A grab bag of interesting links and news:
The first COVID-19 human challenge trials have been approved… in February 2021, instead of February 2020.
If this is a good idea now, when the benefits are vastly lower and the risks are only slightly lower, then it was probably also a good idea a year ago. Opponents of human challenge trials should think hard about the background heuristics that caused them to get this one wrong, so we don’t have to repeat this tragic error again.
From Zvi Mowshowitz on Feb. 11:
The good news is that Johnson & Johnson has applied for emergency use authorization, and they are going to get it. There’s going to be a sprint to review the data in which every second will be used! Which started right after the official application, because you can’t review data that hasn’t been submitted in a completed application, that’s physically impossible, what are you even talking about.
The bad news is that it’s going to take three weeks to get to the meeting, likely with additional time after the meeting before we can distribute the vaccine, but hey:
Last week I went over how we know the Johnson & Johnson vaccine is safe and effective, and there are millions of doses waiting to be distributed, and there’s no good reason we can’t start that process yesterday.
I do realize that there is a difference between, as Scott Alexander discusses, the FDA’s need to be legible and reliable, and follow proper procedures, versus my ability to apply Bayesian reasoning.
That doesn’t mean this needs to happen three weeks after application, and attempts to justify that timeline are obvious nonsense.
Mostly, it’s a call and response. You say ‘why are we letting people die for no reason?’ and they say ‘Thalidomide!’ and ‘people won’t trust it.’
So basically, one time someone had a drug that wasn’t safe. We didn’t approve that drug because our existing review process made it look unsafe, so in response to that we created a more involved and more onerous process, as opposed to noticing that the previous process actually worked in this case exactly as designed. Then we use this as a fully general excuse to freak everyone out about everything that hasn’t gone through this process, and then use that freak out (that, to the extent it exists which it mostly doesn’t, is directly the result of such warnings) as our reason to force everything through the process. Neat trick.
Oh, and did I mention that the ‘safety data’ that requires three weeks to review is, and I quote it in its entirety, ‘nothing serious happened to anyone at all, and no one was struck by lightning.’ Either J&J has created a safe vaccine, or J&J is committing a fraud that will be caught and get everyone involved arrested within three weeks, or they’re committing a fraud so effectively that the review won’t catch the fraud and won’t help. Those are the only possibilities. If the data isn’t fraudulent then the drug is safe, period. […]
On the actual J&J vaccine, I don’t know what more there is to say. As with Moderna and Pfizer, they’ve already done the actual approval process and confirmed that it’s going to get approved before they applied, and now we’re delaying in order to make it clear we are Very Serious People who Follow Proper Procedure and are not In Bed With Industry and Putting People At Risk or Destroying Trust in Vaccines by going ‘too fast.’ Or something like that.
We have now done this three times. It’s one thing to have the first vaccine application point out that there’s weeks of lost time. It’s another thing to not have fixed the problem months later.
From Zvi on Mar. 4:
Meanwhile, now that we were provided a sufficiently urgent excuse that we were able to show that mRNA vaccines work, we’ve adopted them to create a vaccine for Malaria. Still very early but I consider this a favorite to end up working in some form within (regulatory burden) number of years. It’s plausible that the Covid-19 pandemic could end up net massively saving lives, and a lot of Effective Altruists (and anyone looking to actually help people) have some updating to do. It’s also worth saying that 409k people died of malaria in 2020 around the world, despite a lot of mitigation efforts, so can we please please please do some challenge trials and ramp up production in advance and otherwise give this the urgency it deserves? And speed up the approval process at least as much as we did for Covid? And fund the hell out of both testing this and doing research to create more mRNA vaccines? There’s also mRNA vaccines in the works for HIV, influenza and certain types of heart disease and cancer. These things having been around for a long time doesn’t make them not a crisis when we have the chance to fix them.
From Bryan Caplan on Feb. 16: Bioethics: Tuskegee vs. COVID. Excerpts:
[…] Why do bioethicists habitually invoke the Tuskegee experiment? To justify current Human Subjects Review. Which is bizarre, because Human Subjects Review applies to a vast range of obviously innocuous activities. Under current rules, you need approval from Human Subjects merely to conduct a survey – i.e., to talk to a bunch of people and record their answers.
