What About Fluvoxamine?

Continuing in the vein of a discussion going on in comments, in the Wall Street Journal Allysia Finlay reports on a relatively inexpensive drug that’s been approved by the FDA for another purpose for quite a while that has shown some promise in treating COVID-19:

Yet a promising alternative isn’t getting its due: fluvoxamine, a pill the FDA approved in 1994 to treat obsessive-compulsive disorders. Doctors often prescribe it off-label for anxiety, depression and panic attacks. Studies show that fluvoxamine is highly effective at preventing hospitalization in Covid-infected patients, and it’s unlikely to be blunted by Omicron.

Doctors hypothesize that fluvoxamine can trigger a cascade of reactions in cells that modulate inflammation and interfere with virus functions. It could thus prevent an overreactive immune response to pathogens—what’s known as a cytokine storm—that can lead to organ failure and death. It also increases nighttime levels of melatonin—the hormone that makes you sleepy—which evidence suggests can also mitigate inflammation.

[…]

A small randomized control trial last year by psychiatrists at the Washington University School of Medicine in St. Louis was a spectacular success: None of the 80 participants who started fluvoxamine within seven days of developing symptoms deteriorated. In the placebo group, six of the 72 patients got worse, and four were hospitalized. The results were published in November 2020 in the Journal of the American Medical Association and inspired a real-world experiment.

Soon after the study was published, there was a Covid outbreak among employees at the Golden Gate Fields horse racing track in Berkeley, Calif. The physician at the track offered fluvoxamine to workers. After 14 days, none of the 65 patients who took it were hospitalized or still had symptoms. Of the 48 who didn’t take the drug, six, or 12.5%, were hospitalized and one died. Twenty-nine had lingering symptoms, which might have resulted from inflammatory damage to their organs. Those who took the placebo were more likely to be asymptomatic when they tested positive, so they would have been expected to fare better.

The studies drew the attention of Francis Collins, director of the National Institutes of Health. “A big need right now is for a drug that you could take by mouth, that you could be offered as soon as you had a positive test, and that would reduce the likelihood that the virus is going to make you really sick,” he said in an interview with “60 Minutes” in March. “Fluvoxamine could certainly be something you want to put in the tool chest,” Dr. Collins added. “It looks as if it has the promise to reduce the likelihood of severe illness.”

Researchers at McMaster University in Hamilton, Ontario, last winter launched a large clinical trial in Brazil. The results from their trial, published in the Lancet in October, were stunning: Fluvoxamine reduced the odds of hospitalization or emergency care by 66% and death by 90% among unvaccinated high-risk patients who mostly followed the treatment regimen—comparable to monoclonal antibodies. There was no difference in adverse effects between the fluvoxamine and placebo groups.

I have a certain amount of sympathy with the NIH and FDA on this one. I do wonder, however, how you reconcile patience in using a drug that’s been approved for quite and while and, consequently, reasonably well-known with the hurried emergency use authorizations being given to various vaccines and much more expensive pharmaceuticals used for treating the disease. Could its patent having elapsed a year and a half ago have anything to do with it?

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Polarized Politics

At the New Yorker Elizabeth Kolbert provides her take on how our politics became so polarized. Her take seems to be that dividing ourselves into warring tribes is natural and inevitable, citing an anecdote from more than 60 years ago. She concludes:

Americans today seem to be divided into two cabins: the Donkeys and the Elephants. According to a YouGov survey, sixty per cent of Democrats regard the opposing party as “a serious threat to the United States.” For Republicans, that figure approaches seventy per cent. A Pew survey found that more than half of all Republicans and nearly half of all Democrats believe their political opponents to be “immoral.” Another Pew survey, taken a few months before the 2020 election, found that seven out of ten Democrats who were looking for a relationship wouldn’t date a Donald Trump voter, and almost five out of ten Republicans wouldn’t date someone who supported Hillary Clinton.

Even infectious diseases are now subject to partisan conflict. In a Marquette University Law School poll from November, seventy per cent of Democrats said that they considered COVID a “serious problem” in their state, compared with only thirty per cent of Republicans. The day after the World Health Organization declared Omicron a “variant of concern,” Representative Ronny Jackson, a Texas Republican, labelled the newly detected strain a Democratic trick to justify absentee voting. “Here comes the MEV—the Midterm Election Variant,” Jackson, who served as Physician to the President under Trump and also under Barack Obama, tweeted.

