Cleaning the Augean stables (Part I)

24th November 2022

Peer-review: Time to get rid of it

‘There seems to be no study too fragmented, no hypothesis too trivial, no literature citation too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self-serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print.’ Drummond Rennie.

Somewhat damning?

It supports my considered opinion that medical research died decades ago. It is now populated by the undead to become, what could best be called, ‘Zombie science’. Or, possibly, the walking dead.

I would not be the first to think this. In truth, I nicked the term. Here is the abstract of a paper by Bruce Charlton in the Journal ‘Medical Hypotheses.’ It was written in 2008:

Zombie science: a sinister consequence of evaluating scientific theories purely on the basis of enlightened self-interest.’

‘Although the classical ideal is that scientific theories are evaluated by a careful teasing-out of their internal logic and external implications, and checking whether these deductions and predictions are in-line-with old and new observations; the fact that so many vague, dumb or incoherent scientific theories are apparently believed by so many scientists for so many years is suggestive that this ideal does not necessarily reflect real world practice.

In the real world it looks more like most scientists are quite willing to pursue wrong ideas for so long as they are rewarded with a better chance of achieving more grants, publications and status. The classic account has it that bogus theories should readily be demolished by sceptical (or jealous) competitor scientists.

However, in practice even the most conclusive ‘hatchet jobs’ may fail to kill, or even weaken, phoney hypotheses when they are backed-up with sufficient economic muscle in the form of lavish and sustained funding. And when a branch of science based on phoney theories serves a useful but non-scientific purpose, it may be kept-going indefinitely by continuous transfusions of cash from those whose interests it serves.

If this happens, real science expires and a ‘zombie science’ evolves. Zombie science is science that is dead but will not lie down. It keeps twitching and lumbering around so that (from a distance, and with your eyes half-closed) zombie science looks much like the real thing.

But in fact the zombie has no life of its own; it is animated and moved only by the incessant pumping of funds. If zombie science is not scientifically-useable–what is its function? In a nutshell, zombie science is supported because it is useful propaganda to be deployed in arenas such as political rhetoric, public administration, management, public relations, marketing and the mass media generally. It persuades, it constructs taboos, it buttresses some kind of rhetorical attempt to shape mass opinion.

Indeed, zombie science often comes across in the mass media as being more plausible than real science; and it is precisely the superficial face-plausibility which is the sole and sufficient purpose of zombie science.’ 1

Unfortunately, I can only provide you with a reference to the abstract. Because, in what I consider a majestic, universe spanning irony, the full article sits behind a paywall. Nowadays most medical papers are kept safe from the public, or the amateur researchers, or anyone else who is not a millionaire. They can only be viewed by those who have access via their university – usually. I call it ‘censorship by inability to pay.’

You cannot even read medical research that will have been funded by your taxes, or someone else’s taxes in another country. Instead, it sits in a virtual room, secured behind the locked-doors of ‘pay per view.’ Which represents another twitching limb of zombie science. It senses money and reaches out blindly to grab it, with dead, bony fingers. ‘My precious.

Going back a couple of steps. Who is this Bruce Charlton of whom you speak? Well, he used to edit the journal Medical Hypotheses. But he made the error of publishing an article highly critical of the mainstream narrative on HIV. The article in question contained this statement. ‘There is as yet no proof that HIV causes AIDS.’ Inevitably, a major outcry took place. Glasses of Dom Perignon slipped from chubby, quivering fingers. Foie gras was left uneaten, that and the guinea fowl.

Many will strongly believe, that this statement, and the entire article, must be wrong, and should never have been published. But I would contend that this is absolutely not the point. The point is that anyone who believes articles should not be published because they are ‘clearly wrong’ needs to be gently led away from the world of science. Then booted out of the door and told, in no uncertain terms, to get out and stay out. Until they learn the error of their ways.

‘In science, the primary duty of ideas is to be useful and interesting even more than to be true.’ Wilfred Trotter.

What happened next was depressingly predictable. Elsevier, the publishers of Medical Hypotheses, did exactly what you would expect of the walking dead. They did not defend the right of the editor – of a journal titled ‘Medical Hypotheses’ – to publish contentious articles. They panicked, then piled the blame on Bruce Charlton.

After receiving a raft of complaints, Elsevier had the article peer reviewed under the oversight of editors from The Lancet. Following the peer review, the article, and another by Marco Ruggiero of the University of Florence in Italy, was withdrawn and a reform of the journal was mooted.

“They were withdrawn because of concerns expressed by the scientific community about the quality of the articles, and our concern that the papers could potentially be damaging to global public health,” the publisher said in a statement.’ 2

 My favourite comment is below:

‘This journal has published ‘hypotheses’ that are regrettable… “I do not think that the medical community will lose anything if the journal does not continue in its current form.’

And if you want to find a more Stalinist, Big Brother(ist), and frankly sinister comment than the final one, you will need to travel far. ‘Regrettable’ … a word most commonly used by the evil baddie in a James Bond movie. Just before feeding his underling to the sharks waiting below.

Evil bad guy:           ‘Your actions, I am afraid, are regrettable.’ Presses button.

Underling:                ‘Aaaarrrgggh….’ Chomp, thrashing, blood.

And lo it came to pass that Bruce Charlton was fired. Then, in an even more majestic, metaverse spanning irony, Elsevier decreed that the journal Medical Hypotheses must become peer-reviewed. Bruce Charlton had vehemently disagreed to this – another reason why he was fired.

Yes, a journal dedicated to publishing new scientific thinking was to be peer-reviewed. But who could they choose to carry out such a task? All those ‘peers’ who just happened to have previously published the exact same new hypotheses – never published before. A clever trick you may think.

Of course, they do not mean that. What they mean is that established figures within the field should be chosen to do the hatchet job … sorry, peer-review. The very people who would suffer the greatest reputational (and financial) damage, if their established views were to be successfully overturned. Now let me think about the likely outcome of any such review … for approximately one picosecond.

The simple fact is that peer-review has become a slaughtering field for new ideas, and new hypotheses. It is the perfect place to send a timid new-born hypothesis blinking into the sunlight. I visualise a David Attenborough documentary. The bit where a baby wildebeest plops to the ground, under the baleful watching gaze of a pack of hyenas. You know what happens next. It ain’t pretty.

Do you think my view of peer-review is a bit over the top, a wild conspiracy theory of some kind? Well, here is what Richard Horton, long-time editor of the Lancet, has to say of peer-review.

‘The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability — not the validity — of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed, often insulting, usually ignorant, occasionally foolish, and frequently wrong.’

Or this quote from Richard Smith, discussing Drummond Rennie:

‘If peer review was a drug it would never be allowed onto the market,’ says Drummond Rennie, deputy editor of the Journal Of the American Medical Association and intellectual father of the international congresses of peer review that have been held every four years since 1989. Peer review would not get onto the market because we have no convincing evidence of its benefits but a lot of evidence of its flaws. 3  

Listen guys, sorry to disillusion you, but peer-review was never meant to push forward the boundaries of scientific research. It was primarily designed to keep the top guys at the top, and squash anyone with dissenting views. You think not? You think it has been proven to be effective?

‘Multiple studies have shown how if several authors are asked to review a paper, their agreement on whether it should be published is little higher than would be expected by chance. A study in Brain evaluated reviews sent to two neuroscience journals and to two neuroscience meetings. The journals each used two reviewers, but one of the meetings used 16 reviewers while the other used 14. With one of the journals the agreement among the journals was no better than chance while with the other it was slightly higher. For the meetings the variance in the decision to publish was 80 to 90% accounted for by the difference in opinions of the reviewers and only 10 to 20% by the content of the abstract submitted.’4

And yes, since you ask, I have been asked to peer-review papers. I sent one off recently. Hypocrite? Well, hypocrisy makes the world go around. In my defence I believe it’s a good idea for me to recommend that a ‘contentious’ paper on LDL gets published. Otherwise, my sworn enemies get to clamp it within their pitiless jaws and crush it to death. Why do you suppose I get sent papers from time to time? Because the editor knows exactly what I think, and wants the paper published. Hypocrisy! Why, yes.

In reality, peer-review is about as much use as a chocolate teapot. All journal editors know it’s bollocks, most reviewers know it’s bollocks. But it suits everyone to pretend that the ‘all hallowed’ peer-review cleaves the sword of truth in a mighty fist, protecting us all from bad science.

Does it? Just to give you one recent example where you can replace the words ‘peer-review’, with the words ‘chocolate teapot’ I refer you back to the world of COVID19. Where one, now infamous paper, passed straight through the editorial team, peer-review, and every other check and balance, to find itself published in the Lancet, no less. Even though it rested on completely made-up data:

‘The Lancet will alter its peer review process following the retraction of a paper that cited suspect data linking the controversial drug hydroxychloroquine to increased COVID-19 deaths.

In the future, both peer reviewers and authors will need to provide statements giving assurances on the integrity of data and methods in the paper, the journal’s editor Richard Horton told POLITICO.

“We’re going to ask our reviewers more directly, whether they think there are any issues of research integrity in the paper,” he said. This stipulation will apply to every paper submitted to the journal.

“If the answer to that question is yes, that’s the moment where we trigger some kind of data review,” he added.

These changes to the eminent U.K. journal’s peer review policies are a direct result of a paper that used data from the U.S.-based firm Surgisphere, purporting to be from around 700 hospitals in six continents. But as questions emerged over the study, Surgisphere refused to allow a review of its dataset.

It wasn’t just the Lancet paper that had used data from Surgisphere. The New England Journal of Medicine had used the data for a paper.

The paper was retracted at the request of three of its four authors. They claimed that they couldn’t see the raw data because the fourth author — Sapan Desai, the CEO of Surgisphere — refused to hand it over. But the fact that the co-authors hadn’t seen the raw data pre-publication also raised questions for many readers.’ 5

Yes, indeed, the great and mighty Lancet published a paper based on completely fabricated research. Do you think Horton’s sticking plaster solution is going to have the slightest effect? “We’re going to ask our reviewers more directly, whether they think there are any issues of research integrity in the paper.

Yup, that’ll sort everything out, no doubt about it. No … doubt … about … it. Ask a few peer-reviewers to accuse their peers of potential research fraud. I can see no problem with doing that, at all. I can just imagine the frosty silence that will ensue the next time the author and peer-reviewer meet up.

Peer-reviewer:        ‘You’re a liar.’

Researcher:             ‘No, you’re a bloody liar.’

Hands up those who think that Richard Horton was simply attempting to deflect criticism away from himself, towards the peer-reviewers. ‘It’s not my fault, it was the peer-reviewers. They made me do it.’ Boo hoo. Poor little you.

Some may believe (as would I dear reader) that this utterly fraudulent load of crap sailed through editorial control, and the peer-review process, because it was attacking the use of hydroxychloroquine in COVID19. Claiming that it killed people. Of course, this was very much the party line at the time. Still is. [Not getting into that debate here].

However, I know, and you know, and everybody knows – although those at the top of this particular game would deny it vehemently – that if the authors had claimed the opposite well then. Well then… well then, their research paper would have been scrutinised to within an inch of its life, then rejected. On whatever grounds could possibly be found. A semi;colon in the wrong place. ‘Off with their heads.’

Peer-review. Yes, peer-review… a crude means of discovering the acceptability — not the validity — of a new finding.

Max Plank was the man who published Albert Einstein’s special theory of relativity. Much against forceful dismissals by his peers it must be said. Einstein’s theory was, at the time, very much unacceptable to most physicists. Plank held out against them, which was perhaps to be expected. He was a bit of a free-thinker. As he once famously said:

‘A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.’

Science can never be about acceptability – which is, too often, the purpose of peer-review. It is about the truth. Or reality, or whatever term is the best description to use. Science is about rocking the boat, and upsetting the established views, and informing ‘experts’ that they are talking rubbish.

As Richard Feynman said. ‘Science is the belief in the ignorance of experts.’

Peer-review achieves the exact opposite of what we should want from science. It cements the power of experts. It acts as a brake on progress. It rewards those who maintain the status-quo. It helps to ensure that acceptable papers are published, and unacceptable papers are not.

Yes, I am fully aware that the vast majority of people use the term ‘peer-reviewed’ as a term of praise. A stamp of scientific veracity. It has the exact opposite effect on me. It grates horribly. Just publish the damned paper and let me decide if it is a load of rubbish, or not, thank you very much. I do NOT need a board of censors to decide what I can and cannot see. Lest my poor little unformed and childish mind becomes corrupted.

I also know, I really do know that we would all love to believe in peer-review. Surely it is better than doing nothing. We cannot just let any old crap get published, can we? To be perfectly frank, the idea that we have to do something, simply because we believe something must be done, is an insatiable human drive that is another of my pet hates.

A.N. Idiot:                  ‘Something must be done.’

A.N. Other Idiot:       ‘Here’s something, let’s do that.’

Me:                             Sigh. ‘With or without any evidence that it works?’

Further Idiot:             ‘Evidence, we don’t need evidence. It is obvious that this will be effective.

All idiots together:    ‘Well, that’s good enough for me.’

Here is the contrary standpoint. If doing nothing is just as effective as doing something, then I always recommend we take the ‘doing nothing’ option. Apart from anything else it frees up time to do other things that are clearly more beneficial. Such as getting in a bit of whisky tasting or picking your teeth.

In fact, doing nothing is part of my broader ‘don’t just do something, stand there’ initiative. Unfortunately, almost everyone else seems to favour the ‘Work, work, busy, busy, chop, chop, bang, bang.’ philosophy. ‘Looks how busy I am. I must be doing good.’ To quote Bing Crosby:

We’re busy doin’ nothin’

Workin’ the whole day through

Tryin’ to find lots of things not to do

We’re busy goin’ nowhere

Isn’t it just a crime

We’d like to be unhappy, but

We never do have the time

I have to watch the river

To see that it doesn’t stop

And stick around the rosebuds

So they’ll know when to pop

And keep the crickets cheerful

They’re really a solemn bunch

Hustle, bustle

And only an hour for lunch.’

I love that song.

Having said this, I also do believe we should try to ensure that research papers are not complete rubbish, based on fraudulent research (see under the Surgisphere paper on hydroxychloroquine – published in the Lancet). For science to work, we should be able trust what we read. As far as this is possible.

But the peer-review system, as it currently exists, does not achieve this. It allows utter made-up rubbish to be published. Worse, much worse, it stops a great deal of potentially valuable research dead in its tracks.

‘If mankind is to profit freely from the small and sporadic crop of the heroically gifted it produces, it will have to cultivate the delicate art of handling ideas.’ Wilfred Trotter.

Therefore, gentle reader, I have a suggestion. Journal editors should make their own decisions about what should and should not be published, based on how interesting and valuable it seems, then publish. Do not hide behind shadowy peer-reviewers, who have their own agendas to pursue.

At which point you use the Internet for what it is good at. Get a bloody good discussion going. Make the article free to view, for anyone, for the first two or three months – or longer. Invite a broad scientific audience to get involved.

Make it easy for people to attack it or praise it. Hit the upvote button. There are very many, very smart people out there. If they can’t find a problem with a paper, fine. If they can, get the authors to argue their case. Publish the best responses. Expose the discussion to the world. Pull the paper, if needed. Slap various addendums on it, such as ‘readers should note that this paper is a steaming pile of…’

Would this work. Well, it was certainly not the Lancet editorial team, or the peer-reviewers, or even the authors of the paper, who recognised that the hydroxychloroquine paper was fraudulent. It was other researchers from around the world who pointed out that the data were made-up.6

So, in my view, we need to allow the entire world to be reviewers and get rid of peer-review. Other than use it to provide helpful suggestions as to how to make the paper better. Just to add that the helpful elf who edits my blog ramblings, had this to say about this blog:

‘Like it – what you’re suggesting is a TripAdvisor like free scientific paper web site that can be commented on by anyone … ‘ Which is a bloody good summary.

I lay this suggestion before you with all great humility. Next, I hope to discuss the FDA, and the other regulatory bodies around the world. Let me see. What comes after hyenas? Vultures, great white sharks, vampires, leeches … let me think.

1: https://pubmed.ncbi.nlm.nih.gov/18603380/

2: https://www.nature.com/articles/news.2010.132

3: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005733/

4: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005733/

5: https://www.politico.eu/article/lancet-review-process-following-covid-19-saga-coronavirus/

6: https://www.the-scientist.com/features/the-surgisphere-scandal-what-went-wrong–67955

We Love Our Heart

6th November 2022

Ivor Cummins and me, and our part in Big Pharma’s downfall…

Ivor Cummins and Mark Felsted are running another conference looking at the causes of cardiovascular disease. I shall be speaking and presenting a few more thoughts. For example, why has the rate of CVD shot up in the last eighteen months? Possibly explanations? I hope you can attend, and you will all hopefully learn something new, and help us in our endless quest to derail the big pharma leviathan – or perhaps scratch the wing mirrors slightly.

Please follow this link, (or click on the image or follow the link below) and help with the revolution.
(Here’s the link https://www.weloveourheart.com/register?affiliate_id=3687882 )

How the world now works – or doesn’t

30th October 2022

[How fewer doctors means more doctors – it’s official]

This blog has nothing to do with heart disease, or vaccines, or anything directly about medical practice at all.

However, it does have a great deal to do with data manipulation, which is something very close to my heart. It also illustrates how a ‘fact’ can be anything but.

I am also hoping to help highlight an increasingly worrying trend that now scours the planet. Namely that we are living in a world distorted to fit whatever narrative those in power are trying to stuff down our throats. Although, I continue to marvel at how anyone can spout utter, utter, nonsense, and not simply curl-up and die of acute embarrassment.

Anyway, gentle reader, let me set the scene for your delectation.

In the UK, more specifically England, doctors and nurses have been leaving the profession in droves. In particular GPs. This has caused a degree of faux concern by politicians, who always wish to claim they are the great protectors of the NHS. The NHS is inevitably a big issue at every election.

Years ago, Jeremy Hunt, the then health secretary – and slippery eel made flesh – promised he would ensure there would be five thousand more GPs within about five years(ish). The actual number of years it was going to take kept moving around as the target receded into the distance. ‘Did I say three, I meant five… or was it ten.

Commentary on this was not complementary:

“Delivering 5,000 extra GPs in five years, when training a GP takes 10 years, was a practical impossibility that was never going to be achieved,” said Dr Chaand Nagpaul, chair of the BMA’s GPs committee.

“It was a pledge that also ignored the fact that one third of GPs are planning to retire by 2020, and the current medical graduates do not want to join an overworked, underfunded service, with more than 400 GP trainee posts left unfilled last year.”

Andrew Gwynne, the shadow health minister, said Hunt was backtracking on the pledge, and that “the Tories’ election promises are unravelling one by one”.1  

Seven years, or so, have now passed since Hunt’s promise, and the number of GPs has fallen. As predicted by anyone who knew why GPs were leaving. Basically, they were all burnt out, and pissed off, and nothing was being done to make their lives easier, especially, especially not by Jeremy Hunt – who did nothing but make the job considerably more difficult. I should know, I am one. Both burnt out, and pissed off, but clinging on – for increasingly unfathomable reasons. Money, mainly.

Now, however, the UK has a new Prime Minister, a new cabinet, a new health minister and a new Chancellor of the Exchequer (one Jeremy Hunt, no less). Lo and behold, we find that the number of doctors and nurses has actually, mysteriously, who’d have thunk it … increased. Even GP numbers have increased!

‘Latest data published by NHS Digital shows that, compared to August 2021, there are also over 3,700 more doctors and over 9,100 more nurses working in the NHS.

Secretary of State for Health and Social Care Steve Barclay* said:

More healthcare staff means better care for patients, which is why it’s fantastic to see a record number of over 1.2 million staff working hard in the NHS.

With over 3,700 more doctors and 9,100 more nurses, we are really putting patients first and NHS England is developing a long-term workforce plan so we can continue to recruit and retain more NHS staff.

Thanks to all our doctors, nurses and NHS healthcare staff who work tirelessly to look after us and our loved ones and continue to inspire future generations to join this rewarding career.

The government continues to deliver on its commitment to recruit 50,000 more nurses by 2024, with 29,000 more nurses since September 2019.’ 2

[*this is a new, new, health secretary. The previous new one, began this sorry saga]

Phew, all is well. Sorted. What a remarkable thing. How has this been achieved … virtually overnight? Did they manage to compress the average training time for a fully qualified doctor from at least ten years to one month? Did they find a locked room full of 3,700 doctors and 9,100 nurses that no-one had noticed before? ‘You are now free to leave and start working. Go, go now, and tend to the sick.’

No, to understand where these figures come from, let us go back in time. Twenty-nine days from the date I wrote this blog – to be exact. We shall visit a website known as doctors.net. A place where doctors post about various things – but nothing critical of vaccines obviously. Here, twenty-nine days ago, we find this, possibly, strange post:

‘I’ve just had an email from the GMC saying the secretary of state has asked for my emergency registration to run until 2024.  I doubt she had me in mind specifically.  I wonder what has been foretold?’

And this one:

Oh. My wife tells me she has also been re-registered.’

And this one, amongst many others:

‘I’ve had the email too. They’ve also apparently restored emergency registration for the nurses, too; just after some of the ones I was working with at the vaccination centre paid to continue their registration. They are somewhat pissed off.’

What is this emergency registration of which they speak? Well, during the COVID19 panic, sorry pandemic, a number of doctors and nurses who had recently retired, (and who had handed back their registration) were unceremoniously dragged back onto the register. Thus, allowing them to keep on practicing medicine. Whether they wanted to or not … most didn’t.

These doctors and nurses didn’t need to do anything themselves, not even ask to be re-instated. It was just done. This policy was designed to help plug holes in staffing. It was known as emergency registration. As stated here, with regard to nurses:

‘The Coronavirus Act 2020 gives the Registrar a new emergency power to temporarily register a person or group of persons as registered nurses, midwives or nursing associates if the Secretary of State advises that an emergency has occurred, is occurring or is about to occur.’ 3

Then as the panic, sorry pandemic, fell away, emergency registrations began to be withdrawn.

‘Many temporary Coronavirus Act provisions remain in force. However, by default they will expire on 25 March 2022. The Government has said it will allow almost all these provisions to expire.

The following policy areas have temporary changes which are set to expire in England or (where relevant) on a UK-wide basis:


temporary registration of health and social care professionals’ 4

Of course, getting rid of emergency registration would have the effect of (appearing to) sharply reduce the number of doctors and nurses. Even if the vast majority of those who had been plonked on the register never did an extra day’s work and remained happily retired. Yes, this was always a ‘pretend’ workforce. ‘Look at all these additional doctors and nurses we have created… who we haven’t spoken to, and we have no idea if they will ever work again …’

Anyway, the Government was dispensing with emergency registration. Then, out of the blue, it was back again. With retired doctors and nurses placed back on the ‘pretend’ doctors and nurse’s lists once more – until 2024. Which just happens to be the year of the next general election.

What is the explanation for this? Well, according to the General Medical Council in September 2022:

‘The UK government asked us to give temporary emergency registration to suitable people, as part of the response to the coronavirus (COVID-19) pandemic.’ 5

[The General Medical Council (GMC) controls medical registration].

What…? We had a new COVID-19 pandemic last month? I thought it started in 2020. Did you know it was back with a vengeance? Did you? Did you hear anything about it? No, you didn’t, because it never happened. This statement is simply … not true. I would never dream of calling it a damned lie. Other’s may feel differently.

Anyway, let me take you through this from a slightly different angle.

The UK Government is desperately trying to claim they are doing everything they can to support the NHS, which is currently falling to bits, and will damage their prospects at the next election. One of the key things they wish to claim is that they are increasing the work force – especially doctors and nurses (not managers for some strange reason).  However, …

‘More than 40,000 nurses have left the NHS in England in the past year, an analysis by the Nuffield Trust has revealed.

The analysis, conducted by the think tank for the BBC, said that this is the highest number and proportion of nurses leaving the NHS since trend data began.

It found that many of these nurses were often highly skilled and knowledgeable with many more years of work left.’ 6

In addition:

‘Over the last year, the NHS has lost 339 individual (headcount) GP partners and 305 salaried, locum and retainer GPs. This has created a net loss of 644 individual GPs since September 2021… There are now just 0.44 fully qualified GPs per 1,000 patients in England – down from 0.52 in 2015.’ 7

Yet, despite all these people heading for the exit, the Government now informs us that the workforce is not falling, it is going up, up, up, baby. I find this apparent conundrum to be spookily similar to my findings when studying research papers. How can various results be reconciled, when they seem directly contradictory? Heart attacks fell, but deaths from heart disease increased. In the same trial? Oh no, I must read the methodology section – usually impenetrable.

In the same way, we find the number of ‘registered’ doctors is going up, whilst the number of doctors is falling. This leaves us with two seemingly contradictory facts. Which of them is true? Or can they both be true?

In my simple little world, the true ‘fact’ is that the number of doctors is falling, rapidly. However, the Government have solved this issue by creating an equal and opposite fact. Which is that the number of doctors is going up.

They achieved this remarkable feat by bringing back the emergency re-registration of retired doctors, sharply increasing ‘pretend’ doctor’s numbers. In this weird, distorted, manipulated way we have another’ fact’ on our hands. Which is that there are more doctors on the register a.k.a. ‘more doctors.’

Which of these facts is true? Yes, in the hands of politicians, facts can become slippery little swine.

To quote John Martyn: ‘Half the lies I tell you are not true.’

