Research And Censorship In An Uncertain Time

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  1. The Good Doctor

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    Joseph B. Fraiman is an emergency medicine physician currently practicing at Thibodaux Regional Medical Center and three other regional hospitals in Louisiana. This interview, conducted by journalist Martha Rosenberg, has been edited for clarity and length.

    Rosenberg: Working at ERs in Louisiana hospitals that serve bayou communities, how seriously were you affected by COVID-19?

    Fraiman: When COVID-19 began, as the only physician overnight, I was pronouncing or intubating patients two or three times during a shift. Previously this would happen every two to three shifts. There were freezers outside the hospital for the overflow. Now we are no longer seeing this.

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    Rosenberg: What caused the improvement?

    Fraiman: I have stopped pretending that I know what is going on or that we know what to do when it comes to the pandemic. Like the Dunning Kruger effect, you start out confident, and confidence falls as one gains experience. Studies of interventions and government policies for COVID-19 show very mixed benefits. Why, for example, does Vietnam have a 500-fold lower COVID-19 rate than Finland and a 3,500-fold lower rate than the U.S. despite having fewer resources?

    Rosenberg: It is interesting that few scientists say they are confused about this.

    Fraiman: That’s the problem. Scientists who are certain they are correct are censoring those who don’t agree with them. For example, authors of the only randomized controlled trial of mask-wearing (The Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers) could not initially even get published because no one liked the results. Carl Heneghan, director of Oxford’s Centre for Evidence-Based Medicine, wrote a review of the study, which Facebook branded as false information.

    Rosenberg: What other research is unwelcome?

    Fraiman: Anything addressing the vaccines. The Pfizer and Biotech Vaccine trial had 3,410 suspected but unconfirmed cases of COVID-19, and it was unclear if these cases were all tested. If the vaccine group was tested less frequently than the placebo group, this raises questions about the efficacy of 95 percent they claimed to have found. These are important questions, but multiple other concerned physicians and I could not find a medical journal or lay press willing to allow us to raise this issue. We were only able to point it out on the NNT, the physician review site.

    Rosenberg: What work have you done related to COVID-19 diagnostic testing?

    Fraiman: Since early in the pandemic, I advocated for more aggressive testing and contact tracing. Early studies showed the COVID-19 PCR test had a poor sensitivity of 70 percent, causing a high number of false negatives. Some other nations solved this by testing at multiple sites multiple times and using CT scans to greatly reduce the false-negative rate. In the U.S., we simply pretended the test was good and never made any adjustments in testing. It is not logically possible to control COVID-19 with testing and contact tracing if this low sensitivity problem is not addressed.

    Rosenberg: Your research has now taken a different turn?

    Fraiman: Yes. While I initially had been researching and advocating for a more aggressive approach to COVID-19, I have begun questioning, with my co-authors, how effective even the best approach can be. Currently, we are attempting to understand how nations can have 1,000 fold differences in rates of COVID-19. Our data is not published yet, but it appears that whereas island nations are able to use aggressive policies to control COVID-19 rates, the majority of the variability seen with other nations is explained by their demographics which we can’t change.

    With our current model, we can explain approximately 70 percent of differences in COVID-19 rates between countries. But about 40 percent of the world’s nations have a combination of demographics that are so protective they will never see high rates of COVID-19 regardless of their pandemic policies. It would be wise for these nations to avoid any COVID-19 policy that harms their most vulnerable populations through harsh lockdown measures.

    Rosenberg: So government-led COVID-19 interventions have limited value?

    Fraiman: Yes and no. In nations with protective demographics, COVID-19 is already at such low rates, the policies might not be worth it to the population. In nations with highly susceptible demographics, aggressive policies are likely able to reduce COVID-19 cases somewhat, but they should not expect to achieve the impressively low COVID-19 rates seen in some nations. Essentially Finland, even with its highly effective COVID-19 control measures, should not expect to achieve the low COVID-19 rates Vietnam has been able to achieve.

    Rosenberg: As you compile your research, do you feel that the climate of censorship will ease as COVID-19 abates?

    Fraiman: I believe it is getting worse. When you read scientific papers published during Einstein’s time, they would not be published today. As Karl Popper said, a scientific theory can never be proven, it can only be falsified, but today the status quo is so fiercely defended that no breakthroughs are possible. People should be more concerned about that than Qanon conspiracies. When scientific truths are declared by anointed experts, you don’t have science you have a religion. Just because the leading experts agree that the sun revolves around the earth, that doesn’t make it true.

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