How did America get this way? Partisans have a simple answer: the other side has gone nuts! Historians and political scientists tend to look for more nuanced explanations. In the past few years, they have produced a veritable Presidential library’s worth of books with titles like “Fault Lines,” “Angry Politics,” “Must Politics Be War?,” and “The Partisan Next Door.”

proceeding on by quoting the work of a political scientist:

Lilliana Mason is a political scientist at Johns Hopkins. In “Uncivil Agreement: How Politics Became Our Identity,” she notes that not so very long ago the two parties were hard to tell apart, both demographically and ideologically. In the early nineteen-fifties, Blacks were split more or less evenly between the two parties, and so were whites. The same held for men, Catholics, and union members. The parties’ platforms, meanwhile, were so similar that the American Political Science Association issued a plea that Democrats and Republicans make more of an effort to distinguish themselves: “Alternatives between the parties are defined so badly that it is often difficult to determine what the election has decided even in broadest terms.”

The fifties, Mason notes, were “not a time of social peace.” Americans fought, often in ugly ways, over, among many other things, Communism, school desegregation, and immigration. The parties were such tangles, though, that these battles didn’t break down along partisan lines. Americans, Mason writes, could “engage in social prejudice and vitriol, but this was decoupled from their political choices.”

Then came what she calls the great “sorting.” In the wake of the civil-rights movement, the women’s movement, Richard Nixon’s Southern Strategy, and Roe v. Wade, the G.O.P. became whiter, more churchgoing, and more male than its counterpart. These differences, already significant by the early nineteen-nineties, had become even more pronounced by the twenty-tens.

“We have gone from two parties that are a little bit different in a lot of ways to two parties that are very different in a few powerful ways,” Mason says. As the two parties sorted socially, they also drifted apart ideologically, fulfilling the Political Science Association’s plea. In the past few election cycles, there’s been no mistaking the Republican Party’s platform for the Democrats’.

I have problems with that for all sorts of reasons. For example, the “gender gap” was actually in the opposite direction until the election of Bill Clinton in 1992. And I think she’s exaggerating black support for Republicans during the 1950s.

Let me provide some bullet points in no particular order illustrating what I think about polarization:

  • The degree to which we were unified 60 years ago (or ever for that matter) is greatly exaggerated. Much of that is an artifact of the major media outlets being able to control the message as they preferred.
  • We have always been politically divided, largely on a local or regional basis. Modern communications reveals how divided we’ve been.
  • There is a major divide but it isn’t between the two political parties. It’s between the top 1% of the population and the rest of us.
  • There is enough money to be made by stoking up anger that there’s a whole cadre of people who espouse anger as a profession.
  • The greater the spending by the federal government (and the higher the taxation) the greater the incentive to a) remain in power and b) stoke anger about the “other guy”.
  • The less literate the population, the more agonistic (emotional) the discourse.
  • The larger the immigrant population, the greater the political differences will inevitably be. There is a positive feedback effect to that as well.
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Advice From a Russian

At Project Syndicate Nina Lvovna Khrushcheva (great-granddaughter of Nikita) provides some sound commentary on the burgeoning crisis in Ukraine:

When Ukraine’s comedian-turned-president, Volodymyr Zelensky, dons fatigues and praises the military, or presses for a firm commitment on the country’s NATO membership, ordinary Russians get the message that there is a security threat on the border – and it is not the Russian troops now found there. Ukrainian politicians only reinforce this impression by proclaiming that the country must prepare to retake Crimea by force.

The US wants to prevent anything like a repeat of the events of 2014 in Ukraine. This seems like the fair thing to do. But geopolitics is a matter of cold calculation, not fairness. And while the “exceptional” US has long been able to act in its own strategic interest without, as one author put it, “the consequences that come with doing so,” the time may have come for it to account for new variables – namely, that Russians, too, view their country as exceptional.

Unless and until that changes, the cycle of crises will continue, with escalating, and potentially catastrophic, risks. “Such is the destructive potential of advanced modern weapons,” Kennan pointed out, “that another great conflict between any of the leading powers could well do irreparable damage to the entire structure of modern civilization.”

I have no idea why Washington pundits do not heed Russian voices like that. Is it that they don’t like bad news?

There’s more at the link which you will find bears a more than passing resemblance to what I’ve been writing here. Possibly the most important is that Russia is not the Soviet Union but it does have security concerns of its own.