The rationale, presumably, is: “You should only conduct research on human beings if they give you informed consent. And we shouldn’t let researchers decide for themselves if informed consent has been given. Only bioethicists (and their well-trained minions) can make that call.”
On reflection, this just pushes the issue back a step. Researchers aren’t allowed to decide if their human experiment requires informed consent. However, they are allowed to decide if what they’re doing counts as an experiment. No one submits a formal request to their Human Subjects Review Board before emailing other researchers questions about their work. No professor submits a formal request to their Human Subjects Review Board before polling his students. Why not? Because they don’t classify such activities as “experiments.” How is a formal survey any more “experimental” than emailing researchers or polling students?
[…] The safest answer for bioethicists, of course, is simply: “They should get our approval for those activities, too.” The more territory bioethicists claim for themselves, however, the more you have to wonder, “How good is bioethicists’ moral judgment in the first place?”
To answer this question, let me bring up a bioethical incident thousands of times deadlier than the Tuskegee experiment. You see, there was a deadly plague called COVID-19. Researchers quickly came up with promising vaccines. They could have tested the safety and efficacy of these vaccines in about one month using voluntary paid human experimentation.
[…] In the real world, researchers only did Step 1, then waited about six months to compare naturally-occurring infection rates. During this period, ignorance of the various vaccines’ efficacy continued, almost no one received any COVID vaccine, and over a million people died. In the end, researchers discovered that the vaccines were highly effective, so this delay really did cause mass death.
How come no country on Earth tried voluntary paid human experimentation?* As far as I can tell, the most important factor was the formal and informal opposition of bioethicists. In particular, bioethicists converged on absurdly (or impossibly) high standards for “truly informed consent” to deliberate infection. Here’s a prime example:
“An important principle in human challenge studies is that subjects must give their informed consent in order to take part. That means they should be provided with all the relevant information about the risk they are considering. But that is impossible for such a new disease.”
Why can’t you bluntly tell would-be subjects, “This is a very new disease, so there could be all sorts of unforeseen complications. Do you still consent?” Because the real point of bioethics isn’t to ensure informed consent, but to veto informed consent to whatever gives bioethicists the willies.
[…] I’ve said it before and I’ll say it again: Bioethics is to ethics as astrology is to astronomy. If bioethicists had previously prevented a hundred Tuskegees from happening, COVID would still have turned the existence of their entire profession into a net negative for humanity. Verily, we would be better off if their field had never existed.
If you find this hard to believe, remember: What the Tuskegee researchers did was already illegal in 1932. Instead of creating a pile of new rules enforced by a cult of sanctimonious busybodies, the obvious response was to apply the familiar laws of contract and fiduciary duty. These rules alone would have sent people like the Tuskegee researchers to jail where they belong. And they would have left forthright practitioners of voluntary paid human experimentation free to do their vital life-saving work.
In a just world, future generations would hear stories of the monstrous effort to impede COVID-19 vaccine research. Textbooks and documentaries would icily describe bioethicists’ lame rationalizations for allowing over a million people die. If the Tuskegee experiments laid the groundwork for modern Human Subjects Review, the COVID non-experiments would lay the groundwork for the abolition of these deadly shackles on medical progress. […]
General COVID-19 thoughts, from me (someone with no relevant medical background):
1. I’ve head reports of people getting seriously ill or dying from various preventable illnesses, because they’re too scared to go to the hospital for various non-COVID-related ailments. In general, I think people are unduly scared of hospitals: going to the hospital is risky, but not catastrophically so. I’d advise people to stop going into grocery stores (if they can avoid it) long before I advised avoiding hospitals (in cases where they’re worried something might be seriously wrong).
Obviously, now is not the time to go in for routine check-ups, and video calls with doctors are a good first step in most cases, etc.
2. I’ve updated toward thinking it won’t be that hard to avoid catching COVID-19 in March/April in spite of the new strain, if you’re the kind of person who’s in a social network of very cautious people who have ~all avoided catching COVID-19 thus far. A large number of people are taking few or no precautions, and the bulk of COVID-19 exposures has been (and will continue to be) drawn from that group.
