Rod Driver’s recent piece was interesting but perhaps in black and white rather than shades of grey. There is, to be sure, overenthusiasm for new drugs, and occasionally concealment of risk, but the situation is more nuanced than he sets out.
In my medical career of nearly 50 years, 28 as a consultant rheumatologist, I have taken a great deal of notice of drugs – which is hardly surprising, as I have used many. As a trainee I was fascinated by the sharp dissection of a series of trials of anti-inflammatory drugs made by one of my friends. He outlined a long series of faults, ranging from inappropriate comparators, poor trial construction, inappropriate dosing schedules and use of the wrong statistical analytical tools. In my book “Mad Medicine” I have described some of these, with a specific personal episode illustrating how data can be ignored.
In 1982 I went to a company symposium abroad launching a new drug; this was not the ill-famed Orient Express trip, but much gin was tasted, as the meeting was in Amsterdam. This may not be quite as bad as it looks, because it was cheaper to fly all the British rheumatologists to Amsterdam than it was to fly the much smaller number of worldwide experts to London. The pharmacodynamics of the drug had been tested on, I think, eight normal subjects. Seven were very similar in terms of the plasma half-life. The eighth was quite different. In the presentation the pharmacologist blithely told the audience that the outlier had been ignored in the analysis of the data. I got up and asked how it was scientific to exclude over 12% of the sample; perhaps the wayward subject had some genetic difference that meant he metabolised the drug differently. He couldn’t possibly assume that this one was unique and, if they had done another hundred tests, who was to know whether another 11 subjects would have produced the same result? Much muttering and harrumphing went on. I ignored the rest of the programme and went sightseeing. You cannot analyse only the data that fit your model, and similar selective data manipulation has been exposed in other large-scale trials. I am a fan of Ben Goldacre’s book “Bad Pharma”, but it’s not just the industry that’s to blame; I wonder when the clinicians who misuse data on statins (and are often funded by the industry, so have a conflict of interest) will finally be brought to book. But to damn the pharmaceutical industry as a whole is risky. The baby may well go out with the bathwater.
Rod asks why we don’t learn the lessons of preliminary data being overtaken by new evidence, so that we realise drugs may do more harm than good. Actually this is a matter of scale. Drug trials have many phases; animal testing (though animals may develop side-effects that humans do not, and vice-versa); pharmacodynamic studies that look at how a drug may be metabolised, as above; trials on volunteers; small-scale trials on patients; and finally larger scale trials. But if a drug has, say, a serious side-effect that occurs in one in 100,000 a standard trial will not attribute it. If you get 200 people who develop it, such that you might become suspicious, you will have exhibited it in 20 million patients. You cannot do a trial that big, so serious but rare side-effects will only come out in the wash much later.
Furthermore, the initial trials may have used the wrong patient cohort. Thus benoxaprofen, known as Opren, was never tested in the over-65s, which is where in the end the serious renal side-effects appeared because, surprise, older people metabolised the drug more slowly, so it accumulated. Phocomelia is a rare phenomenon, and appears at random, but it required many pregnant women to have had thalidomide, and then (as it was pre-internet) several unconnected case reports, to attribute effect to drug. If you weren’t pregnant then obviously that effect did not appear. The use of radiotherapy in the 1950s to treat a spinal condition, ankylosing spondylitis, was found to provoke leukaemia, but this did not appear immediately. In fact, a re-analysis I did suggested that many of those who developed it may well have been treated too late and with the wrong diagnosis. Thalidomide would have been abandoned anyway, because it produced significant peripheral nerve damage, and radiotherapy caused multiple skin cancers in the X-ray field which would have proved enough to finish radiotherapy as a treatment. But if something turns up that is unexpected then the only way you find it is, if you like, to suck it and see. And you may have to do much sucking to establish a causal relationship when the side-effect is rare.
We do learn from the lessons. After thalidomide and benoxaprofen, among others, drug trial regimes were tightened up; patient cohorts were changed; statistical analysis was improved. But now and again something will slip through for reasons only understood by using the infallible instrument of the retrospectoscope – the volunteer trial of TGN-1412 is a case in point. There were errors in conducting the trial, not least that all the subjects had the drug administered together, but no-one could have predicted the side-effect (multiple organ failure). However, once the details were known, anyone who had seen that constellation of symptoms and signs – as I had once – could have been in no doubt why it happened. And so subsequent trials were adjusted to avoid the risk.