In truth, once you cut through the utter steaming bullshit, I know, and you now know, what is going on – as did many doctors at the time. Here are a few more posts, from twenty-nine days ago, commenting on the re-introduction of emergency registration:

‘After a few hours to consider, I have now emailed the GMC to ask that my temporary registration be removed. FWIW (for what it is worth) I think it highly likely that this is an attempt by the government to inflate the apparent numbers of doctors available.’

Or this one:

‘It has been foretold that for purposes of political spin, they need to say that they have more doctors on the register.’

Another doctor was even more acute in their observation – twenty-nine days ago:

‘The weird thing about this is the clear and direct nature of cheating.

If – as is highly likely – this process relates to absolutely nothing at all apart from manipulating stats to misrepresent reality for political ambitions, then there would be people with job time allocated to it, meetings, emails, conclusions, notes, presentations etc.

“Are you going to the meeting about cheating the doctor numbers tomorrow?”

“Yes, I should make that meeting where we deliberately lie about how many doctors there are”

“Great, see you there. Hopefully we can cheat those figures really efficiently and get away on time!”

And lo, the game played out, exactly as predicted. One month ago, the Government very deliberately inflated figures on doctor’s numbers (and nurse’s numbers). Now they are crowing, in public, about this magnificent increase. ‘Look how brilliant we are. ‘

Crikey, how did you manage this totes amazeballs thing?’

Well, wouldn’t like to boast about it, really. Hard work, dedication … I would like to thank my team. Golly, is that the time, must dash.’

Do they think we are all completely stupid? Don’t answer that, they clearly do. Do they think no-one noticed? People were tweeting about it at the time:

‘Why has Secretary of State for Health and Social Care @theresecoffey asked the GMC @gmcuk to extend temporary registrations until 2024? Is this to prevent a sudden drop in the number of doctors on the register, causing embarrassing stats in the press?’ 8

Today, we are swimming in a sea of misinformation, and deliberately manipulated statistics. Yet, people seem to shrug their shoulders. ‘Don’t get worked up about it. Everyone is up to it, who cares. Same old, same old. The other lot are just as bad.

It is time, I believe, for pitchforks and burning torches, and people taking to the streets in protest about the way that this world is going. So very badly wrong.

In a time of deceit telling the truth is a revolutionary act.’ George Orwell.

1: https://www.theguardian.com/society/2015/jun/24/doubt-lingers-over-jeremy-hunts-pledge-5000-new-gps

2: https://www.gov.uk/government/news/record-numbers-of-staff-working-in-the-nhs

3: ‘https://www.nmc.org.uk/globalassets/sitedocuments/registration/covid-19-temporary-emergency-registration-policy.pdf

4: https://commonslibrary.parliament.uk/expiry-of-the-coronavirus-acts-temporary-provisions/

5: https://www.gmc-uk.org/registration-and-licensing/guide-for-doctors-granted-temporary-registration

6: https://www.nursingtimes.net/news/workforce/record-number-of-nurses-leaving-the-nhs-in-england-30-09-2022/

7: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis#:~:text=%2D-,Number%20of%20NHS%20GPs%20by,FTE)%20%2D%20fully%20qualified%20GPs%20only&text=Over%20the%20last%20year%2C%20the,individual%20GPs%20since%20September%202021.

8: https://twitter.com/TheSmartGP/status/1575832771821727746

COVID19 vaccination

25th October 2022

I have been somewhat quiet recently. I have started about ten blogs, then got bogged down …. possibly blogged down? Then stopped, and started again, then tore it all up – metaphorically.

The problem is that I have been looking at COVID19 vaccination.

There is much to say, maybe too much. However, one treads a very fine line here. I liken it to walking along a cliffside, in the dark. At any point you can make a small mis-step and plummet to your doom. Or, perhaps it is more like being in the trenches in World War I, knowing that at any point, a sniper could pick you off.

Yes, it is true that WordPress doesn’t seem to care much what anyone writes. Good for them, I say. So, I can write pretty much whatever I want. But the rest of the world watches, waiting for the slightest mistake. At which point you shall be denounced, then silenced, in all other outlets. If this happens, the vast majority of people stop listening to you. ‘Oh him, he’s one of those anti-vaxx nutters. Don’t listen to a word he says.’

Yes, I know there is a large community out there who do not follow the mainstream narrative. Those who know there are – or certainly may be – some significant issues with the COVID19 vaccines. In particular the mRNA vaccines. Speaking to them is easy, gaining their support is easy. They cheer you on.

However, there is no real point in reaching out to them, enjoyable though it may be. It is preaching to the converted. The people that I would really like to get at are those who firmly and absolutely believe that mRNA vaccines are highly effective, absolutely safe, and that everyone should be happy to be vaccinated. Along with their children.

The people who are also very critical of those who do not get vaccinated [I have had three doses, but I shall not be having a fourth, unless things change dramatically].

How do you reach these people? How can you even begin to get them listening to anything you have to say?

To give one example of the problem of starting a discussion. I posted a link in a discussion forum on the Doctors.net website (a website that can only be accessed by UK registered doctors). This link discussed some issues with vaccines. It didn’t seem, to me, to be hyper-critical.

However, I got a message from the moderators informing me that if I attached links to any information critical of vaccines, again, they would remove me from the site. This was my final warning. No discussion.

More recently, the post below was published on the same site. It was in response to a twitter comment which followed an interview with Dr Aseem Malhotra:

‘This is a disgraceful interview with this self-publicising charlatan and hypocrite. He says that “until proven otherwise, it is likely that Covid mRNA vaccines played a significant or primary role in all unexplained heart attacks, strokes, cardiac arrhythmias, & heart failure since 2021”.

That is so grossly irresponsible and untrue It staggers me to think he can be allowed to say this and remain a registered medical practitioner.’

The post I have duplicated here was published by a doctor who works, full-time, for a pharmaceutical company. Something he, surprisingly, failed to mention as a potential conflict of interest. Others piled on in support of him. Many of them agreeing that Aseem Malhotra should be flung off the GMC register forthwith – which would render him unable to work as a doctor.

I suggested that, perhaps it would be better to engage Dr Malhotra in debate, rather than attacking him as a charlatan. At which point I was attacked. In my opinion, if you find yourself being attacked for suggesting that it would be a good ideal to have a debate, it is not difficult to work out which way the wind is blowing.

I have discussed vaccination at my local sports club. At which point, almost everyone takes on that silent, arms crossed look, if you mention you have some concerns about vaccines.

They don’t debate the issue, because they can’t, because they don’t know anything other than what they have been told by mainstream media. But it is clear that some of them now see me as a bloody anti-vaxxer. Even if I say nothing more than, ‘I have some concerns.’

Yes, to ask for debate, or to dare express some concerns, is to be labelled an anti-vaxxer.

This is a very high barrier to overcome. I have tried irony. ‘Oh yes, I am absolutely one hundred per cent in favour of COVID19 vaccines. I think everyone should have them four times a year. Pregnant women, children from the moment they are born. No exceptions at all. Yes, these mRNA vaccines have been fully tested. It is clear that they are one hundred per cent safe and one hundred per cent effective. Yup, I cannot see any problems with them at all.’

Response. You are taking the mickey and you are an anti-vaxxer. I claim my prize.

I have also tried saying absolutely nothing at all. I still got accused of being an anti-vaxxer because I did not enthusiastic agree with criticising someone who was believed to be an anti-vaxxer.

Maybe I should just attend this meeting ‘The New Frontier of RNA Nanotherapeutic. Monday, October 24, 2022 8:30 a.m. – 5 p.m. Hybrid Conference’:

‘The RNA vaccines against COVID-19 mark the beginning of a technological revolution that will transform the way we treat disease and restore health. “The New Frontier of RNA Nanotherapeutics” presented by the George and Angelina Kostas Research Center for Cardiovascular Nanomedicine, will feature a discussion on the events that led to the RNA vaccine breakthrough and preview emerging RNA Nanotherapeutics. Advances in the design of RNA constructs to improve stability and translational efficiency will be presented along with the leading-edge developments in nanomedicine to improve delivery and tissue specificity. The potential of nanotechnology-enabled RNA therapeutics to enhance health is virtually limitless.’

Any doubts I have will evaporate …. maybe.

Anyway. The answer as to … how can I even start a discussion on mRNA vaccines without being shot, falling of the edge of cliff, or being silenced, continues to elude me. Farewell enlightenment. Hello dark ages.

Science, to me, is debate. Science is attacking ideas from all directions. No exceptions. Those ideas which cannot be destroyed may turn out to be correct. But, if an idea is considered sacrosanct, with anyone questioning it condemned as an unbeliever, then we do not have science. We have religion. So yes, in my opinion, vaccines, and vaccination, have become a religious belief. No evidence needed.

Scary. Anyway. If anyone has any good ideas about how a debate can even get started, without descending into anger and accusation … please let me know. It seems beyond me. The end.

Saturated fat

21st September 2022

Once again, saturated fat is found not guilty [yes, once again]

I suppose that what I am about to tell you is pretty much old hat. Many people, including me, have been saying – for many years – that saturated fat has no impact on cardiovascular disease. Never has, never will. The scientific support for it has always been non-existent, and the hypothesis has always been complete fact-free, evidence-free, thought-free, nonsense.

Indeed, it is more likely that saturated fat may have beneficial effects. It certainly does if you replace fat in the diet with carbs, carbs, carbs … and more carbs. Which is what most people have done. Happily following the idiotic advice of nutritional experts around the world.

Anyway, mainly so that I can sit back and say, ‘I told you so’ once again, here is the abstract from a paper that was published in the European Journal of Preventive Cardiology a couple of weeks ago ‘Saturated fat: villain and bogeyman in the development of cardiovascular disease?1

Key comment – to be found at the end.

‘…there is no scientific ground to demonize SFA as a cause of CVD. SFA naturally occurring in nutrient-dense foods can be safely included in the diet.’

Abstract

Background

Cardiovascular disease (CVD) is the leading global cause of death. For decades, the conventional wisdom has been that the consumption of saturated fat (SFA) undermines cardiovascular health, clogs the arteries, increases risk of CVD and leads to heart attacks. It is timely to investigate whether this claim holds up to scientific scrutiny.

Objectives

The purpose of this paper is to review and discuss recent scientific evidence on the association between dietary SFA and CVD.

Methods

PubMed, Google scholar and Scopus were searched for articles published between 2010 and 2021 on the association between SFA consumption and CVD risk and outcomes. A review was conducted examining observational studies and prospective epidemiologic cohort studies, RCTs, systematic reviews and meta-analyses of observational studies and prospective epidemiologic cohort studies and long-term RCTs.

Results

Collectively, neither observational studies, prospective epidemiologic cohort studies, RCTs, systematic reviews and meta-analyses have conclusively established a significant association between SFA in the diet and subsequent cardiovascular risk and CAD, MI or mortality nor a benefit of reducing dietary SFAs on CVD rick, events and mortality. Beneficial effects of replacement of SFA by polyunsaturated or monounsaturated fat or carbohydrates remain elusive.

Conclusions

Findings from the studies reviewed in this paper indicate that the consumption of SFA is not significantly associated with CVD risk, events or mortality. Based on the scientific evidence, there is no scientific ground to demonize SFA as a cause of CVD. SFA naturally occurring in nutrient-dense foods can be safely included in the diet.

Will this paper have any effect on anything? Will it heck!

Although maybe, just maybe, a few people out there will stop for a moment to ponder the known fact, verily the truth, that saturated fat causes cardiovascular disease. As for the rest …

‘Man will occasionally stumble over the truth, but most of the time he just picks himself up and stumbles on.’ Winston Churchill

Just so I am not accused of sexism. Women do this do too. Please now write out one hundred times:

Saturated fat does not cause cardiovascular disease

Saturated fat does not cause cardiovascular disease

Saturated fat does not cause cardiovascular disease rpt x 97

1: https://academic.oup.com/eurjpc/advance-article-abstract/doi/10.1093/eurjpc/zwac194/6691821?redirectedFrom=fulltext&login=false

Postscript

In my last blog I asked the question. Why did COVID19 lead to a spike in overall mortality in England, but not (or far less so) in Wales, Northern Ireland and Scotland? In a number of age groups, there was no impact on mortality – at all.

The most likely answer, I think, is the proportion of ‘non-white’* people living in each country. England has far more non-white people. Around 18% – it is difficult to be absolutely certain about this figure. In Scotland, Wales and Northern Ireland it is about 4%, maybe even less in Northern Ireland.

This difference could also explain Sweden and Norway. The Norwegians do not publish data on ‘race.’ It is considered racist to do so. Which of course leads to problems in situations like this where you might need the data to help protect those of different races.

So, ironically, it could be considered racist to have no data on different races? Discuss. However, the estimate is that around 3% of the Norwegian population is ‘non-white.’ In Sweden the proportion is very similar to that in England.

Therefore, my working hypothesis is that non-white people living in countries at a high latitude, are significantly more likely to be vitamin D deficient.

‘Non-white populations in Europe are at higher risk of vitamin D deficiency than their white counterparts. For example, compared with white populations in the United Kingdom, Norway, and Finland, the non-white population subgroups have 3- to 71-fold higher yearly prevalence of vitamin D deficiency.’ 1

Vitamin D deficiency increases the risk of mortality from COVID19:

‘The all-cause 30-day mortality was 13.8% in the group of patients with sufficient plasma 25(OH)D levels and 32.1% among those with deficient plasma 25(OH)D levels. Cox regression showed that plasma 25(OH)D levels remained a significant predictor of mortality even after adjusting for the covariates sex, age, length of the delay between symptom onset and hospitalization, and disease severity.

Conclusion

Vitamin D deficiency predicts higher mortality risk in adults with COVID-19’ 2

The ratio between 13.8% and 32.1% is 2.3. Which is big.

A number of people suggested race, and vitamin D, as a possibly hypothesis. I agree with them. Now, what are we going to do about it …before winter arrives that is. I recommend several thousand units of vitamin D each day, until March.

I recommend this for everyone.

I would like to reinforce this, because other studies have shown that giving people Vitamin D, once they are infected, does nothing. It is too late. So, start now. In this case prevention truly is better than (no) cure.

*I use the term non-white as it appears to be most acceptable way of describing those who are not, genetically, native to countries such as England. I do realise that whatever term is used to try and describe ‘racial difference’ some people will be offended. This is the reason why the term BAME: black, Asian and minority ethic is not being used anymore (Please be assured that I mean no offence).

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527850/
2: https://clinicalnutritionespen.com/article/S2405-4577(22)00293-5/fulltext

COVID19 – so many questions, so few real answers

14th September 2022

Some of you may remember COVID19. We had an epidemic, or a pandemic, or … choose whatever word you like best. The legacy of it still hangs about in many strange, disconnected actions.

My last flight in late August, on Lufthansa, required me to wear a mask. The connecting flight with Swissair, did not. No mask was required whilst waiting at Munich airport or being transported to and from the planes in a crowded bus. Go figure. I am sure this all makes sense to someone, somewhere.

Anyway, I thought it might be good time to have a catch up and see if we can learn anything more about the pandemic and the drastic actions taken to control it. The first thing to say is that this is a complex task. Mainly because the data surrounding COVID19 are unreliable. To say the least.

How many people have been infected with Sars-Cov2? How many have died? I believe we can only really guess. Worldometer, as of the tenth of September 2022, confidently informed me there have been around six hundred million people infected with COVID19 worldwide (613,234,326). The number of deaths is just over six million (6,514,989)1.

Quite remarkably, this represents infection fatality rate of pretty much bang on one per cent. As predicted by Imperial College London and Professor Neill Ferguson. Take a bow that man? Or perhaps not. How many people think that those figures are remotely accurate? Certainly not me. Just to start with, do we really believe that ninety per cent of people have managed to avoid a Sars-Cov2 infection?

My own belief is that virtually everyone in the world has been exposed to/infected by Sars-Cov2 and at least once. (The concept of what ‘infection’ means has undergone a bit of a transformation, a.k.a. mangling). We already know many people have been infected several times. In fact, as early as the autumn of 2020, doctors were seeing people who had been, proven, to be infected twice. Even then, these cases were considered to be the tip of the iceberg.2

If people were getting infected twice, within six months of the virus arriving, I think we can safely assume almost everyone else has been infected at least once. Maybe a few villagers in the Amazonian rain forest have remained exposure, and infection, free. As for everyone else… unlikely.

And as for the numbers of COVID19 deaths, again, can we know anything for certain? I wrote out four death certificates which included COVID19 as a cause. This was early on, before much testing was possible. I have no idea if they had COVID19, or not. I cannot imagine I was alone in adding to the COVID19 stats, whilst blundering around in the dark.

If we can’t really rely on these, the most basic of facts, then can we learn anything? I think so, I hope so. Indeed, from the very start I tended to focus my attention away from COVID19 specific data, towards data I felt I could trust. Namely, the overall mortality rate.

Although these data do not allow us to be certain who died of COVID19, the numbers are the most robust we have. Someone is either alive, or dead, and it is difficult to get the diagnosis wrong. Yes, there can be some delays in reporting etc. but in general dead is dead and alive is alive, and that is that. One hundred per cent accurate.

Of course, in order to use these figures, I have to make assumption (made by many others), that spikes in overall mortality would be the best way to get a fix on how many people COVID19 was actually killing. A big spike – more deaths from COVID19. No spike, no extra deaths from COVID19 (or very few).

So, did every country show pretty much the same pattern in mortality? Or were there extremes or outliers? I am a believer that it is at the extremes where answers can often be found.

I began by looking for countries – or populations within those countries – that suffered a major increase in overall mortality. Then I looked for matching countries, and populations, that showed no change, or very little change. Because here, maybe, we could find some solid ground to stand on.

The most easily accessed data can be found at EuroMOMO3. This is a resource where data on overall mortality are collated from many different European countries. The site then plots mortality against a (moving) five-year average.

I ended up focussing on European data, not just because it was easy to find, but mainly because most European countries are very similar in many important parameters. Standard of living, health service provision, demographics, life expectancy and suchlike. Which means that you are comparing like with like. Try to compare Norway with, say, Kenya, and you end up with a mess.

On the other hand, you can more reasonably compare Norway and Sweden. There are far fewer differences between them, which should make it simpler to spot the key one(s).

However, to start with I am not going to look at Norway and Sweden. Instead. I want to draw your attention to four countries that are not, in truth, separate countries. They are Scotland, England, Wales and Northern Ireland. Four different ‘parts’ that make up the single entity known as ‘The United Kingdom of Great Britain and Northern Ireland’. Longest country name in the world – good pub quiz question.

It is true these four ‘countries’ did not do precisely the same things during lockdown. But the differences in timings and actions, were small – with a few (look at me, I’m locking down harder than anyone else, vote for me … thank you Nicola) variants. However, you will struggle to find any other four countries that were more alike in their characteristics and actions.

Despite their many similarities, one of these populations showed a hugely significant increase in overall mortality, and the other three did not. This difference can be seen most starkly within the age group of forty-five to sixty-four.

First, a short explanation of what you can see in the graphs below.

The – somewhat difficult to make out – dotted line represents the rate of overall mortality five standard deviations above the norm for the time of year. Mortality is always higher in winter than summer, but these graphs take this into account, and are mathematically flattened out.

The darker, spiky line represents the overall mortality rate. If it rises above the dotted line this is considered to be a ‘statistically significant’ event. Or, to put it another way, something is happening that is killing far more people than we would expect to see, and we need to find out what. This is normally due an infectious disease of some kind, almost always influenza.

The scale on the left -10, 0, 10, 20 is not an absolute figure. It represents the standard deviation from the mean (the z score). If it goes above ten, this is big time trouble. Above twenty, look out, the sky is falling. In general, two standard deviations from the mean is considered ‘statistically significant’ in medical research.

OVERALL MORTALITY RATES AGE 45- 64 IN THE UNITED KINGDOM
2017 TO SEPT 2022

As you can see. England had a three major mortality ‘peaks’. Spring 2020. Winter 2020/21 and a far more diffuse mountain range in autumn and winter 2021. The other three countries showed almost nothing at all.

I will just add in here that the difference is not restricted to this one age group. Below is a graph of the sixty-five to seventy-four-year-olds.

OVERALL MORTALITY RATES AGE 65 to 74 IN THE UNITED KINGDOM
2017 TO SEPT 2022

Pretty much the same pattern emerges. Two massive upticks in overall mortality in England, very little elsewhere. Absolutely nothing to see in Northern Ireland. If COVID19 was killing lots of people in Northern Ireland, it was not showing up.

First question, does England have a worse health service than the other three countries? No, it does not. Is the overall health worse in England? Well, in general, the English have a longer life expectancy than those in the other three countries, rather than the other way around. Which suggests that the English are, in general, healthier 4.

What was the same in these countries

  • The health services
  • The age of those dying (I matched people for age)
  • The lockdowns (very minor differences)
  • The treatments given
  • The vaccinations given
  • The climate
  • Overall life expectancy (very minor differences, should be favouring England)

So, what was different?

Over to you. Because if we can work out what caused all these people to die in England, and not in Scotland, Wales and Northern Ireland, we can probably learn something of great value.

Before that – and changing tack for a moment or two, in the early days of COVID19, everyone jumped around claiming that Norway had done things fantastically well, as they had no change in overall mortality, and very few recorded COVID19 deaths. ‘Look at them shutting their borders and enforcing a very tight lock-down. Way to go whoop, whoop.’

No-one bothered to mention Northern Ireland. Which did precisely the same as England. Yet also had no change in overall mortality, as per Norway. You could argue that Northern Ireland did not fit the agreed narrative, whereas Norway did.

Sweden, on the other hand, famously did not lock down, ‘shock-horror, everyone in charge should be fired, or thrown in jail’. Sweden did have significant uptick in overall mortality. Proof that lock-downs were essential?

Possibly … probably not. Many other countries in Europe which did lock down, have had far more COVID19 deaths, and a greater impact on overall mortality, than Sweden.

Here are the European countries that have recorded more COVID19 deaths, per head of population, than Sweden. In descending order1:

  • Bulgaria
  • Bosnia and Herzegovina
  • Hungary
  • North Macedonia
  • Georgia
  • Croatia
  • Czechia
  • Slovakia
  • Romania
  • Lithuania
  • San Marino
  • Slovenia
  • Latvia
  • Gibraltar
  • Greece
  • Poland
  • Moldova
  • Italy
  • Armenia
  • Belgium
  • UK
  • Russia
  • Ukraine
  • Portugal
  • Spain
  • France
  • Liechtenstein
  • Austria
  • Estonia
  • Andorra
  • SWEDEN

Here, I did use COVID19 deaths, as reported on Worldometer – with all caveats recognised. The reason for using these figures rather than overall mortality, is that they were, initially, used to attack, the Swedish response. [People are a lot quieter about Sweden now] Also, calculating the overall mortality increases in these countries represents a very major task – with complex adjustments to be made. So, I didn’t do it here. I would also point out, for the sake of completeness, that Sweden is reported to have had 1,968 COVID19 deaths per one million of the population. Norway 728. [Two per thousand vs. point seven per thousand]

Lithuania, by the way, like Norway, is very similar to Sweden. For about a hundred years they ruled central Europe together within the Union of Kedainiai. In many ways, they have more in common than Sweden and Norway. It should be noted that Lithuania locked down early, and hard. You may note Lithuania pops up at number ten in the list above. Reported COVID19 death rate 3,528 per million.

You may disagree with my definition of European country … Gibraltar? Listen, I got this from Worldometer, so you can fight with them. However, if anyone wishes to tell me that Sweden suffered a unique catastrophe due to their reluctance to fully lock down, they may struggle to convince me that it was the critical factor. In fact, I may give a hollow laugh, even raise a quizzical eyebrow.

So, what else was different between Norway and Sweden? Something that could reasonably explain the difference in both recorded COVID19 deaths, and overall mortality. I believe there is another clue within the EuroMOMO data. If you choose to look at what you are actually seeing.

Below are the data from Norway from late 2017 (slightly annoyingly, their data only started in late 2017).

OVERALL MORTALITY NORWAY LATE 2017 TO 2022 – all ages

What stands out very clearly is that the Norwegian overall mortality rate has never spiked. At least not since late 2017… on EuroMOMO. This was even the case in the winter of 2018, which was a bad flu season across most of Europe. Something that shows up most clearly in Germany, although the same pattern can also be seen, to a lesser extent, in France, Belgium, Austria, the Netherlands, UK, Portugal, Italy etc.

OVERALL MORTALITY GERMANY 2017 TO 2022 – all ages

Did the Norwegians lock down in 2018. No, they did not. So, what stopped them dying from flu? The answer is … something else. And that something may well be the same thing that stopped them dying of COVID19.

As an aside, why did the Germans not panic in 2018, when more people were dying then, than from COVID19 in 2021? They had a z-score of very nearly twenty. Did anyone even notice? Was it front page headlines? No, of course not. It passed in virtual silence. Compare and contrast, as they say.

Anyway, I hope that I have given you a little puzzle to solve. I have been contemplating this puzzle for some time, and I think I may have identified the key factor that can explain the patterns in the UK, and also between Norway and Sweden. I am interested to see what other people’s thoughts might be.

Before coming back with answers. Remember, these data are age-matched. They compare overall mortality, not the number of recorded deaths from COVID19. They are not the absolute numbers of deaths, but variation from the mean. The z-score.