If you’re young and your whole social network has almost completely avoided anyone catching COVID-19 thus far, it’s more likely your social network is being over-cautious.
3. A lot of sources have been exaggerating the risk that you’ll be infected, or infect others, even if you’ve previously caught COVID-19 or been vaccinated. I think most people who’ve recovered from COVID-19 should mostly act as though COVID-19 doesn’t exist at all, at least for the next few months (in areas where the Brazil and South Africa strains aren’t widespread yet).
I’d say the same for people who have had two shots of the Pfizer or Moderna vaccine, as long as it’s been ~2 weeks since you had your second shot. For more detailed risk assessments than that, I recommend using the microCOVID website.
4. This is the home stretch. Universal vaccine availability is on the horizon, and our vaccines seem amazingly effective (especially for preventing deaths and hospitalizations). It goes without saying that it’s extra-unfortunate to catch COVID-19 shortly before you would have gotten vaccinated.
From Scott Alexander’s March link post:
CTRL+F “Blackrock” in this Matt Levine column for a discussion of how we accidentally stumbled into true communism for the good of all. The short version: an investing company called Blackrock owns so much of the economy that it’s in their self-interest to have all companies cooperate for the good of the economy as a whole. While they don’t usually push this too hard, the coronavirus pandemic was a big enough threat that “BlackRock is actually calling drug companies and telling them to cooperate to find a cure without worrying about credit or patents or profits”.
Also from Scott’s link post:
The class-first left’s case for why the Sanders campaign failed: he tried too hard to reinvent himself as a typical liberal to fit in, but people who wanted typical liberals had better choices, and it lost him his outsider energy (see especially the description of his “astoundingly dysfunctional” South Carolina campaign – “not only did basic tasks go unfulfilled, phone-banking and canvassing data were outright fabricated” – the article claims nobody was able to fix it because it was run by social justice activists who interpreted any criticism of them as racist/sexist. Interested to hear if anyone knows of other perspectives on this). Counterpoint: South Carolina was always going to be hostile territory for him, and maybe he didn’t reinvent himself as a typical liberal enough. I cannot find any other source confirming the South Carolina campaign allegations; interested in hearing what people think.
Marginal Revolution (also linked in Scott’s roundup) quotes Tanaya Devi and Roland Fryer’s “Policing the Police: The Impact of ‘Pattern-or-Practice’ Investigations on Crime”:
This paper provides the first empirical examination of the impact of federal and state “Pattern-or-Practice” investigations on crime and policing. For investigations that were not preceded by “viral” incidents of deadly force, investigations, on average, led to a statistically significant reduction in homicides and total crime. In stark contrast, all investigations that were preceded by “viral” incidents of deadly force have led to a large and statistically significant increase in homicides and total crime. We estimate that these investigations caused almost 900 excess homicides and almost 34,000 excess felonies. The leading hypothesis for why these investigations increase homicides and total crime is an abrupt change in the quantity of policing activity. In Chicago, the number of police-civilian interactions decreased by almost 90% in the month after the investigation was announced. In Riverside CA, interactions decreased 54%. In St. Louis, self-initiated police activities declined by 46%. Other theories we test such as changes in community trust or the aggressiveness of consent decrees associated with investigations — all contradict the data in important ways.
Neal Zupancic comments:
The authors seem to suggest it is mostly the investigations themselves causing the increase in crime, rather than any particular policy changes. The mechanism they propose is that police officers greatly reduce their quantity of policing when under federal investigation after a “viral” incident, but there is little indication that this comes about as the result of any particular policy reform – the suggestion is that police are either reducing public contact in an effort to avoid having their own actions scrutinized, or are trying to make a point (in the case of deliberate strikes and slowdowns/sickouts). There’s also a section (page 27) where the authors talk about the possible impact of increased paperwork, and estimate it might account for about 20% of the reduction in police activity in one city. I’m not sure if we’re calling this “reform” but even if we do it’s a small proposed effect.