Next – patents. There is no doubt that patents are a form of protectionism, but their existence is protean and I cannot see any reason for any sector of manufacturing industry not to use them, unless they are altruistic fools. The cost of developing new drugs is immense and while trials may be conducted by hospitals and university departments it’s the industry, by and large, that funds them. People do not realise that companies must take into account both the development costs and manufacturing costs. The development costs are skewed because a large number of compounds never reach the market because something goes wrong; they may not work, they may work no better than existing drugs, they produce early side-effects and so on. All these costs have to be written into the price of the drugs that get through all the hoops and reach the marketplace. And the manufacturing costs for some of the immune therapies are huge. Would you, as an entrepreneur, be happy to spend millions in development and initial production for some other company then to pirate your hard work? And anyway, patents expire eventually. People imagine that then the drug cost falls like a stone. Actually often it does not. There are many examples of drugs no longer made by their originators because it’s not worth their while. A series of generic manufacturers jump aboard, and then discover that it’s not worth their while either; maybe the profit is inadequate or the market too small. You then get left with a single generic maker who hikes the price. They may get their comeuppance, but there have been numerous examples of one monopoly replacing another.
Do companies try to charge as much as they can get away with? I am sure they do sometimes, but I was involved with the introduction of a new biologic agent for inflammatory arthritis which was priced well above its competitors (it had a different mode of action, so was not a ‘me-too’ drug). I pointed out that this created a financial disincentive to prescribing, and notice was taken.
So I think that drug companies are entitled to protect their investment, not least because their ‘profit’ covers the cost of the myriad preparations that don’t make it.
I agree that many new drugs are no better than those they replace. That they do succeed may be down to marketing and disinformation. If I read that a trial has shown that new drug B is ‘at least as good as’ old drug A, I want to know what evidence there is. Often the fault is in a misunderstanding of comparative sequential trials. In these, a plot of each patient is made on a graph depending on whether drug A is better than drug B, or vice-versa. A plot enables one to tell, and you can change the confidence limits, when one is better than the other. However, if the graph line continues and fails to show a difference, it doesn’t mean there is no difference, merely that you have failed to prove that there is a difference. The two are not the same. Many such trials are interpreted, however, as showing no difference.
Yes, huge amounts of money are spent on drugs that are useless, such as Avandia and Tamiflu. There is no excuse for withholding data (hello, I hear statins again). But such developments underpin my argument that successful drugs must finance the failures – and there’s no way of knowing which will be which when you start.
Conflict of interest alert. I have been to conferences that were heavily supported by drug companies, and even been paid to go. Companies were particularly keen to finance British rheumatologists’ trips to the American College of Rheumatology conferences; I never went to one of them. But is it necessarily a Bad Thing? Am I really being bought? Certainly in my specialty there were so many alternatives to choose from that one could only be accused of being bought by the whole lot. Did I go to conferences to learn about new drugs? A bit, but I was mindful of all the trial pitfalls on show, and so carried large quantities of pinches of salt. No, I went to meet my colleagues and learn from their experience, not only of drugs but of management issues, clinical problems and other important but drug-unrelated things, and learn about real and significant scientific breakthroughs. Even in science, things are not black and white; one line of investigation into a viral origin for rheumatoid arthritis occupied several departments for some years, but was eventually found to be false thanks to a contaminated assay. But if the conferences were not supported by the drug industry, many would in all probability not happen, which could be a disaster for medicine. I have no doubt that there are egregious attempts at bribery, but one has to look at the pros as well as the cons.
I once gave a talk to a group of general practitioners about non-steroidal anti-inflammatory drugs. It was in the evening, and a drug rep supplied food. I told them not to use his drug; there were others that were older and thus better-researched. The drug was Vioxx. This was before the scandal of data concealment. My opinion was based on scientific evidence (and lack of it). Had the food been missing I would not have had an audience. So inducements may have their benefits.