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The Real Culprits

I see that Julianne Geiger has lurched uncontrollably onto a point I have made repeatedly here in her article at OilPrice.com:

Let’s start with a rather unpopular but absolutely factual issue that is a major obstacle in meeting climate targets. You can focus on how we’re producing energy, or you can focus on consuming energy. Focusing on the former is more palatable, if not scientifically complex and pricey. Focusing on energy consumption, on the other hand, is often met with immediate resistance–understandably so. Yet, it has a far simpler solution and is much less expensive. But it is a likely go-nowhere solution because if the world is truly to affect consumption, it must focus on a very specific group of individuals: the superconsumer.

Analysts love to cite facts and figures about which country per capita is responsible for the greatest amount of oil and gas consumption–or energy consumption–or has the highest carbon footprint. Aside from the fact that those figures are routinely disputed, those analysts lose sight of a wildly different perspective: further drilling down into precisely who the heavy consumers are within those nations.

A UN report from last December shows exactly who those people are: they are the world’s wealthiest 10%, who the UN alleges make up 50% of the world’s carbon footprint. The wealthiest 1% account for 15% of the world’s emissions–more than twice the emissions generated by people in the bottom 50%.

Now, this isn’t to shame all those jet-setting superconsumers and energy wasters. Nay, it is merely to point out the fallacy in thinking that the other 90% of the world’s population–representing a mere 50% of the world’s carbon footprint–has the ability to carry the world into our greener tomorrow.

Such thinking is popular yet foolish.

According to the UN, the global rich would have to cut their carbon footprint by 97% to stave off climate change. That the rich exact a higher carbon footprint on the world–or that income and the size of one’s carbon footprint is correlated–is not new. It is also not popular.

Setting carbon goals that focus on Average Joe instead of those superconsumers is like trying to curb teen social media use by banning Twitter instead of Snapchat or TikTok.

How surprising is it, really, that those tasked with formulating policy miraculously come up with policies that barely touch themselves at all while falling most heavily on those who have practically no ability to effect the change notionally intended? And talk about undemocratic!

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What Will NATO Do?

This piece by Andrew A. Michta at 1945 on potential NATO responses to a Russian invasion of Ukraine illustrates neatly a point I have been making for some time:

Amidst continued speculation as to whether Russian President Vladimir Putin will unleash yet another attack against Ukraine, the focus has been on the likelihood of a kinetic conflict in Europe along NATO’s Eastern Flank. Still, judging by the scope of the demands presented by Russia in the two so-called “draft treaties” with NATO and the United States, respectively, Moscow must have no illusions that these would be accepted, for they would remake Euro-Atlantic security, creating conditions that would undermine NATO and America’s ability to work with its allies. Putin may have already decided to move militarily, and calls for the West to negotiate could create a “maskirovka” and in doing so provide a casus belli for Moscow, which would try to claim that Washington had refused to consider its terms.

Mr. Michta is a Pole, born in Poland. As such he has interests in the situation that go beyond American interests. I’m not saying his advice should be rejected out-of-hand. Just that we need to take his advice with a grain of salt. Why does everybody involved with crafting our policy with respect to Russia and Ukraine seem to be a Pole or a Ukrainian?

At any rate he offers what I think is a fantastical scenario:

It is critical to consider what might happen should Russia invade Ukraine, and what might happen if we do not start thinking long-term about the impact of this crisis. A second Russian attack on Ukraine, should it happen, ought to serve as a long-overdue wake-up call for the West about Russia’s intentions to establish an exclusive sphere of influence in Eastern Europe and assert Moscow’s claims to exercising influence in Central Europe, within NATO’s perimeter. Assuming the West finally recognizes the immediacy of the threat, the best ancillary outcome would be the rearmament of European NATO allies and an increase in U.S. military presence along the Eastern Flank, including permanent U.S. bases in Poland and Romania. Next, Europeans would need to spend money, not only on developing real, exercised military capabilities, but also on shoring up the infrastructure across the Continent, especially North-South, to ensure that military mobility requirements are met, and to demonstrate this through a series of exercises. Most importantly, the European NATO allies and partners would need to show that they are capable of reaching consensus to respond with meaningful sanctions, beginning with cutting Russian banks off from SWIFT and stopping Nord Stream 2, as well as showing resolve to respond with force should Putin try to use military threats against the alliance. Last but not least, if Ukraine decides to fight back the West should support its resistance against this new Russian assault on its national sovereignty.

