alexandra Ocasio-Cortez and her "squad". But she has joined the chorus of those baselessly claiming that sexism was to blame for Elizabeth Warren's exit:
“I do think there’s a certain element of misogyny that is there,” Pelosi said. “Some of it isn’t really mean-spirited, it just isn’t their experience.”

“Many of them will tell you they had a strong mom, they have strong sisters, they have strong daughters, but they have their own insecurities,” Pelosi continued.
I increasingly think this will not end but for some crushing defeats; however, even that might not be enough.

No, Socialized Medicine Does Not Provide Superior Epidemic Planning

There have lately been a number of people using the COVID-19 epidemic as a justification for single-payer or socialized medicine. Particularly, Bernie Sanders has come out claiming that "it has never been more important to finally guarantee that health care as a human right by passing Medicare for All." Yesterday, I heard someone claim that the for-profit medical system we have in the US is less prepared than those of other countries, because its operators trim all non-exigent expenses down to average usage levels.

This of course is the purest nonsense, and anyone who has paid attention to the goings-on overseas would recognize this with just a little bit of research. Particularly, I wanted to look at one of the first things that will get used up in a real pandemic: intensive-care unit (ICU) beds. Eric Toner, M.D. and Richard Waldhorn, MD writing in Clinicians' Biosecurity News report an estimated 46,500 ICU beds in the United States versus low-case needs of 200,000 beds for a 1968 influenza breakout, and a high-end need of 2.9 million. Needless to say, the availability of ICU beds will become very stressed under epidemic conditions:
  • The UK has 4,000 ICU beds, of which "about four-fifths are occupied" according to a recent BBC story. The UK's population is about 66 million, which translates to
    4,000 ICU beds / 66M = 6 ICU beds/100k
  • Canadian ICU beds are broken down by hospital type, with occupancy rates of 86% for large urban facilities, and 90% for teaching hospitals, with rates as low as 50% for smaller/rural hospitals. I was unable to find an overall national occupancy rate, but it appears Canada has an occupancy rate at the very least comparable to the US if not greater. Canada's population is 38 million, over 3,715 ICU beds as of 2015, which means
    3,715 ICU beds / 38M = 8.3 ICU beds/100k
  • The Society of Critical Care Management says that ICU occupancy in the US is 68% as of 2010, the last year figures were available. The US has 46,500 ICU beds distributed over a population of 331 million, so
    46,500 ICU beds/331M = 14 ICU beds/100k
In other words, the US has more beds, and more free capacity in the beds it does have, than two of the premier systems often touted as superior to the US. In fact, in general, the US's 14 ICU beds to 100,000 population ratio comes out looking positively rosy compared to most of the European systems (as of 2011):

(The figures above may actually overstate the ratios because the authors were unable to get standardized counts of critical versus acute care beds in many cases.) And it's not just ICU beds. As Noah Rothman points out in Commentary, public systems are struggling to cope with COVID-19. In Lombardy, Italy, the Italian Society of Anesthesia, Resuscitation, and Intensive Care has proposed an age limit for intensive care bed space. The UK's NHS has already run into ICU bed space problems and has inadequate ventilators, a situation that is "going to end in death". If there is a public system doing a better job (or capable of doing so) addressing COVID-19 planning, it hardly seems universal or even anything like a majority.

Friday, March 6, 2020

The Inevitable, Vacant Charge Of "Sexism" In Elizabeth Warren Postmortems

Katie Herzog (@kittypurrzog on Twitter) has done me the solid of cataloguing at least some of the "Elizabeth Warren didn't win because, sexism" balderdash you just knew would be rolling in following Warren's conceding the race. (Emboldening mine below.)
The feeling is nicely summed up by Jason Stanley, professor of philosophy at Yale and author of How Fascism Works: The Politics of Us and Them. "To repeat the obvious: there is no other explanation except for misogyny for what has happened to Senator Warren this year," Stanley tweeted after Warren suffered across-the-board losses on Super Tuesday. He called this "profoundly depressing."