I can only agree with Rod that negative evidence is suppressed. It should be a requirement that all registered trials are published, positive, negative or abandoned. And like must be compared with like. Statins again. The benefit of many is suggested to be a 50% reduction in heart attacks. Sounds great, but 50% of what? If the absolute risk of a heart attack is 5%, then a 50% reduction takes it down to 2.5%. Not so great. Meanwhile the side-effects are always given as absolute risks, so benefit is overstated in relation to risk. In addition, attempts to access the source data of some research has been impossible, so one cannot judge the veracity of the conclusions. The excuse given is commercial sensitivity or confidentiality. Not a good enough excuse. This should be something properly investigated. There is accumulating evidence that the (small) effect of statins is not related to their cholesterol-lowering properties, and the whole basis of the cholesterol-heart hypothesis is based on selective data-picking. Malcolm Kendrick and Uffe Ravnskov are two authors who have dissected this in detail. The astronomical cost of statins warrants a closer look. Well, you may think, they are actually cheap pills, but multiplying a low cost by a large number comes out worse than multiplying a large cost by a small one.
I disagree with Rod that nationalisation of the industry is the answer; it would be rapidly bogged down in bureaucracy, and thus unworkable. So let’s stick to something easy. All drug trials should be registered (already coming in the U.K.), all registered drug trials should be published, and all trials should have their source data open to independent review, and all trial authors should append truthful conflict of interest statements. Not only that, but the statistical methods of each trial should be transparent. The possibilities of inappropriate analysis, hiding of unwanted facts and outright fraud and deception would be dramatically reduced by these simple measures. Suck it and see?
Dr. Andrew Bamji is Gillies Archivist to the British Association of Plastic, Reconstructive and Aesthetic Surgeons. A retired consultant in rheumatology and rehabilitation, he was President of the British Society for Rheumatology from 2006-8.
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“Modellers are finding it increasingly difficult to know what will happen next…”
They’ve never known.
We need to show our resistance to the likes of Ferguson as much a possible
Friday 22nd October 11am
Yellow Boards Event – Stand by the Road
Tesco Superstore
17 County Ln, Warfield, Bracknell RG42 3JP
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Rebels at Roundabouts
Friday 22nd October, 5-6.30pm
Blackheath Gate, Greenwich Park
Beowulf is so right, but more so we need to show our greater relevance than our supine Parliament.
Perhaps they are getting it even more wrong?
It seems as ever when the models and reality diverge the reality needs changing. this is post-normal science.
Maybe he is getting scared of his reputation.
LOL what reputation? between buggy code, p*sspoor assumptions and sneaking out to bonk his mistress he shredded it months ago
Why the fuck is this charlatan still given airtime? Oh yes because he’s a useful idiot and fully in step with “The Narrative”
It’s simple, he is one of Gate’s mates.
Yes, he is director of the GatesGavi funded Vaccine Impact Modelling Consortium which is paid huge bucks essentially to drum up business https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/hosted-initiatives-and-groups/vaccine-impact-modelling-consortium/
He’s also Director of the Abdul Latif Jameel Institute at Imperial (sic) College.
On the subject of our global overlord Gates
https://www.youtube.com/watch?v=LNAwUxZ5nfw
Gates, Schwab, Von de Leyen, and all the rest of the puppets and useful idiots.
Says it all in one handy graphic.
Simple, putting on the show a bumbling idiot hated by everybody brings more clicks/views/advertisement revenue. We have a similar clown down here in Germany, fond of warning about apocalypse (surname starts with L) without any pause – and he gets the exact same treatment by media (there’s been hardly a single day on which he did not give a doomsday interview to someone, and his greatest hope is to become the next health minister).
For crying out loud go away Ferguson.
I had to laugh at this one :
“Modellers are finding it increasingly difficult to know what will happen next,”
… given that the accuracy has always been around zero.
I guess that we need to know that the Imperial Clown is still getting airtime.
But ….. ???
If in doubt, create some really big, scary numbers.
Ah yes, the good old “we must introduce more measures because others have introduced more measures”, the brilliant policy which has worked so extremely well since the very beginning of this pandemic.
In politics this well-established doctrine is known as Race to the Bottom, and in academic circles it goes by Mutually Assured Dumbassity (MAD).
Yep, this why face nap mandates were brought in…”because other countries were doing it! ” And none of this worked last time, if you believe any of this crap was meant to work…but, like the dangerous lunatics they are they’ll keep doing it anyway, knowing damn well what the result will be!