1: https://www.worldometers.info/coronavirus/

2: https://www.science.org/content/article/more-people-are-getting-covid-19-twice-suggesting-immunity-wanes-quickly-some

3: https://www.euromomo.eu/graphs-and-maps

4: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2018to2020#:~:text=estimates%20for%20Wales.-,Life%20expectancy%20at%20birth%20in%202018%20to%202020%20was%20estimated,for%20females%20in%20Northern%20Ireland.

A new paper by me – please share widely

26th August 2022

And so, after a great deal of faffing about, my article on cardiovascular disease ‘Assessing cardiovascular disease: looking beyond cholesterol’ has been made free to view.

Writing an article for a medical journal is not that difficult. Trying to submit it through Kafkaesque editorial systems, now, that is tricky. They seem incapable of understanding that I am not funded by anyone. Shock, horror, I do it simply for the love of science – or something of the sort.

As for allowing the article to be open access … don’t go there. I would rather fill in a US tax form, in triplicate and, yes, I have seen US tax forms in all their incomprehensible glory. I also spent considerable time trying to explain to the editorial team that the two risk calculators I discussed in the paper could not be referenced in the approved Vancouver style.

Vancouver style: required elements:

Author. Title [Type of medium]. Place of publication: Publisher; Date of publication [Date of update/revision; Date of citation]. Availability.

I could not use Vancouver style because there was no author, place or date of publication – to start with. They were both on-line tools used to assess cardiovascular risk. Helloooo… ever heard of the Internet. Thud!

Anyway, I was invited to write the article by Dr Eric Westman, who was the guest editor for this edition of ‘Current Opinion in Endocrinology, Diabetes and Obesity.’ In truth, I get about fifty invites a day to write articles. This is not a boast, anyone who has written almost anything that has been published in a medical journal is bombarded with such requests. New journals spring up like desert flowers after the rain.

Most of the requests are, essentially, vanity publishing. You spend ages putting together a paper that you then must pay to get published – you certainly have to pay a lot to allow open access. Usually thousands of dollars. The publisher meanwhile gains copyright. Then hardly anyone ever reads it. But, hey, you can send a copy to your mum – who will be very proud. If none the wiser what you are trying to say.

Thus, I do not respond to such requests normally. But in this case, I did. Eric Westman is a staunch ally in the crusade to look at different causal models of cardiovascular disease. Models not based on LDL/cholesterol levels.

For this edition he also invited others e.g., David Diamond to write other articles casting doubt on the LDL/cholesterol hypothesis – in the proper scientific manner. Dr Westman then paid to make them open access. A cost running into many thousands of dollars. Good man.

Anyway, here it is. https://journals.lww.com/co-endocrinology/Fulltext/9900/Assessing_cardiovascular_disease__looking_beyond.21.aspx

For those who have read my blog assiduously, or have read ‘The Clot Thickens’, none of this is new, or any surprise. However, I hope that it does add some more scientific credibility.  Here is the abstract.

Abstract

Purpose of review

The low-density lipoprotein (LDL)-cholesterol level is a weak predictor of developing cardiovascular (CV) disease and can only explain a small proportion of CV risk. It is not used to determine CV risk on either the atherosclerotic cardiovascular disease (ASCVD) calculator in the United States, or the Qrisk3 in the UK.

A study in JAMA in 2022 suggested that ‘the absolute benefits of statins are modest and may not be strongly mediated through the degree of LDL reduction’. Perhaps it is time to look beyond cholesterol to a different causal model – the ‘thrombogenic’ model of ASCVD.

Recent findings

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic demonstrated that infectious agents damage the endothelium and the glycocalyx – the glycoprotein layer protecting underlying endothelial cells. There are numerous other conditions leading to this kind of damage, which can trigger thrombus formation, causing strokes and myocardial infarctions.

Although these are acute events, they highlight a mechanism for the development of ASCVD which centres on endothelial damage and thrombus formation as both the primary causal mechanism for acute events, and the driver behind progression towards atherosclerotic plaque development.

Summary

The cholesterol hypothesis, that a raised LDL is directly causal for ASCVD, does not adequately explain cardiovascular risk in individuals, or populations. An alternative ‘thrombogenic’ hypothesis is proposed as a more valid causal model.

Here are the key points

KEY POINTS

  • Low-density lipoprotein (LDL)-cholesterol is a weak predictor of cardiovascular risk
  • Factors that drive endothelial damage and thrombus formation greatly increase atherosclerotic cardiovascular disease (ASCVD) risk.
  • The thrombogenic can explain a number of causal risk factors that do not fit within the LDL-cholesterol hypothesis, including type II diabetes, smoking and systemic lupus erythematosus.
  • The thrombogenic hypothesis, that endothelial damage and subsequent clot formation underlies the formation and growth of plaques, may represent a better model for ASCVD.
  • There is a need to research the thrombogenic hypothesis in more depth.

Stripping away the scientific obfuscation which is now required of all scientific writing. If anyone understands what you are trying to say, you lose. The two points that I was trying to make were the following:

  • The LDL/cholesterol hypothesis is most likely wrong. It is a weak predictor of risk, at best, and cannot explain how many factors known to increase the risk of cardiovascular disease, actually cause cardiovascular disease.
  • There is an alternative hypothesis, the ‘thrombogenic’ hypothesis which can explain how, and why, many different, apparently unconnected factors actually do cause cardiovascular disease.

I hope that the readers of this blog can make as much noise about it as possible and share it as widely as possible. You may even want to read the entire paper. It is not very long, and it is not too technical. At least I don’t think so.

Thank you.

THE REASON WHY

24th August 2022

As a change in direction, I thought I would share a short story I wrote. This was an entry to the New England Journal of Medicine competition. This one under the theme “A patient who presented too late”. It did not win, but I thought some of the readers of this blog may like it.

THE REASON WHY

The ewe was suffering, lying on its side, its bleat reduced to a painful gasp. ‘It’s nae coming out father.’ Annie wiped the blood down her trouser leg.

He hurled his shovel to the ground in a rage. ‘Whit have you done wrong this time!’

‘Nothing I…’ She stumbled away from him as he hauled open the entrance to the pen. He glared down at the sheep, struggling to give birth. ‘We lose another one, and I’m telling ye.’ He bent down to examine it. ‘Wrong way round. How could you no’ see that?’

‘I…should we call the vet?’

‘Vet!’ He looked ready to explode. ‘Do you ken how much a vet costs… do you?’

‘But it’ll die.’

‘It’s nae worth anything.’

‘It’s… I don’t know.’ Her shoulders slumped.

‘Oh, poor wee Annie disnae want to see the ewe die.’

Annie touched her own stomach lightly, tenderly. ‘No, I.’

‘Get the gun.’

‘Can you no just get it out, please… father?’

‘Dinnae be an idiot.’ His voice was a club. ‘Gun, now. You shoot it, and skin it. We freeze it and eat it ourselves.’

She stumbled out of the barn, into a fierce wind. Rain and sleet blowing down from the North, falling in sheets from heavy dark clouds. The hills above were now laced with wet snow. The courtyard glistening, moss covered, slippery. The house was freezing inside. The gun in a cupboard below the stairs.

She pulled it out and made her way back to the kitchen. For a moment she held the gun up, squinting through the sights. She could make out her father’s angry back through the dirty window. He turned, and for a moment, it was as though he were staring straight at her. But she knew he wouldn’t be able to see her, standing alone within a darkened room … Watching, heart beating too fast.

            ‘Hey Annie.’ Arthur was striding along a path beside the field. The sun was high, it was a lovely day, with small flowers studded amongst the grass. Below her the Cromarty Firth shone like a steel plate, as the sea cleaved the hills on either side. A lark was singing frantically above her, hovering high, a fluttering dot. She loved the early summer up here.

She was in a t-shirt and jeans, trying to fix the tap that fed a trough for the cattle. It was old, rusted, they badly needed a new one. Her fingers were already cut in several places.

            ‘Hello Arthur.’ She didn’t look up, but she knew he was studying her with interest. She pulled the t-shirt more closely round her neck.

            ‘Do you need a hand?’ He worked at the farm next door. She had watched him from a distance. Driving the tractor, chatting with other workers, talking to his cows. Yelling at them. Kicking them when they wouldn’t move, then laughing. At night, sometimes, she thought about him.

‘Just look at you.’ He had come up close. He took one of her hands in his, examining it with care. ‘What are you doing to yourself?’

            ‘The tap needed fixed.’ She allowed her hand to rest in his.

            ‘That piece o’ rusting rubbish?’ He laughed. ‘You’ll no fix that. You need a new one.’

            ‘Father says we cannae afford it.’

            ‘Aye… well I’m sure he did. I’m sure he did.’ For once, there was no trace of humour in his voice. ‘What about you Annie?’

            ‘Whit do you mean?’ She flushed.

            ‘Up here, by yourself, stuck wi’ your gloomy dad. What does Annie do?’

            ‘I work…’ She glanced round, making sure her father was nowhere nearby, watching. ‘The farm needs me, after mother died.’

            ‘I hear you have a brother. Big lad.’

            ‘Aye, but he… he left. He hasnae been back for years now. He works in the big city.’

            ‘What, Inverness. Aye, the great big city. Even got a MacDonald’s, might just be the centre of the World. Mind, he could walk back in a day… if he wanted.’

            ‘Well, I don’t know.’ She had no idea what to say next. She wasn’t good at conversations. She didn’t have many. An awkward chat about the weather over a cup of tea, down at the kirk on a Sunday. A half-hearted promise to visit from one of her mother’s old friends. Nobody really wanted to come to the farm anymore.

            ‘A bonnie lass like you.’ He touched her shoulder lightly. For a moment she allowed herself to lean in towards him.

            ‘No…No. I cannae stay.’ She leapt up.

            ‘Hey, hey up Annie. I didnae do anything.’

            ‘I  …I have to go!’ She gathered her things together furiously into a leather bag, then almost ran up the road. Arthur watched her. He always noticed when she was in the fields. Working the dogs, driving the tractor, hair blowing in the wind like some Pictish warrior queen. That long vanished race who once roamed these lands. She always looked to be concentrating furiously, passionately, on everything she did. She made him feel alive, and awkward, like a wee boy…

…This night, the pain was worse than ever, grabbing at her stomach fiercely. Her periods had almost stopped and… and she reached down to touch her stomach. It was definitely growing. ‘You’re getting fat. I cannae have you slowing down, not now.’ Her father had snapped.

How she wished her mother was with her to offer some comfort and kindness. After she died, her father had become so different. Angry, shouting, red faced. He would be sitting slumped in front of the coal fire now, whisky bottle close to hand, no doubt. Staring at the flames.

Sometimes though. Sometimes he came to her room, and he was different then. She reached down to scratch the head of her Bramble, her collie dog. Bramble licked her hand.

            ‘Whit can I do lassie.’ Annie looked down into Bramble’s adoring eyes. ‘Whit can I do.’ She closed her eyes tightly as the pain caught at her again. She wondered about going to the doctor. Then she thought about her father finding out. What if it was a child… what if it was a child?’ The thought filled her with desperate longing, and terror. She knew you could get tests, but…

‘How many this morning.’ I felt the need for an early finish. It had been an unrelenting week.

            ‘Sixteen, the usual.’ Jill, the receptionist, brought my list up on her screen. I was the on-call doctor, starting early.

            Five regulars, who were all depressingly regular in their visits and vague, never ending, untreatable complaints. ‘Who’s that first one, never seen her before. Anne Pierce? You know her?’ Jill had been born and brought up locally, she always seemed to know everyone, and everything about them. Mother to every waif and stray.

            ‘That’s her, she was waiting when I opened the door. Arthur Mackenzie brought her down, I saw him in the car, pretending he wasn’t watching.’ Jill kept her voice low and nodded towards the only patient in the waiting room. Hands gripped together; head down, staring at the floor. Hair dragged back a painfully tight bun. ‘She lives with her father on High Range farm, poor lass.’

            ‘Poor lass? Tell me more.’

            ‘Her father is…’ Jill flushed.

            ‘He is, what? Is this the secret service?’ I whispered into her ear.

            Jill giggled. ‘Not very nice.’ I knew she would say nothing more. Miss confidentiality. Even though I was the doctor.

            ‘Well, if she’s a farmer, it must be something serious.’ Famers were notorious for putting up with anything. Bone broken after a fall… ‘Just a wee break, strapped a couple of bits of wood round it, hurts a bit when I walk.’ Or coughing up blood. ‘Just a wee cough, had it three years. Took some of the antibiotics we use for the cattle. Thought it would clear up doc.’ Yes, well, everything clears up when you’re in a coffin.

Annie had entered the room without meeting my eye. Her history had been simple. Abdominal pain, a bit of swelling. No periods. The pregnancy test I gave her to do was negative. She had been jumpy, wary, an injured bird. I watched the silent spasm of pain on her face as she got up on the couch.

Her abdomen was certainly enlarged, but it didn’t seem like any pregnancy I had seen before. I put my hand on and pressed down. It was like pushing on a car tyre. Hard, very hard. I tried to find an edge, but there was none. A mass was literally filling her abdomen. It must have been the size of a pillow. This was one of the few times when I had absolutely no idea what to say to a patient.

            ‘Are you okay doctor.’ My attempt to hide my emotions had failed completely. She seemed more concerned about me than her.

            ‘Yes, yes, thanks. But I think we may need to get you looked at.’

Vaccines – how did they come about?

6th August 2022

I find vaccines quite fascinating. To be more accurate, I find the thinking and emotion around vaccines endlessly fascinating… and often quite disturbing. They have become, what we in the UK call ‘national treasures.’

A national treasure is someone, such as Dame Judi Dench, or Sir David Attenborough. We laugh at their little jokes, we forgive them any possible weakness, we treat their statements as carrying a great and solemn weight. They have moved to a sainted realm.

If, for example, someone was to say about David Attenborough. ‘God, what a terrible bore. Time he was put into a nursing home, and stopped moaning on about Climate Change…’ This statement would not, I can guarantee, be met with Universal approval.  Moving on …

Mithridatism. Most people have never heard of it.

‘Mithridatism is the practice of protecting oneself against a poison by gradually self-administering non-lethal amounts. The word is derived from Mithridates VI, the King of Pontus, who so feared being poisoned that he regularly ingested small doses, aiming to develop immunity.’ From my favourite website of all time – Wikipedia. Hey, before you start, it’s good for non-contentious subjects.

From mithridatism came the substance Theriac Mithridatium. Also called Galene, or Venetian treacle. These were the universal panaceas, designed to cure all ailments suffered by mankind … and, of course, womankind. They were complex to prepare:

‘The preparation of Galene was simple in that its ingredients were free of fractional measures. Four vipers cut down small were placed in a solution of sal ammoniac, about one gallon, to which were added nine specified herbs and Attic wine, together with five fresh squills also cut down small. The pot was covered with clay and set upon a fire. When the vapour came out of the four small holes left in the clay seal, dark and turgid, the heat had reached the vipers and they were cooked. The pot was left to cool for a night and day. The roasted matter was taken out and pounded until all was reduced to powder. After 10 days the powder was ready for the next stage of manufacture.

At the final stage the prescribed quantities of 55 herbs previously prepared by various processes, along with the prescribed quantity of squill and viper flesh powder (48 drachms), were added to hedychium, long pepper and poppy juice (all at 24 drachms); eight herbs including cinnamon and opobalsam (all at 12 drachms); 18 herbs including myrrh, black and white pepper and turpentine resin (at 6 drachms); 22 others and then Lemnian earth and roasted copper (at 4 drachms each); bitumen and castoreum (the secretion of beaver); 150 drachms of honey and 80 drachms of vetch meal.

The concoction took some 40 days to prepare, after which the process of maturation began. Twelve years was considered by Galen the proper period to keep it before use. Galen records that the Emperor Marcus Aurelius consumed the preparation within 2 months of its being compounded without ill effect.

Mithridatium was similar but contained fewer ingredients and no viper but did contain lizard! The other differences were that the opium content of Andromachus’ theriac was higher than that of Mithridatium, which also differed in containing no Lemnian earth, copper or bitumen and 14 fewer herbal ingredients…1

Simple to prepare … I think I would prefer to make a bacon sandwich, thanks very much.

Various formulations of mithridatium were painstakingly put together, in public, to ensure that no-one was cutting corners, by substituting newt for lizard – or some other such underhand substitutions. Yes, it was vitally important that mithridatium was made of pure unadulterated nonsense. No cut-price, corner-cutting nonsense here, thank you very much. It was then sold for a fortune. And people flocked to buy it.

The manufacture of mithridatium, and its variants, went on from the second century BC to the end of the eighteenth century. Or, to frame this another way. The idea of creating a substance that contained small portions of various poisons, in order to allow the body to build up immunity, and fight off all illnesses and infections, has an extremely long history.

All doctors in the mid to late eighteenth century would have been acutely aware of mithridatium, and its variants, and the thinking behind it.

William Heberden, a famous UK physician, is the man we can most credit with attacking the idea of ‘Mithridatium and Theriaca’. His pamphlet on the matter was written in 1745. He argued that it was all complete, unscientific, twaddle. Following this, and other attacks, the sales of Theriac mithridatium suffered a rapid decline.

By the end of the eighteenth century Mithridatium had pretty much disappeared from the world. To the point whereby nowadays ninety-nine per cent of people – or more – have no idea that such a substance ever existed. Or how hugely significant it was.

Let us move on a few years to 1796. A moment in time when an eight-year-old boy, James Phipps, was inoculated with ‘matter’ from Sarah Nelms, a dairy-maid, who had cowpox. Three months later, the same boy was ‘inoculated’ with fresh ‘matter’ from a smallpox lesion – and no disease developed. Lucky boy. Not sure you would get that past the ethics committee today. ‘I am fairly confident that he will not die of smallpox ... probably.’

Yes, as mithridatism departed from this world, vaccination moved in to take up the available space – a different substance to protect against future illness. In truth, the idea of inoculating people with small amounts of smallpox ‘matter’ to help the body fight off a more serious infection had been around for some time before this.

It was carried out in China, Africa, and the Ottoman empire perhaps for, hundreds of years. Although the idea that it is possible to have a ‘small’ inoculation with a deadly virus is interesting …. Do not try this at home.

To me, the important point I am trying to make here, is that the underlying idea behind vaccination had been around for millennia. Vaccination was, in effect, a variation on the theme of mithridatism.

However, the idea that a cowpox infection could protect against future smallpox was new, and it was Jenner’s idea. At least he made the most noise about it. Others claim it was Benjamin Jesty. Who knows? Success has a thousand authors, failure but one.

I think I shall credit the milk maids instead. They had known for many years that if you got infected with cowpox, you were protected against smallpox. An observation that Jenner picked up on, then ran with. Good for him …

‘… The record shows that it was there that Jenner heard a dairymaid say, “I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face.” In fact, it was a common belief that dairymaids were in some way protected from smallpox.’ 2

But, of course, at the time all this this was complete speculation and guesswork. When vaccination began no-one knew that there such things as bacteria, or viruses. No-one knew there was an immune system. No-one had the faintest idea about T-cells and B-cells and suchlike. Which leads to the question. What did Jenner actually think he was doing? How did he believe vaccination could possibly work?

After all, he was experimenting with vaccination decades before germ theory had emerged. This happened in the late(r) nineteenth century. A time when Pasteur, John Snow and the like, finally managed to convince the medical profession that infectious diseases were not spread by Miasma – essentially nasty smelly stuff that floated about in the atmosphere. Instead, disease was spread by very small ‘germs.’

If Jenner did not know that germs existed, what did he think was causing smallpox? If it was via miasma, how would vaccination work? A part of me thinks that he must have believed that a physical agent, or some sort, was causing ‘pox’. Otherwise, why would he scrape away at cowpox blisters to get ‘stuff’ off. He couldn’t have believed he was transferring miasma from one person to another.

Maybe he thought the miasma theory was complete nonsense but didn’t dare point this out. Semmelweis certainly found out, to his cost, that trying to suggest infection could be passed on by physical contact was not well received.

A Hungarian physician, he did some thinking, and research, on how infections were passed on. He recommended that it might be a good idea if doctors might just, possibly might, consider washing their hands after doing a post-mortem … then helping women to deliver their babies.

For which heresy, he ended up being flung into a lunatic asylum. He was later beaten to death by a warden. This was some forty years after Jenner began his experiments on vaccination. Yes, Semmelweis is now a very famous figure in the history of medicine, the ‘saviour of mothers’ but it didn’t do him much good at the time.

As you can probably tell, I find the development of medical thinking – indeed all scientific thinking – to be fascinating. Where do the ideas come from? At times I believe it is all complete luck. Good ideas, bonkers ideas, they all appear to be taken up with equal enthusiasm. All you need is a good tale and a charismatic promoter, then off you go.

‘It was not noisy prejudice that caused the work of Mendel to lie dead for thirty years, but the sheer inability of contemporary opinion to distinguish between a new idea and nonsense.’ Wilfred Trotter

With vaccination though, there was no major new idea. There were two thousand years of Mithridatism to build on. Namely, use a small amount of a substance to create future immunity. A general concept that was, and remains, highly seductive to the human mind. With vaccination it just happened to be right.  

However, it could just as easily have been wrong. For example, the thinking behind mithridatism also underpins homeopathy. A concept that first came to Samuel Hahnemann. A doctor who obtained his medical degree in 1779. Yes, he was kicking around at very much the same time as Jenner.

‘Hahnemann believed that if a patient had an illness, it could be cured by giving a medicine which, if given to a healthy person, would produce similar symptoms of that same illness but to a slighter degree. Thus, if a patient was suffering from severe nausea, he was given a medicine which in a healthy person would provoke mild nausea. By a process he called ‘proving’, Hahnemann claimed to be able to compile a selection of appropriate remedies. This led to his famous aphorism, ‘like cures like’, which is often called the ‘principle of similars’; and he cited Jenner’s use of cowpox vaccination to prevent smallpox as an example.’ 3

It is said that the idea of homeopathy first popped into Hahnemann’s head because he noted that quinine, in small doses, created similarly symptoms to malaria, although in a much milder form. So, he tried to use quinine to protect against malaria. Then he expanded the concept, to infinity and beyond.

Mind you, the use of quinine to protect against malaria led to the creation of tonic water, to protect the British in India. This, in turn, led to the creation of gin and tonic. So, Hahnemann must be celebrated for this wonderous legacy, at least. Yes, for this, I can forgive him just about everything.

And, of course, quinine does protect against malaria. If not that well. Oh, the delicious irony.

Mithridatism:           Ingestion of small doses of poisons to create immunity

Homeopathy:          Use of very small doses of a substance to create immunity/cure

Vaccination:            Deliberate infection, using small doses of an agent, to create immunity

  • Mithridatism is gone
  • Homeopathy is mocked
  • Vaccination is venerated

Imagine if, on the other hand, Jenner had decided to keep on using smallpox scrapings to try and prevent a later, more deadly smallpox infection. Maybe vaccination would never have happened, at all.

Just to give one example of the problems with smallpox inoculation. In 1783, Prince Octavius, the youngest son of King George II was inoculated with the smallpox virus. He died soon after – of smallpox. Had King George then taken violently against ‘vaccination’ at this point, the entire idea may have died right then and there. At least in the UK.

Instead, with Jenner came the crossroads. The point where mithridatism, homeopathy, and vaccination parted company. One works, the other two don’t.

This is because there is no such thing as a vanishingly small dose of an infection. You get infected, or you do not. The dose is pretty much irrelevant. Of course, what happens after infection can vary enormously. Some people get no symptoms, at all, others may die.

The key point of difference with vaccination is that you are notgiving a small dose of the infective agent – however vanishingly small. The point, the critical difference, is that you have to give ‘something else’ instead. Something other than the actual infective agent. This stimulates the immune system and leads to the creation of memory cells that will recognise a ‘similar’ agent in the future, and then kill it off. Hopefully.

However, there is no way on earth that Jenner, or anyone else at the time, would have had the slightest idea why this would be the case. They thought it might work. So, they did it, and it worked. And lo, vaccination was born.

It amuses to me look at articles describing the history of vaccination, and Edward Jenner, and compare them with – for example – articles on Hahnemann:

‘While it can scarcely compare in antiquity with Chinese or Indian medicine, homeopathy is the longest established CAM (complementary medicine) to have arisen in Europe. It was founded by Samuel Hahnemann (1755-1843), who grew up in Meissen in Germany, received his medical degree in Erlangen in 1779, and died a millionaire in Paris in 1843. During his first fifteen years as a physician Hahnemann struggled desperately to make a living.’ 4

If we turn to Jenner …

In addition to his training and experience in biology, Jenner made great progress in clinical surgery while studying with John Hunter in London … In 1773, at the end of two years with John Hunter, Jenner returned to Berkeley to practice medicine. There he enjoyed substantial success, for he was capable, skillful, and popular. In addition to the practice of medicine, he joined two local medical groups for the promotion of medical knowledge and continued to write occasional medical papers. He also played the violin in a musical club and wrote light verse and poetry. As a natural scientist, he continued to make many observations on birds and the hibernation of hedgehogs and collected many specimens for John Hunter in London.

So, it seems that, on one hand, Hahnemann was both a scoundrel, and a failure as a doctor. Only when he turned to the dark side, did he become that worst of all things. A greedy millionaire, selling snake oil.

