Dying expertise – have we really had “enough of experts”?

I had an interesting response to my last blog post that I was grateful that Premier Christianity picked up and gave it a very wide audience (Thanks Sam Hailes!).

Most of the feedback was positive which was a surprise! Maybe I tapped into something that a lot of us are thinking but choose to not say publicly. There is an issue with a situation where Christian leaders are perceived to represent all Christians which by definition they don’t and can’t. It’s not that they seek to do that but it can make for fairly awkward situations disagreeing publically with our brethren. As Protestants, you’d think we love nothing better than falling out over things but usually we keep that to very specific doctrine issues (infant baptism, the rapture, double predestination…). Science is a generally ignored topic – it’s thorny with the huge swathe of opinions we have (young earth creationism to standard evolution).

The main pushback I had was not due to the Christian perspective interestingly but from my generally dim view of lockdownsceptics. The points made against the piece seemed to be as follow:

• The fact someone wrote a scientific piece on Lockdownsceptics about masks did not believe in viruses takes nothing away from that piece (i.e. I’m playing the player not the ball, the so-called ad hominem attack)
• Even if Lockdownsceptics have a point of view, that’s the same as any other website – such as my blog.
• Even if they did publish one scientific review by someone who didn’t believe in viruses, that doesn’t mean the rest of the website isn’t correct.
• Why isn’t my blog peer reviewed? Isn’t it hypocritical to demand peer review from others but not for myself.

I think it’s worth talking through this in some detail as it is probably underpins a lot of why we are in this situation in the first place.

ad hominem? et tu?

First up, the ad hominem attack seems to be a fairly common response when people with no qualifications post a diatribe of nonsense. When you point out that they have no expertise in the area, the usual defence is “but you’re not dealing with the ideas!”. For one, I had previously dealt with the ideas of the article. But I found odd the idea that a demonstration of someone’s lack of qualification and non-belief in viruses can be perceived as an ad hominem attack rather than a rather clear demonstration of lack of scientific insight.

There is an article I love that was written prophetically 6 years ago by Tom Nichols called The Death of Expertise. It encapsulates a lot of what we are now living through.

I fear we are witnessing the “death of expertise”: a Google-fueled, Wikipedia-based, blog-sodden collapse of any division between professionals and laymen, students and teachers, knowers and wonderers – in other words, between those of any achievement in an area and those with none at all. […] Critics might dismiss all this by saying that everyone has a right to participate in the public sphere. That’s true. But every discussion must take place within limits and above a certain baseline of competence. And competence is sorely lacking in the public arena. […] None of this ignorance stops people from arguing as though they are research scientists. 

The obvious criticism is that it seems elitist. It is actually for lack of a better word “expertist”. If someone is making fairly grand pronouncements over the fact that masks don’t work when he has a severely flawed understanding of the topic of viruses (some would say understanding of reality), are we not allowed infer anything from that? Does it seriously not impinge on what he has to say about masks in relation to viruses?

Obviously that’s patent nonsense – everyone realises that not all opinions are equal. My theological opinions are limited by my lack of education in the area, and that I’ve picked most of it up from YouTube videos and books. If it turns out my GP has faked their qualifications, even if I’ve come to no harm, I’m not going to dismiss it as being of no importance that they are a fraud. There’s nothing wrong with arguing that someone who has studied an area and practiced in it has more expertise that the person who hasn’t. [That doesn’t mean the expert is always right as is discussed in the article – also see Andrew Wakefield for another example!]

Source control

I’m not sure how the idea that the name of my blog shows bias – it’s called MarkSurg because I’m called Mark and I’m a surgeon. Lockdownsceptics clearly assume their bias with pride in their name. That’s fine but that means that they are not going to be neutral guardians of factual science or facts. The Guardian and The Times have a point of view but that’s not the same as having no editorial overview or input. They won’t publish anything that just fits into their perspective regardless of expertise, facts or knowledge of that field. There are high(ish) standards to adhere to – but that’s not the case for lockdownsceptics.

My main point was that Christian leaders were using it as a primary source for what they thought was scientific information. As there clearly is no editorial oversight (or peer-review – more of that later) or review of the author’s expertise, it’s just mostly non-expert opinion pieces of a certain bias – nothing more… There’s always room for that but take it as such – don’t give it an elevated “factual” or “scientific” status as if on par with Nature or The Lancet.

Peer review

I commented that none of the output from lockdownsceptics is peer-reviewed. The response back to me was “nor is your blog or your tweets!” which you can say is a fair point. My blog indeed isn’t and I’m also semi-anonymous here (Premier Christianity were given my medical registration details as well as ID so they could check I was actually a doctor). So isn’t that hypocritical? Can you take my takedowns seriously?

