28 January 2021 — Dr Malcolm Kendrick
This blog was published on RT-com, after much discussion and a few changes. It can be seen here It took a few days. The editors were concerned about the fact-checkers having a go at it and demanding retraction.
We went back and forward. I assured them that all my quoted facts were correct, so the fact-checkers could only attack the ‘opinion’ stated. Which they may well do. If so, fact checkers are no longer checking facts, they are decreeing which scientific opinions are correct, and which are wrong.
Which puts them in a very dangerous place indeed. We do not know who the fact checkers are, we do not know how much they are paid, we do not know what editorial control is exerted over them. We know nothing about them, yet their pronouncements are decreed final on all matters.
This is the recreation of Soviet show trials of another era. “We know you are guilty, you will be found guilty, all that is required of you is that you admit your guilt. We, the judges in this case, however, are subject to no control, no-one can find us in the wrong, or punish us in any way.”
Anyway, the main concerns of Russia Today were that I did not look at enough variable factors. What about population density? What about secondary lockdowns etc. I replied it was impossible to assess all variables fully. I sat and thought about the confounding variables inherent in lockdown, that you would probably need to include in any study on them:
Number of tests carried out
How deaths are recorded/validated
Percentage of population living in cities [not the same as population density]
Population density within cities
Number of single person households
Average age of population
Percentage of ethnic minorities
Primary ethnicity of population
Number of people with multimorbidity’s
ICU beds per head of population
Time of first lockdown
Time of relaxation of first lockdown
How well lockdown measures were followed.
Time of second lockdown
Restrictions within lockdowns curfews etc.
Test and trace set-up
Vitamin D levels
Northern or Southern hemisphere
Strain 1 COVID
Strain 2 COVID
Strain 3 COVID
Main method of commuting, underground, buses etc.
That’s just for starters.
The total number of interactions between these twenty-seven factors is twenty-seven factorial 27 x 26 x 25….x 3 x 2 x 1
Which is …
10,888,869,450,418,352,160,768,000,000 possible interactions.
So, if anyone says you have not taken the interactions of all variables into account, you can say that this is – effectively – impossible. Perhaps they would like to demonstrate they have done so.
I also pointed out I was not the only person to believe that lockdowns had little, or no effect on transmission rates and death from COVID. Here is part of an article from South Africa, based on the paper ‘COVID-19 in South Africa’
The article was published on Prevention Web:
Lockdown didn’t work in South Africa: why it shouldn’t happen again
By Benjamin T H Smart, Alex Broadbent and Herkulaas MvE Combrink
At the start of October, the World Health Organisation (WHO) and the Chinese government lauded South Africa’s response to the global COVID-19 pandemic. Yet data concerning both the spread of the virus and the indirect consequences of the lockdown suggest that the severe restrictions imposed in South Africa – some of the strictest in the world – were far from effective.
We recently reviewed the evidence for the effectiveness of the lockdown at slowing the spread of the pandemic. The mitigation strategies initially implemented may well have gone some way to “flattening-the-curve” – that is, reducing the rate at which the virus spreads through the population. But we found no decline in either daily new cases or deaths between around 27 March, which was the first day of level 5; and the latter part of July, when cases began to tail off during level 3.
Lockdown level 5 in South Africa was one of the world’s strictest. Citizens weren’t allowed to leave their residence except for essential purposes such as grocery shopping and medical care. All non-essential businesses were shut down, and cigarette and alcohol sales were banned.
If this “hard lockdown” had been effective, the rate of infection would have dropped significantly 7-14 days after lockdown was implemented. Note that one must look for a delay due to the disease’s 5-6 day average incubation period, and time for test results to be released. This simply did not happen.
Of course, the number of cases did increase over time, but what counts is whether the rate of increase changed when lockdowns changed. We found no such changes. As lockdown restrictions were relaxed and South Africa entered levels 4 and 3, when much of the economy re-opened and restrictions on movement were substantially reduced, there was no increase in the rate of infection.
In fact, during level 3, the pandemic peaked. And as the country entered level 2, the pandemic started to recede. If lockdown regulations were having the intended effect, one would expect the rate of infection to spike as restrictions were relaxed. This did not happen…..