On the other hand, Jenner was virtually a saint. A man both skilful and popular, and successful. He even wrote poetry (unlikely to be a good thing in my opinion) and he played the violin (almost certainly not a good thing). My goodness, this is a man you would want your daughter to marry. An intelligent man, a man of the most delicate and thoughtful sensibilities, was he not …

‘Although he received worldwide recognition and many honors, Jenner made no attempt to enrich himself through his discovery. He actually devoted so much time to the cause of vaccination that his private practice and his personal affairs suffered severely.’

Maybe this wasn’t a man you would want your daughter to marry … after all, ‘It is a truth universally acknowledged, that a single man in possession of good fortune, must be in want of a wife.’ So, Hahnemann, in possession of a good fortune as he was, might have been a better choice.

Despite his lack of money, indeed because of it – Jenner has become a historical national treasure. A selfless searcher for the truth. A delicate man, a popular man, a sensitive man. A man with a soul above such grubby things as making money… and suchlike. One is reminded of the propaganda surrounding Kim Jong-Il. The first time he played golf, he had eleven holes in one …

‘That time Kim Jong-Il tried golf for the first time and finished with 11 holes-in-one to achieve a 38-under-par game on a championship 18-hole golf course.’5

I imagine Jenner would have had twelve holes in one. Playing blindfolded, whilst entertaining an enraptured crowd with an impromptu violin and poetry recital. All for free, of course.

Yes, Jenner is a now national treasure; vaccination has also become a national treasure. Both exist in a realm above all criticism. This is never a good thing. Particularly not in the world of science. But it has happened. Dare to critically examine either, at your great peril. Try suggesting that the whole concept of vaccination was pure luck, primarily based on a two-thousand-year-old idea, and you will be attacked. This, I guarantee.

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884566/

2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/

3: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1676328/

4: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1676328/

5: https://www.wearethemighty.com/articles/north-korea-propaganda/

The crushing power of the pharmaceutical industry – a sorry tale

18th July 2022

Here is a sorry tale about the power of the pharmaceutical industry to crush all dissent … dead. The key player is Dr. Aseem Malhotra, who some of you may know. He is a consultant cardiologist. Very bright, sparky, willing to take on the establishment when required. I get on well with him, we communicate on many different issues. He has his detractors – I am not one of them.

First, some background, to put this tale into some kind of context. It is part of an e-mail that I was sent, by Aseem. I I have modified it slightly. Basically, I changed it from first person and got rid of some typos. I have also checked with other independent witnesses, to ensure the accuracy of events:

‘Dr Aseem Malhotra was invited to deliver a keynote lecture/speech at the International Medical Graduates dinner by its organiser, Consultant Psychiatrist and Chair of the British Association of Physicians of Indian Origin (BAPIO) Dr JS Bamrah CBE. The event took place on Monday 27th June as a fringe event of the British Medical Association (BMA) Annual Representative Meeting (ARM).

Other chief guests included the Chair of the BMA (Dr Chaand Nagpaul) and the President of the BMA (Professor Nina Modi). The title of his talk was “Advocating for REAL evidence-based medicine”.

The talk was well received with excellent personal feedback including the Chair of BAPIO, Dr JS Bamrah. The event also commemorated Aseem’s late father Dr Kailash Chand Malhotra who died suddenly last year. He was honorary vice president of the BMA and on the BMA council.

The organiser of BMA education events Beryl De Souza also personally told Aseem it was a brilliant talk, and the next day sent him a text message asking him to present the same talk as an educational webinar to BMA members.

Aseem had also given a talk to over one hundred BMA members earlier in the year about heart disease, statins and cholesterol with excellent feedback. The Chairman of the British Egyptian Medical Association who was very complimentary about the talk also met Aseem the following day and asked if he would give the same talk to his members.’

It all sounded rather splendid, and mainstream, and suchlike.

But, gentle reader, beware. For there is a malignant ghost hovering over this feast. The ghost of ‘anti-vaxxer present’. Now it doesn’t take much to be accused of being an anti-vaxxer. The phrase ‘I have some concerns about mRNA vaccines’ is usually enough to be mercilessly attacked by the dementors, controlled by Facebook, Twitter and suchlike.

In this case, during his talk, Aseem presented data from a study called ‘Serious Adverse Events of Special Interest Following mRNA Vaccination in Randomized Trials.’

It is a pre-print paper, at this point, and has not yet been peer-reviewed. It is due to be published in the Elsevier journal SSRN. You can see the full paper here 1.

The authors, from such places as Stanford, UCLA and Maryland, are of high academic standing. What they did was to look at serious adverse events associated with the Pfizer and Moderna vaccines. The Discussion section of the paper states the following:

‘The excess risk of serious adverse events found in our study points to the need for formal harm-benefit analyses, particularly those that are stratified according to risk of serious COVID-19 outcomes such as hospitalization or death.’

The ‘abstract’ further states, in the results section:

Pfizer and Moderna mRNA COVID-19 vaccines were associated with an increased risk of serious adverse events of special interest, with an absolute risk increase of 10.1 and 15.1 per 10,000 vaccinated over placebo baselines of 17.6 and 42.2 (95% CI -0.4 to 20.6 and -3.6 to 33.8) respectively.

Combined, the mRNA vaccines were associated with an absolute risk increase of serious adverse events of special interest of 12.5 per 10,000 (95% CI 2.1 to 22.9). The excess risk of serious adverse events of special interest surpassed the risk reduction for COVID-19 hospitalization relative to the placebo group in both Pfizer and Moderna trials (2.3 and 6.4 per 10,000 participants, respectively).’

Now, in English. According to this paper, the risk of a serious adverse event (caused by the vaccine) was greater than the reduction in hospitalisation from COVID-19 (prevented by the vaccine). Therefore, on this metric, the vaccine(s) may be doing more harm than good. [Please don’t hit me, I said ‘may’.]

Thus, Aseem committed the greatest sin imaginable today. He dared to mention a scientific study that asked questions about mRNA vaccines. And, of course, oops, I have now mentioned it too. Which clearly makes me an anti-vaxxer. Yes, quoting scientific papers is now, virtually, a crime. So, I have to strongly advise you … don’t look at the paper. Else you will become contaminated with impure thoughts and may have to be stomped on.

Oh, what a world we now live in.

Anyway. Back to Aseem’s story. Here he was, basking in glory. To top it all, he was then presented with an award. To quote … with some slight edits:

‘The next day Dr JS Bamrah informed Aseem that he was going to receive an award, to be presented by the BMA Chair, Dr Nagpaul. The award was “Champion of Preventative Medicine”. He had spoken to Dr Nagpaul on the phone who agreed.

The award was given in a break at the BMA conference. Dr Nagpaul was asked where he wants the photo to be taken of him presenting Aseem with the award. He suggested the main podium at the BMA conference hall, but the picture quality is poor, so they go elsewhere, and Dr Nagpaul was more than happy for Aseem to receive the award in front of a board in the main lobby with the BMA logo in the background. This was NOT Aseem’s suggestion.

Later that afternoon (Tuesday 28th) Aseem received the photo via text and put a tweet out (see below) in the evening with the three photos of Aseem receiving the award including with a larger group of people including the BMA president which read:

“Truly honoured to receive the “Champion of Preventive Medicine award from the Chair of the BMA @Cnagpaul. In my talk I said the science alone isn’t enough; opposition from vested interests needs to be overcome to save the #NHS. It’s time for REAL evidence-based medicine (fist bump emoji).’

But the all-seeing eye of Sauron had been ‘observing’ this unfortunate series of events. Grima Wormtongue was dispatched to whisper in the ears of those in power. ‘Yes, my precious (to mix my characters, stories, and metaphors, horribly), nasty hobbitses won’t be seen to criticise vaccines will they.’

Behind the scenes … all hell broke loose. Someone had dared to mention a study mildly critical of vaccines, and the BMA chairman GAVE HIM AN AWARD. Off with his head. ‘Whose head, please?’

‘Everyone involved in this treachery.

‘Yes boss, sure boss, right away boss….’

The tale continues:

‘The next morning, Aseem noticed a missed call and message from Dr Bamrah. “Please call Aseem. Need your tweet modified. Delete the bit about BMA council. Just say Chaand Nagpaul. Happy to explain.”

Aseem did as requested and sent another tweet specifically clarifying that it was an IMG forum award and was given to me by Chaand Nagpaul, without mentioning the BMA at all. Aseem also messaged Dr Bamrah in reference to Chaand which he also shared with him “He needs to stand his ground and not capitulate. We’ve compromised by deleting the tweet. My dad would say always stand up to bullies and cowards – that’s what he taught me.”

Chaand (CN) replies to me “Aseem the issue is who the award originated from. They’re questioning my governance – it was not an award “from me”. I know it’s semantics but real uproar”

AM: “Ok. I will delete the tweet altogether”

CN: “Much wider than this individual – within BMA too sadly – everything attributed to me has to be cleared with BMA comms while BMA chair”

AM: “Tweet deleted”

CN: “I’m going to get some sleep! It’s been incessant”

BMA releases a statement from the Chair that is read out at the conference essentially stating that the BMA does not endorse the views of Dr Aseem Malhotra and that Chaand had not actually given me the award but had “handed it over” due to politeness.

Why such a storm? Why the behind-the-scenes desperate machinations to ensure that the BMA could not, and would not be associated in any way with Aseem? Why the personal humiliations and climbdowns? Why the control over Chaand Nagpaul – who was stepping down as BMA chairman anyway? The incessant tweeting and criticism.

Was it because Aseem has always been critical of vaccines? I refer you to the fact that in early 2021 Aseem was asked to help promote the COVID-19 vaccine to the, so called, BAME (Black Asian Minority Ethnic) community. Yes, he promoted the vaccine to a particular vaccine hesitant community 2.

However, he has also, like me, been alert to the possibility of potential harm that the vaccines may cause. He is also, like me, well aware of the way that data from clinical studies can be, and is, manipulated and biased.

We both cast a highly sceptical eye over any ‘evidence’ that emerges from commercial organisations. Neither of us happily chants ‘two vaccines good, four vaccines better.’ We are both in the ‘but that man is wearing no clothes’ section of the audience. A rather smaller section, it must be said. Usually containing only two people. Him, and me.

Anyway, I thought it would be interesting to find out who, exactly, started the ‘bring me the head of Aseem Malhotra’ movement within the BMA. Could it be, I wondered, that they had a commercial conflict of interest? By which I mean, had they worked with a pharmaceutical company that made mRNA COVID19 vaccines.

Well, I have spoken to people within the BMA, at a high level, to find out exactly what went on. They confirm the details of Aseem’s story. But wish to remain nameless. It seems that a certain individual, who led the attack on Aseem, has close connections with Moderna. Surprise, surprise. As you can tell, I am treading on potentially libellous ground here, so I am not naming names. I am currently involved in a monstrously long, and complex libel suit, and I don’t want another one at present, thank you very much.

This all comes hot on the heels of an article in the British Medical Journal by Maryanne Demasi. A medical journalist whose career was destroyed when she produced and presented programmes in Australia that were critical of the cholesterol hypothesis and the, potential, over-prescribing of statins. They even tried to get her PhD removed, to further destroy her reputation.

The BMJ article was called ‘From FDA to MHRA: are drug regulators for hire?’

‘Patients and doctors expect drug regulators to provide an unbiased, rigorous assessment of investigational medicines before they hit the market. But do they have sufficient independence from the companies they are meant to regulate?’3

The short answer is no. Drug regulators have been bought and paid for by the companies that they are supposed to regulate. But the commercial influence spreads far wider than the regulators. Key opinion leaders (KOLs) who carry out the big clinical trials, who speak at conferences, and who appear at the top of influential medical organisations and write the guidelines – are often bought and paid for too.

There is virtually no area of the medical world that has not been lobbied, infiltrated and – in many cases – paid for and controlled by the pharmaceutical industry. We have a major crisis on our hands, that no-one is doing anything about.

Aseem’s tale is just one more example of the fact that anyone who dares to stand up to the relentless marketing of more and more drugs, and vaccines, will be attacked and crushed. In this case, under the banner of the British Medical Association. An organisation that I am increasingly unproud to be a member of. If the BMA can no longer support freedom of speech, then no-one can. The future looks bleak.

To quote George Orwell. ‘If you want a picture of the future, imagine a boot stamping on a human face, forever.’

1: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4125239

2: https://twitter.com/gmb/status/1357600088617611266?s=21&t=giXjno9w9ksPRjItQhC9_w

3: https://www.bmj.com/content/377/bmj.o1538

A bit of a pause

A bit of a pause

For those of you who are regular readers of my blog, you may have noted little activity recently. I found myself diagnosed with prostate cancer, and then radiotherapy, and anti-androgens, then in the midst of that I went down with COVID19. So, energy levels have been a little low. Particularly my ability to concentrate on writing, anything of great value.

I am going to give it a month, or so, to see how I feel. Then, I hope to be back on-line after that. I wil get back to approving comments this week. Thank you.

Care homes and COVID19

1st May 2022

[Lessons must be learned]

I love the phrase ‘lessons need to be learned’. It always makes me laugh when I hear it. Usually intoned with a voice of great seriousness by the leaders of an organisation found to have made disastrous errors. It is right up there with ‘safety is our number one priority.’ About the only group I have yet to hear say this are arms manufacturers. Although I wouldn’t put it past them. Maybe … ‘You could take someone’s eye out with that.

As I have occasionally remarked about airlines … when they tell us that safety is their number one priority. Well, in that case don’t take off. Everything is perfectly safe when your plane is on the ground. It’s that hurling yourself into the air, dashing about in the skies, then landing, where all the accidents take place.

Getting back to lessons learned. The only lesson I have ever learned, about lessons being learned, is that lessons are never learned. The same disasters occur again, and again, for all the same reasons. The reasons being institutional inertia and the overwhelming desire of those at the top to protect themselves from any criticism.

What I have also learned is that the primary function of any enquiry is to make sure that no-one who actually made those terrible decisions can be blamed for anything. A few scapegoats further down the pecking order will be dragged out and punished. Then all goes quiet again.

Mistakes were made.’ This is another one I enjoy. Mistakes were made – but who made them? The use of the passive voice is all you ever need to pay attention to Here. You never hear. ‘I made this mistake. Or, that person made this mistake.’ Even more rarely will you hear ‘I, alone, made this mistake.

Yes, once the dreaded passive voice comes into play, you know that no-one is going to be singled out, no lessons are going to be learned by anyone. Instead, some vague unidentifiable entity will have to learn from the mistakes that some other vague and unidentifiable entity may, or may not, have made.

Mistakes were certainly made in the COVID19 pandemic, and I have found myself bombarded by the ‘lessons have been learned’ claptrap.

The man in charge of healthcare in the UK, when COVID19 crashed upon the world, was Matt Hancock. This was also the time when patients were being flung out of hospitals into care homes, thousands of whom then went on to die.

He chose to hide behind an excuse. ‘No-one told me, so it wasn’t my fault.’ Is that what the Captain of the Titanic thought to himself as his ship slipped beneath the waves?

Here is one article about what went on during that terrible time. I cannot reference it for everyone, because it came to me through doctors.net, which is for doctors in the UK only. Here it is anyway, although, unless you are a doctor you will have no access. ‘Poor planning behind the illegal pandemic care home discharges’1. By the way, you are not missing anything. It mirrors many other articles that said exactly the same thing:

Bed shortages led to the illegal discharge policies that led to the deaths of hundreds of patients in care homes, the British Medical Association has alleged.

A court yesterday delivered a ground-breaking ruling that the government acted unlawfully in the advice it issued to the NHS on hospital discharge during the early stages of the pandemic.

The advice stated that there was not a risk from patients who had no symptoms of COVID infection. It led to the virus running amok in the care sector and a judicial review by two bereaved relatives gained the support of the courts yesterday.

I would disagree with the statement that hundreds of deaths occurred. It was in the region of twenty to thirty thousand, maybe more. What was Matt Hancock’s response?

Yesterday he (Matt Hancock) claimed the court ruling had not found him culpable, blaming Public Health England for failing to advise that the asymptomatic patients could transmit the virus.

So, what lesson do we think Matt Hancock has learned? ‘A big boy (public health England) made me do it’, seems an adequate summary. Yes, we know there was a lot going on at the time. A great deal of pressure, and panic, and suchlike.

Using pressure in a rapid changing situation as an excuse, as this Government has repeatedly done … This makes me think of a General explaining that all the mistakes he made during a battle were due to people rushing about firing guns and yelling. No-one can possibly concentrate, and get things right, with all that bloody racket going on.

The reason why you had a position of such power and responsibility, Mr Hancock, is that you needed to be the big grown-up boy. You were required to think quickly, and clearly. If people didn’t tell you things, such as the fact that an airborne virus can spread though asymptomatic people – as they all do, then, quite frankly, you bloody well needed to ask.

Of course, it seems he was told, he just doesn’t want to admit that he was … and someone has told him he can probably get away with that pathetic excuse, of an excuse:

Here is what, I think, he should have said. ‘Whilst the situation was difficult, I should have ensured that I looked at this issue in more detail. I needed to find out more about the impact of discharging elderly people back into care homes. The risk of transmission with asymptomatic patients. The difficulty in isolating elderly and often demented patients in that environment. I did not do any of these things adequately. I was the man in charge, I am deeply sorry … please hand me a gun.’

It is not as if this impending disaster was beyond the understanding of us mere mortals. On the 17th April 2020 I wrote a blog about it:

‘The government’s disregard of care home residents – old, sick people, acutely vulnerable to COVID19 – has been scandalous. As a GP, I regularly visit care homes. At one I visit, they recently had eight residents who died in a week, probably from coronavirus. But there’s no testing, so who could possibly know …

When COVID struck, many things were not known, and could not have been accurately predicted. The transmission rate, the case fatality rate, the best way to treat those infected

However, it was very clear, very early on, that COVID was killing the elderly in far greater numbers than anyone else. In Italy, the early figures released revealed that the average age of death was seventy-nine. The figures were slightly higher in Germany, and around eighty years old in pretty much every other country.

Equally, it was known that amongst the elderly who were dying, almost all of them had other serious medical conditions. Heart disease, high blood pressure, diabetes, chronic pulmonary disease and suchlike. This is often known in my line of work as “multimorbidity.”

In a world of uncertainty, one thing stood out. Which is that the unwell elderly were the ones who were most likely to die. Equally, they were the ones most likely to end up in hospital, potentially overwhelming the health services. As happened in Italy and Spain.

Ergo, you would think that someone, somewhere in the UK government, would have asked the obvious question. Where do we have the greatest concentrations of elderly, frail, people with multimorbidity? Could it possibly be that they are being looked after in care homes around the country?

Nursing homes, residential homes, care homes. They are all pretty much the same thing nowadays. Nursing homes tend to look after those with greater health needs, and they must have registered nurses looking after patients, but the distinctions have become blurred.

Many care homes are also specialised in looking after the elderly with dementia. In the UK, they are called EMI units [elderly mentally infirm]. These represent a particular problem in that residents tend to wander about from room to room.

So, in care homes we potentially had the perfect storm for the pandemic. They are full of elderly and infirm and highly vulnerable people. Environments where it is often impossible to isolate residents, and staff who have never been adequately trained in isolation measures. Equally, whilst relatives cannot visit hospitals, care homes have been continuing to allow them in.

It is not as if the warning signs were not there, flashing red.

What was the government’s strategy for dealing with nursing homes?  It has been, up until the last couple of days, to make things even worse. The instructions from the Dept of Health have been to send patients diagnosed with COVID out of hospital, and back into care homes, with further instructions to “barrier nurse” them, a term for a set of stringent infection control techniques.  Care homes were informed that they could not refuse to take the residents back …’ 2

It was after this that Dr Kathy Gardner (PhD, not medical doctor) contacted me, as her father had died of COVID19 in a care home. I wrote various lengthy replies to her lawyers about the situation, and my experience thereof. They may, or may not, have used my missives in the court case. The case that she battled so long and hard to get heard. She is quoted in the article:

At the time the Health Secretary Matt Hancock had claimed he was throwing a “protective ring” around care homes.

Yesterday he claimed the court ruling had not found him culpable, blaming Public Health England for failing to advise that the asymptomatic patients could transmit the virus.

One of the claimants, Dr Cathy Gardner, said the “protective ring” had proved to be a “despicable lie.”

Dr Gardner said: “I believed all along that my father and other residents of care homes were neglected and let down by the government. The high court has now vindicated that belief, and our campaign to expose the truth.’

Within the NHS I was also fighting my own lonely battles. Here is an e-mail (identifiers redacted) that I send to my manager in April 2020

‘I had a short chat with A yesterday about nursing homes X and Y.

Although things seem to be getting sorted out at Intermediate Care facility B there do not seem to have been any changes at nursing homes X and Y Both homes have several patients with Covid (proven positive swabs). It seems that the Hub is still sending Covid negative patients into both homes – putting these patients at immense risk. We have had staff to patient transmission at Intermediate Care facility B.

Equally patients are being discharged home without having swabs. So, they are arriving home and potentially infecting any partner living there – usually elderly and vulnerable. Equally, if community staff are going in to visit, they can also get infected – then pass the infection on to other clients in the community. The only patients being swabbed on discharge from nursing home X are those going to other care homes – at that care homes request.

Two out of three swabbed patients in nursing home X have come back positive. Which means we are clearly sending Covid positive patients back home – without a swab. I spoke to H, who said that this was still policy? I am not quite sure who’s policy?

I believe we must stop the hub sending Covid negative patients into our nursing homes. – until they are clear of infection. I also believe we cannot discharge anyone from our nursing homes without a clear swab.

I think if anyone were to be made aware that their relatives were being transferring into a Covid positive care home, where they will be at high risk of getting Covid, they would rightly be up in arms. They would rightly be up in arms because it is unsafe, it is putting staff and patients at risk. We already know that nursing homes are becoming the focus of Covid deaths, we should not be making this situation worse in nursing home X and Y.’

I am no genius. I was not the only one who could see that this was a stupid and deadly policy. I wrote about it, and complained about it, at the time. We have now had a court case saying what was done was illegal. But [squeaky voice] ‘no-one knew…’ The care home managers were all up in arms at the time. They bloody knew. But no-one chose to listen to their inconvenient truth.

So now what happens. It it almost impossible to see that anything of any value will occur as a result of this judicial health review. What lessons we be learned? None by the Department of Health and Social Care. Their comment:

‘A spokesperson for the Department of Health and Social Care, said: “We specifically sought to safeguard care home residents based on the best information at the time.’ Yup, safety was their number one priority.

Well, God only knows what would have been the result if they hadn’t decided to ‘specifically safeguard care home residents, based on the best information at the time.’ It is difficult to think of anything they could have done to make things worse.

The best information?’ Who gave them this information? The same vague unidentifiable entity who made the mistakes and will now be learning the lessons I suppose. Maybe it was the exact same god-like entity that was spoken of, in hushed tones, during the pandemic …The Science. Yes, The Mighty Science that works in mysterious ways, its wonders to perform.

1: https://news.doctors.net.uk/news/6K3xX7oGioThSkt9LJYz0S?pk_campaign=dnb&pk_kwd=article02_button

2: https://drmalcolmkendrick.org/2020/04/17/care-homes-and-covid19/

Evidence Based Medicine – it was a good idea

25th April 2022

[Until it died]

Once upon a time I was a member of the General Practitioners Committee. A sub-committee of the British Medical Association that represents GPs. This was during a time when the Quality and Outcomes Framework (QOF) system was being rolled out. There is hardly anyone working in the NHS, including almost all hospital doctors, who has any idea what QOF is. But GPs [Family physicians] sure as hell do.

I donned my armour and battled against it, in a purely Don Quixote style. I was aware that I was tilting at windmills, but I felt the need to do something, however unlikely I was to succeed. This stance did offer the advantage that I could then say two things that really irritate other people. First ‘It wasn’t my fault.’ Even worse ‘I told you so.’

Ah yes, what on earth is he talking about this time? What is this QOF thingy, you ask? And what has it to do with evidence-based medicine? Well, you could say that QOF represents the inevitable end-point of evidence-based medicine. The crowning glory of a system designed to remove uncertainty from clinical practice. Replace it with carefully crafted treatment algorithms, based on the best possible evidence.

To explain in a little more detail. QOF itself is a system whereby GPs can earn points for reaching various targets. They are then paid money for each point gained. How much money? You can skip the next bit, but it makes me laugh. It is but the tip of a mighty iceberg of complexity. A system that makes filling in a tax return look like light-hearted fun.

‘To work out your actual QOF value for your practice, you need to divide your population by 8,479 to derive a factor and multiply this to the QOF point value to derive the actual QOF value for your practice.

For example, if your practice has 4000 patients.

4000/8479 = 0.4717537

0.4717537 x £187.74 = £88.57 per QOF point.’

At present it is possible to achieve a maximum of 567 points (last time I looked). This equates to an income of roughly fifty thousand pounds, for a practice of four thousand patients. If, that is, you achieve all the points on offer. Which is tricky.

What sort of activity earns points? Well, take diabetes as an example. You start by establishing, and maintaining, a register of all patients, aged seventeen or over, with diabetes. The register must also specify the type of diabetes – where a diagnosis has been confirmed.

You may think this all sounds perfectly reasonable, but then ask yourself why does it need to be done? In the UK, all GPs use computer systems. If someone has diabetes, this will be known. It will be on screen. It’s not as if the GP is going to be taken by surprise to learn that the patient has diabetes when they carry out an audit.

In short, an up-to-date list makes no difference to their management. Nor are you going to suddenly stumble across more patients with diabetes simply by the magical act of creating a list.