That generally misunderstands how peer review works – if I make a grand pronouncement on this blog that “Two cloves of garlic a day cures impotence”, it would (hopefully!) be met with some scepticism by my peers. “What research have you done to prove it?”, “Is it replicable?”, “What was your experimental design?” and the usual “You’re full of it!”. That’s informal peer review (albeit a polite and genteel version). Same if I’m saying that I have proof that the Swedish Government’s approach to Covid-19 was the best approach to take or that masks don’t work – with grand claims, comes the requirements to substantiate those claims and submit them for criticism by your peers.

So if I really believe in this Garlic theory, I would have generated data to back it up and try to get it published. It’s a painful process of getting knocked back and criticised endlessly – it’s the least fun I’ve ever had. If my peers (usually at least two) think that my methodology and stats are correct, then it can be published as peer-reviewed. (I assume the next question will be “Ah but who peer reviews the peer reviewers?” – at that point, it’s probably best giving up)

The thing is on this blog, I’m not making grand pronouncements of any major impact on people’s lives. If I would say anything major, then yes – I should be trying to get it published and peer reviewed if I believe in it. Otherwise, it’s just non-expert opinion – just a guy down the pub. As we can now agree, that’s just what lockdownsceptics is – and should remain without being given an unduly hallowed status.

[As an aside, the recent pandemic has created an explosion of non-peer reviewed pre-publications – you can post it online at medrxiv with no peer review as most of them stay. I’ve gone over one of those that was quoted by Tegnell. It’s been looked at positively (peer-reviewed paper here) though I take a dimmer view that there’s a lot of people using this as a way to mystify the masses that “it’s a publication therefore reliable”. ]

Where to from here?

I wonder if the internet has uncorked a genie of pseudo-expertise / pseudo-science or if it’s just always been there latent. There’s a very fine line between genuine scientific divergence and pure quackery/conspiracy theory that seems to be getting harder to discern at times often with people straddling the line in a rather mesmerising fashion.

I’m not calling for peer-review on every publication – if you are serious about you are putting out is science, get it peer reviewed. If what you are putting out is worthwhile opinion, have some decent editorial standards on your website. And the main point remains to Christian leaders – please check your sources and don’t claim biased opinion to be “scientific fact”.

Sleepwalking into disaster – Christians and pseudo-science

As a surgeon who spends a large part of his life covered in other people’s bodily fluids, you would think that I would have developed a fairly solid stomach. Yet every time I venture back on to Twitter or Facebook, I feel a flutter in my stomach that fills me with dread. Who will be the latest leading Christian to be endorsing another pseudo-scientific Covid idea?

Invariably it will fit into a relatively simple scheme of anti-lockdown / anti-mask sentiment which will be backed by “scientific evidence” (which is usually neither) from a list of sources carefully culled from a select list. Lockdownsceptics has made a name for themselves in the UK as being willing to publish anything that advances the agenda stated in their name – no peer review required. When I say anything, I really mean anything. For example, an article against masks was written by a mast-cell engineer who doesn’t believe in the existence of viruses. Obviously, masks won’t be of much use to you if you don’t think the virus exists in the first place! Still it didn’t stop a leading Christian blogger from reporting this as “fact and reasoning on masks”.

Ivor Cummins has also been a mainstay of Christian blogosphere despite him not being a doctor but an engineer with a large YouTube presence and diet book to sell (his previous obsession). Of course, he has no peer reviewed publications in the area but he does make nice videos which have been noted multiple times to be just pseudo-scientific claptrap.

There are also some  doctors who take a dissenting view from the general scientific consensus. For example, Carl Heneghan is a GP and professor of Evidence Based Medicine who I disagree with on a few points but is a respected source. Karol Sikora, an oncologist and vociferous critic of the NHS cancer care, is another doctor who sometimes gets called on but has a bit of a checkered history with the truth such as claiming to be a professor of Oncology at Imperial College.

The problem faced by Christian scientists and doctors are multiple – we are by definition fairly busy people and as many know, the time taken to correct misinformation is much longer than it takes to retweet it. I spent a few hours researching and writing a response to the masks article from Lockdown Sceptics – the blogger probably took at most 10 minutes in the interaction we had that followed – he also still hasn’t deleted the tweet months later. In that kind of environment, it’s hardly surprising that, as noted in The Social Dilemma on Netflix, lies propagate 6 times more rapidly than the truth. Debunking is a bit of a whack -a-mole situation – you deal with one and another five equally bad theories are popping up.