Their policies have worked so extremely well! You must adjust your thinking and appreciate that they are hell bent on destruction.
Neil sum game
Saw this in the Telegraph and the comments were great…they were so good they closed down the comment section within a couple of hours! So I never got chance to add to it!! HaHaHa.
I nearly bought a copy of the Telegraph on Sunday but thought better of it. Closing down comments is hardly the way to endear itself to readers.
“Cases are growing, because boosters are stalling, if we don’t get boosters rolled, we will have to take measures, if we don’t take measures, we will have cases growing, blah, blah, blah” Yawn.
One of the many things you’ve got to watch out for with politicians, is them saying that they had the right policy all along and the reason it didn’t work is because it didn’t go far enough — hence needing more of the same to ‘solve the problem’.
This is exactly why we’re where we are — they’ve bet on vaccinations as the saviour and the more they fail to solve the problem the more they’ll demand are vaccinated / boosted.
You’d think that people would realise this sort of thing as a standard behaviour of politicians and call them out on it, but people never do seem to realise, and instead side with the politicians in demanding more of the same. Oh well, looks like we’re stuck with them.
Oh yes, vaccines, the Cavalry just around the corner to save us as Matt Wankok kept telling us before his timely departure.
The “vaccine” has not worked so let’s increase the dose; sounds like the theory that GPs etc use to dispense anti-depressants ” So Mr/Mrs X , I see you are still of a low mood with your current dose, let’s cycle up your medication to improve the outcome”.
And we all “know” that the UK as elsewhere is very heavily over medicated with SSRI…..all because of a community of medics driven by the “Herd Instinct”.
It is so comforting to have the mad modeller’s predictions, which we know will be out by a Fergu (the new epidemiological constant invented by him), and as long as we do the maths (just divide his doomsday forecasts by 10), we should be ready for what awaits us.
Love the “Fergu” as a measure of failure!
As you say, always divide his “forecasts” by at least 10 times.
Not listening, not interested, he’s never been right yet
“People need to be aware that we have currently higher levels of infection in the community than we’ve almost ever had during the pandemic “
Sane conclusion : Jabs and other bullshit do f. all. Ignore Public Health significance seekers.
Insane conclusion : Let’s do more pointlessness. Listen to Fergusson
Deleted
It’s not good news until it translates into a different perception.
Maybe it’s because I’m tired but is it just me who reads his statement and thinks that it’s not even grammatically correct? I presume to know what he is trying to say but I would have failed O level English language had I come out with such a disjointed combination of words. Presumably he had time in advance to think about it which makes it even more confounding.
I think living in a perpetual state of hysteria has an affect on the grammar part of a person’s brain.
It occurred to me that it is the sort of sentence someone with dyslexia might come up with. Apparently “many children have dyslexia and dyscalculia together”. Dyscalculia is the mathematical equivalent of dyslexia. In all seriousness, that could well explain a lot.
Count me, and millions of others, out.
#UnitedDisobedience
Ferguson is a laughing stock in his own profession. He’s now being openly mocked and frequently disparaged by his peers online. Numerous scientists in interviews have referred to “scientists doing questionable modelling”, or similar. Everyone knows who they’re talking about. How much longer can the likes of Imperial stand behind this guy?
ICL are the dam wall protecting this idiot – the weight of the scientific criticism – “water”- filling the lake behind that wall is evidently growing; we all now what happens when dams, holding back lakes when full, burst – they take out a lot of innocent people ( with apologies to Chastise/617 casualties)
That doesn’t say much for the vaccines, does it.
Italian news blackout is almost complete, they are still marching though!
https://www.youtube.com/watch?v=rx8Th581wJI
Watching the news nowadays is like watching Punch and Judy. Everyone has the internet, so it’s easy to see what’s going on. And easy to see the readers have a hand stuck up their arse.
In the old days the news told you what actually happened and you had to work out what to think of it.
Now the news tells you what you should think and you have to work out what actually happened.
“we have currently higher levels of infection in the community than we’ve almost ever had during the pandemic”, and we also have some of the highest levels of asymptomatic testing we have almost ever had.
Looking at the gov stats, I see that “cases” have dropped significantly in Scotland where the kids went back to school a couple of weeks before England. Thus I confidently predict that they will drop here too, especially given the impact of half term.