Here is the article that first appeared in RT-com:
The scientific evidence so far on COVID lockdowns suggests that they don’t work – and may actually increase the death rate
We are being told that lockdowns halt the spread of the infection, but where’s the proof? The places with the worst death rates all followed that path – and the ones who didn’t have generally fared better.
‘Paradoxically, human beings, when compelled to act, learn to justify a chosen course with an assurance unwarranted by the evidence for the course chosen.’ Bernard Lown.
I have studied the history of medicine, and medical interventions, for many years. The most extreme disasters have always followed a fairly distinct pattern. A series of steps, if you like.
Step one = we have a serious disease that is killing lots of people.
Step two = it creates great fear, and the medical profession has nothing much in place to deal with it.
Step three = a charismatic leader emerges to decree that he (almost always a ‘he’ up to now) knows how to treat it/control it, etc. This is ‘the idea’.
Step four = The ‘idea’ is enthusiastically taken up around the world and becomes mainstream thinking.
Step five = the ‘idea’ becomes standard practice.
Step six – the ‘idea’ is taught to medics and becomes accepted truth, a fact.
Step six = anyone who goes against the ‘idea’ is ruthlessly attacked.
There is always, of course, the possibility that the ‘idea’ is the best thing to do. This happens from time to time. However, there seems to be little or no correlation between the enthusiasm, and speed, with which ideas are taken up, and the likelihood they are correct.
The problem, as I came to recognise, lies between step two and step four. By which I mean that a charismatic figure convinces everyone that they have the answer, before there is any evidence to support it. The person may not be charismatic, simply someone who has the ability to grab attention and push the ‘idea’ forward. Such as the Chinese Premier.
Another thing that leads to disaster, which is perhaps of even greater importance, is that the ‘idea’ must sound like the most obvious common sense. It should trigger a response along the lines of ‘Yes, of course, that sounds perfectly reasonable’. Once that’s been achieved, the ‘idea’ drops neatly into people’s minds, settles down, and grows roots, creating not a ripple of cognitive dissonance.
At which point it cements itself in, and becomes difficult, even painful, to remove.
To quote the film Inception: ‘What is the most resilient parasite? Bacteria? A virus? An intestinal worm? An idea. Resilient… highly contagious. Once an idea has taken hold of the brain it’s almost impossible to eradicate. An idea that is fully formed – fully understood – that sticks; right in there somewhere.’
We love ideas, they make us who we are. We defend them, sometimes with our very lives.
“Why do people insist on defending their ideas and opinions with such ferocity, as if defending honour itself? What could be easier to change than an idea?” J.G. Farrell.
So, yes, I have no illusions about the strength of ideas. They are so powerful, and so dangerous that you must be very careful where you aim them. Because ideas also have a God-like power, which is that they are immortal.
The damage inflicted by medical ideas
You can kill a person who holds an idea. You can kill thousands of people who hold the same idea – but you cannot kill that idea. Unless you kill every single person who believes in it, then wipe it from the historical record, so that no-one can ever think it again. See 1984.
I will give you a couple of examples of horribly damaging medical ideas. The first is the radical mastectomy. An idea first driven by William Halsted, a US surgeon from the end of the nineteenth century. He believed, as did almost everyone else at the time, that breast cancer spread locally – as did all cancers. Therefore, anything located anywhere near the cancer had to be cut away in case it had already been polluted.
With a radical mastectomy the entire breast, the other breast, muscles on the chest wall, lymph nodes, more muscles were cut out. Almost anything that could be removed without actually killing the women in the process.
The mutilated women were immensely grateful, and the surgeons proud of their expertise. They were doing a good thing, because the idea was considered to be inarguably correct. Questioning it was to be met with the response like, ‘Do you want these women to die – you heartless swine?’
Except that it wasn’t correct. Breast cancer does not spread locally. At least, when it does, it does so very slowly. The spread that causes problems, and kills women, is not local. Cancer cells get into the lymphatic system, and the bloodstream, and spread widely around the body, very early on. Often, long before the primary cancer can be detected.