Going forward, there are a few points that I think should be helpful coming from Christian scientists to Christian leaders

Christian leaders have to accept their limitations 

I don’t think anyone would take a surgeon seriously trying to give a novel and ground-breaking perspective on penal substitution. I wouldn’t recommend a 200 kg patient to aspire to be a ballet dancer. We should all be aware of our limits. Yet Christian leaders suddenly feel after reading a few articles and watching a few youtube videos, they have gained a full insight into the science and stats of what most people in the field are struggling to get their minds around. There’s also no appreciation in where the information they are being fed stands against the medical consensus. Humility goes a long way but it will reduce your blogging / tweeting output – that’s not necessarily going to be a bad thing.

Know your sources 

A non-peer reviewed article on LockdownSceptics is as valuable as some chap down the pub telling you something – he may be right but the context doesn’t really make it as likely as something in Nature or Cell. Don’t embarrass yourselves demanding others to debunk “facts” from such tainted sources – if it was such great data, then why has it not been published in a peer-reviewed journal? Why is this author only publishing on their own website and /or lockdownsceptics? These questions should be asked before you ever consider retweeting this or using in an article that will be circulated widely.

Think of the impact on the gospel

It’s fair to say, seeing so many leaders following this conga line has made me think twice about my faith. At the crux of most scientists’ faith, is the reasonable, rational centre of the evidence for Christ’s life and resurrection. To us, Christianity is the Truth and something that allows us to see the truth of what is around us. When atheists mock those theories, I’m sorry to say but they’ve got a point. Can they really take the arguments for the existence of Christ and his death seriously from people who have just been peddling at best poor science at worst conspiracy theories?

Let us try to be as gracious as we can to one another

You should be correcting your blog or deleting your tweet if it doesn’t pass the most basic fact checking. Biologos have started an excellent Christian Statement on Science for these pandemic times. I think it’s worth reading and signing if you feel you can. If you can’t, it’s worth wondering what parts of it you take issue with and maybe asking why.  I’ll keep on plugging away as gracefully as I can – apologies if you get offended. If you feel I’m being harsher with you than with non-Christians, that’s probably the case!

Image by Pete Linforth from Pixabay

The mysterious paper around the Flu and Covid link

I noted in the previous post that I’m not looking at deciding (yet) if the Tegnell/Swedish approach worked. I’m still working around how this is being reported and what is pushing people to argue about this as if it’s of utmost importance.

However, there has been a very odd non peer-reviewed paper by 3 economists (first publication for one of them) at the centre of some renewed controversy. The paper is here as yet unpublished but has been referenced by Tegnell and caused an annoyed response from his Norwegian counterpart. Tegnell when cornered about it said that we should be asking the authors questions. Since it’s being quoted by the architect of Sweden’s response (though yet still unpublished and not peer reviewed) and used by amongst others Ivor Cummins (ketodiet author), it seems worth casting a look at it and seeing what the fuss is all about.

It offers 16 possible explanations for Sweden’s high death rate from Covid-19 – the first is the light lockdown, the rest range from interesting to stretching the imagination a bit – but it’s always worth thinking outside the box at times.

Here’s a few excerpts from it that got me wondering if it was actually a serious paper at all:

We suggest that in a complete causal account, the lighter-lockdown counts for less than, oh, say, 25 percent

p.2

To address the question of what some other causal factors might be, we pondered Nordic
experience, focused on Sweden, reading widely but also talking to friends and fellow
researchers, bona fide creatures of Nordic affairs.

p.2

So a fairly casual approach to writing which would not be acceptable in anywhere I submit papers to (maybe economics papers take a more casual chatty style than medicine?)

Likewise, The Lancet recently published a paper finding no effect of lockdowns

p.3

So that’s this paper. And what they saying here is not actually true – there was a significant effect of early border closure and hard lockdowns (as opposed to partial or curfew) on patient recovery and on the amount of covid cases. Mortality was associated with lower income countries but not directly to the lockdown. So what they are saying is that there was no statistically significant link between lockdown and mortality found in that paper – they noted that this was likely due to their data being limited to the 1st of May 2020 (which seems like a lifetime ago!)

Our decisions can alter the future, but not the past.

p.10

Again, very odd style making me wonder whether they really think if they are seriously trying to get this published. Very Star Wars-lite.

February skiing, vacation, and travel

p.12

This is where things get a bit weird(er) – they talk about the holidays which may have caused Sweden to have more cases due to less downhill slopes so they went to Italy (a hotspot). Fair enough but I guess the question was didn’t the Norwegians/Danes/Finns go there?