Axiom: ‘In order to advance a communist ideological belief system, the rulers must *pretend* not to know things’.
Individually, in groups, or in the systems they construct, that axiom has always been true.
Not sure if that’s confined to just communism, probably applies to any belief system based on lies. But it’s very true. They know what they are doing.
Indeed – what we are seeing is fascism rather than communism.
It’s anti-democratic totalitarianism – which is sui generis, and can emerge from behind a range of fronts, be they communist, fascist, nationalist or vaguely populist or paternalistic. In this case, and in this country it’s actually Toryism that is the operative front.
Oh God, you’re still spouting this crap.
The only opposition – feeble, I admit – to this tyranny in the HOC has come from Torys.
Did Mussolini support the replacement of the indigenous Italian population with Third Worlders?
Did he want to close down cafes, cinemas, local shops, theatres and restaurants?
This is ‘communism’ the same way that Ferguson’s models are accurate predictions.
Bring it on. Lockdowns and boosters forever. People need to have their noses rubbed in it to understand they’ve been conned. A general lockdown will help us. The nightmare scenario is vaccine passports everywhere. I think they are sadly too smart to close stuff again. The smart play is to demonise the unvaxxed.
‘Of all ignorance, the ignorance of the educated is the most dangerous. Not only are educated people likely to have more influence, they are the last people to suspect that they don’t know what they are talking about when they go outside their narrow fields.’ –
Thomas Sowell
I doubt he’s ignorant. He’s getting away with talking shit and being listened to. Why would he stop?
Vaccine passport: a device used in early 21st century society to segregate unvaccinated people from the people who were given an ineffective vaccine that didn’t actually stop them catching or spreading covid. This device was also used to give the appearance of “doing something” while nudging the populous into carrying around digital identification, and into compliance with government commands. The devices were eventually abandoned after the Second Pandemic War.
Awesome!
Oh, do naff orf, Ferguson.
Ferguson is a cunt
Apologies, but there is no other way of saying that
Tempted to say
he is not as useful as thatbut I won’t for fear of being branded a sexistHow come people can become infected if they are vaccinated?
Impossible surely?
Can we dig up Jimmy Saville and ask him what to do about child sexual exploitation?
Didn’t the bbc just do that?
Good heavens. Imagining still listening to this crank. How on earth is this cretin (yes, philosophically speaking, he’s a cretin) still gaining airtime?
This inept specimen stands as a single indictment of our society.
So they’re trying the same “Don’t panic” move that they tried with car fuel.
Ferguson doesn’t panic about restrictions anyway – he just breaks them while telling everyone else to obey them.
Since 2020/03/31, 304,655,729 Sars-CoV2 test have been done in the UK, statistically this means every person living in this country has been tested 4.53 times. 27% of these tests have been done in the 92 days since freedom day. But these represent only 15.89% of the 579 days since testing started. Up to and including 2021/07/18, on average, 562,980.32 tests were done per day. From 2021/07/19, this increased by a factor of almost 1.6 (1.59) to an average of 894,331.55 per day. This exceeds the number of tests performed in every other major western European country (France, Germany, Italy, Spain) by a margin.
Could this perhaps be related to the higher case numbers in the UK and not enforced mask wearing and vaccination passes elsewhere?
Nearly 900k tests a day is a lot. Who exactly is getting tested? I think we should be provided with this information.
Also…. How many haven’t ever been tested? Apart from me
No, never. I once wore a face covering in summer 2020 but then read up on it and realised it was a con.
Me neither. Some people have to get tested at work or in school. And the remainder are probably a rather small (compared to the number of people) set of volunteer repeat offenders who absolutely want have a pandemic going on.
Well i’ve never submitted to one so some poor smuck has had more than 5!
In the absence of a functioning democracy, in the absence of any actual opposition to the Government, and in the absence of any members of Parliament to represent our views, and given all of the weapons (literal and metaphorical) which the State holds against us, our sole responsibility as citizens is to resist, not comply, not co-operate, not collaborate and in general cause as much friction for central and local government as we possibly can.
“we have currently higher levels of infection in the community than we’ve almost ever had during the pandemic”
Great ‘vaccines’ aren’t they?
Charlatan on the loose again. The BBC’s favourite fantasist.