Those who questioned the radical mastectomy, were attacked. Geoffrey Keynes, brother of John Maynard, tried less radical surgery in the 1920s. It did not go down well:
‘Halsted’s followers in America ridiculed this approach, and came up with the name “lumpectomy” to call the local surgery. In their minds, the surgeon was simply removing “just” a lump, and this did not make much sense. They were aligning themselves with the paradigm of Radical Mastectomy. In fact, some of the surgeons even went further to come up with “superradical” and “ultraradical” procedures that were morbidly disfiguring procedures where the breast, underlying muscles, axillary nodes, the chest wall, and occasionally the ribs, part of the sternum, the clavicle and the lymph nodes inside the chest were removed. The idea of “more was better” became prevalent.’
More is better… this is another of the deadly repeating themes of ‘the idea.’ The idea can never be wrong, it is just that people are not doing with sufficient vigour. If women are still dying from metastatic breast cancer, even after radical mastectomies (and they were), the answer could not possibly be that the procedure doesn’t work. The answer is that we are not being radical enough: ‘Hack away more, and then more.’
‘I was greeted with hands stretched out in a Nazi salute’
Another big medical idea is that of bed rest following a heart attack. It was thought, at one time, that all heart attacks were fatal. James Herrick, another US doctor, described the first non-fatal heart attack in 1912, then suggested that following such an attack, strict bed rest was important. This would take pressure off the heart and allow it a chance to heal. Again, this sounds perfectly reasonable. As described by Dr Bernard Lown, a professor of cardiology and the developer of the defibrillator:
“To a medical novice like me, the justification for enforced bed rest was persuasive. It was based on a sacrosanct therapeutic principle, the need to rest a diseased body part, be it a fractured limb or a tuberculosis-affected lung. Unlike a broken bone, which could be immobilized in a cast, or a lung lobe, which could be collapsed by inflating the chest cavity with air, the heart could not be cradled into quietude. The only approximation for a diseased heart was to diminish its workload. It was long known that during recumbency the heart rate slows and blood pressure drops, both indices of less oxygen usage and therefore of decreased cardiac work. Heart rest was therefore equated with bed rest.”
And so it became standard practice. It was simply what you did:
“Patients were confined to strict bed rest for four to six weeks. Sitting in a chair was prohibited. They were not allowed to turn from side to side without assistance. During the first week, they were fed. Moving their bowels and urinating required a bedpan. For the constipated, which included nearly every patient, precariously balancing on a bedpan was agonizing as well as embarrassing.
“Because world events might provoke unease, some physicians prohibited their patients from listening to the radio or reading a newspaper. Visits by family members were limited. Since recumbency provoked much restiveness and anxiety, patients required heavy sedation, which contributed to a pervasive sense of hopelessness and depression. Around one in three patients died.”
Bed rest started as a relatively mild thing. However, as it is with almost all things, it became increasingly ‘radical’. Lown, along with his mentor Dr Samuel Levine, tried to change this. He became involved in trying to get patients up out of bed to sit in a chair:
“Little did I realize that violating firmly held traditions can raise a tsunami of opposition. The idea of moving critically ill patients into a chair was regarded as off‑the‑wall. Initially the house staff refused to cooperate and strenuously resisted getting patients out of bed. They accused me of planning to commit crimes not unlike those of the heinous Nazi experimentations in concentration camps. Arriving on the medical ward one morning I was greeted by interns and residents lined up with hands stretched out in a Nazi salute and a “Heil Hitler!” shouted in unison.”
Step six = anyone who goes against the ‘idea’ is ruthlessly attacked
No evidence, no problem
Then, among all the other problems with ‘the idea’, between steps two and three, is one that I have not yet mentioned. It is that no study is ever done to find out if the idea works, or not. It is just conceived to be so obviously beneficial, such common sense, that there would be no point in wasting time and resources trying to prove it works.
No-one ever did a study to find out if the radical mastectomy improved survival. No-one ever did a study to prove that bed rest saved lives. They were both introduced on the back of absolutely nothing. In time, eventually, the folly of both was finally recognised. It took seventy years for radical mastectomy, fifty for bed rest.
Which takes us to lockdowns. The most expensive, invasive, and potentially destructive medical intervention ever attempted by humanity. Was there any evidence from anywhere, in history, that lockdowns would work? No, there was none. But we have the six steps on full display here.
Step one = we have a serious disease that is killing lots of people – check.
Step two = it creates great fear, and the medical profession has nothing in place to deal with it – check.
Step three = a charismatic leader emerges to decree that he (almost always a ‘he’ up to now) knows how to treat it/control it etc. This is the ‘idea’ – check.