Here they have to call Wikipedia and Quora in as references to answer this one. See this screenshot:

So they are using medals to demonstrate how much a country likes a certain type of skiing then how likely they will go to the Italian alps. It’s a bit tenuous to hang it on that but there could be something there but this is just isn’t enough to get the data to demonstrate anything at all (except that France, Italy and Norway are better than Sweden at skiing at the Olympics).

They then note the prevalence was higher in migrant communities which is larger in Sweden than in the other Nordic countries which is fair enough (though some of the links to evidence didn’t work). But, as we know from the Lancet article they quoted earlier, an early lockdown and closure of frontiers did cause a lower prevalence of the disease so it’s hard to say that the high death rate is due to the larger immigrant population.

Age care homes

They report that 70% of the deaths were in care homes in Sweden but that’s in May. By July it was 47% which actually makes a difference to the rest of their argument in that they are trying to argue that the high death rate was due having a very high amount of Swedish deaths from Covid in care homes and that Sweden had a different organization of care homes and a higher percentage of the population.

I think we can accept that the care homes were very poorly managed in most countries but I don’t really get how an early lockdown which we know would have reduced the rate of community covid-19 (as per the Lancet article) would not have improved the outcome of the care home residents. Unless I’m missing something…

“Dry Tinder” (p.18)

This is the area that has been most quoted but also where things getting much more controversial than they already were.

Their theory goes thus – there was an unusually low amount of deaths the previous year in Sweden, therefore there were more vulnerable people around to die. They argue this was not the case in Denmark/Finland/Norway thus they have that very low death rate and none of this is related to Sweden not having a lockdown.

It’s not a completely crazy idea (Tegnell himself was interested in it though obviously he’d probably be happy to find another reason for the deaths than his soft lockdown) but the issue is all the data they are referring to is second hand – they are basically grabbing nice graphs from Twitter users and pasting them in as evidence with no analysis, just eyeballing. Weirdly, the first graph refers to someone who refers back to them – so it’s a bit a self-fulfilling evidence chain (and also a bit chicken or egg) – “I use you to back up my argument, whilst you use this very same argument that I make here to back up the initial argument”.

Maybe the issue with this isn’t that clear to casual readers but it’s a huge problem. The data they refer to is not one they have personally analysed and I found it actually quite hard to extrapolate the same data from the sources of the mostly anonymous Twitterers.

We don’t have any of the analysis that was in the Lancet article they were using to incorrectly demonstrate their point earlier. Figure 7 is (we are told) uses mortality data to demonstrate the difference between Sweden and the Nordic neighbours to show they are very different but as far as I can see, there is little difference between Norway and Sweden (bar the huge Covid peak that Sweden had in deaths). As there is no analysis, we are just left to be led into that opinion.

Look – there may be an effect there. The way to find this out is to do proper analysis like in that Lancet article, not just post a load of Twitter users cool looking graphs.

Conclusion

First up, this is not a serious paper. It screams from everywhere as a bit of a collage of ideas that really haven’t been fully fleshed out let alone seriously tested. To call it a paper is a bit of a stetch as it will never get published in it’s current state. If this gets published in a serious journal in its current state, then we have witnessed the death of peer review.

Secondly, that it gets quoted seriously by Tegnell is in itself concerning and makes me seriously question if he had actually read it himself or was just told about it. Public adulation on Twitter until further notice is no replacement for serious scientific inquiry. If there really is a serious scientific basis for explaining the extra deaths, I’m happy to see it. This just isn’t it…

Finally, this seems to be another milestone in the poor quality of evidence that the lockdown sceptics seem to be using. I’ve been over how not believing in Virii will make you a “reliable source” on Twitter and the poor reporting of the knock-on deaths from lockdown. The change now is that we have moved beyond just fringe Twitterers peddling their version of science and moved to a more concerning situation where international health figures are starting to quote this non-science. Lord help us…

Why is everything so polarised?

I watched The Social Dilemma on Netflix a few nights back and this prompted me to take a bit of a step back and consider how much the social media world is probably feeding in to our current state of affairs.

To put it in a nutshell, the documentary looks at how social media is forming huge echoboxes for people and nudging them subtly but inexorably towards more and more extreme views. One startling figure is that lies spread six times faster than the truth. This seems to have been happening since 2009 which was the point most of them launched phone apps.

