The History
The term “Snack Oil Salesman” has long been used and associated with seedy profiteers who sell fake wares to an unsuspecting public, and that is the way I use the term here (ironically the origins were at odds with this). But the term is relatively well understood as a metaphor for individuals who are offering advice and have some associated solution that you can buy from them to solve the problem they are referring to. In the case of COVID19, we appear to have reached new extremes of information, sometimes based on some original facts but twisted to have new meaning or intent.
In the original form, these individuals roamed our world limited by their capacity to move from one location to another offering their wares, moving on either voluntarily before too many people discovered their subterfuge or sometimes forced on by the population that had been duped. Either way, there was always another village, town, or city they could move on to with people ready to believe their version of the data.
Newspapers and publications became amplifiers allowing these schemes to reach far beyond the in-person event and in many cases shielding the individuals from the victims of their fraud.
(Social) Media has made this far, far worse.
How do you combat the infodemic of information on COVID19 and what is a fact, what is fiction? This overabundance of information has proven especially hard to combat as many individuals amplify fiction, some unintentionally as they get sucked into the vortex of information amplified by social media that fails, as we know deliberately to perpetuates these stories as it serves their business model.
But it’s Worse Than That
Unfortunately, another side effect of the media that plays to our inherent biases, and boy to we have a few of these:
That leads many to believe they know the answer and can determine truth from fiction. That actually can prove quite hard, harder still if you face a veritable deluge of information that has been filtered by an algorithm, working to keep your eyeballs there. Present counter-arguments or positions and people who were previously happily scrolling through a “feed” will quickly shift away, whereas a feed filled with “like-minded” content is addictive – we like finding information to confirm our views. In fact, our built-in bias makes our brains especially vulnerable to misinformation spread by social media. In 2018 when this was originally penned the estimate of bots on twitter was 15% – it’s now a whole lot higher as Dr. Kathleen Carley, Ph.D., Professor at Carnegie Mellon University detailed in an upcoming episode on my radio show “Shall we Play a Game” (nearly 1/2 the accounts tweeting about COVID19 are likely bots).
Of the many biases in play have seen a fair amount of the Dunning-Kruger effect that was captured aptly in this cartoon by John Nosta.
But What About Me
I have bias, and I am constantly challenging myself and the information I review and read. I often declare my bias (there is plenty about my bias around whisky) whenever I am aware of any and rely on friends, colleagues, and even strangers to point out failures of bias in thinking. I am also quick to tap-out in instances where I don’t have good information or insights bowing to the expertise of others or acknowledging a deficit in my own knowledge. Am I perfect – hell no, but I bring to bear many years of scientific analysis, voracious critical reading of the material, and a foundation in fundamental science, medicine, and its application to bear on all my thinking. An epidemiologist I am not, but I know several that I use as resources to guide my thinking. The same with statistics, economics, pharmacology. All of which plays into the distillation of insights that become my views and the foundation of the material I post and amplify.
What seems to challenge many is the science is not clear and we are chasing information that is moving in real-time. We are making informed educated judgments every time.
I have changed my opinions on aspects of this disease over time as evidence and insights emerge that have shifted our understanding. Masks usage was an early flip but the story behind that was not a simple change in understanding.
Sometimes, as in the case of the early guidance around masks, it has resulted in a complete reversal. But to be clear, that reversal was not about the understanding but linked to the challenge of limited availability of masks to protect our frontline workers at most risk of exposure. Telling everyone to wear a mask at the outset would have resulted in a shortage akin to the toilet paper debacle but in this case, our health care workers would not be at risk of a dirty bottom but of dying from exposure to COVID19 because they could not protect themselves with appropriate Personal Protective Equipment (PPE).
I have a degree and decent education, but many of the people pushing out this drivel do as well, including the daddy of them all Mr (NOT a Doctor anymore as he was struck off by the General Medical Council) Wakefield. So why should you trust what I say? As the Skeptical Raptor points out:
The only thing that matters is evidence, not false authority. If you present a point in scientific discussions that are supported by the scientific consensus, then it’s pretty much settled.