Step four = The ‘idea’ is enthusiastically taken up around the world and becomes ‘mainstream thinking’ – check.
Step five = the ‘idea’ becomes standard practice – check.
Step six – the ‘idea’ is taught to medics and becomes accepted truth, a fact – check.
Step six = anyone who goes against the ‘idea’ is ruthlessly attacked – check.
Does it work – have lockdowns worked? You can pick and choose countries to support the case that it does and dismiss any evidence you don’t much like. Unfortunately, once you introduce a medical intervention that affects everyone, everywhere, you have lost the possibility of carrying out a controlled experiment of any sort.
Despite the lack of any randomised evidence, most people are absolutely convinced that lockdowns work to control the spread of COVID-19. They point to various countries, e.g. New Zealand, Norway, Australia and Taiwan, to prove their case. They always have a ready explanation as to why countries that underwent lockdown still have high death rates and vice-versa.
The ‘idea’ has become the truth. Its proponents now demand that those who doubt the efficacy of lockdowns prove that they don’t work. However, I don’t believe it’s up to those who don’t believe that lockdowns work, to prove that case.
The starting point, for any scientific hypothesis, is for the proponents to disprove the null hypothesis. Demanding that those who believe something may not work, to prove that it doesn’t, is to turn the scientific method upside down. You can never prove a negative.
The null hypothesis, by the way, is that there is no difference between two things. Randomised Controlled Trials (RCTs) in medicine are designed to prove, statistically, that there is an actual difference between doing A or B. This is how science is done, how research is done.
We must look carefully at the death rates
Unfortunately, it is not possible to do a controlled trial with COVID-19. The possibility of doing any randomised study was lost very early on. Which means that we are forced to rely, instead, on observational studies. We can look at country X, that did Y, and see how it compares with country Z that did not do Y.
Or we can look at two countries that did Y, to see how they compare. Or two countries that did not do Y. With COVID, of course, no two countries did exactly the same thing. Not even the four ‘countries’ within the UK. So any observations become more difficult to rely on due to this ‘confounding variable’.
In some UK countries, six people could meet up, in others it was eight, or two households, or only one household etc. In some, restaurants were open, in others they were shut – at varying times. From a scientific perspective, it’s a mess.
Anyway, to simplify things, let’s look at the 10 countries around the world with the highest death rate from COVID. That is, deaths per million population (I have left out countries with population of less than one million, such as Monaco, or Liechtenstein, or Andorra because a few deaths here or there can distort the death rate considerably)
What did they do differently, what did they do the same? Looking only at first lockdown dates:
Belgium first locked down on March 18th, 2020.
Slovenia first locked down on March 20th, 2020.
Czechia first locked down on March 16th, 2020.
The UK first locked down March 23rd, 2020.
Bosnia-Herzegovina first locked down March 16th, 2020.
Italy first locked down March 9th, 2020.
North Macedonia first locked down March 18th, 2020.
The USA is highly federal and different states took different approaches – seven states did not issue lockdown orders: Arkansas, Iowa, Nebraska, North and South Dakota, Utah, and Wyoming. In those seven states the death rate from COVID averaged at 1,280 per million vs. 1,254 as the US average.
In comparison, New Jersey first locked down March 21st, 2020, and its current death rate is 2,310 per million. New York locked down on March 12th – its current death rate is 2,130 per million. These states have the highest COVID related deaths in the US.
Bulgaria first locked down on March 13th, 2020.
Hungary first locked down on March 28th, 2020.
All countries locked down, Italy first, Hungary last. As you can see, the date of first lockdown is unrelated to the death rate. The other stand out facts are that these are all ‘European’ countries. All with majority Caucasian populations. They are all in the Northern hemisphere.
If I were thinking of running a clinical trial where the hypothesis was that a lockdown was the best way to prevent deaths from COVID, then I would start by looking at observational data such as this.
I would find that the ten countries in the world with the highest death rates all locked down at similar times, with similar restrictions.
I would look at the US where the death rate in states that locked down, and those that did not, were almost the same rate (or vastly higher in the cases of New Jersey and New York), and I would conclude that the observational studies had – thus far – failed to disprove the null hypothesis. In fact, the evidence up to this point could suggest that lockdowns may actually increase the death rate.
In short, I would look for another idea.