Over the last few months, I have noted that people seem to be dropping in to two boxes on most issues for the last few months – pro-lockdown or anti-lockdown, pro-masks or anti-masks, pro-BLM or anti-BLM, support police or defund police, pro mass-testing or anti mass testing, Trans affirming or TERF…

The latest appears to be pro-Sweden or anti-Sweden. The choice to stay neutral on the matter appears to be taken from us. Google has been flagging up news articles for me on Sweden that are usually critical though on Twitter, I’m seeing people posting articles that could be perceived as pro-Sweden (although when I read some of them, they seem to be debatable whether they are really backing Sweden). The underlying message from the pro-Sweden side was “Why didn’t we do like Sweden?”…

This blog post won’t be a pro or against Sweden – for one it’s far too soon to decide on what approach was correct in the face of a virus that was completely novel. The architect of Sweden’s response, Tegnell, himself told unHerd to wait a year from now before drawing any conclusions. In the meanwhile, I think there’s a lot to be analysed as to why people are trying to make this call and that’s possibly what I find the most interesting part.

Sources

Here is the main issue I’m having with people – most people are not very good at discriminating on sources (and why should they? They’re usually not medically trained and even if you were, statistics, infectious disease and epidemiology are not exactly a medical forte for most of us doctors). Many websites that were unheard of pre-covid are now coming to the fore as often quoted sources – unherd and lockdownskeptics seem to be those playing the anti-lockdown sentiment with the Spectator, The Daily Mail and the Telegraph in the UK doing the mainstream work. If they were really good at providing us with balanced information, that would be fantastic but sadly that’s very far from the case. As I previously posted, Telegraph and Daily Mail have done a rather dishonest task with the expected lockdown deaths and I’ve had to take apart an article on LockdownSkeptics – a posting of anti-mask “evidence” by someone whose main qualification was mast cell technology related and who was sceptical about the existence of virii (yes, you read that correctly). On YouTube, there are videos that have been widely circulated, which are great entertainment but poor science (here’s one being debunked at length) – again the person holding this controversial view is an engineer most famous for a keto-diet book.

[Sidenote: Apparently, one of the controversial theories from this video, was picked up by some economists in a non-peer reviewed paper. This was then picked up by Tegnell then immediately slammed by his Norwegian counterpart. When Tegnell was challenged about this he just said “If this article was wrong, it should be discussed with the article authors”. I think Tegnell was probably caught off guard with that one and I’ll be charitable to not count that against him given that he’s been under the spotlight more than should be reasonable given his job. If this theory has legs, then they can get it peer-reviewed and published. In the current state, that paper will never get published with comments like “the lighter-lockdown counts for less than, oh, say, 25 percent.”, admitted bias from the outset and a lot of the main data coming from anonymous Twitter accounts who didn’t given anyone the data.]

In the world of unlimited information, I’m constantly being asked for opinions from patients, family and friends about what my take on a new “interesting” view is – invariably, it’s rarely interesting and more often a complete waste of my time (something that apparently is in ample supply to most people these days except frontline workers). It’s becoming like whack-a-mole and most of us are giving up.

Realistically, I’m not going to look through every single crank’s data at length to see if this lone person has found something that we should be paying attention to. If it gets published in a peer reviewed journal or if they come with a reputable background (Laneghan and Jefferson at least work in Evidence Based Medicine though seem to be the main contrarians within the medical world – they seem to be the go-to-guys for the Spectator along with Simon Woods for statistics), then I’m happy to read the article. As you can see from the reviews I’ve done, I have read a fair amount of “new evidence” that is just ideology pretending to be scientific, extreme cherry picking of evidence or complete conspiracy theory – my concern here is that most people are not seeing through this.

Politics

Another oddity is the splitting of perspectives based on political allegiance. The US as always offered us the most extreme version of this with the pro-Trump brigade giving us the first embers of anti-lockdown sentiment.

In the UK, the Brexit divisions seem to have just continued into a Covid division splitting as far as I can fathom, with the pro-Brexit media going with anti-lockdown and anti-masks. The oddity of this is you now see Remainers supporting Boris Johnson’s lockdown, whilst the magazine he used to edit is on the other side.

There is absolutely no reason for this to break down along political lines – should views on hand washing be a political view? Should my belief that excessive red meat is not beneficial for my health be dependent on my politics? It’s not sensible for things to break that way unless of course there’s an implicit belief you are trying to comfort (probably libertarian vs non libertarian) and that’s a certain perspective that Spiked online have taken but let’s not pretend this is anything more than ideology driving the data analysis – that’s just not the best approach.

The Voice in the Wilderness

This is for my Christian brothers and sisters – I’m concerned that we are starting to weave a lot of our Biblical narratives into this age unconsciously. Throughout the Bible, there are many characters triumphing against the odds, speaking the truth to power and facing down the authority of the day – Daniel, Joshua, David, most of the prophets, John the Baptist, Paul and so on. I think we are predisposed to see in a quasi-prophetic way any voice going against the flow as important (if not always correct).