before at arriving at what appears to me to be the most likely outcome:

The worst-case scenario would be yet another round of verbal condemnations and toothless sanctions, which would serve to strengthen Putin’s belief that Europe lacks the will to match his challenge. Should the response to Russia’s invasion of Ukraine be more of the same, Europe’s security would deteriorate dramatically. The zone of competition would shift from Eastern Europe to Central Europe and the Baltic states, where the next round of Putin’s demands could be a de facto “Finlandization” of the Baltic States and pressure on the United States and NATO to remove military assets from the intermarium between the Baltic and the Black Seas, especially from Poland and Romania. In this scenario Putin would target Germany as his “partner of preference,” with the expectation that by applying its energy weapon Moscow could eventually coax Berlin into a “neo-Bismarckian” accommodation that would in effect divide Europe into two spheres of influence, rendering the United States increasingly irrelevant to the overall strategic balance in Europe.

In my view our actual interests in Ukraine are quite limited. They are, in John Quincy Adams’s words, as the “well-wisher to the freedom and independence of all” but, continuing with that quote, we should be the “champion and vindicator only of our own”. In that regard we might do well to take our cue from Germany. As long as Germany is content with what’s happening in Eastern Europe, cozying up to Russia, and not preparing for armed conflict, why should we do otherwise?

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The Wrong Question

At UnHerd Tom Chivers asks a serious question: how many lives has bioethics cost?

In April, the US Centres for Disease Control paused the use of the Johnson & Johnson vaccine. They had noticed that among the 6.8 million people who had been given the J&J jab, six people had suffered a rare blood clot known as a “cerebral venous sinus thrombosis” (CVST). They said in a statement that they were recommending that healthcare providers stop using it, until the FDA had reviewed the evidence, and that they were doing so “out of an abundance of caution”.

Caution is a strange word to use. On the day they released the statement, about 70,000 new cases of Covid were confirmed in the United States, and about 1,000 people died of it. Is it “cautious” to stop using a vaccine which would almost certainly reduce those numbers, because of an uncertain chance that it might have negative effects in a tiny cohort?

But caution, in this sense, has been rife during the pandemic. The governments of various European countries stopped the use of the AstraZeneca vaccine over similar concerns. Germany, the Guardian reported in March, “was the first country to refuse to allow people over the age of 65 to have the AstraZeneca vaccine because of the absence of evidence of how well it worked in older people, indicating a more cautious approach than most”.

Over the last two years, again and again, the fears of some possible risk caused by something we might do have outweighed the fears of a thoroughly real, utterly obvious risk which was killing people at the time. And it has, I think, been a failure of the field, or at least the practice, of bioethics.

I think he’s pointing his finger in the wrong direction and, indeed, asking the wrong question. There have been multiple failures in two different political administrations with one thing in common: medical bureaucracies and it isn’t just one. Early in the pandemic the Centers for Disease Control fumbled in developing a test for COVID-19. Right now the Food and Drug Administration is delaying approval of Paxlovid in a wild sort of Catch-22. It has not been proven effective enough to approve but it is too effective to continue testing. To my eye the problem is not politics or bioethics or physicians. It’s bureaucracy.

Bureaucracies live and die by process and they are the outcome of largeness. When an organization grows beyond a certain, small size it will be governed by a bureaucracy. We know of no other alternative. Solve that problem and you’ll have solved one of the greatest curses of the modern world, afflicting both liberal democracies and autocracies.

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What Is “Misinformation”?

After reading this piece at The Conversation on misinformation in social media, in which three “experts” weigh in with their observations, I was left with one question: what is “misinformation”? The question is similar to another: what do you mean by “a lie”? I’ve provided my definition of lying previously: knowing telling of an untruth with the intent to deceive. I’m not sure I can come up with a similar definition of misinformation.

Here’s an example of my confusion. One of the experts cited above declaims:

There are two primary challenges in addressing misinformation. The first is the dearth of regulatory mechanisms that address it. Mandating transparency and giving users greater access to and control over their data might go a long way in addressing the challenges of misinformation. But there’s also a need for independent audits, including tools that assess social media algorithms. These can establish how the social media platforms’ choices in curating news feeds and presenting content affect how people see information.