No, the reason why a list must be created is that you can gain points for such things as lowering the blood pressure to a ‘target’ level in the approved percentage of patients. Or driving the cholesterol level down below the ‘target level’, or getting the blood sugar (HbA1c) level below the ‘target’ level in the approved percentage of patients.

In short, for QOF to work, the GP needs to create database after database of different diseases. Then carry out audit … after audit. What a great use of clinical time it all is. Appointment after appointment filled with patients called in to have their annual blood pressure check, which just sneaks in just below target level – every single time.

For the pharmaceutical companies this is manna from heaven. Every patient with diabetes logged and audited. Every one driven to reach a ‘target’. A target that will inevitably require medication. Medication that the pharmaceutical company just, ahem, happens to have developed. Medication where they just, ahem, happen to have done all the clinical trials.

In addition to QOF, you also need to link everything into NICE guidelines. NICE stands for ‘The National Institute for Health and Care Excellence’. They produce magnificent ‘evidence based’ medical guidelines on such matters as the management of low back pain, or treatment of high blood pressure. Amongst a multitude of other things.

Some of these guideline documents are, literally, hundreds of pages long. But if you do not follow them then you are in trouble. You could find yourself struck off the medical register.

If you add NICE to QOF, what do you get?

What you get are extraordinarily rigid pathways, and algorithms, for treating patients. Soviet style central planning at its finest. Everything commanded from on high, everything measured, everything inspected. All five-year plans in place …comrade.

At this point you may well ask, why the need for highly trained clinicians? Disease X requires treatment Y, at dose Z, to achieve the desired outcome. Anyone sitting in front of a computer can do this. It requires no knowledge of why you are doing any of it.

Equally, it requires zero understanding of the complex relationship between various physiological systems, or the specific medical needs of a patient either. What if the patient has three different diseases, where you must balance one system against another? What if no-one has ever studied the use, benefit, or harms, of four different drugs given at the same time? How do you balance one set of guidelines against another?

Leaving such issues to one side, depending on your philosophy of life, you may believe this is all a fantastic idea. Repeatable and reliable treatment protocols replacing potentially flawed clinical judgement. Factory worker vs. skilled artisan. Ford vs Rolls Royce.  In general, we know who usually wins this one. Command and control vs. individual decision making. No contest.

However, if the medical authorities decide, as they have done, to go down the bureaucratic ‘command and control’ model – based on the best evidence available – then there is a critical thing. It is the absolute requirement to be certain that the evidence you use is of the highest quality. Untouched by bias … if not, your house of algorithms simply collapses.

So, how reliable is the evidence base? Here is what Richard Horton (editor of The Lancet) stated a few years ago in an article ‘Has science “taken a turn towards darkness”?

“The case against science,” wrote Richard Horton, editor of the medical journal the Lancet, “is straightforward: much of the scientific literature, perhaps half, may simply be untrue.”1

A while back I wrote a book called Doctoring Data, in which I tried to help people understand the many, many, ways in which the data from major clinical trials are manipulated and biased. How they are carefully designed to obtain only the desired results. I also attempted to clarify the endless data manipulations used to report the results themselves.

If I had to sum up the overall message of the book, it is that we are all, essentially, bunny rabbits caught in the headlights of an onrushing car. The onrushing car, in this case, being pharmaceutical company profits.

More recently the BMJ published an article entitled ‘The illusion of evidence-based medicine.’ 2

It begins, thus:

‘The advent of evidence-based medicine was a paradigm shift intended to provide a solid scientific foundation for medicine. The validity of this new paradigm, however, depends on reliable data from clinical trials, most of which are conducted by the pharmaceutical industry and reported in the names of senior academics. The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry sponsored clinical trials are misrepresented. Until this problem is corrected, evidence-based medicine will remain an illusion.’

It goes on to say:

‘Regulators receive funding from industry and use industry funded and performed trials to approve drugs, without in most cases seeing the raw data. What confidence do we have in a system in which drug companies are permitted to “mark their own homework” rather than having their products tested by independent experts as part of a public regulatory system? Unconcerned governments and captured regulators are unlikely to initiate necessary change to remove research from industry altogether and clean up publishing models that depend on reprint revenue, advertising, and sponsorship revenue.’

I have been saying this, or something pretty much like this, for years. As have many other voices … howling in the wilderness. Has anything changed? Well, yes, it has changed. It has all got considerably worse.

For example, much of the recent research done during the COVID19 pandemic was almost laughably biased and dreadful. Anything that could make a pharmaceutical company money was promoted ruthlessly – did someone say remdesivir. Anything where no little money could be made was slammed though the floor. Did someone say hydroxychloroquine?

As for the vaccine trials themselves. Let us draw a discrete veil over those …vague approximations to science.

What we currently have is a crisis in evidence-based medicine. The evidence that we use is, at best flawed and incomplete. At worst, just plain wrong. Yet, this is this evidence used to create the NICE guidelines and drive the QOF targets.

Any wonder so many GPs are completely fed up. It is not the only reason, but it is a major reason. ‘You trained me for ten years, now I cannot even make a bloody clinical decision. What is the point?’ A GP colleague calls it ‘monkey medicine.’ In that a well-trained monkey could do it.

When QOF was first being heavily promoted as the glorious future of primary care, I made a prediction. I predicted that life expectancy of the elderly (where most of the QOF points aggregate) would gently start to fall. This would happen because everyone was going to be monitored and measured. Then treated with drug after flawed ‘evidence-based ‘drug.

Two problems. First, this would inevitably drive polypharmacy [many different drugs prescribed simultaneously], and the evidence for this is overwhelming, and clear. Here is a short section from a paper examining the increasing use of multiple medications. ‘Medication usage change in older people (65+) in England over 20 years: findings from CFAS I and CFAS II.’

‘The number of people taking five or more items quadrupled from 12 to 49%, while the proportion of people who did not take any medication has decreased from around 1 in 5 to 1 in 13.’3

Polypharmacy is, in of itself, potentially dangerous, in that all the different drugs can start interacting with each other in unexpected and, often, damaging ways. Many studies have demonstrated this unequivocally. 4

These inherent problems with polypharmacy are, of course, made far worse by being driven by biased evidence. It does not take a genius to add two and two in order to predict that, in this situation, life expectancy may well go down, rather than up.

Biased evidence base + polypharmacy = increased morbidity and mortality

In support of this, here is an analysis from Imperial College London entitled ‘Life expectancy declining in many English communities even before pandemic.’

‘A substantial number of English communities experienced a decline in life expectancy from 2010-2019, Imperial College London researchers have found … For such declines to be seen in ‘normal times’ before the pandemic is alarming.’’ 5

Cause and effect? This cannot be said for certain – rather too many variables flying about. I know what I think.

However, one thing you can certainly argue is the following. If the evidence we now use to audit and treat everyone, using QOF, was of unbiased high quality, then you should expect to see some improvement in life expectancy.

But that is not what happened. What happened, was a fall. Not a huge, oh my God fall, but a fall, nonetheless. Has anyone pointed to QOF, and NICE, and the endless proliferation of guidelines as potential factors? You already know the answer to that one. Not a chance.

Whilst other countries do not have QOF, or NICE, the relentless march of evidence-based guidelines, and the subsequent clinical algorithms that they are based on, has become a world-wide phenomenon. The US, too, is seeing a fall in life expectancy.

At one time, long ago, I was a great believer in evidence-based medicine. It seemed like a good idea at the time. I now recognise that I was hopelessly naïve. First, as a student of history, I should have known that centralised command and control systems always end in disaster.

This happens, no matter how well intentioned it may have been to start with, and QOF was well intentioned. A crushing and inflexible bureaucracy will inexorably grow, and suffocate, and drain enthusiasm and energy from the workplace. The guidelines themselves would also, inevitably, end up as a Procrustean bed, upon which no patient can ever fit. So, you have to chop bits off, or stretch, as required.

Procrustes “the stretcher [who hammers out the metal]”, was a rogue smith and bandit from Attica who attacked people by stretching them or cutting off their legs, so as to force them to fit the size of an iron bed. [The process was always fatal].

In this case, the Procrustean bed has been further distorted by the fact that the evidence base itself rests of quicksand. It is a horribly biased mess. So, yes, evidence-based medicine was a good idea (sort of). It died long ago. R.I.P.

As an end-note, the impact of QOF was reviewed a few years ago. In 2017, to be precise. Nothing since that I am aware of. As the study concluded:

‘The lack of effect of the QOF on mortality is surprising, given that the indicators are based on high-quality evidence of effectiveness of interventions. Why this is the case is not clear… ‘6

Not clear… There are none so blind as those who have not eyes to see.

1: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60696-1/fulltext

2: https://www.bmj.com/content/376/bmj.o702

3: https://academic.oup.com/ageing/article/47/2/220/4237359

4: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02192-1#:~:text=Background,among%20older%20adults%20with%20polypharmacy.

5: https://www.imperial.ac.uk/news/231119/life-expectancy-declining-many-english-communities/

6: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647921/

Pfizer and me – Best Buddies

21st March 2022


Someone once said to me that I really must despise the pharmaceutical industry. There are certainly times when this is true, and my anger with them is sharp … and hot.

But yet, and yet, I know many people who work in the industry, and they all seem nice, concerned about the world, caring. Trying to do good. The industry itself has also produced some great innovations and medications. Without which the world would be a much scarier and more unpleasant place.

In truth, I find the industry is a bit like capitalism. Both fantastic and dreadful. Which is a bit like humanity itself. Both fantastic and dreadful. Capable of the most amazing things, yet the darker side can be very dark indeed. Dr Jekyll and Mr Hyde.

To be frank, my personal problems with the pharmaceutical industry have mainly centred around cholesterol lowering. Various companies have made billions, nay tens of billions, nay hundreds of billions, pushing LDL-Cholesterol reduction with all their might.

However, I have oft sat with my head in my hands in despair at such nonsense. Pfizer with Lipitor (atorvastatin) pushed the hardest and made the most … and horribly distorted the entire world of cardiovascular disease research in so doing.

However, thirty years ago, and purely by chance, the planets Pfizer and Kendrick were in a strange alignment. Briefly, I found myself on the same side as Pfizer when it came to cardiovascular disease.

How could this possibly be so? Well, gentle reader, let me take you back to a time when Pfizer had a very different drug to promote, called Doxazocin. It was a type of blood pressure lowering agent known as an Alpha-1 blocker. It was not selling terribly well, so they were looking for other angles in an attempt to boost sales.

I should mention that this was before Pfizer had a statin. A time that you could refer to as the ‘BS’ era. (Or maybe we are now in the true BS era – discuss). Then, in the year 2000, Pfizer took over Warner Lambert, which just happened to have a statin called atorvastatin (Lipitor). Yes, Pfizer didn’t actually develop atorvastatin. They just bought out the company that did. Nifty move.

Anyway, in 1992, Pfizer was not much interested in lowering LDL-Cholesterol, as they didn’t have a statin. Which meant they had other fish to fry with their cardiovascular drugs. They were more focussed on blood pressure lowering. But their Alpha-1 blocker for this, doxazocin (Cardura) was a bit rubbish.

So, what to do? What to do indeed. What they did was to use the tried and trusted mechanisms of looking at different effects that this drug might have.

To explain, almost all drugs when they are launched are marketed for one indication, and that indication only – the thing that will make the most money. Achieving marketing approval, for any indication e.g., blood pressure lowering, costs vast sums of money. Which means that companies must keep their focus tight, to drive the drug through the clinical trials process.

However, almost all drugs will do many other things, and you cannot run separate clinical trials on them all. To long, too complex, too costly.

There may be some ‘magic bullet’ drug that hits one target, and one alone, and spares everything else. Sniper fire. However, with most of them, you select automatic, raise the gun over your head from behind a sheltering wall, close your eyes, and spray bullets vaguely towards the target. Hoping you manage to hit the thing you’re aiming at.

Just to give a few well-known examples from history. Aspirin was initially found to reduce pain, inflammation and temperature. It was later discovered it helps to prevent platelets (small blood cells) sticking together. So, it was also an anti-coagulant – it reduced the risk of blood clots forming – and thus reduced the risk of dying of a heart attack. Now, it is being used to prevent cancer.

Sildenafil (Viagra) was initially developed as a drug for angina. The rest, as they say is history. It ended up being marketed for erectile dysfunction because it had an unknown, at the time, ‘off-target effect’ that had nothing, directly to do with angina at all. Or, at least, no-one could see the connection at the time.

Thalidomide was originally developed as a sedative. It was then sold for treating colds, flu, nausea and morning sickness. As everyone now knows, it caused horrible deformities in the unborn child.

Coincidentally, it was discovered the very same mechanism that led to the terrible deformities, also meant it was pretty good at treating a whole series of different diseases, such as multiple myeloma and leprosy. It is now prescribed as Thalomid – it has many different names. But certainly not thalidomide.

Last time I bothered counting, statins had thirty-four off-target effects. These are sometimes called ‘pleiotropic’ effects. I suppose this makes them sound more scientific. I am only surprised that statins have not yet been repurposed as anti COVID19 drugs. Probably because they are all off-patent, thus cannot make vast sums of money.

In an attempt to pull all these strands together, if your drug is not selling that well, have a closer look at all the other things it may do. The off-target effects, the ‘pleiotropics’. It has already reached market, at great cost, and whilst you are not allowed advertise it for ‘off-label’ benefits i.e., benefits not studied in the clinical trials, you can hold educational meetings and produce educational booklets to promote these additional things.

You can, effectively, launch it again as ‘Cardura two point one’. Ladies and Gentlemen …. drum roll. ‘A new era in cardiovascular disease prevention has begun.’ Dun, dun, duuuuuuuuun!’

At which point you can purchase a few off the shelf cardiology opinion leaders to push Cardura two point one with great enthusiasm. Throw a few million – carefully labelled – free pens, sticky pads, and BP cuffs around as an appreciative gift to doctors. Take them to a free lunch, sorry, educational meeting. Bore them for ten minutes, then reward them with a prawn sandwich. Feed the sea-lions.

And lo it came to pass that Pfizer scrutinised Cardura in greater detail, and found that it, like aspirin, helped to stop platelets sticking together. Platelets are small cells that float around in the bloodstream and play the key role in blood clotting. They have been described as the conductors of the clotting orchestra.

If you stop platelets sticking together, you can reduce the risk of cardiovascular disease, as was discovered with aspirin. Aha! So, not only does Cardura lower blood pressure, but it also has ‘anti-coagulant’ properties. Even better, it reduced fibrinogen, and PAI-1 and increased TPa activity. These are all ‘good’ in reducing the formation and increasing the breakdown of blood clots. As Pfizer stated:

‘These recent studies suggest that doxazosin may have a range of significant antithrombotic effects in many patients…’

Unfortunately, in 1992 doctors had already been under heavy and continuous bombardment with the message that lowering cholesterol and blood pressure were, by far, the most important things you could possibly do to prevent cardiovascular disease.

Blood clotting? Well, aspirin was used, a bit. But this was mainly to help with the final event. The big blood clot that blocked a major artery. No-one was suggesting that blood clotting had anything to do with atherosclerosis itself.

After all, how can blood clotting possibly cause atherosclerotic plaques to develop? As everyone had already been told, and told, and told … and told, and then told some more, atherosclerotic plaques (the entities that gradually grow and narrow down arteries) were full of cholesterol. Not the remnants of blood clots.

Love and marriage may go together like a horse and carriage, but platelet aggregation and atherosclerotic plaques …. You certainly cannot get a rhyme out of that – go on, I challenge you. Ergo, it must be wrong.

It was certainly a big mountain to climb. ‘You know that stuff about cholesterol…. Sorry. Turns out we should have been looking at Platelets and blood clotting instead.’ Here from a booklet on Cardura in 1992:

Platelets and atherosclerosis progression

Several features of mature plaques, such as their multi-layered pattern, suggest that platelet aggregation and thrombus formation are key elements in the progression of atherosclerosis. Platelets are also known to provide a rich source of growth factors, with can stimulate plaque development.

Given the insidious nature of atherosclerosis, it is vital to consider the role of platelets and thrombosis in this process, and the serious events that may be triggered once plaques are already present.

Goodness me. Who said all this? Why, of course it was Pfizer … Pfizer, Pfizer, Pfizer.

However, they didn’t get very far with this story. Merck were hammering away with simvastatin (Zocor) and Bristol Myers Squibb were also promoting pravastatin (Pravachol) with relentless fervour. The world of cardiovascular disease prevention was moving even more firmly in the direction of cholesterol lowering and statins.

As King Cnut (Canute to you and me) once demonstrated, once the tide starts to come in, not even a king can stop it. And the statin wave was very powerful. On the basis that, if you can’t beat them, join them, Pfizer decided to ride that wave. So, they went out and bought a large part of it, then bought the surf-boards and the tinnies.

To their (money making) credit, they then rode the cholesterol wave exceptionally well. To be frank you would buy a used car from Pfizer. I don’t know how they got so brilliant at spraying bull-shit with yellow paint, to make it look like one-hundred per-cent gold bullion, but there is no doubt they are the masters of pharmaceutical marketing.

At which point the Kendrick and Pfizer, planets were no longer in alignment. We span off on different orbits. I was still slowly plodding along the ‘platelets and atherosclerosis progression’ path, trying to make sense of it all.

Pfizer, to flip my analogies, firmly jumped on the ‘all singing, all dancing’ cholesterol lowering bandwagon.’ Complete with dancing girls in fancy costumes, a brass band, champagne, hundreds of balloons – and all the key opinion leaders in cardiology singing ‘We’re in the money.’

We’re in the money

We’re in the money

We’ve got a lot of what it takes to get along

We’re in the money

The sky is sunny

Old man depression, you are through you done us wrong, oh

We never see a headline

‘Bout a breadline today

And when we see the landlord

We can look that guy right in the eye

Oh, We’re in the money

Come, on my honey

Let’s lend it, spend it, send it rolling around…

And lo it came to pass that Pfizer and I were no longer friends. But there was a time when I like to think we could have danced all night, and still have begged for more. I could have spread my wings, and done a thousand things, I’ve never done before. Yes, my bandwagon would have been much better. Better music too. John Martyn, Fleetwood Mac, Randy Newman, The Pretenders, Jools Holland ….

Yes, it’s a little bit funny that Pfizer knew, thirty years ago, that blood clotting and atherosclerosis were intimately connected. They had seen the research. They knew:

‘Important evidence is now emerging that the selective alpha-1 inhibitor, doxazosin, in addition to its beneficial effects on elevated blood pressure and the serum lipid profile, may help to intervene in the evolution of thrombosis, a key component of atherosclerosis.’

In my recent book The Clot Thickens, I said I would put up the Pfizer booklet for all to see. It proved a bit more of a technical challenge than I thought, but here it is. And when people tell me that atherosclerotic cardiovascular disease (ASCVD) is all due to raised cholesterol I can say, not even Pfizer believes that. Not really. Not deep in their hearts …. They have a ghost in the machine that still stalks the corridors of Pfizer HQ. And if it doesn’t, it should.

They knew, oh yes once upon a time, they knew. It’s just not very profitable for them to admit it. To quote John Martyn:

Half the lies I tell you are not true.’

Introduction

To date, most of our attempts to prevent atherosclerosis have centered on the control of hypertension and hyperlipidaemia, as well as lifestyle factors . However, recent insights into the pathology of coronary heart disease have sharpened our focus on the natural history of atheroma and its relentless progression to acute cardiac events.

Platelets and atherosclerosis progression

Several features of mature plaques, such as their multi-layered pattern, suggest that platelet aggregation and thrombus formation are key elements in the progression of atherosclerosis. Platelets are also known to provide a rich source of growth factors which can stimulate plaque development.

Given the insidious nature of atherosclerosis, it is vital to consider the role of platelets and thrombosis in this process, and the serious events that may be triggered once plaques are already present.

Fibrinolysis

If fibrinolysis is incomplete, thrombus may become incorporated into the plaque, and may cause severe stenosis. Alternatively, any residual thrombus can act as a powerful stimulant to further platelet aggregation. The growing mass of fibrin, platelets and enmeshed red cells may become solid enough to cause complete vessel obstruction.

It is significant to note that complete obstruction and myocardial infarction often develops from mild lesion initially causing less than 50% stenosis. Rupture of these plaques and the cascade of events that leads to thrombosis can occur rapidly and it now recognized as a common and major precipitant of unstable angina, myocardial infarction and sudden cardiac death. Studies suggest that thrombotic events may account for up to 90% of acute myocardial infarction.

Triggering factors in thrombosis

Hypertensive patients are known to have greater platelet adhesiveness and aggregability, which could increase clot formation at the site of plaque injury. In addition, thrombolysis is often defective in hypertension and hyperlipidaemia, which may result in an impaired ability to dissolved clots in the presence of atherosclerosis.

Clot propagation

Any residual thrombus can act as a powerful stimulant to further platelet aggregation. The growing mass of fibbing, platelets and enmeshed red-cells may become solid enough to cause complete vessel obstruction.

It is significant to not that complete obstruction and myocardial infarction often develops form mild lesions initially causing less than 50% stenosis. Rupture of these plaques and the cascade of events that leads to thrombosis can occur rapidly and it now recognized as a common and major precipitant of unstable angina, myocardial infarction and sudden cardiac deaths. Studies suggest that thrombotic events may account for up to 90% of acute myocardial infarctions.

The atherosclerotic process begins with infiltration of low-density lipoproteins or LDL into the arterial intima to create lipid-rich foam cells which form the basis of the ‘fatty streak.’ This early lesion contains large amounts of cholesterol, but its development to atherosclerosis is not inevitable. Progression appears to depend critically upon endothelial injury, caused by oxidation of LDL by the shearing forces of hypertension and by smoking.

Conclusion

With each decade, new insight is gained into how drug therapy can reduce the risk of coronary heart disease and stroke, the primary goal in the management of the hypertensive patient.
Important evidence is now emerging that the selective alpha-1 inhibitor, doxazosin, in addition to its beneficial effects on elevated blood pressure and the serum lipid profile, may help to intervene in the evolution of thrombosis, a key component of atherosclerosis.

The Document is called Pathological Triggers ‘New Insights into Cardiovascular Risk.’

Produced by Medi Cine Inc
488 Madison Avenue
New York
NY 10022

For Pfizer Inc
New York
NY 10017 Copyright 1992 Pfizer Inc. All rights reserved.

An online meeting on Heart Disease

We Love Our Heart.’ 9th April 2022

Please sign up here

Ivor Cummins [not Cummings please Mr spell check] has organised an on-line meeting on the 9th of April. Ivor is a brilliant man. He must be, he asked me to give one of the talks. He has brought together a great list of presenters who have been innovative thinkers in the world of cardiovascular disease for many years.

We are all, in different ways, trying to break out of the suffocating embrace of the ‘diet-heart cholesterol hypothesis’ and move things along. Our focus and thoughts are not exactly the same – thank goodness. Ivor is highly focussed on the metabolic causes of heart disease. Essentially insulin resistance, type II diabetes and suchlike.

Others have been researching the microbiome and related issues. However, the approaches are all complementary. Those who have read my stuff will know that there is not one cause of heart disease, there are many. Equally, you are not going to protect yourself against heart disease doing one thing. You need to do many.

The purpose of this conference is to look at many different areas, and many different approaches, to discuss how each of them can provide benefit. The synergies that you can find. There is also an opportunity to discuss your specific questions with the presenters. I hope this conference will be the first of many.

Please sign up. Thank you.

Why do we have Experts?

9th March 2022

The COVID19 pandemic has thrown an issue into sharp focus that I have been observing for many years now. What is an expert? The simple answer is someone who has expertise. Deep knowledge of a subject that has been gained by spending many years researching, reading, speaking to colleagues, and suchlike.

However, that is clearly not enough. I have spent years researching cardiovascular disease. I have written papers about it, written books, given lectures… but I have never been referred to, by any in mainstream medical research at least, as an ‘expert’. I am very much something else. A maverick, a denier, zealot a … [insert insult of choice here].

I used to joke that there must be a secret expert exam that you have to pass in order to be called an expert. Or perhaps it’s a bit like the Freemasons. Someone has a quiet word in your ear to sound you out. Then asks if you would like to join the international brotherhood of ‘experts.’ Dedicated to something, or other.

Very soon, after the COVID19 pandemic struck, Imperial College Business School had this to say on experts:

‘In 2016, when Michael Gove made his famous statement that “people in this country have had enough of experts”, it seemed experts and expert knowledge were on their way out. The opinion of populist politicians and online influencers were deemed much more relevant to decision making than the findings of scientists or the theories of economists. From the antivax movement to newly resurgent creationists, the spirit of the times was very much against the expert. Science and its evidence-based rationality were in retreat and the trend seemed unstoppable. 

Fast-forward four years and the world is suddenly a very different place. Experts like Imperial College London’s Neil Ferguson, and Peter Piot from the London School of Hygiene & Tropical Medicine are now central advisors to government and the profiles of experts are the material of front-page stories. With the arrival of a global pandemic, experts are back – and with a vengeance!

So, what has changed? And what can we learn from the recent success of the experts who are shaping government policy on coronavirus? First, the experts who are currently leading the government’s policy response to the pandemic are not just experts, they are leaders. They know that simply understanding a topic deeply and having something to say on an issue is not enough.’ Etc. etc, glory glory Imperial College 1.