I think we shouldn’t ignore these voices but also keep a very critical mind when you listen to them. We should also be aware of how little knowledge and insight we have on a given topic before reposting them on twitter – as I pointed out in the opening, nothing spreads better than lies and nothing is more depressing than seeing Christians accidentally spreading disinformation. When we are challenged about it and it becomes evident we are not likely to be on the side of the truth, we need to delete the tweet and not try to find more and more dubious evidence to back our claims.

I get it: like everyone else, I’d love to get back to a normal church life, have a cup of tea and become part of my faith community in the flesh. But what made me a Christian was the truth – a lot of what put me off Christianity was the added-on stuff that turned out to be well meaning untruths. When I was able to get to a bedrock of the important facts of the Christian faith, only then was I able to come to faith. The truth is sacred and we must never compromise on it. It doesn’t matter which area it is in – lying for Christ is at best embarrassing at worst just damaging to the cause even if it’s done unwittingly .

So in advance, I’m sorry if you’re offended if I correct you or come across as difficult – Twitter is great for a put down, not great for anything elaborate sadly.

[I’m not arguing only theologians should discuss theology but I think it’s fair to say, if I started talking about the intricacies of penal substitution, I’d rapidly embarrass myself to anyone who has done any study in the area.]

Moving on

This is what concerns me the most – I think the division in society is sadly being mirrored in the last place it should be, the Church. We are called to talk to each other with love and understanding and I think we are all failing at this – myself included. I think we are also being blinded by how powerful social media has become and how crucial it is becoming in the “facts” that are being drip fed to us. The Gospels give us a different perspective on this – it provides us with four different perspectives on a life that changed the world. They all are radically different – you won’t find a single demon in John for example – but they all complement each other for a greater vision of what divine incarnation means. Maybe that gives us an idea of how we can move on from this polarised mess as a Church?

Media lies – Deaths from lockdown in the UK

200 000 was the estimate reported in late July by the Daily Telegraph and the Daily Mail as “all caused by lockdown”. Metro were more nuanced (!) on this front and reported it as knockon effect of lockdown and effects of Covid on the NHS. The news brought the usual array of people who previously saw Sweden as a failed left-wing utopia to now see them as the last beacon of hope… Strange times indeed.

But what was the source of this data? It’s a governmental report from April 2020 (so some time back) and you can read it here. If you have enough time to look into it, it’s an interesting insight into how much things are getting wilfully distorted – to anyone who works in medicine, that’s sadly unsuprising in normal times but this pandemic seems to have made this reach new heights.

They break down the expected deaths into 4 categories (I’ve edited them a little to make them more readable and added the estimated deaths in thousands)

1. Deaths from Covid – 41k to 45k
2. Indirect Covid deaths due to additional pressures on the health care & social care system, being unable to maintain previous standards due to the influx of Covid patients – 12k to 25k
3. Deaths from changes to healthcare activity, such as cancellation or postponement of elective surgeries and non-urgent treatments – 185k
4. Deaths from factors affecting the wider population both direct resulting from pandemic and from government’s Behavioural and Social Interventions to address the pandemic, and economic – unclear

So category two and three are not deaths caused by the lockdown but by the pandemic – however this is where the headline 200k came from. These tragic deaths are clearly related to the NHS not being able to cope due to the sheer numbers of Covid patients coming through as well as being underprepared. It would be fair to argue that the lateness of the lockdown would have caused these deaths to be much larger as a result.

Let us dig a bit deeper into the summary table on page 4. This is for category 3:

Non-urgent care is being re-prioritised to protect patients and to free up stretched NHS resources. As an upper limit, if 75% of elective care that would have been done over 6 months is cancelled, […] would ordinarily be expected to increase mortality by 185,000 deaths (medium and long term) […] However, with reprioritisation of cases when services return to normal, the actual mortality impact can be expected to be far smaller than this.

So clearly nothing to do with lockdown there. So what are we left with related to lockdown? Well that’s parts of Category 4 – it refers to the government’s Behavioural and Social Interventions (BSIs) and the economic downturn caused by both the lockdown and the effects of the virus. Here the paper is incredibly vague – they refuse to name a number (“unclear”) and point out that actually:

a large body of evidence suggests that mortality rates decrease during times of recession. The most likely short-term scenario therefore, including both direct effects and a modest recession, might see a fall in mortality in the low thousands.