Why Not Just Answer this Question
As we have seen with the Anti-Vaccine movement – no amount of information, facts or science will dissuade the believers to change their minds. In fact, the question you should ask anyone before spending time answering questions, researching, providing links is
What answer or piece of data would make you change you mind
My experience to date has been nada, nothing, silence……crickets. That quickly exposes the soft underbelly of this time sink activity. Answering that question leaves the person open to a risk of being presented with information that answers this question and would mean they truly would have to change their mind.
Unfortunately, this is an imperfect approach because as many philosophers will know there are questions that are unanswerable with Münchhausen trilemma being a standout and added layer of complexity to the challenge of proof of the negative in science
Absence of evidence is not evidence of absence
For example, the classic version of this relates to extraterrestrials, recognizing that water has become even muddier with the recent release of the unexplained visual phenomenon by the Pentagon). That aside, saying there are no extraterrestrials since we have not seen one is hard to prove given we may not interact with them yet. It only takes one extraterrestrial interaction to disprove this position. (BTW – I am not commenting on their existence or otherwise – I have a view based on the available evidence but simply using this to explain the point)
In the case of the Anti-Vaccine movement presentation of data is never sufficient as we saw with thimerosal – which was removed from the majority of vaccines in 2001 so these folks using a well-understood technique in debating, the gish gallop (proof by verbosity), find something else you need to answer. They will wear you out, consume huge amounts of time and even if you have a stock of answers or responses, it will never be enough nor the end of the never-ending train of “articles” or data they have that supports their viewpoint.
Anti Vaccine Experts
There are plenty of so-called experts who claim credentials and hawk their wares under the guise of looking out for you. Here is a useful link if you happen to find yourself in a fight over vaccines effectiveness and wonder about the “doctor” who supports this viewpoint here is a handy dandy list put together of the various individuals plying their version of the truth and details of their lack of knowledge and oftentimes the underlying driver to their position – they are selling something
As a quick side note here. If you find yourself struggling under an onslaught of a well-organized mob (the anti-vaccine crowd) you can always call in the calvary – Shotsheard (@ShotsHeard)is a group that will bring additional help and resources to bear to help defend against a highly coordinated attack by the anti-vaccine thugs
Just Block ‘Em
That’s certainly worthy of consideration and for some people a necessity as they end up on the receiving end of a tirade of abuse and vitriol. I have received my share of this and it can be unpleasant and blocking (or in some cases muting since that is a less public method to suppress other people’s content) is a necessary step.
But if you do, you are missing out on two major things. You miss what is being said or believed that is counter to the general consensus view (this btw is why you should never judge someone based on who they follow!) and you miss opportunities to intervene and provide counter-arguments and data. Sometimes the latter descends very quickly into attacks and it may already be too late, but that’s what the bloc/mute or report button is for
Snake Oil Can Kill You
Some of the proposed solutions can be downright dangerous with recommendations to take toxic chemicals into your body. Hydroxychloroquine (HCQ) is a case in point – this drug has some serious cardiac side effects that are well known (including the sometimes fatal torsade de pointes) so taking this drug should only be done if the benefits outweigh the risks. The benefit of this drug in COVID19 has not been shown. The frequently circulated meme that suggests that Dr. Anthony Fauci (actually the research team working in his organization) discovered that “Chloroquine is a potent inhibitor of SARS coronavirus infection and spread”. They did and they published this paper in 2005. But the reality of the paper vs what circulates as facts or science from this are two entirely different things
First things first. If there were a cheap easily accessible cure, why would there be resistance to getting this out and taken by the widest possible number of people? The idea that Drug Companies might suppress this because they can make more money by selling some expensive variation is not born out economically. Selling 6 billion treatments at a low cost vs selling a few thousand at a high cost is an easy equation to solve. And besides which, on what planet do you think this information could be kept secret and suppressed without it leaking out?
But take a look at the image posted online that conveniently includes some evocative commentary
Which includes some facts such as the title of the article but then drops quickly to “Dr Fauci has known for 15 years …not only treat … but prevent. So HCQ functions as both a cure and a vaccine.”