I found the final sentence interesting. ‘They know that simply understanding a topic deeply and having something to say on an issue is not enough.’

In short, to be an expert you must also be a leader? I think this is probably true …. You certainly have to be at the top of some organisation or other.

Anthony Fauci for example. He was held by the mainstream media to be the number one expert about COVID19. His position unassailable – or at least it was. He was, and remains, the head of the National Institute of Allergy and Infectious Diseases. He remains the Chief Medical Advisor to the President.

Did he know more than anyone else about Sars-Cov2? Was this even a requirement? Tricky, as this was a completely new virus. Was he the perfect man for the job? He most certainly ticked all the expert boxes – so he should have been the ideal man? Hire that man right now…

Of course, there are those who have been far more sceptical about the value added by experts – to anything. David Sackett, who was a driving force behind the Evidence Based Medicine (EBM) movement – and who was also a very good man – wrote an article in 2000 entitled ‘The sins of expertness and a proposal for redemption.’

Here are a couple of sections. I suggest you read the entire article; it is not very long:

‘Is redemption possible for the sins of expertness? The only one I know that works requires the systematic retirement of experts. To be sure, many of them are sucked into chairs, deanships, vice presidencies, and other black holes in which they are unlikely to influence the progress of science or anything else for that matter.’

‘But there are still far more experts around than is healthy for the advancement of science. Because their voluntary retirement does not seem to be any more frequent in 2000 than it was in 1980, I repeat my proposal that the retirement of experts be made compulsory at the point of their academic promotion and tenure.’ 2

In this paper he refers to an earlier piece, written in 1983, where he first called for the retirement of all experts. Having voluntarily ‘retired’ himself as an expert in the field of ‘compliance with therapeutic regimes’. As he added:

I received lots of fan mail about this paper from young investigators, but almost none from experts.’

Some twenty years later he ‘retired’ himself again. This time as an expert in the field of evidence-based medicine, some would say the expert. He believed he had attained too much power and status and was therefore distorting everything around him.

As with all other acknowledged experts, he found that junior researchers deferred to him, and simply would not question him. He came to the conclusion that the very presence of an expert impaired scientific progress. [Of course, of all the experts in the world, he was the one that should not have retired].

In his opinion, experts crystallised into barriers to the progress of new ideas, and most other forms of innovative thinking. Their primary role became an immovable pillar, supporting the existing status quo. Of course, this expert problem has been recognised by many others … For example, Max Plank, in his famous quote:

‘A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.’

Or:

Science advances one funeral at a time.’

So, who you going to call? If, that is, you are a government, and there is a pandemic? You do what everybody does. You call on the established experts. Leaders who sit at the top of the pyramid.

Those professors garlanded with honours. Opinion leaders. Even the mighty key opinion leaders (KOLs). No need to look elsewhere. All the expertise can easily be found, right? And the experts all know each other, so they can also recommend their expert friends – the ones they know and get on with.

A few years ago, there used to be an expression in business, which went something like this: ‘you never get fired for hiring IBM?’ Why not? Because IBM was huge, and they had the reputation of being the major players in IT solutions.

No-one would ever ask you to explain why you hired them. You just did. IBM was also bloated, cumbersome and vastly expensive – containing about as much innovation as a squashed cabbage. Which eventually caught up with them… eventually. Now, you tend to hire another massive company … GE, or suchlike. IBM still exists, but it came very close to the edge.

Of course, everyone needs expertise. If you want to build a bridge, then hire an architect and engineers who are capable of designing and constructing one that does not fall down. This requires skills and knowledge that take years to attain. True, validated, expertise.

Equally, if you want someone to replace your hip, find an anaesthetist and an orthopaedic surgeon, and their team of experts. Don’t pop down the local Botox clinic and hope for the best.

However, if you find yourself in a situation never seen before, where no-one really knows what to do … Then you will find experts are always going to propose doing only what they have always done. What they already know. As used to be said of generals, that they always started off any new war, using the exact same tactics that were being used at the end of the last war. Which never worked. Things had moved on … they hadn’t.

I do find it ironic that when the pandemic started, the key advisor to Boris Johnson was Dominic Cummings? The great ‘disruptor,’ the man who wanted to break apart the ‘cosy establishment’ and replace it with new thinking, and innovation. Here from the article: ‘Dominic Cummings: A model of disruptive leadership?’ [Sub-header. “The best way to spot those at the vanguard of disruption is by their unpopularity”].

The underlying problem is widespread institutional inertia that serves to contain rather than facilitate change. Leaders soon realise that being truly disruptive carries risks that either they, their board-level superiors, or those they lead find hard to tolerate. Few therefore follow through on good intentions, the common default being safety first…

Rightly or wrongly, Cummings believes the UK is being held back by a cosy establishment that stands in the way of reform. He openly disdains convention, as when deliberately bypassing traditional campaigning methods to sell Vote Leave’s ‘Take Back Control’ message, even if this means sailing close to the ethical wind.

You can tell that Cummings hits raw nerves because criticism of his modus operandi is laced with attacks on everything from his personal manner to his dress sense. But you wouldn’t bet on him lasting much longer in the Whitehall machine. The quicksand of inertia has a habit of swallowing disrupters in organisations a lot less complex and cunning than that of government … [Good call]

Change rhetoric might tell us that we need more people prepared to break the mould but our recent political experience indicates that having the will to disrupt rarely guarantees success against stubborn guardians of the ‘same old, same old’. 3

Well, as everyone in the UK knows, Dominic Cummings is now history. Disruptor no more. However, in February/March 2020 he was still very much in place – and he had Boris Johnson’s ear, as his most trusted advisor. You might have thought, therefore, that the scientific advisory group for emergencies (SAGE) would have contained a disruptor or two.

But no, we got the exact same old, same old. The well-established experts. The Chief Medical Officer, the Deputy Chief Medical Officer, the Chief Scientific Officer, the chief of this, the professor of that.

The great problem is that this ‘same old same old’ was going to have an in-built, and almost pathological resistance to risk – of any sort. In this case, by risk, I mean doing anything that is slightly different. Anything that may open you up to criticism. This is the main reason why the SAGE doomsday predictions have never matched reality.

Just as you never got fired for hiring IBM. If you are an epidemiologist, you never get fired for modelling a worst-case scenario. If you say there will be six thousand Omicron deaths a day – in the UK alone – yet the highest number reached was three hundred. Then are safe. This is the approved, standard direction of error.

On the other hand, if you said there would be three hundred deaths a day and it ended up at six thousand… all hell breaks loose. To quote Professor Graham Medley, who chaired the SAGE modelling group.

‘Professor Medley said one of the ‘worst things’ would be for the modellers to under-predict the approaching wave.

He told MPs: ‘The worst thing for me as chair of the committee is for the Government to say “why didn’t you tell us it would be that bad?”, so inevitably we are going to have a worst case that is worse than reality.4

inevitably we are going to have a worst case, that is worse than reality’… Roll that idea around for a moment or two. I did, and this was my interpretation. ‘Inevitably, our models will always be worse than the worst thing than can ever happen.’ Ergo, our models are designed to be utterly useless and inaccurate. A great way to plan your response?

Any decent disruptor would have questioned the assumptions underlying this ‘worst thing’. A disrupter would flip the question on its head. The worst thing, surely, would be to drive the Government into a massive over-reaction that could lead to such things as … thousands of deaths from undiagnosed cancers.

Or patients dying of heart attacks, terrified to attend hospital. Or care homes being flooded with COVID19 positive patients, because the hospital had to be cleared out. Or a tidal wave of mental health problems in children and adolescents. Or an increase in domestic abuse. Or … keep going, there are many damaging things that were caused by lockdown.

They would also have questioned the massive financial cost of extended lock-downs. The new hospitals that could not be built in the future. The much-needed healthcare staff not being hired – because we have run out of money. The inability to pay inflation matching pay rises, leading to staff resignations and loss of morale. The drugs that can’t be paid for, and on and on.

They would have remined those on the advisory board that this was not a zero-sum game. Every COVID19 death prevented, no matter how much it costs, is not necessarily a positive. There will be major, damaging, downsides to your actions, and these have to be taken into account.

However, if you stuff your advisory body with established experts you will get what you got. A group of people whose primary motivation is to ensure that they cannot be blamed for making a mistake. They will ‘hire IBM’. They will battle to maintain the status-quo. ‘Think of how terrible things would have been if we had not driven lock-downs on the entire country for weeks and months.’

Disruptor: ‘Look at how badly wrong your predictions have been, and the enormous and widespread damage you have caused. The cost of which may never even be known.’

Yes, as you can probably gather, I am not a great fan of experts. Of course, I do love expertise… and I love doing things as well as possible. At least those things that have been proven to work. I love innovation, and new thinking. Different ways of looking at the world.

What I hate, what we should all hate, is that any attempt to shift the status quo seems doomed to fail:

‘Change rhetoric might tell us that we need more people prepared to break the mould, but our recent political experience indicates that having the will to disrupt rarely guarantees success against stubborn guardians of the ‘same old, same old’.

When COVID19 arrived, we needed disruptors, new ways of thinking, and acting. We needed clear sighted innovators. What we got, predictably, inevitably, depressingly, were ‘experts’ to lay their cold, dead, hands on the situation. Experts desperate never to be ‘wrong.’ Having first decided what wrong meant. In this case it meant never, ever, underestimating the number of COVID19 deaths.

At this point I feel the need to quote David Sackett once more: I repeat my proposal that the retirement of experts be made compulsory at the point of their academic promotion and tenure.

Hear, hear. ‘Do I have a second for this proposal?’

1: https://www.imperial.ac.uk/business-school/ib-knowledge/strategy-leadership/coronavirus-and-the-return-the-expert

2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118019/

3: https://www.managementtoday.co.uk/dominic-cummings-model-disruptive-leadership/food-for-thought/article/1673425

4: https://www.dailymail.co.uk/news/article-10571661/SAGE-expert-says-wildly-wrong-Omicron-death-predictions-failed-account-behaviour-change.html

Vaccination – silencing doctors in the UK

27th February 2022

My last blog discussed the possibility that mRNA COVID19 vaccines significantly increase the risk of myocarditis. Following this, a fellow doctor reached out to tell me about what has happened to them. They too, had questioned some aspects of the safety and efficacy of the vaccines.

As a result, they have been sent two threatening letters, which are both of the ‘iron fist in a velvet glove’ variety. I asked their permission to reproduce them here. One is from the General Medical Council (GMC). The other from their responsible officer – I shall explain what this title means a bit further on.

Below is the letter from the GMC:

Dear Dr….

The GMC have received several complaints regarding your recent social media posts.

All doctors have a right to express their personal opinion regarding the Covid-19 vaccine, and while the GMC in no way supports this opinion, we don’t consider your comments are sufficiently strong to open a fitness to practice investigation at this stage.

However, we are referring this matter to your Responsible Office for your reflection through the appraisal process.

We ask that you consider what implications this complaint might have for your practise when you are discussing this with your appraiser. We would also like to remind you of GMC guidance, in particular ‘Doctors’ use of social media, and of the requirement of doctors to act with honesty and integrity to justify the public’s trust in them

What we will do now

We will share the complaint with your responsible officer for them to consider in the wider context of your practice and revalidation.

‘The wider context of your practice and revalidation.’ Which means what, exactly? I sometimes wonder if there a special training scheme where you learn to write creepy and threatening phrases that can later be denied as being creepy and threatening? ‘I was only trying to be nice. They just took it the wrong way.

‘Your children look charming. However, you may want to consider their continued existence on the planet in the wider context of your practice.’

The GMC, as mentioned before, have the powers to investigate complaints made against doctors in the UK, and impose various punishments (they call them sanctions, which sounds far prettier). Ranging from nothing very much to permanent erasure from the medical performers list.

The latter means that you cannot work as a doctor ever again. Anywhere in the world. The GMC will communicate your erasure to other national statutory bodies, upon request. They do it gladly… and speedily.

On the face of it, in this case, the GMC have decided to do nothing. ‘We don’t consider your comments are sufficiently strong to open a fitness to practice investigation at this stage.’

Jolly good.Nothing to see here, move along. Although they add the rider … ‘at this stage.’ Well, what other stages are left, after deciding to take no action? The … I have changed my mind and I am going to have you guillotined, stage?

However, in reality they have not done nothing – have they dear reader? The GMC have decided to refer the complaint to this doctor’s responsible officer. A responsible officer is a doctor who is ‘responsible’ for ensuring that other doctors working in their area have met the necessary requirement for revalidation.

Revalidation is a five-year cycle whereby a doctor has to meet various requirements. A few hundred hours of medical education, keeping up do date with mandatory training. Carrying out an audit, and a patient satisfaction questionnaire, getting sufficient colleague feedback, and suchlike.

There is also a need to have a yearly appraisal. Which is a meeting with an allocated appraiser, to discuss how things have gone. A look through any complaints about you, work you have done, audits that have been completed, actions to take in the next year to improve your practice – a personal development plan. Release of thumbscrews – or a tightening.

If all this is done successfully, over a five-year period, the responsible officer ‘signs you off’ and you are now able to continue work. If not, you are removed from the performers list, and you cannot work as a doctor until you are successfully re-validated. No-one has ever explained to me how you actually do get revalidated. In fact, there is no system in place for this to happen.

If you manage to fulfil the re-validation cycle, and attend appraisals, in theory there can be no grounds for removal. You cannot actually ‘fail’ an appraisal. You simply have to turn up, and ‘reflect’ on your practice. I have never heard of a responsible officer stepping in to remove a doctor from the performers list any time they so wish.

Bearing all that in mind, here is the follow up letter from the responsible officer.

Dear Dr….

I have today received a communication from the GMC regarding an ‘incident that occurred on social media.’ The GMC have advised that they have reviewed the complaint and that it does not meet the threshold for investigation.

However, I understand that you have been asked to consider what implications this complaint may have for your practise and there is a requirement for you to reflect on this matter at your next appraisal meeting.

As your Responsible Officer I have a statutory duty to ensure that any concern or complaint about your practise is responded to and dealt with appropriately.

I would be grateful if you could let me have your views on this issue, by completing the attached form and returning it as a matter of urgency.

Can you also complete the attached Monitoring of Clinical Practise for your file, please.

Your co-operation with this process is vital in order for us to come to an acceptable resolution as soon as possible, minimising impact to your practice and cost in time and money.

If you have any questions regarding this process, please to contact me to discuss further.

Kind regards

Dr X

Responsible Officer for X region.

I love the ‘Kind regards’ sign off. For this is a letter dripping with unspoken menace. Just to highlight one phrase ‘An incident that occurred on social media…’ An ‘incident’. You mean, someone wrote something that someone didn’t like, they then complained about it. This was not an incident, in the sense that anyone would normally choose to use this word.

[I also note that the GMC spells practice, practice. The responsible officer spells it practise – maybe they need to reflect on their spelling between them].

If you look up the word ‘incident’ on the Cambridge Dictionary it gives an example of its use:

‘A youth was seriously injured in a shooting incident on Saturday night.’1

It does not say. ‘Someone wrote a blog post that upset someone, somewhere, for a bit. But it’s alright now, they are looking at pictures of kittens to recover.’

Words. Words, words, words. They can be used in so many different ways. Their true meaning hidden behind layers of sophistry. But we all know what the word ‘incident’ means in this case. Someone was badly damaged by your actions on that day – do not attempt to deny it, comrade.

Then we move onto the real threat. The responsible officer wants to ensure an acceptable resolution, thus … ‘minimising impact to your practise and cost in time and money.’

What the responsible officer here is saying is that I have the powers to stop you practising medicine in the UK. If I find that your answer to this complaint – which was not strong enough to open a fitness to practice investigation by the GMC – does not satisfy me. Indeed (subtext), I do not actually care what answer you give, I may remove you anyway. This will certainly maximise the impact on this doctor’s ‘practise and cost in time and money’.

If you think this is not what is being threatened. Then ask yourself what else it could mean? There is nothing that needs to be ‘resolved’. A complaint has been made, but the GMC didn’t think it was serious enough to take forward. No patient was harmed, no laws broken … no wrecks and nobody drowned, in fact nothing to laugh at, at all. (small prize for who knows where that came from).

At this point you may have begun to allow the thought to enter your mind that the GMC have quite deliberately handed this complaint down to the responsible officer to carry out the required sentence and execution. Whatever the accused doctor says, the responsible officer can simply respond. ‘Sorry, not satisfied with your answer. I am now going to stop you working – for as long as I wish.’ No hearing, no possibility of review, no accountability. Bosh.

In truth I have always known that responsible officers possess this amazing and unrestrained power. I tried, and failed, to stop this happening years ago – when I was on various British Medical Association (BMA) committees. I found it incredible that the legislation in this area was going to hand over, to one individual, the ability to destroy someone’s career, with no regard to anyone else, or anything else.

Yes, we live in a democracy that has created a form of local tyranny.

Tyranny (noun) def: government by a ruler or small group of people who have unlimited power of the people in their country or state and use it unfairly, and cruelly.

You could say that this situation suits the GMC very well … Very well indeed. Because, you see, the GMC has tried to remove other doctors from the medical register for criticising vaccination. [The medical register is not quite the same thing as the performer’s list, but you need to be on both of them to work as a doctor in the UK].

These punishments were quashed in the High Court. Here from a legal firm that works in this area:

‘On Friday, the High Court handed down a judgment quashing the GMC interim order of conditions previously imposed on a GP, Dr Samuel White, as a result of his actions arising from the pandemic.  Dr White came to the GMC’s attention as a result of “spreading misinformation and inaccurate details about the Coronavirus and how it is diagnosed and treated”.  His comments have included assertions that the COVID-19 vaccine “inserts a code”, masks do “absolutely nothing” and hydroxychloroquine, budesonide inhalers and ivermectin are “safe and proven treatments”.  

The interesting point arising from Dr White’s High Court appeal is the technical point on which he won. The High Court found that the Medical Practitioners Tribunal Service (MPTS – the adjudication wing of the GMC) panel made an error of law in not properly considering the test required by section 12(3) of the Human Rights Act 1998 when deciding whether to impose an interim order.2

As this company also says:

As time goes on, we’re seeing more fitness to practise cases arising from COVID-19-related activities.  We’ve previously posted about the Irish GP interim suspended after describing COVID-19 as a hoax and the first UK nurse struck off by the Nursing and Midwifery Council (NMC) as a result of COVID-19 denial activities.

‘COVID denial activities’ – what a deliciously Soviet phrase.

I have to say that I very much enjoyed the lawyers’ assertion that the GMC interim order was quashed on a ‘technical point’. Namely that the GMC had failed to consider the small matter of the Human Rights Act 1998. Riding roughshod over someone’s human rights is now a technical point of law. How quaint.

However, undeterred, the GMC have not been deterred from their vital work in punishing COVID-19 vaccine deniers – to ensure that they can never work again. They have just found another, simpler, far cheaper, and far quicker route to obliterate a doctor’s career. Call the responsible officer. No-one expects the responsible officer.

Who needs time consuming and costly hearings, where you might have to bear in mind the Human Rights act 1998 – and other such woolly liberal nonsense? When you can alert the local ‘tyrant’ to a doctor’s non-comradely Soviet ‘denial’ activities. Sorry, COVID19 ‘denial’ activities.

They will know precisely what to do, and they have the powers to do it. Why on earth did the GMC not think of this of this before? I could have told them about the ridiculous, frightening, and untrammelled powers of a responsible officer, but they never asked me.

Of course, you could argue the following. If the local responsible officer does obliterate someone’s medical career and does this without paying any heed to such things as well, the law, for example, then their actions will be over-turned in court. Well, I certainly hope so, in fact I would expect so. This may act as a deterrent … maybe.

However, during the months, or years, that it takes to get such a case to court, the doctor will be out of work and unable to earn. They will almost certainly end up bankrupt, and their reputation (have been struck off the performers’ list) will lie shattered in the gutter.

As for the responsible officer. Their punishment ‘please don’t do it again,’ would just about cover it. This is very much asymmetric warfare. I can punish you, terribly, but you can do absolutely nothing to me in return.

In the financial world they call this moral hazard. A banker can bankrupt you, and your family, and half the country, making stupid and risky decisions – that will earn them huge short-term bonuses. If, as a result, their bank goes bust, the Government simply bails them out and they keep their job, and their bonus. All gain, no pain.

As a sign off, the responsible officer (washing his hands of any personal responsibility of course) wrote this ‘I have a statutory duty to ensure that any concern or complaint about your practise is responded to and dealt with appropriately.’ Kind regards … Pontius.

However, one thing that has not happened, so far, is to actually take the time and effort to forward a copy of the complaints to the doctor concerned. Still, they must be guilty of something or other. So, it is clearly critical that they respond to these unknown complaints, of some sort or another, in some-way or other. ‘Here is a bottle of whisky, and a revolver…. You know what you must do.’

What a world this has become. I had hoped I would not live to see such a time in this country, but I have.

1: https://dictionary.cambridge.org/dictionary/english/incident

2: https://www.brabners.com/blogs/high-court-quashes-doctors-gmc-interim-order-arising-covid-19-activities

A few thoughts on COVID19 vaccination

23rd February 2022

The first thing I want to say here is that there should be nothing in science that is beyond analysis and potential criticism. Because, once this happens, we can find ourselves in a very dangerous situation indeed. A place of unquestioned acceptance of the accepted narrative, with criticism enforced by the authorities.

Unfortunately, I believe this is the place we have reached with COVID19 vaccination. Here is just one example from the UK.

‘GPs have been warned that criticising the Covid vaccine or other pandemic measures via social media could leave them ‘vulnerable’ to GMC* investigation.’1

*GMC = General Medical Council. This is the body that can strike doctors from the medical register so they cannot work as a doctor.

‘Vulnerable to GMC investigation’. What a deliciously creepy phrase that is, dripping with unspoken menace, whilst pretending to be helpful. It sounds like something the Mafia would come up with.

‘I would keep quiet about this, if I were you.’ Baseball bat tapping gently on the floor. ‘No, this is not a threat, think of it as advice from a friend. We don’t like to see anybody making themselves, or their family, vulnerable, and getting seriously injured now, would we?’

It seems that, unless you prostrate yourself before the mighty vaccine, and intone ‘Our vaccine, which art in heaven, hallowed be thy name…’ and suchlike, you will be attacked from all sides … simultaneously. Indeed, to suggest that vaccines are not perfect in every way is the twenty first century’s equivalent of blasphemy.

he said Jehovah. Stone him.’

This does make any discussion on vaccines somewhat tricky. To criticize any individual vaccine, indeed any aspect of any individual vaccine, is also to be instantly defined as an anti-vaxxer. Then you will be furiously fact-checked by someone with a fine arts degree, or suchlike, who will decree that you are ‘wrong’.

At which point you will be unceremoniously booted off various internet platforms – amongst other sanctions open to the ‘vulnerable’. This includes, for example, finding yourself struck off the medical register, and unable to earn any money:

            ‘Hell, we ain’t like that around here. We don’t just string people up, son. First, we have a trial to find ‘em guilty, only then do we string ‘em up. Yeeee Ha!’

Spit … ding!

Yes, it seems you must support the position that all vaccines are equally wonderful, no exceptions. Try this with any other pharmaceutical product. ‘He doesn’t think statins are that great, so he obviously believes that antibiotics are useless.’ Would this sound utterly ridiculous?

But with vaccines… All are the same, all are great, not a problem in sight? I said, NOT! a problem in sight. However, I genuinely believe there are some questions which still have not been answered and simply because of the different types of vaccines that are available, no, not all vaccines are the same.

Just for starters, vaccines come in many different forms. Live, dead, those only containing specific bits of the virus, and suchlike. Now we have the brand new, never used on humans before, messenger RNA (mRNA) vaccines. So no, all vaccines are not alike. Not even remotely.

In addition to the major difference between vaccines, the diseases we vaccinate against vary hugely. Some are viruses, others bacteria, others somewhere in between, TB for example.

Some, like influenza, mutate madly in all directions. Others, such as measles, do not. Some viruses are DNA viruses – which tend to remain unchanged over the years. Others, e.g. influenza, are single strand RNA viruses, and they mutate each year.

Adding to this variety, some of those viruses which mutate very little, also have no other host species to hide in. Smallpox, for example. Which means that the virus was unable to run away and hide in, say, a chicken, or a bat. Others are fully capable of flitting from animal species to animal species. Bird flu and Ebola spring to mind.

Some vaccines just haven’t worked at all. For over thirty years, people have tried to develop an HIV vaccine, and have thus far failed. Early trials on animal coronavirus vaccines also showed some concerning results. Here from the paper ‘Early death after feline infectious peritonitis virus challenge due to recombinant vaccinia virus immunization.’

The gene encoding the fusogenic spike protein of the coronavirus causing feline infectious peritonitis was recombined into the genome of vaccinia virus. The recombinant induced spike-protein-specific, in vitro neutralizing antibodies in mice. When kittens were immunized with the recombinant, low titers of neutralizing antibodies were obtained. After challenge with feline infectious peritonitis virus, these animals succumbed earlier than did the control group immunized with wild-type vaccinia virus (early death syndrome).’2  

Yet, despite all this massive variety flying in all directions, with some spike protein vaccines found to increase the risk of death (in a few animal studies), attach the word vaccine to any substance, and it suddenly has miraculous properties that transcend all critical thought. Vaccines move in mysterious ways, their wonders to perform.