Absent a definition, how do you regulate something? That sounds to me like a sweeping and tyrannical mandate to control speech.

Let’s consider some cases. I think that Biden won the 2020 presidential election beyond reasonable doubt and as evidence I would suhmit that no challenge to date has yet proven otherwise. And yet there are lots of otherwise reasonable people who don’t agree. If you say that Trump won the 2020 election, that is generally given as an example of “misinformation”.

Let’s consider some others.

Is anthropogenic global warming misinformation? It is certainly non-falsifiable. Every occurrence of an unexpected meteorological event these days is submitted as evidence of it. Is that misinformation? The models are only weakly predictive if that.

How about the existence of God? Is that misinformation?

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The Week Between Christmas and New Years

I’m working this week. Practically nobody else working for my employer is—since most are in the UK they’re taking today off (since Christmas fell on a Saturday) and tomorrow off (since Boxing Day fell on a Sunday). It’s making for a quiet week.

I’m guessing that there will be a half-hearted attempt at working on Wednesday and Thursday, substantially impeded by the people prudent enough to take the whole week off, and an even more phlegmatic attempt at working on New Years Eve.

Apparently, there’s a lot of this going around and not just in the UK. I’ve mentioned before that blogging is largely a reactive form, i.e. I react to what other people are writing about. Other than the regular bickering, complaining about people who haven’t been vaccinated, and saber-rattling about Russia, not much is being written for me to react to.

It was a quiet Christmas here and the day after was even quieter. Muy pesents to my wife largely consisted of chocolate or materials for our indoor garden. I’m hoping she’ll plant some lettuce soon. Her present to me largely consisted of kitchen tools—cutting boards and towels. My Christmas dinner menu was pork chop braised with sauerkraut, prunes, dried apricots, and apples; mashed potatoes. My wife and I eat pretty sparingly. That was one pork chop split between the two of us. I’ve calculated out our annual red meat consumption. It’s less than 30 pounds per year—about a quarter that of most Americans.

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Christmas 2021


The merriest Christmas to you and yours!

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Does Generation Z Read?

This post at RealClearMarkets by A. J. Rice caught my eye because it touches on one of my recurring themes. He opens with an anecdote, the first about the “Lost Generation” that included Fitzgerald and Hemingway among others and then with this one:

Apparently, Gen-Z doesn’t read.

Even college students. Especially college students.

How does one learn without reading? Without even paying attention.

University of Tennessee Associate Professor Kenyon Wilson found out just how many of his students were reading – and paying attention.

Which was none of them.

Within the course syllabus he provided to every one of his music seminar students were instructions to open a locker – within which the professor had placed a crisp $50 bill. It was easy money. Free money. Isn’t that what young people want? Free stuff? No strings attached. The locker number – and combination – were provided. All a student had to do was open it. It was a minimal effort exercise.

But that was predicated on their reading about it.

The instructions to the free-and-easy money were embedded within the text, as follows:

“Thus (free to the first who claims; locker one hundred forty-seven; combination fifteen, twenty-five, thirty-five) students may be ineligible to make up classes . . .”

Right there, in black and white.

But you had to look to see.

And no one did.

Going on to lament:

Those who do not read, who do not pay attention – who think they already know – do not learn differently. Or more. They cannot learn. They are inert, in stasis.

How then can they think?

The answer, of course, is that many do not. They feel – and react, based upon those feelings. Without thinking – the thinking being done for them, by those who have learned the value of thoughtlessness and passivity.

That’s completely consistent with something I have posted about here from time to time, i.e. visualcy. “Literate” does not mean you can read the words on a page. It means you derive information by reading. Increasingly, people today are not literate but visual. They obtain information from images, pictures, graphs, and videos.

I don’t entirely agree with him. People who are visual rather than literate are able to learn but they do learn differently. They tend to follow authorities (“influencers”). They find it difficult to follow or comprehend logical arguments or deductive reasoning. They tend to perceive things as a whole. They are more agonistic in their expression.

Where I agree with him is that I don’t think it bodes well for the future and particularly liberal democracy in the future.

There is a counter-argument. How do you reconcile the fact that the Harry Potter books sold a half billion copies with the claim that young people don’t read? My response to that is that there are 8 billion people in the world, about half of them in the target audience for the Harry Potter books. That’s almost 4 billion young people. It’s completely possible for substantial book sales and young people not reading both to be true.

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