Really! So Dr. Fauci is sitting at home wondering how to keep this news out of the hands of the 6 Billion people in the world worried and struggling to know how they will cope with our Pandemic crisis.
First off – this was a cellular study, not done in a living organism but in a petri dish. That science does not always translate well to the real world. The cutting room floor of many researchers and their laboratories is knee-deep in petri dish experiments that when tried in a living organism did not work, or worse killed the organism.
Secondly – the cells used were primate cells. Not human or human cell lines but from a primate (Vero E6 cells from a Cercopithecus aethiops – an African Green Monkey). So a reasonable proxy but another challenge when you try to move this to any human model.
Let’s dig into the actual article for a second. A quick search for “potent” only finds one other use of the word
The potential contribution of these drugs in the elevation of endosomal pH and its impact on subsequent virus entry or exit could not be ruled out.
There was the commentary on the potential as a relatively cheap and effective drug to inhibit notes that the drug can be used effectively in inhibiting the infection and spread of SARS CoV in cell culture (emphasis mine).
This is a standard process and one of the many ways in which we identify possible candidates for future investigation in human subjects
There were other articles pushed across my desk but anything or anyone touting pseudosciences such as Orthomolecular or Homeopathy, to mention just a couple, gets quickly tossed to the quackery pile. There has been plenty of studies and science demonstrating the lack of validity to these approaches. You can start here with Trick or Treatment penned in part by Edzard Ernst, MD, PhD who was leading complementary and alternative medicine.
So as opposed to me answering these repeated requests to look at the latest in Pseudoscience – tell me why the following trials and published data don’t answer the question
Some Trial Data
Recovery Trial: United Kingdom. In a group of 1542 hospitalized patients treated with hydroxychloroquine, 25.7% had died after 28 days, compared with 23.5% in a group of 3132 patients who had only received standard care. “These data convincingly rule out any meaningful mortality benefit”
A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19: United States. AKA postexposure prophylaxis (PEP), giving HCT after possible exposure to test if this can either prevent or reduce the severity of COVID19. 12% of the people who took the drug went on to develop COVID-19 symptoms, versus 14% in a placebo group, a difference that was not statistically significant
Treatment of COVID-19 Cases and Chemoprophylaxis of Contacts as Prevention (HCQ4COV19). Barcelona. That study randomized more than 2300 people exposed to the virus to either hydroxychloroquine or the usual care. There was no significant difference between the number of people in each group who developed COVID-19
This Meta-Analysis of 24 published studies: Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review. Concluded there was “insufficient and often conflicting evidence on the benefits and harms of using hydroxychloroquine or chloroquine to treat COVID-19”.
Harm
Put aside the potential clinical harm for one second and consider this. Every moment spent on things we have shown to have no benefit or limited benefits robs doctors and patients of the opportunity to be trying other more promising solutions. Continuing the prophylaxis studies can make sense since this does not distract from the tasks of finding working solutions. But it is not risk-free and should be carried out as part of a study that has an IRB, ethics review, and a control arm.
From a bias standpoint, I will share that I have personal experience through family members of some side effects of this drug (no nothing to do with COVID19 as this was years ago). But my position is not changed by this fact and I would be delighted to find that this proves to be a highly effective prophylactic drug that can be given to anyone coming into contact with a COVID19 infected individual to successfully prevent the disease. But at this point, that seems highly unlikely.
But it’s Cheap/Easy/Risk-Free
As for Vitamin C, flavonoid <insert name of whatever supplement> as a cure or prevention. See above. Require evidence and rest assured some of these “harmless” substances are harmful in high doses (yes you can overdose on some vitamins) and even if it is harmless it’s likely damaging your wallet. If you want to spend your money and time on a harmless substance then start by making sure
- It is really harmless (has it been tested, humans)
- Does it interact with any drug you take for your health
- Any alternative is additional and not a replacement to the real treatment prescribed by your doctor
Incremental Steps to Stopping the Tide
So what should you do? Take these incremental steps
- Stop
- Think before your hit RT or Repost content
- Learn and Understand the science behind the claim(s)
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