This feeling was mirrored by feminist writer Jessica Valenti, who wrote in an essay that Warren had been "outright erased and ignored" by both media and voters. "Don't tell me this isn't about sexism," Valenti wrote. "I've been around too long for that." Sure, Warren may have been the most exhaustively covered female candidate since Hillary Clinton, and she may have one of the biggest war chests in the race, and she may have had among the most stage time at the debates, but still! She lost. The only explanation is that she's been systematically ignored and erased.
Valenti, one of the most predictable hacks out there, was hardly the only individual to make this spurious and risible cause the basis for Warren's failure to catch fire. In addition to those mentioned above, a few more:
  • Warren herself:
    "Gender in this race, you know, that is the trap question for every woman. If you say, 'yeah, there was sexism in this race,' everyone says 'whiner,'" she said. "And if you say, 'no, there was no sexism,' about a bazillion women think, 'what planet do you live on?''"
  • Emily Stewart in Vox:
    There’s no clear answer as to why she didn’t succeed and why her campaign, while resonating with millions of voters, didn’t quite get there. Misogyny is almost certainly an element — many Americans still question whether a woman can win the White House, and thus far, a woman hasn’t. And Warren’s campaign in some ways exemplified the challenges women face in so many aspects of life: They often have to work harder and gather more credentials to even attempt to reach the same heights as men, and even then, there’s no guarantee of success.
  • Hanh Nguyen in Salon:
    "We had all that this time, right?" said Yang. "And it looks like America is not going to elect her, which really comes down to me, to a recognition that whatever we want to claim, gender is at the core of this. It may not be deliberate. It may not be that people outright say they cannot imagine supporting a woman or having a woman president. But when the going gets tough, when there's concern about electability, when there is a push-comes-to-shove around priority, things still seem to line up the same way. And that soft bigotry, that soft filtering, that consistently I think serves as the toughest of glass ceilings for women to raise."

    [Actress Sara] Gorsky also holds this belief. "I think that she faced an enormous amount of sexism and misogyny that's inherent in the system and in everyday voters still in America, which is hugely disappointing to me," she said. "I think the media painted a picture of a candidate who 'couldn't do it' and couldn't be elected. It breaks my heart that the media sent that message and that Americans seemed to receive it."
  • Megan Garber in The Atlantic:
    Kate Manne, a philosopher at Cornell University, describes misogyny as an ideology that serves, ultimately, to reinforce a patriarchal status quo. “Misogyny is the law-enforcement branch of patriarchy,” Manne argues. It rewards those who uphold the existing order of things; it punishes those who fight against it. It is perhaps the mechanism at play when a woman puts herself forward as a presidential candidate and finds her attributes—her intelligence, her experience, her compassion—understood as threats. It is perhaps that mechanism at play when a woman says, “I believe in us,” and is accused of being “self-righteous.”
You really could do this all day, although I note with some interest that Jezebel has surprisingly failed to level this charge in their coverage, to their credit. The simple, obvious rejoinder to this idiocy is that Hillary Clinton won the Democratic primaries as their standard-bearer in 2016, and why are Democrats such sexists now? It says a great deal about the state of the Democratic polity that this is such a go-to answer for any and all of Warren's failings. As Herzog put it, "Warren's followers are both primed to see sexism everywhere and so enamored with their candidate—so sure of her (and their own) righteousness—that they are unable to see any of the flaws that are so apparent to anyone outside their bubble."

Update: It occurred to me that we have seen this exact, data-free approach before, with two other female candidates in the 2020 presidential race:
  •  Kamala Harris herself in an HBO interview after she suspended her campaign:
    Harris: Essentially is America ready for a woman, and a woman of color, to be president of the United States?
    Margaret Talev: America was ready for a black man to be president of the United States.
    Harris: And this conversation happened for him. There is a lack of ability, or a difficult — a difficulty in imagining that someone who we have never seen can do a job that has been done forty-five times by someone who is not that person.
  • Kirsten Gillibrand: "Gillibrand’s exit is particularly significant – and betrays a worrying anti-feminist undercurrent within the Democratic Party."
Yet it's truly hard to find similar charges leveled at the voters for rejecting Amy Klobuchar, Marianne Williamson, or Tulsi Gabbard. (I did manage to pick up a piece complaining about differential media treatment of Klobuchar in Politico, but it has yet to be raised as a justification for her campaign's dissolution.) The idea that the press coverage is aimed at the audience has never been more apt.