So mortality will improve thanks to a recession? Apparantly so. (Note: I’m not an expert in this area). P. 44 and onward go into more details which is an interesting insight into what seems to happen in recessions (cardiac death, boozing and smoking goes down but suicide goes up) They do note in the next paragraph that if there is a severe recession we could have deaths in the low thousands as a knock on from deprivation. So even if we pin a serious recession solely to lockdown (which is hotly contested), we are nowhere near the headline and in terms of lives saved from lockdown, it’s no contest.

Finally, they get to lockdown itself – they conclude the following:

There is insufficient evidence to estimate the size of impact on deaths as a result of the BSIs. In the short-term, it is unclear what net impact BSIs would have on mortality. Evidence does suggest that mortality rates would decrease from a reduction in road traffic accidents and potentially air pollution,however we could see a rise in mortality from increases in domestic violence, suicide and other factors.

So they have absolutely no idea if the direct benefits of lockdown (aside from reducing the impact on the NHS) are as bad as the negatives of increased depression, domestic violence and so on. You can read about the specifics in more detail later in the report – they even discussed the impact of lockdown on LGBTQ+ (“unclear”).

200k down to maybe a few thousand at a stretch by just reading the source. That’s an enormous difference – 100:1. Clearly, some people don’t want you looking beyond the headline. That we have a healthcare system that is failing is the real headline but that’s hardly suprising given a chronic stafffing issue which has now been compounded by impending Brexit. Brexit? That’s funny – neither the Mail or the Telegraph want you to think that Brexit is going to impact us heavily (which it has been projected to in the strangest ways). Shifting the blame to Lockdown is so much simpler but also a complete lie.

[For the record, by taking to task right wing lies clearly does not imply that there are no lies on the left side of spectrum. The insistence of the BLM movement to ignore the risk of spreading Covid was equally dissapointing. It does seem however that in the case of the medicine surrounding this virus, there seems to be a rightwing fixation. There’s a Sociology/Politics PhD to be written as to why that’s become the case at this specific point in time but that’s for another day.]

How not believing in Virii will make you a “reliable source” on Twitter

In these troubled times, we have limited time to read stuff so something that is billed as facts and reasoning should be a welcome sign surely? David Robertson seemed to think it was essential stuff so I dove right in… What followed was a rather interesting but ultimately wasteful trip.

Not that facts or reason will bother either the UK or Scottish governments but here are some facts and reasoning on the subject of masks https://t.co/fnObq9ELK0

— David Robertson (@theweeflea) June 5, 2020

Appraising evidence 101 – look at potential bias.

Lockdownsceptics.org – so not exactly the BMJ is it? Will we get a multidisciplinary peer review? Let’s see:

So it’s a single author – nothing identifying them but their name (and clearly no peer review). Any medical/nursing background, any work in ID etc… General rule of thumb: if it’s not stated, it’s probably as good as your man on the bus telling you his latest tale.

Let’s find out more about this author – Google in a few seconds showed that he writes on the theinfectiousmyth.com and runs an eponymous podcast. We rapidly find out that he’s is “a wireless telecom consultant” (so he *is* a consultant just not in anything vaguely related to healthcare). The killer blow is a fantastic post where he declares that most likely viruses don’t exist. The rest of his website seems to follow that line.

Clearly, I think a saner person can probably go no further than the header. If someone is going to deny the obvious, I’m fairly sure there’s going to be a few gaps in the rest of the logic. I certainly won’t be taking medical advice from this chap. At this point, you have to go back to square one and restart your quest. Go to the original sources (not just those cherrypicked for you) and work from there – if you don’t think you can, I can 100% guarantee that this gentleman is NOT the guide you’re looking for.

I’ll give it to this person, they make a good pastiche at what looks like a review of evidence (though someone needs to show this guy how a hyperlink works – hardly any of them point to the correct place!).

Let’s start with the first thing he refers to which is a Cochrane review – this is what you want to find as Doctor. It means that huge volumes of peer-reviewed evidence has been read by a team, pored over endlessly and after much discussion and reviewing a consensus of sorts has been arrived at. This is what you should be reading – not me nor David Robertson nor the unfortunate author of this “piece”. Just look at the header and see the difference with the lockdownskeptics article.

Ah! What a refreshing change – multiple authors, declaration of interest, working hyperlinks, no British bulldog… You can download the PDF and read the full findings and make your own mind up.

However, this author grabs it and starts by excluding in his “analysis” any research that was not from the SARS era so we go from 67 to 7 papers. He’s making a fatal assumption – that SARS is the same as covid-19. They aren’t. We know the transmission rate for covid if much higher than SARS so just looking at them is pointless. Either look at the entire Cochrane review and accept the limitations of it not being research into covid but mostly less infectious virii (which would been the findings are more likely to be relevant to a highly interactive virus) or don’t use it at all.