Yes, of course, some have worked extremely well. The polio vaccine, for example, although I have seen some valid criticisms. Smallpox… I am less certain about. Even though it is held up as the greatest vaccine success story of all. Maybe it was. Smallpox has certainly gone, for which we should be truly thankful. It was a truly terrible disease.

My doubts about the unmatched efficacy of smallpox vaccine simply arise from the fact that diseases come, and diseases go. The plague, for example. This was the scourge of mankind at one time. It tore round and round the world and leaving millions of dead in its wake, over a period of hundreds of years.

We do not vaccinate against the plague, yet it is virtually unknown today. Cholera killed millions and millions, thousands each year in the UK alone. Now … gone. In the UK at least. This had nothing to do with vaccination either. Measles. There seems little doubt that the measles vaccine is effective. But vaccination cannot explain the fact that measles deaths fell off a cliff and were bumping along the bottom for years and long before we started vaccination programmes.

In the US vaccination did not begin until 1963. So, what happened here? The virus did not mutate, so far as we know. It did not mutate because apparently it cannot. Or, if it did, it would no longer be able to be infective. At least not to humans:

‘While the influenza virus mutates constantly and requires a yearly shot that offers a certain percentage of protection, old reliable measles needs only a two-dose vaccine during childhood for lifelong immunity. A new study publishing May 21 in Cell Reports has an explanation: The surface proteins that the measles virus uses to enter cells are ineffective if they suffer any mutation, meaning that any changes to the virus come at a major cost.’3

So, measles didn’t change, but it did become far less damaging. From around ten deaths per one hundred thousand in the first two decades of the twentieth century, down to much less than one.

Why? What I believe happened with measles is primarily that the ‘terrain’ changed. Nutrition greatly improved. Vitamins, perhaps most importantly vitamin D, were discovered and added to the food supply. Rickets and other manifestation of vitamin D deficiency were rife in the late nineteenth and early twentieth centuries. Virtually gone by 1940.

Of course treatments improved as well, although antibiotics (to treat secondary bacteria pneumonia following measles), did not come into play until the late 1940s, at the earliest.

What we see with measles is simply the fact that infectious diseases have far less impact when they hit a healthy, well nourished person (healthy terrain), than when they hit an impoverished and undernourished child caught in the war in the Yemen, for example.

So, yes, vaccines have played a role in improving human health and wellbeing, but we shouldn’t inflate their impact to the point where they have become the unmatched saviours of humankind. They have certainly not been the only thing that reduced the impact of infectious diseases. They were probably not even the most important thing. ‘Yes … how dare you say this… string up the unbeliever, I know, I know.

Moving on, and and I think this is even more pertinant to the disucssion that follows. If we cannot accept the possiblility that, at least some vaccines, may have significant adverse effects, if we will not permit anyone to look into this, in any meaningful way. Then we can never improve them. Criticism is good, not bad.

Speaking personally, I do not criticize things that I do not care about. Primarily, because I don’t care if they improve, or not. I only criticize things when I want them to be as good as they possibly can be. It is a character trait of mine to hunt for flaws, and potential problems. Both real and imagined.

Some criticism is, of course, close to bonkers. Suggesting that COVID19 vaccines contain transhuman nanotechnology and microchips of some kind that will become activated by 5G phones … to what end? ‘World domination Mr Bond. Mwahahahahaha etc.’ Quantum dots? Yes, these do exist. But they would be pretty useless at collecting informaiton, and suchlike. Give it fifty years and … maybe.

The problem here is that wild conspiracy theories are simply gathered together with reasonable science-based criticism, to be dismissed as a package of equally mad, unscientific woo-woo tin-foil hat wearing, conspiracy theorist, gibberish.

Which means that, when people (such as me) suggested that COVID19 mRNA vaccination could, potentially, lead to an increased risk of blood clots – this was treated with utter scathing dismissal. I did not understand ‘the science’ apparently. Fact check number one. ‘Oh, look… clots.’

When people questioned the ‘fact’ that the safety phases of the normal clincial trial pathway had been seriously truncated, and that some parts were just non-existent, they were told that they knew nothing of ‘the science’ either.

I looked on the BBC website to find out the ‘official’ party line on vaccine safety information, sanctioned and approved by HM Govt, and SAGE I presume. It was an article entitled ‘How do I know if the vaccine is safe?’ The information rapidly contradicts reality. They say:

  • There are different approved types and brands available and all have undergone rigorous testing and safety checks
  • Safety trials begin in the lab, with tests and research on cells and animals, before moving on to human studies
  • The principle is to start small and only move to the next stage of testing if there are no outstanding safety concerns

The article then looks at fast track approval for vaccines against new variants

  • The UK’s drug regulator says new vaccines can be fast tracked for approval if needed.
  • No corners will be cut, with safety paramount.
  • But lengthy clinical trials with thousands of volunteers will not be needed4

What is wrong here? Well, ‘if the principle is to start small and only move to the next stage of testing if there are no outstanding safety concerns,’ then this principle was not followed. After pre-clinical and animal testing, we move onto trials in humans. Phase I, then II and then III.

Phase I may include as few as twenty people to check that humans don’t simply drop dead on contact with the new agent (it has happened).

Phase II may include a couple of hundred individuals, and usually lasts a few months… a bit more safety, and an attempt to establish the potential size of any health benefit.

Phase III may have up to thirty or forty thousand participants. This phase often lasts for several years.

Well, with the Pfizer Biontech vaccine, the concept of waiting to move to the next stage of testing did not truly occur. Because phase II and III were combined… and the phase III trials have now been, effectively abandoned. They were not supposed to finish until May 2022 at the earliest, and now apparently, they are not going to finish at all. At least not as a double-blind placebo controlled trial.

Yet, we are still informed by the BBC, in all seriousness, that no corners were cut, or will be cut. The fact is that corners were absolutely one hundred per cent cut. Slashed to the bone would perhaps be more accurate. To pretend otherwise is simply to deny reality.

It normally takes around ten years for any drug, or vaccine, to move through the clinical trials process, with each step done in series. COVID19 vaccines took around six months from start to finish, with critical steps done in parallel, and the animal testing was rushed – to say the least. To claim that no corners were cut is nonsense. Nonsense that we are virtually forced to believe?

It is possible/quite likely/probable that vaccine development can be shortened, but please do not tell us that all the normal processes were followed.  No-one is that easily fooled.

‘Freedom is the freedom to say that two plus two make four[NK1] . If that is granted, all else follows.’ That freedom disappeared pretty early on in the COVID19 pandemic. I enjoyed the slant that ‘Important quotes explained’ had on the quote from Orwell’s 1984.

By weakening the independence and strength of individuals’ minds and forcing them to live in a constant state of propaganda-induced fear, the Party is able to force its subjects to accept anything it decrees, even if it is entirely illogical.

Of course, it could be that despite the speed with which these vaccines were pushed through nothing important was missed. It is almost certainly true that the standard ten years from start to finish in vaccine and drug development can be compressed, if everyone really wished. Bureaucracy expands to fill the space available.

But in general we are talking about a ten-year process, cut down to six months, or thereabouts. An additional concern is that this happened using mRNA vaccines, which represent a completely new form of technology. One that has never been used on humans before at all, ever.

We are not talking about the sixth drug in a long line of very similar drugs e.g. the statins.

  1. Lovastatin
  2. Fluvastatin
  3. Simvastatin
  4. Pravastatin
  5. Atorvastatin
  6. Cerivastatin
  7. Rosuvastatin etc.

Statins all do pretty much the exact same thing thing, in exactly the same way. Yet, each one fo them still had to go through the entire laborious clincial trial process. Years and years.

‘Can we not just skip this phase….please?’

‘No.’

‘Please?’

‘No.’

Hold on one moment, just step back, what was that at number six on this list, I hear you say… cerivastatin. You mean you’ve never heard of it. Well, it got through all the pre-clinical trials, then the animal trials. It then sailed through the human Phase II and III trials without a murmur. It was then was launched to wild acclaim. In truth that may be over-egging its real impact, which was a bit more ‘who cares, do we really need another one?

Here from a 1998 paper: ‘Clinical efficacy and safety of cerivastatin: summary of pivotal phase IIb/III studies.’

‘In conclusion, these studies indicate that cerivastatin is a safe and effective long-term treatment for patients with primary hypercholesterolemia and also suggest that higher doses should be investigated.’ 5

Here from 2001, and an article entitled: ‘Withdrawal of cerivastatin from the world market.’

‘Rhabdomyolysis was 10 times more common with cerivastatin than the other five approved statins. We address three important questions raised by this withdrawal. Should we continue to approve drugs on surrogate efficacy? Are all statins interchangeable? Do the benefits outweigh the risks of statins? We conclude that decisions regarding the use of drugs should be based on direct evidence from long-term clinical outcome trials.’ 6  

Yes, as it turns out, cerivastatin caused far more cases of severe muscle breakdown, and death, in a significant number of people. Which meant that it was hoiked from the market.

The moral of this particular story is that, even if you DO do all the clinical studies, fully and completely, one step at a time, over many years, in a widely used class of drug, your particular drug may still be found in the long term, not to be safe. Not even if it is the sixth of its class to launch.

The cerivastatin withdrawal is not an isolated event. You can, if you wish, read this paper ‘Post-marketing withdrawal of 462 medicinal products because of adverse drug reactions: a systematic review of the world literature.’7. So, what happens if you try to compress the entire ten year clinical trial process into around six months, on a completely new type of agent?

… Well then, it may be time to cross your fingers and hope for the best. But please do not insult my intelligence, or the intelligence of anyone else, by trying to tell me that vaccines have undergone: Rigorous testing and safety checks. Compared to what, exactly? Certainly not any other drug or vaccine launched in the last fifty years. ‘We rushed them through, and launched two years before the phase III clinical trials were due to finish.’ would be considerably more accurate.

Two plus two does not equal five, it never has, and it never will. However much you try to browbeat me, and everyone else, into accepting that it does. Indeed, as I write this, the simple fact is that not a single phase III clinical trial has yet ever been completed, on any mRNA COVID19 vaccine, and possibly not ever will be, in truth.

To repeat, this does not mean that mRNA vaccines may not be entirely safe. However, it has become impossible to to claim that we have not seen significant adverse effects from the mRNA vaccines. Effects that were not picked up in any phase of the clincial trials. Here, from the Journal of the American Medical Association in February. One of the most highly cited medical journals in the world:

‘Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men.8

I highlighted the first bit here. Namely, the words ‘based on passive surveillance reporting in the US.’ Whilst this adverse effect was not seen, or reported in the clinical trials it was picked up by the passive surveillance reporting system a.k.a. spontaneous reporting systems.

Drug adverse event reporting systems

Frankly, it is surprising that anything at all is ever seen using passive surviellance. In the UK we have the passive/spontaneous reporting system, known as the ‘Yellow Card system.’ In this US (specifically for vaccines) there is ‘VAERS’ (Vaccine Adverse Event Reporting System).

When I use the term ‘spontaneous reporting’, I mean a system whereby someone may (or more likely may not) report an adverse effect to a healthcare professional. They may (or more likely may not) fill in a form, whereupon it goes through to VAERS, who then look at it and can decide whether or not the adverse effect may (or more likely may not) be due to the vaccine. Same basic principle in the UK.

How good are these types of spontaneous reporting system in picking up adverse effects?

Well, as far as I am aware, only one serious attempt has been made to look at how many drug and vaccine-related events were actually reported in the US. Here, from a study by The Agency for Healthcare Research and Quality:

‘Adverse events from drugs and vaccines are common, but under-reported. Although 25% of ambulatory patients experience an adverse drug event, less than 0.3% of all adverse drug events and 1-13% of serious events are reported to the Food and Drug Administration (FDA). Likewise, fewer than 1% of vaccine adverse events are reported.’ 9

Fewer than one per cent of vaccine adverse events are reported. Their words, not mine. Even though, in the US, unlike the UK, there is a legal responsibility to report adverse events – I believe.

When the authors of this report tried to follow up with the CDC and perform further assessment of the system, with testing and evaluation, the doors quietly, but firmly, shut:

‘Unfortunately, there was never an opportunity to perform system performance assessments because the necessary CDC contacts were no longer available and the CDC consultants responsible for receiving data were no longer responsive to our multiple requests to proceed with testing and evaluation.’

This study was done over ten years ago, but nothing about the VAERS system has changed since, as far as I know, or can find out.

In the UK the Yellow Card system may be better, or it may not be. No-one has carried out the sort of detailed analysis that was attempted in the US. However it has been accepted that:

…all spontaneous reporting schemes have a problem with numbers: the MHRA (Medicines and Healthcare products Regulatory Agency) itself says that only 10% of serious reactions and 2 – 4% of all reactions are reported using the Yellow Card Scheme. This means that most iatrogenic* morbidity goes unreported.’ 10

*Iatrogenic means – damage/disease caused by the treatment itself.

Frankly, I see no reason why the Yellow Card system would be any better than VAERS. The barriers to reporting are exactly the same. As the US report states:

‘Barriers to reporting include a lack of clinician awareness, uncertainty about when and what to report, as well as the burdens of reporting: reporting is not part of clinicians’ usual workflow, takes time, and is duplicative.’9

In other words, reporting an adverse event takes an enormous amount of time and effort. You don’t get paid for doing it, you certainly don’t get thanked for it, and you have no idea if anyone paid any attention to it. All made worse if you are not sure if the adverse event was due to the vaccine, or not.

I have filled in yellow cards three times, and several hours of work followed each one. As directed, I searched though patient notes for all previous drugs prescribed, the patient’s medical conditions, a review of the consultations and on, and on. Back and forth from the pharmaceutical company the questions went. Until the will to live was very nearly lost.

If you wanted to devise a system to ensure that adverse effects were under-reported, you could not devise anything better. Yes, doctor, please do report adverse effects to us. The result will be endless hours of work, with no attempt to report back that what you did had the slightest effect, on anything. Thank you for your continued and future co-operation. And yet this, ladies and gentlemen, is the system we have in place to monitor and review all drug and vaccine-related adverse effects.

Which becomes even more worrying because, as mentioned before a couple of times so far, nothing else of much use is going to come out of the clinical trials. With the Pfizer BioNTech trial, crossover occurred in Oct 2020. By crossover I mean the point at which they started giving the vaccine to those in the placebo group as well. End of randomisation, end of useful data. End of … well of anything of any use.

mRNA vaccines and myocarditis

Anyway, getting back to the JAMA study. Even with all the formidable barriers in place to reporting adverse events, JAMA reported an increase in the rate of myocarditis of around thirty-two-fold, as reported via the VAERS system.

I should make it clear that this was the increase seen in the most highly affected population. Males aged eighteen to twenty-four. [Myocarditis = inflammation and damage to heart muscle]. The risk was lower in females, and also in other age groups, although still high. But, to keep things simple, I am going to focus on this, the highest risk group, as far as possible.

The first thing to say is that a thirty-two-fold increase probably does sound enormous. Another way to report this would be, a three thousand one hundred per cent increase, which may sound even more dramatic?

However, myocarditis is not exactly common. In this age group, over a seven-day period, you would expect to see around one and three-quarter cases per million of the population. Multiplying this by thirty-two still only gets you to fifty-six cases per million.

Which is not exactly the end of the world. In addition, most cases may fully recover. Although, having just said this, I have no long-term data to support that statement. The closest condition we have to go on as a comparator, is post-viral infectious myocarditis. And this has a mortality rate of 20% after one year and 50% after five years.11

Which means that myocarditis is certainly not a benign condition of little concern.

Anyway, at this point, you could argue that if around only one in twenty thousand men, in the highest risk population, suffer from myocarditis post-vaccination, then this does not represent a major problem.

It could indeed be worse to allow them to catch COVID19, where the risk of myocarditis is even higher than with vaccination. In reality, we may be protecting them from myocarditis through vaccination. This certainly seems to be the current party line. I might even agree with it…. maybe. So, as is my wont, I looked deeper.

I looked for the highest rate of (reported) post-viral infection myocarditis, in younger people. I believe it can be found here. ‘Risk of Myocarditis from COVID-19 Infection in People Under Age 20: A Population-Based Analysis’ 12

Here, the reported rate was around four-hundred-and-fifty cases per million. On the face of it, this is much higher than the fifty-six cases per million post-vaccination. Approximately ten times as high. But … there are, as always, several very important buts here. There were two key factors that alter the equation.

First, in the JAMA post-vaccine study, the time period for reporting myocarditis was limited to seven days after vaccination. Any case appearing after that was not considered to be anything to do with the vaccine and was thus ‘censored’. In the study above, the time period was far longer. Anything up to ninety days post-infection was counted. A period thirteen times as long.

In addition, although it is difficult to work out exactly what was done from the details provided, the four-hundred-and fifty study only looked at young people who attended outpatients at hospital. These would have been the most severely affected by COVID19, or who had other underlying medical conditions. So, they represent a small proportion, of a small proportion …. of everyone who was actually infected. The vast majority of whom would only have suffered very mild symptoms, or none at all.

In short, we are not remotely comparing like with like here. I find that we very rarely are. We are not only going to vaccinate a small proportion, of a small proportion, of the population who are at high risk of myocarditis. We are going to vaccinate virtually everybody. So, the two populations are completely different.

Leaving that to one side, where else can we look for a comparison between the risk of post-vaccine myocarditis vs post-infection myocarditis. The CDC published this statement.

‘During March 2020–January 2021, patients with COVID-19 had nearly 16 times the risk for myocarditis compared with patients who did not have COVID-19, and risk varied by sex and age.’ 13 

Their figure appears to have been entirely derived from a paper published in the British Medical Journal: ‘Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study’ 14. Different age groups were studied here which, again, makes any direct comparison tricky.

This study found a sixteen-fold increased risk, rather than a four hundred and fifty-times risk. A sixteen times risk is around half of the post-vaccination myocarditis risk reported in JAMA, in the eighteen-to twenty-four-year-old group.

Again, though, there were major differences. In the BMJ paper the observation period for inclusion of myocarditis considered to be ‘caused by’ COVID19, was one hundred- and forty-days post infection, not seven days. Twenty times as long for cases to build up.

Equally, after looking at nine million patients records over a year, slightly over two hundred thousand were diagnosed as having had COVID19. Of these, only fourteen thousand had post-infection problems, known as clinical sequelae. In this sub-group, which represents, one point two per-cent of one per-cent of the total, population there were so few cases of myocarditis that they didn’t even appear in the chart published in the main paper. You had to go to supplemental tables and figures 15

To be frank, there are far too many unknowns and uncontrolled variables kicking around here to make any accurate comparisons. However, I do not think it would be unreasonable to suggest that the risk of myocarditis post-vaccination, from these studies, is roughly the same as if you are infected with COVID19.

Once again though, we need to take a further step back. All of our figures here only make sense if all – or the majority of cases of myocarditis – are actually being picked up. What if they are not?

Worst case scenario

SAGE – the UK Governments scientific advisory group for emergencies – have been accused of scaremongering, and only presenting worst case scenarios for COVID19 hospital admissions and deaths. They are not the only ones. This is a worldwide phenomenon.

However, as Sir Patrick Vallance – one of the key members of (SAGE) – has stated, in response to such criticism.

‘It’s not my job to be an optimist’: Sir Patrick Vallance takes swipe at critics accusing scientists of scaremongering over Covid saying ministers need to ‘hear the information whether uncomfortable or encouraging.’ 16

SAGE believe it is their role to highlight the worst possible scenarios, the highest possible death tolls, and such like. So, let us now do the same, and focus on the worst-case scenario regarding mRNA vaccines and myocarditis. Whether ‘uncomfortable or encouraging’.

The worst-case scenario starts like this. If the VAERS system only picks up one per cent of vaccine related adverse effects, this means that we can start by multiplying the JAMA figures by one hundred.

Thus, instead of fifty-six cases per million, the reality is that we could be looking at five thousand six hundred cases per million, post-vaccination. Or very nearly one in two hundred.

If, in this model, we then include the possibility that post-vaccination myocarditis is as damaging as post-viral infection myocarditis, it means that one in four hundred eighteen to twenty-four-year-olds could be dead five years after vaccination.

Do I think that this is likely? I have to say that no, I don’t, really. Although this is where the figures, such as they can be relied upon, inevitably take you. Just to run you through the process a bit more slowly.

  • Relying on the VAERS system, JAMA reported a thirty-three-fold increase in myocarditis post COVID19 vaccination. An increase from 1.76, to 56.31 cases per million (in the seven-day period post vaccination)
  • It has been established that VAERS may pick up only one per cent of all vaccine related adverse effects
  • Therefore, the actual number could be as high as five-thousand six-hundred cases per million ~ 1 in 200.
  • Myocarditis (post viral infection) has a mortality rate of 50% over 5 years. So, we need to consider the possibility that post-vaccination myocarditis will carry the same mortality.
  • Therefore, the rate of death after five years could be one in four hundred (males aged 18-24)

There are approximately sixteen million men aged between eighteen and twenty-four in the US.

Total number of deaths within five years (men aged eighteen to twenty-four in the US)

16,000,000 ÷ 400                 = 40,000

(Divide by five for the UK) = 8,000.

Now, if I were in charge of anything, which I am not, which is probably a good thing, I would hope to have been made aware of these worst-case scenario figures. I would then immediately have begun to do everything I possibly could to verify them.

For starters I would want to know two critical things:

1: Is the VAERS system truly only picking up one per cent of vaccine related adverse effects?

2: Does vaccine related myocarditis lead to the same mortality and morbidity as caused by a viral infection?

If the answer to both of these questions were, yes, then I would have to decide what to do. And that could not possibly, be nothing. At least I would hope not. Yet, nothing appears to be exactly what is currently happening.

As you can tell, I still cling to the concept of ‘first do no harm.’ Today, with COVID19, it seems this this idea has become hopelessly naïve. The current attitude seems to be. ‘We are at war; you must expect casualties’ ‘Also, careless talk costs lives.So, my friend, I advise you to keep your ‘vulnerable’ mouth shut, if you know what is good for you.’

Well then, I just hope for everyone’s sake, that these figures are completely wrong. They are, after all, only a model. A worst-case scenario created using the most accurate information available at this time. However, as per the SAGE underlying philosophy, I believe it is important to present the information whether uncomfortable or encouraging.

The thing that most concerns me the most is that we have a worrying signal emerging about the mRNA vaccines. A signal surrounded by a lot of noise, admittedly. Yet, the ‘official’ response continues to be to sweep the entire thing under the carpet. ‘Nothing to see here, move along.’

Postscript

As with regard to the GMC, and the threat of sanctions, as you can see, I am only following their guidance

‘Healthcare professionals must also be open and honest with their colleagues, employers and relevant organisations, and take part in reviews and investigations when requested. They must also be open and honest with their regulators, raising concerns where appropriate. They must support and encourage each other to be open and honest, and not stop someone from raising concerns.’ 17

What do you do if it is the GMC itself that may be stopping someone from raising concerns. Should I report the GMC to the GMC? I imagine they will find themselves innocent of any wrongdoing. Quis custodiet Ipsos custodes?

1: https://www.pulsetoday.co.uk/news/breaking-news/gps-who-criticise-covid-vaccine-on-social-media-vulnerable-to-gmc-investigation/

2: https://europepmc.org/article/MED/2154621

3: https://www.sciencedaily.com/releases/2015/05/150521133628.htm

4: https://www.bbc.co.uk/news/health-55056016

5: https://pubmed.ncbi.nlm.nih.gov/9737644/#:~:text=In%20conclusion%2C%20these%20studies%20indicate,higher%20doses%20should%20be%20investigated.

6: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC59524/

7: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740994/

8: https://jamanetwork.com/journals/jama/fullarticle/2788346

9: https://digital.ahrq.gov/sites/default/files/docs/publication/r18hs017045-lazarus-final-report-2011.pdf

10: https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1789

11: https://www.ncbi.nlm.nih.gov/books/NBK459259/#:~:text=Immediate%20complications%20of%20myocarditis%20include,and%2050%25%20at%205%20years.

12: https://pubmed.ncbi.nlm.nih.gov/34341797/

13: https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm

14: https://www.bmj.com/content/373/bmj.n1098  

15: https://www.bmj.com/content/bmj/suppl/2021/05/19/bmj.n1098.DC1/daus063716.wt.pdf

16: https://www.dailymail.co.uk/news/article-10341547/Sir-Patrick-Vallance-takes-swipe-critics-accusing-scientists-scaremongering-Covid.html

17: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/candour—openness-and-honesty-when-things-go-wrong/the-professional-duty-of-candour


My interview with Joe Mercola

12th February 2022

Catch it while you can.

Dr Joe Mercola – a man who I admire – interviewed me about The Clot Thickens recently. This is my latest book, in case you are unaware of this majestic tome… if so, where have you been? It was all over the mainstream press, all major news channels… then I woke up.

This interview is now going to be available from Sunday 13th February, for forty-eight hours only* [unless you go behind the pay wall]. I am not entirely sure what hour it will posted, as the US is several hours behind the UK.

As some of you may know, various authorities tried very hard to shut down Mercola’s website, as he had many articles critical of the mainstream response to COVID. He ended up having to take down all his articles after forty-eight hours, then put them behind a pay wall. Some weird compromise or other, that I don’t fully understand. Anyway, you can hear my great words of wisdom if you wish, from Sunday the 13th for forty-eight hours only*. You have been warned.

