The accidental ‘stupidpower’ — It is what it is
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Published earlier this month in The New England Journal of Medicine is yet another well-conducted study that demonstrates lack of efficacy of hydroxychloroquine against COVID-19.
Although it does not show increased toxicity compared with placebo, it does show that this drug is not active and should not be used. For more than 50 years, negative randomized trials have prevented patients with cancer from wasting time on inactive treatment.
I have spent much of my career as an oncologist trying to achieve improved outcomes from better treatment approaches, although many advances were incremental.
Testing, population size and death rates
When thinking about improving survival of the population, I am so irritated by the conflict between the rational majority of physicians and the inhabitants of the White House, a collection of random politicians of conservative bent, and a small group of flat-Earth physicians (apparently led by one who views demons as the purveyors of illness in the land), regarding science and real data. Despite the NEJM and other reports, President Trump continues to espouse hydroxychloroquine against COVID-19.
Having recently finished Peter Zeihan’s The Accidental Superpower, a very interesting view of the primary role of the U.S. in geopolitics and the global economy, I cannot help but feel frustration at how this type of anti-science nonthought is contributing to the U.S. failing to maintain its primacy and to avoid massive numbers of deaths.
It seems likely that, by the end of this month, more than 175,000 COVID-related deaths will have occurred in the U.S. The conservative Trumpeters are fond of saying that this is a function of the U.S. doing more tests than any other nation.
Nonsense.
In the U.S., many of our population cannot access tests swiftly, nor gain the results in a sufficiently timely fashion to provide real preventive or personal health benefit. The number of tests is just a surrogate, and the number of hospitalizations or deaths (vs. population size) the truly important endpoint.
I think about the equation in simple, reductionist terms — the U.S. has a population of 330 million and has had 160,000 deaths. By contrast, Taiwan has a population of 23.8 million with seven deaths. Let me make it simple for those who believe in demons: If Taiwan had 330 million people, it would have had less than 100 deaths.
If you don’t believe these data, see the Table for other comparisons.
If we consider results within the U.S., North Carolina, with a population of 10.5 million, has lost around 2,000 of its citizens.
Contrast that with the foolish state governance in Florida, with a population of 21.5 million and 7,400 deaths; South Carolina, with a population of 5 million and 1,850 deaths; and Georgia, with a population of 10.5 million and 3,850 deaths.
Populations with community participation in the simple strategies of routine masking and social distancing have COVID-19-related death rates vs. population size of less than 10% of the conservative U.S. states and the nation as a whole.
Politicizing the pandemic
How do we explain one of the leading democracies in the world, with magnificent fiscal and geographical resources, screwing up so badly?
National stupidity.
To speak about the falsehoods and miscalculations emerging from the White House is pointless and a waste of space. To answer the question, in the April 25 edition of HemOnc Today, I wrote accurately and prophetically on the topic in my editorial, “How many errors to kill a population?” and there is no need to enumerate those errors again (feel free to read the article here).
In addition to those points, the mistake that we citizens of the U.S. have made is to allow our politicians to politicize this pandemic. This is a medical problem and should not be politicized. If there were a decent number of statesmen of courage on both sides of the House, they should have rallied in bipartisan fashion to regain control of the situation.
America has allowed itself to be deluded into thinking that human rights are lost when simple concepts like masking and social distancing are enforced (consider the 250,000 unmasked idiots heading to South Dakota on motorcycles as I write this). What is the difference between this concept and having penalties for exceeding the speed limit, theft, kidnapping or murder? As the bikers return home, should each associated case of COVID-19 that they spread that leads to death be considered as manslaughter?
Another influential constituency that has abrogated its responsibility is the CDC — having initially lost some of its formerly authoritative credibility in the botched introduction of testing, it has compounded the felony by consistently issuing misinformation, caving into the scientific mumbo-jumbo being quoted by the White House, and reversing sensible decisions whenever someone of influence frowns at them. I believe that their leadership should be removed from their posts for incompetence, inconsistency and malfeasance.
‘It is time for action’
Let us all be very clear about the following, despite the consistent lies from inside the beltway and other unreliable political sources of misinformation:
- There is still a shortage of optimal personal protective equipment for health care workers and first responders (not all masks are optimal, and N95s are not available for many of these personnel).
- Thousands of patients or potential patients still are unable to get tested in a timely fashion, and many of the extant tests are unreliable.
- It is thus extremely difficult to conduct effective contact tracing, despite its proven value.
- A substantial proportion of the population are allowed to create vast potential health hazards without penalty under the rubric of individual freedoms.
- Although the absolute death rate may not seem high to fools, 160,000 deaths in any nation (even China) is a very large number, especially as they are mostly preventable deaths.
- There is no real requirement to shut down the nation again if rational approaches to all ongoing activities are adopted and enforced, despite the rhetoric that links masking to shutdown.
- There is a serious challenge to science, based on arguments and “data” that are idiotic at best, not even mentioning the outrageous attempts to threaten those who try to speak the truth (maybe that’s why CDC leaders are so craven).
Is this just a rant? No — it is an exhortation to remember this in November, and also a request for thinking physicians to approach their professional bodies to be more active in defending science and reason, both of which are under such threat.
It is time for action to protect those on the front lines — and ourselves.
Reference:
Boulware DR, et al. N Engl J Med. 2020;doi:10.1056/NEJMoa2016638.
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Share your thoughts on this editorial at healio.com/authors/draghavan.
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