He then excludes those that used healthcare workers to end up with 2 papers. Why is he doing this? Apparently, he never argued that healthcare workers shouldn’t wear masks – though given that he doubts the existence of viruses, you’d think he should argue that no-one needs masks at all, no? Of course, he doesn’t tell us which papers he’s referring to so we can read the original ones so we’ve moved from a body of evidence to 2 papers out of it. He then makes claims on them but we can’t check if any of that is true or incorrect. This is not fact or science – it’s just opinion unless you give us the means to verify it but maybe he doesn’t this to be too closely observed.

The case against comes next – now remember in the Cochrane review (which demonstrated evidence in favour of masks) he excluded anything that was not SARS related? Well that doesn’t apply anymore when he’s looking for evidence against masks – now he’ll use research into influenza. If you can’t see how wrong this is, then that’s beyond the scope of this post but suffice to say it’s not common practice. You can’t exclude evidence on one side but then include it on the other. It’s a bit like that friend who changes the rules of a game halfway through the boardgame and _always_ when it’s to their advantage.

If you read the first article he uses as against you find they don’t have a statistically significant effect (only for influenza remember) but there is something rather interesting in the conclusion:

However, as with hand hygiene, face masks might be able to reduce the transmission of other infections and therefore have value in an influenza pandemic when healthcare resources are stretched.

There’s also the caveat that this was early in the COVID outbreak and that the transmission mode wasn’t clear so how much of these findings would apply to COVID.

The next article he quotes is a RETRACTED article (of course no working link in their article!) as the methodology for detecting the virus wasn’t sound. So the findings are meaningless. That won’t stop it being quoted as evidence against masks. And that’s that for the against side.

He does later quote a BMJ article that cloth masks can cause a higher rate of influenza like illness in healthcare workers which is probably the strongest article he has (although the Corchrane review is by far a more powerful test than a single journal article). This wasn’t applied to SARS specifically and involved healthcare workers so by the standards of evidence he uses for the in favour evidence this article should therefore be ignored. (I know: it makes no sense to exclude it but I’m not the one making up these rules!)

The rest is arguments about the consequences of wearing masks as they are uncomfortable. He misreports that the headaches were caused by lack of oxygen (the paper does nothing of the sort if you look at the discussion section). I can’t deny that they’re uncomfortable as I wear one most days and I think it’s debatable whether the public can be educated to wear one properly but that’s not a fact. I’ve got no research to show that hunch I have so I’ll leave it at that – one person’s opinion. This article‘s very hesitant suggestion for example demonstrates the issues we have in a pandemic of a novel virus – we can make our best bet but hard evidence is well… hard to come by.

Ok then… why am I bothering? I mean it was clear to me early on from just looking at the website name and then the author that this was highly likely to not be a thorough or an unbiased fact seeking exercise – and boy! they did not prove me wrong. You can judge me as having pre-determined opinions about things and I think most of us do this – does everyone treat an article about health in the Daily Mail the same as one published in JAMA? Well for what it’s worth, I did actually read the article and could see the glaring issues with it (beyond it’s author).

Wouldn’t I be better off spending my time looking at the evidence of my own bat rather than debunking the musings of someone on the internet? If you read the back and forth between me and David you can get an idea why.

I think being a Christian means that we stand for the truth wherever that takes us. We shouldn’t retweet garbage just because it fits into our chosen narrative, we should fact check what we are going to spread especially when we are public figures or even when we are not. Now Twitter is not a great medium for that – it’s very much back and forth which again is not ideal. Sadly what we are ending up with is the equivalent of the backmasking scares from the 70s-80s – spreading falsehood unknowingly and damaging people’s trust in us as Christians.

How to waste time and waste more time

Twitter is a real waste of time. Having mostly read people over the years, I started to respond (first mistake).

I’ve stuck to being semi-anonymous on twitter and here for a variety of reasons – none of them being cowardice – but find that I’m going to have to use this blog space for more complex writing so here we go.

A few things about me – I’m a doctor and the reason for being a doctor was most likely my faith. I think it’s hard to not look at the work of Jesus in the healing and caring for people and not be inspired by it. Now beyond that, I came to believe that Christ’s claims of divinity were true and that the claims of the gospel were also true – that part took me about 15 years to work out for myself (between the ages of 15 and 30) and that I continue to work at on a quasi-daily basis.

Along the way, I also found artistic expressions of the struggle with faith to be quite helpful at least in my progress towards refining my faith.

So there you have at…