*at least officially. You may want to try the link now to see if it works.
https://articles.mercola.com/sites/articles/archive/2022/02/13/root-cause-of-all-heart-disease.aspx

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Some observations on the infection fatality rate of COVID19

10th February 2022

Some observations on the infection fatality rate of COVID19
[Mainly that it does not really exist]

When COVID struck the world two years ago, or thereabouts, the first thing that happened was rather unfortunate. Namely, the instant and widespread distortion, nay destruction, of data. This happened so fast that it became almost impossible to know what on earth was going on. Who to believe … what to believe?

I have never been so naïve as to think that we are not constantly subjected to certain ‘truths’, which may or may not be true. After all, I have been battling against the dreaded ‘cholesterol hypothesis’ for decades. In doing so I have become something of an expert in recognising seriously distorted data when I see it.

I have learned to search for things not said, which are usually far more important than the things that are. I have also learned to treat the words used with great distrust. Words such as ‘fact’ for example. Facts have a disturbing tendency to crumble under pressure … note to the dreaded dementors, sorry fact checkers.

However, I felt I had become pretty expert in navigating the games played. I had learned to sail the stormy waters of scientific truths, or facts, reasonably well. Then came COVID, and the world of fact distortion achieved warp drive. Alleged facts flashed past so fast, and in such great numbers, that it all became a blur.

In this blog I will attempt to remove some of the blur surrounding the issue which became key to ‘The Great COVID Wars’. This is the Infection fatality rate (IFR) of COVID19.

You may not feel this was central to everything that occurred, or remains so, but I hope to convince you that it is the single most important ‘fact’ of them all. The keystone. Also, the one most jealously guarded by the fact checkers. ‘Put your weapon down, place both hands in the air, and step away from your IFR.

To begin. There was a time when epidemiologists, with regard to infectious diseases, used two different terms. Infection fatality rate (IFR) and case fatality rate (CFR). Although it has to be said that the distinction between the two was never exactly black and white.

After all, how do you decide when someone who is ‘infected ‘with a disease, reaches the point when they become a ‘case?’ Historically this happened when someone became so unwell that they were admitted to hospital. Whereupon the disease itself would be diagnosed with a test of some sort – sometimes. Sometimes clinical signs and symptoms were all that were used.

Which means that ‘cases’ have always been somewhat easier to count and compare. However, no-one has ever really known how many people were infected in the first place. By which I mean those people who were not seen anywhere, by anyone, and so never managed to the reach the status of a ‘case.’

In general, those with a mild infection just lay in bed, for a while feeling a bit sorry for themselves. Indeed, the advice for those with ‘flu’ always used to be to stay at home, drink plenty, and take some medication to control the temp and the aches and pains. This represents the traditional three Ps management technique. ‘Take two paracetamol and piss off.’ [Paracetamol is called acetomenophin in the US – take two As and piss off … nah, doesn’t really work]

Ergo, those with few symptoms, or no symptoms, were never seen or counted. So, the Infection Fatality Rate (IFR), which represent the total number of people who become infected, who then die, has always been subject to a great deal of guesswork.

A whole series of the underlying problems with defining IFR [and also CFR] were highlighted in the paper ‘case fatality risk of influenza A (HIN1pdm09): a systemic review.’ The authors looked at the Swine Flu epidemic of 2009, and also reviewed data on infection and case fatality rates from the past.

I shall paraphrasetheir main findings. ‘We haven’t a clue what the infection fatality rate was for this, or any other flu. In truth, neither does anyone else, because the data are complete rubbish.’

Their actual conclusion, couched in more scientific language:

‘A consensus is needed on how to define and measure the seriousness of infection before the next pandemic.’1

Did this consensus ever happen? You must be joking.

As you may have noticed, we have begun the move into very blurry waters indeed. You may ask how it is possible to compare the Infection Fatality Rate of COVID19 with previous influenza epidemics, when we have no idea what the IFR rate of previous influenza epidemics may have been.

Despite such great uncertainty, this IFR rapidly become a red line issue for the COVID wars.

On one side were the CDC, Fauci, Neil Ferguson and Imperial College London – and suchlike. The ‘establishment’ – the ‘experts’. They confidently stated, from the very beginning, that the Infection Fatality Rate of COVID19 was around one per cent. Meaning that for every one hundred people infected, one person would die (on average).

Quite how they knew this is beyond any real understanding? They say modelling. I say guesswork. Which, in truth, is pretty much the same thing. A brand new, never seen before disease, and they just knew what the IFR was.

This was also at a time before any accurate testing existed, and we had no idea how many people had actually been infected? Indeed, at this point, they were primarily relying on information from China … Oh well, at least we know that Chinese data are always fully reliable … thank God. Just don’t mention that pesky laboratory in Wuhan, or gain of function research. Or pretty much anything else that emanates from China, in truth.

On the other side were…. Well, there wasn’t really another side so to speak of. A rag tag bunch of researchers and epidemiologists who were fascinated by the data coming in, and what it was saying. It included those such as Professor John Ioannidis and Professor Carl Heneghan at the Centre of Evidence Based Medicine in Oxford, and suchlike.

I just watched with interest, at first. My own bias has always been to be very wary of any expert consensus that springs into life. This is because it will almost always be a slave to the inherent problems with human thinking that ride roughshod over a disinterested pursuit of the truth. Particularly in a crisis.

Problems such as: groupthink, confirmation bias, fast thinking rather than slow thinking, deference to ‘experts’, the desperate need to come up with ‘the answer’ and stick to it, and suchlike. We all know what they are. They all came into play, as expected.

Anyway, a key question here was, how did their one per cent figure compare with more common or garden influenza? This is very hard to say. I have seen figures of 0.67% for the flu epidemic of 1967. I have seen far less. ‘Spanish flu’, the big daddy of them all, was estimated to have had an IFR of around two to three per cent.

But how accurate can these figures be? In the paper I quoted above, the IFR estimates for swine flu (HIN1pdm09) ranged from less than one death, per hundred thousand infections, to more than ten thousand. Yes, from one in a hundred thousand, all the way up to ten per cent. This is what scientists call…. A pretty wide range.  You could call it other things.

Cutting to the chase, the reality is that, at the start of the COVID19 epidemic we had no idea what the IFR of a severe influenza epidemic was, nor did we know the IFR of COVID19. You would think that this would make any comparison somewhat tricky.

However, the mainstream consensus rapidly coalesced around two ‘facts’.

Fact one: a severe seasonal influenza has an IFR of around point one per cent. Or, to put it another way, one death per one thousand infections.

Fact two: COVID19 has an IFR of around one per cent. Which meant that COVID19 was going to be ten times as deadly. This, then, became our starting point.

What would this mean in the real world?

The UK has a population of sixty-seven million people. Which meant that if everyone were infected, we would end up with almost exactly two thirds of a million deaths. Which is one per cent of the entire population. The population of the US is three hundred and thirty million, so there would be three point three million deaths

Hold on a minute. The models also predicted that not everyone would get COVID19. Full herd immunity would kick in once about eighty per cent of the population – or thereabouts – had been infected. This, by the way, was another thing that the experts just knew, right from the very beginning. [But what about mutations, and variants, and re-infections I hear you cry…. ‘Oh, do shut up’].

In effect, the COVID19 epidemic would come to an end when eighty per cent of people had become ill, maybe slightly less. Ergo, the overall death figure would be about five hundred thousand in the UK, and just over two million in the US. Or thereabouts.

This is a lot of deaths. Around the entire world pop: ~7.9 billion. We could see nearly seventy million deaths.

This one per cent figure, then, became the trigger for everything that followed. I think of it as the ‘justification’ figure. It was used to justify lockdowns, and everything else that went along with them. Here, after all, was a disease ten times as deadly as a bad influenza epidemic. Something must be done, or millions will die.

A further complication

Of course, things are rarely this simple. Even if the one per cent figure were true, it is essential to ask a follow up question. Who exactly is dying?

The average age of death caused by the Spanish flu was estimated at twenty-eight. Yes, twenty-eight.2 The average age of death caused by COVID19 is around eighty-one – in the UK.3

I feel that the fact [and unusually this fact is almost certainly true] that COVID19 almost exclusively kills the elderly, and almost always the elderly who have many other comorbidities, had to be taken into consideration. But it wasn’t.

Instead of a disease that can wipe out young healthy people, aged twenty-eight, we had a disease on our hands that primarily kills those close to the end of their lives. Children and young adults, even middle-aged adults, even nearly old adults, have been almost remarkably unaffected by COVID19. This was known very early on.

What are the actual figures here? Turning attention specifically to the UK, we have had, at the time of writing, around one hundred and fifty thousand COVID19 deaths. Defined as… those deaths with COVID19 mentioned on the death certificate [whatever this actually means – another whole can of worms].

On the other hand, the number of people under the age of sixty, who have died from COVID19, with no other disease mentioned on the death certificate, is five hundred and forty-two. That was, by the 1st of February 2022.4

This is slightly under one per day during the epidemic. Or, to frame it another way, the risk of dying, for a healthy (or at least believed to be healthy – who knows for sure if they are or not) person under the age of sixty has been one in 79,131. [UK pop < 60 = 42,869,306].5

This risk, however, has been over very nearly two years. So, the yearly risk of death from COVID19 per years is 1:158,263. Or ~ 0.0075% … for this population. Just to give a comparator. The risk of dying from a road traffic accident in the UK, per year, is around eight times higher 6.

1in 20,000 per year vs 1 in 160,000

Thus, for more than two thirds of the population, the risk of dying from COVID19 has been 0.0075%. Instead of one per cent… it has been seven thousandths of one per cent.

Some people will say that this doesn’t matter. All deaths are of equal importance, we cannot discriminate on grounds of age, illness etc. In which case, taking the UK population as a whole, we have had 158,000 deaths with COVID19 mentioned on the death certificate. This represents a total risk of death of 1 in 424. Or ~ 0.25%.

Again, this has been over two years, so the total risk of death, per year [which is how risk is normally presented] has been 1 in 848, or ~ 0.125% per year. Which, as you may have noted, is around seven times less than one per cent.

Strangely, with COVID19, we have not stopped counting at the end of one year, and then started again. We have just kept on adding the figures year upon year – and will continue to do so? We have also continued to add in people who have been infected more than once…Double, treble, nay quadruple counting.

If we keep doing this, the IFR of COVID19 will eventually reach one. Not one per cent, but one. As in the entire population of the world will end up dying of COVID19. Although, at 0.125% per year this, as you may have worked out yourself, will take about seven hundred years. You may want to go and lie down and think about this.

Of course, the rough figures I have calculated above do not represent the Infection Fatality Rate. Instead, they represent the population fatality rate (PFR) i.e., forgetting about IFR and CFR, how many people, in total, have actually died. The population fatality has to be significantly lower than the infection fatality rate because not everyone has been infected… or have they?

The terrain is all?

We must now venture into yet another layer of complication. Yes, this onion has many layers. Most of which, you may be glad to know, I am not going to consider, or else this blog becomes a book. But the next layer is critical.

What does being ‘infected’ actually mean, and can we even know that it has happened?

At the risk of terrible oversimplification, historically there are two camps in the infectious disease world.

  • Camp one: the microbe is all (The germ theory).
  • Camp two: the terrain is all (The terrain theory).

Camp one believes that if you become exposed to an infectious agent you will inevitably become ‘infected’. You will then inevitably suffer (at least some) symptoms from the infection. You will then become unwell – maybe very unwell – and may even die. The germ theory. The severity of the disease is almost entirely dependent on the ‘viral load’ that you encounter.

Camp two states that the ‘terrain’ of the human body is far more important. We are surrounded by, and harbour microorganisms in our bodies. When exposed to pathogens ‘germs’ we become ill if our defences are weakened by deficiencies or toxicities. The germ itself is pretty much unimportant.

This is the ‘terrain’ theory. It means that many/most people, may not become ‘infected’ at all. Or that they may not even notice it – they simply shrug the infection off.

Historically, the two camps were led by Louis ‘the germ’ Pasteur and Claude ‘the terrain’ Bernard. It is said that, on his death bed Pasteur admitted. ‘Bernard was right, the pathogen is nothing, the terrain is everything.’

Well, yes and no. It is difficult to suffer any symptoms from a disease if you are never exposed to the germ. Which means that the pathogen clearly is something, not nothing. But … but we are making a greater mistake if we think that everyone is going to respond the same way to a germ. An assumption upon which our response has been predicated.

You may not think it, but the thinking behind all the actions taken is that COVID19 will inevitably ‘infect’ anyone who comes into contact with it. It will spread from person to person in a predicable manner, it will cause illness in everyone, and suchlike. In effect therefore, we have acted as if the terrain truly is nothing. Therefore, we must do everything possible to reduce contact, in order to reduce morbidity and mortality. In essence, the microbe is all.

The next assumption, following on from this, is that those who have not demonstrated any signs of symptoms have simply not been exposed to it, or not exposed to a sufficient ‘viral load’.

Personally, I find this impossible to believe. My daughter, a junior doctor who caught COVID19 working on a COVID ward in Wales, stayed at our house, suffered anosmia, and was diagnosed with COVID19 – with a PCR test, no less. No-one else got a snuffle.

At one point during the first couple of months of the epidemic, in May 2020 to be precise, I was standing next to two unmasked nurses in a small treatment room (we were not allowed to wear masks at this time) who were both coughing repeatedly in my face. Both were diagnosed with COVID19 the very next day and went off ill.

Every working day for six months, I went into nursing homes and an intermediate care centre. During which time, thirty-six patients died of – probably – COVID19. All of whom I saw and examined at least once. However, I did not become infected, and I never have. I also showed no antibodies – in a test in Autumn 2020.

If anyone tries to tell me that I was not exposed to the virus, or a sufficient viral load to cause infection, I can only laugh. I would reckon myself to be amongst an elite ‘most exposed to SARS-Cov2 virus in the world’ workforce. For at least two months I was working with no PPE – at all. Surrounding by staff and patients – many of whom died of COVID19 [no staff members, only patients].

If I was not infected, and officially I have not been, it raises the question. What, exactly, does infected mean? I speak as someone who also had to have seven Hepatitis B injections before I was able to raise a feeble, and pretty transient, antibody response. A friend and colleague had, if memory serves, over thirty Hep B vaccinations, and never raised a single antibody.

What does this, in turn, mean? That neither of us has any immunity to Hep B? That antibody tests are hopelessly flawed. That ‘immunity’ exists in ways that we have no idea how to measure – my current view.

Looking more specifically at COVID19, what happens if someone is found to be infected, as part of routine testing, yet has no symptoms, and produces no antibodies. Can you state that they were ‘infected’?

You may want to have a look at ‘The Flawed Science of Antibody Testing for SARS-CoV-2 Immunity.’ 7

It quotes this FDA statement

‘…results from currently authorized SARS-CoV-2 antibody tests should not be used to evaluate a person’s level of immunity or protection from COVID-19 at any time, and especially after the person received a COVID-19 vaccination.’

So, antibody tests cannot tell us if someone has been infected, or effectively, vaccinated, nor if they are immune to SARS-Cov2. Just run that idea round your head for a while. Then see what answer pops out.

One small study further suggested that if you were diagnosed with [had a positive test for], COVID19, but suffered no symptoms, there was a 92% chance that you would show no measurable immune response post infection. 8

These people, with a positive test, yet no symptoms, and no antibodies, were clearly ‘infected’ – they had a positive test after all [another can of worms]. However, these people must represent the most immune population of all. COVID19 hit them but was simply shrugged off. Leaving behind no sign that it was ever there.

Before I spin off down another hundred complications and side-issues – all of which are fascinating in themselves – I will attempt to highlight one immutable fact.

We have no idea how many people have been infected with SARS-Cov2, primarily because we have no idea how many people have been ‘infected’ yet demonstrate no sign of contact with the virus (unless they were coincidentally tested at the time). People such as, to pluck an example from the air … me.

It follows, therefore, that we cannot know what IFR rate might be. All we really have to go on (for all its further myriad flaws) is the Population Fatality Rate. Namely, how many people have actually died of COVID19.

In this end, this is the key figure. The one that counts [even if I have serious doubts about how this figure is created].

Thus far, across the world, over a period of very nearly two years, we have officially had five point seven million deaths from COVID19.

The total population of the world is seven point nine billion. Therefore:

  • The total population fatality rate is 0.072%
  • The total population fatality rate per year is 0.036%

This is a long, long way from the IFR of one per cent. Indeed, per year, it is around thirteen times less.

Is this because only one thirteenth of the world’s population have been infected? This is extraordinarily unlikely. The recent REACT study in the UK, found that 65% of those infected with the Omicron variant in January 2022 had previously been diagnosed with COVID-19.9

Seven per cent more had symptoms strongly suggestive of previous infection but had not had a confirmatory test at the time. Ergo, very nearly three quarters of those getting COVID19 in January 2022 had been infected before.

The authors are now attempting to backtrack from this finding. Why? Because, if it is correct that the vast majority of people infected represent re-infections, it means that the infection rate must be extremely high, much higher than anyone admits.

It also follows that exposure and transmission is extremely high. This, in turn, means that the IFR is significantly lower than anyone admits – or indeed can admit.

It is no surprise then to find that those running the REACT study are based in Imperial College London. Which is where all the original IFR estimates came from. The lair of Neil Ferguson et all. The originator of the ‘justification’ figure. Those who are now doing all they can to suggest that the number of people who have been infected with COVID19 remains low.

Even more telling, although this is less easy to confirm, we have cases of people with three, or even four, infections. How can anyone get infected four times, when people around them have not been infected once? Are they dancing naked around a flagpole, breathing in deeply from an inverted loudhailer in a COVID19 ward?

No, they are not. The explanation is that those getting re-infected are those who are unable to simply shrug of COVID19, for whatever reasons. Their terrain was different. Which means that they will likely keep on getting infected as new variants appear. Hopefully in milder and milder versions.

On the other hand, if we look at those individuals who show no evidence of infection – those who have never suffered symptoms and developed no antibodies – it is not that they have never been exposed, or ‘infected’. It is that they have more robust defences. As Claude Bernard argued, the most important thing here is not the germ, it is the terrain. It always was, and always will be.

As you may have gathered, I am convinced that we have all been exposed to and ‘infected’ with COVID19, probably all within the first year [even if I don’t know how you determine being infected]. Which means, in turn, that the PFR and the IFR – after two years of the virus spreading around – will have will be very much the same.

Can I prove this. No. If a large number of people develop no symptoms, and there is no test used that can accurately determine infection/exposure, I cannot possibly prove this. Equally, no-one can prove anything in the opposite direction.

A bit of a standout clue, however, is that three quarters of those found to be infected had been infected before. This could only have happened if people have been repeatedly exposed to a sufficient ‘viral load’ to get COVID19. And if they have, so has everyone else.

Of course, if we cannot accurately define what we mean by ‘infected’ no prediction can have been right. In turn, this means that we bet the house on an outcome measure so deeply flawed as to be virtually meaningless.

A strong clue that has been more widely recognised to be meaningless, is that it no longer exists. How so, I hear you cry? Well, it was decreed fairly early on that any positive COVID19 test represents a ‘case’ of COVID19. Something that kind of slipped through, without anyone noticing.

It was a worldwide thing, but the text below is taken from an NHS press briefing conference, using data from coronavirus.data.gov.uk. The bit in bold is most important.

Number of daily cases, UK:
Number of people who have had at least one positive COVID-19 test result, either lab-reported or lateral flow device (England only), by date reported – the date the case was first included in the published totals. COVID-19 cases are identified by taking specimens from people and testing them for the presence of the SARS-CoV-2 virus. If the test is positive, this is referred to as a case.
10

Once this happened, any historical comparison of IFRs, or CFRs, became impossible. If everyone who is infected is also a ‘case’ then everyone is an I/C, (infected/case). There is no longer an IFR. Nor can there be a CFR. There is a combination I/CFR.

This, in turn, means that the IFR rate has been artificially boosted. Case fatality rates will always higher than IFRs [people who become very ill from a disease are always more likely to die from the disease, than those who suffer no symptoms].

Add them together and the IFR jumps up. Or at least it does if no-one notices that you are flipping between, and combining IFR and CFR, at speed, and continue talking about the IFR as if it remains the same thing. Oh, the tricks that are played to inflate the IFR and ‘prove’ that the experts were right all along.

Despite the fact that it is now devoid of any meaning, the one per cent IFR for COVID19 remains the most fiercely guarded figure of all. Dare to state the IFR is significantly lower than the one per cent ‘justification’ figure and the dreaded dementors, sorry fact-checkers, descend from on high.

They will attack you, your personal habits, your professionalism, your motivations, your clear ‘anti-vaxx’ stance, your lack of being an expert – and anything else they can think of to personally denigrate and humiliate.

They will countenance no arguments, no discussion. It will be determined that you are simply wrong, certainly stupid, and unable to understand The Science and probably in the pay of someone evil cabal, or other. It is somewhat irritating. I want to discuss science, if not ‘THE SCIENCE’. They want me crushed and silenced.

End thoughts

We understand far less about infections than we like to think. We are simply scratching at the surface at present. It is all extremely complex. If you are up for it, you may wish to read this paper. ‘Pathogenesis of COVID-19 described through the lens of an undersulfated and degraded epithelial and endothelial glycocalyx.11

This paper represents a monstrously complex discussion of ‘the terrain.’ Namely, why do some people shrug off COVID19, whereas others may become so seriously ill that they may die?

According to this paper, it has nothing whatsoever to do with the things that we think of as part of the classic ‘immune response.’ T-cells, B-cells, cytokines, antibodies and suchlike. It is almost entirely to do with the ability of cells in our body to prevent viral entry.

Keeping things as simple as possible. If COVID19 (or other viruses) cannot get into an endothelial cell – or find it very difficult to do so – because the glycocalyx is healthy and robust, then SARS-Cov2 simply bounces off, and you will not become seriously ‘infected’. Yes, you will ‘shrug’ the virus off. It may enter your bloodstream, but that is about as far as it is going to get.

I mean, I have always been aware of the importance of cell entry in viral diseases. Both HIV and the Ebola virus enter a cell by hijacking a protein called CCR5 attached to cell membranes. There are a few people who have a thing called the CCR5delta32 mutation. If you have this mutation, it means that HIV and Ebola cannot attach themselves to the protein. Neither virus can then get into the cell and ‘infection’ cannot occur. The terrain is all.

Have any of those on SAGE, or Fauci, or Ferguson, or the CDC paid any heed to such things? I would be very surprised if any of them had even heard of the glycocalyx. A perfect example of the Dunning-Kruger* effect, I feel.

Yet, despite their stunning ignorance about such things, certain individuals and organisations grabbed the reins of influence in order to convince those in power that they had the answer.

The most important ‘answer’ being that COVID19 has an IFR of one per cent, which is at least ten times that of a serious influenza epidemic. Then, as the ‘germ’ is obviously everything, the only way to prevent hundreds of thousands, nay millions, of deaths was through lockdown, mask wearing, societal control, and suchlike.

We must stop spread, the ‘the germ is everything brigade’ cried. Although, with a 75% re-infection rate it is hard to argue that we have managed anything of the sort.

If this IFR figure was grossly inflated, which certainly seems to be the case, then all that we did was to create untold damage – for no good reason. I shall leave you with a post that I put up in a WhatsApp group recently. It followed a study from John Hopkins which estimated that COVID19 lockdowns only reduced deaths by 0.2%. [A study that will be attacked remorselessly, no doubt].12

‘Did lockdown work? No, the difference it made was marginal, at best. Were the models that we relied on accurate? No, they were bloody useless. Are the vaccines safe and effective? – Jury is out. Is there anything that was done justifiable by the evidence, in so much as it can be relied upon. I do not believe so.  What we certainly did was to explode the economy, pile vast debt on UK Plc. create a massive backlog of work for the NHS. Fail to diagnose and treat hundreds of thousands of cases of cancer, and suchlike and create a tsunami of mental health problems. We also ran roughshod over incredibly important human rights, that have taken centuries to take hold and grow. In my opinion, almost everything that was done has caused more harm than good. What is the counter-argument? If we hadn’t done all these things, it would have been far worse. The evidence to support this position is sadly lacking.’

*Dunning-Kruger effect is, in psychology, a cognitive bias whereby people with limited knowledge or competence in a given intellectual or social domain greatly overestimate their own knowledge or competence in that domain relative to objective criteria or to the performance of their peers or of people in general.

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029/

2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734171/

3: https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/averageageofthosewhohaddiedwithCOVID19

4: https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/deathsofthoseunder60fromCOVID19withnocomorbiditiesandmortalityratesin2020

5: https://www.statista.com/statistics/281208/population-of-the-england-by-age-group/

6: http://www.bandolier.org.uk/booth/Risk/trasnsportpop.html#:~:text=While%20the%20risk%20of%20dying,risk%20is%201%20in%20240.

7: https://jamanetwork.com/journals/jama/fullarticle/2785530

8: https://www.ox.ac.uk/news/2021-06-18-latest-data-immune-response-COVID-19-reinforces-need-vaccination-says-oxford-led

9: https://www.beckershospitalreview.com/public-health/two-thirds-of-omicron-cases-are-reinfections-uk-study-suggests.html

10: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1041270/2021-12-15_COVID-19_Press_Conference_Slides_PUBLICATION.pptx.pdf

11: https://doi.org/10.1096/fj.202101100RR

12: https://www.sciencemediacentre.org/expert-reaction-to-a-preprint-looking-at-the-impact-of-lockdowns-as-posted-on-the-john-hopkins-krieger-school-of-arts-and-sciences-website/