Wednesday, March 4, 2020

A Narcissist Misses Erin Pizzey's Big Story

The Atlantic, to which I have been a diffident subscriber over the years, recently ran a piece on Erin Pizzey, a British domestic violence advocate (h/t Janice Fiamengo). As it turns out, Pizzey is a complicated and interesting figure whose violent and verbally abusive mother sparked her subsequent political interests — ones which sometimes aligned with institutional feminism, and sometimes did not. That story, a much longer and better one, is told in her autobiography This Way To The Revolution, and also in the links Helen Lewis' Atlantic story provides. Particularly, her responses in this interview are enlightening:
Dean: So, you have recently, in the last year or so, published a book called This Way to the Revolution: A Memoir from Peter Owen Publishers. What can you tell me about that book, Erin?

Erin: I’ve always tried to tell the truth about the beginnings. I was one of the first people in England to get involved with the Women’s Movement and what I saw there, I knew perfectly well was going to be extremely destructive. And, when I began to stand up at these great big Collective meetings—and interestingly enough there were a lot of women from America who came over with initial instruction to show the British women how to be radical feminists. They’re a pretty frightening crowd and I got screamed at a lot partly because I said many women like myself, who are married, with or without children are perfectly happy to have the choice to be able to stay home. So, in the end last year actually … it took me 10 years to get this book published, it was turned down by every major publisher in this country. ...
Pizzey's father worked for the British Foreign Office in Tientsin at the time of the communist revolution, so she had an up-close look at their methods:
[The communists] had marched up the driveway and [her parents] were arrested. They were very lucky, my parents, because they were just under house arrest. Most of the others were put into prisons. ... So, I had no love of Communism from the very beginning. From what I saw when I was in these great big collectives was really Marxism. We were all organized into groups in our own homes and told that we must have consciousness-raising sessions. And I remember the woman who came to our [feminist] consciousness-raising and when she finished, I said this has nothing to do with women, this is actually Marxist. I said so we’re supposed to go to work full-time and put our children into care provided by the state—like the Communist government—and why are we calling this liberation? And so very quickly I was booted out and went off to open a community center for mothers and children. ...
So the feminists of that era drew a lot of their playbooks directly from the communists. It's an interesting story, but to Lewis, it's mainly a story about Lewis:
Reading [This Way To The Revolution], I could feel the familiar grooves of the arguments about feminists versus “ordinary women.” There has long been a tendency to depict feminism as an elite project, and university-educated women are more likely to describe themselves as feminists.
Finding herself promoted deputy editor at the New Statesman, she got caught in the maelstrom following the publication of Caitlin Moran's How To Be A Woman, with now long-established patterns of insult and magic words hurled like so many hand grenades: "privileged", "transphobe", "white feminist", and on and on. She receives a Twitter pile-on that didn't really end until ... wait, whose story is this? It could be worse, but it could have been a lot shorter, too.

Monday, March 2, 2020

Transgender Desister Sues The UK's Tavistock Clinic

Yes, it's the Daily Mail, but interesting times in the UK as a (biological) woman taken in by the infamous Tavistock Clinic for sex reassignment claims she was given experimental puberty-blockers at age 16, when she did not have legal ability to consent. She is now suing the clinic. It will be interesting to see how this proceeds.

On a related note, I'm adding Transgender Trend to the sidebar. They first came to my attention because of this post about the exponential increase in children sent to the Tavistock clinic, and the astonishing graph therein:
I really hope they win this battle; it seems to me that medicalization of young people needs to be delayed until they can make these sorts of decisions on their own.

New Sidebar Link: New Discourses

 It brings me great pleasure to add New Discourses to the sidebar, a product of the merry pranksters Peter Boghossian, James Lindsay, and Helen Pluckrose. Particularly, I wanted to mention their social justice encyclopedia section, with an excellent definition of "good white":
...Social Justice Theory is particularly harsh on “white progressives” (that is, good whites), who it insists are the most complicit in causing and perpetuating racism. In plain language, this supports the hypothesis that the more woke one gets, the more intensely one will be criticized by the woke. This makes it very difficult to avoid concluding that critical whiteness studies done by white people are hardly more than the masochistic projections of the theorists engaging in it (and reveals a particularly sadistic component to the same when done by people of color).
 There simply isn't enough of this sort of thing in the world, and it needs praise at every turn.