Sheer lunacy to think our lives will probably be dictated by this nutter and his cronies under the pretense of protecting the NHS.
Imagine HAVING to pay for a service, but then when this service gets used as per what we’re paying for, we then get locked down to prevent us from using the service that we’re paying for.
Oh and when we’re at it, because you used that service you already pay for we’re going to have to charge you more now – because you used it.
Shame on us all eh
Is this man a doctor? No. He’s a maths geek. So why the hell is this goon shooting his gob off about health matters? Worse, why is anyone paying attention to his entrail reading prognostications, let alone the bloody Govt who frankly should know better but would rather outsource their decisions and claim immunity from blame? Get a grip, Johnson and stop acting the clown.
This guy isn’t a maths geek, either. He’s a self-taught C++-programmer with no background in computer science (not per se something bad — my official job designation is senior software engineer and I’m self taughy as well) whose main occupation is forever working on a single program claimed to model pandemic spread by simulating population behaviour in a way he pulled out of his ass.
This guy isn’t really an expert in anything except this particular piece of crap code.
That’s a little harsh, didn’t he get his data from that esteemed impartial font of knowledge, Wikipedia?
Can’t help thinking that masks, lockdowns, and this man’s finger in the air guesses are all about as useful as each other, i.e. not very.
This has seriously reached peak farce.
Zero evidence that restrictions “work” but lots of evidence of the harm they cause. But let’s do more of them.
God designed a perfectly effective breathing system so let’s cover it with a cloth mask to stop it working properly. With zero evidence that this impacts anything.
Vaccines are awesome and are so good that you need to keep taking them again and again.
I believe that this whole Covid theatre is sheer garbage. My own views increasingly align with Sam Bailey and “Virus Mania”.
Western “science” is fixated on viruses as the cause of illness and is programmed to find them and show them as the cause of everything. This suits big business interests that can then sell “remedies” and “vaccines”. But the evidence behind it is shaky, at best. A giant wrong turn.
In my opinion, we do not really know what causes the illness that has been identified as Covid. The “virus” may simply be a by product of it rather than a “cause”. The so called science is deep down based on a deck of cards where more assumption is piled on more assumptions.
History will equate what we are doing with bloodletting in the Middle Ages. Or the great moment in Star Trek IV (sorry this ages me…) where Dr McCoy encounters a patient in a 1980s hospital. On being told of the treatment he decries the barbarism of it and produces a simple gadget that he just waves at the patient, who is then cured.
I think that in reality illness is caused by toxins and many harmful substances in our environment. The true cause of Covid is actually not known. Heresy, of course.
Most have kept controls ….. except Sweden, Denmark and a range of American States all of which have far fewer deaths/infections than those who have kept controls.
But that’s irrelevant to Lockdown Ferguson.
They should try the radical practice of actually treating ill cov patients early as out patients with known, effective protocols such a as used by AAPS, FLCCC,etc instead of STILL doing nothing. If they did this from the start >85% of the deaths would have been avoided and we wouldn’t be in this mess. This is medical malpractice and the heads of NHS, Ferguson,sage and this government should be arrested and charged with mass murder.
More lockdowns says ‘Professor’ Fergusson?
Thats not like him to be so alarmist.
‘Authority’ can try imposing restrictions but whether or not they happen depends on whether or not we do them.
Rules only stand if majority comply with them and there’s nothing except personal choice that stops them being not complied with.
I and others learnt that that’s the way it is when we were children. ‘Grown-ups’ in our sphere never admitted it was so but most had the sense to not try to deny it in the face of the proof we kids provided
Er!
Who’s asking Ferguson?
Why are we asking Ferguson?
Why hasn’t Boris, SAGE, etc. twigged yet that Ferguson just has no clue, and *IS* the danger?
“Sajid Javid says winter poses the “greatest threat” to the recovery from Covid, with cases rising.
He adds that case numbers could go as high as 100,000 per day – but that the NHS is performing with “distinction”.” (news conference as reported by BBC)
I presume the numbers are a Ferguson factors.
I haven’t read this, but I just wanted to say that I don’t give a BUGGER what this dishonourable and dishonoured, discredited, disgusting piece of rancid offal has to say. Why on earth is he still being quoted?
Can’t think of anything profound or intelligent to say, other than “fuck off, Ferguson”.