Bill Gates slams 'shocking' U.S. response to Covid-19 pandemic
statnews.com
statnews.com
His idea that no one should be paid for a test result if it takes more than 24 hours to result is not bad, but the existing system is not set up for it. Decades of regulation of all aspects of the US medical system, from billing codes even to electronic health records, would prevent that kind of change from being adopted overnight. If we adopted this change, you'd very likely see almost no one running any COVID tests at all - the risk and infrastructure investment would be too high, for too little payout. (Recouping the cost of lab tests is generally hard as is, since the costs of running a medical lab are almost entirely fixed, both in terms of labor and capital. Routine maintenance must be performed, the lab must have a certain contingent on duty to handle stat tests, etc.)
I'm not sure the US system can be improved unless we have some practitioners who want to make a clean break from the existing regime, and they get some cover from the government to actually innovate. I'm not holding my breath.
What worries me is this may be decades away.
> What worries me is this may be decades away.
First the good news: That day is here!!
Now the bad news: that medication isn't working out great for them. Apparently some wingnut told people that drinking bleach was a potential cure for some ills. Didn't go great.
And thats the problem with what you wish for - a popular facebooker, youtuber, instagrammer, president tells people that they can design their own medication, people are going to do it.
There one example
It lead to actual problems of US American citizens ingesting/consuming bleach which forced government agencies to put out warnings: https://www.forbes.com/sites/nicholasreimann/2020/08/24/some...
Never once does he mention the word 'bleach'. He uses the terms UV light and disinfectant. But I guess using disinfectant, to the average American reader, is synonymous with literally injecting bleach into your body or guzzling it down your throat...
Remember when NPR came out with this article entitled: "No, You Don't Need To Disinfect Your Groceries", and the media was outraged because millions of Americans were dumb enough to start soaking their food in bleach? Yeah, me neither.
https://www.npr.org/sections/health-shots/2020/04/12/8322692...
Interestingly, looks like he was right about it anyway:
https://www.nbcnews.com/nightly-news/video/using-uv-light-to...
Quackery is much easier than actual medicine. Quacks don't have to spend anything on R&D and quack medicines are a lot easier to manufacture (look up the synthesis pathways for popular pharmaceuticals!), and this means quacks can spend more on marketing and operate with much higher margins. This translates into a huge market advantage. Pretty soon you'll have nothing but quacks.
Medicine has a unique and extreme case of the "uninformed consumer problem." In medicine it's incredibly difficult even for professionals to tell whether something actually works, let alone individuals.
"Do your own research" doesn't work at all in medicine unless you have a billion dollars burning a hole in your pocket and can assemble your own research lab. Excluding emergency medicine and the most instantly and dramatically effective drugs, it's really hard as an individual consumer of health care to tell whether a treatment is working over the short term. Check out gwern.net and how much work he's put into trying to tell if various nootropics work and how much uncertainty remains.
The fact that individual discernment is so hard in medicine means defrauding people is incredibly easy. It's a market that is inherently vulnerable to massive fraud, and there is no easy way (that we know of) to fix this. Even with the FDA there is still a tremendous amount of quackery. Without the FDA and strict licensing and supervision there would be only quackery.
BTW news seems to suffer from a similar problem. Actual investigative journalism is expensive, hard, and sometimes dangerous. (Old PI joke: How do you know if a conspiracy theorist might be right? They are missing and presumed dead.) Fake news is cheap and easy, and since it's fake you can craft your stories for maximum click bait appeal without having to be limited by pesky "reality" and "honesty" constraints. The reader meanwhile has neither the time nor the ability nor the expertise to really fact check anything.
In general markets where the consumer is unable or unwilling to discern tend to be flooded with and overcome by fraud.
It's extreme but not unique. Do you know what's running in any of your devices? Almost not, I believe. Yesterday I had the pleasure of needing to copy some medical reports of mine on a multipurpose printer I own. I shortly gave it a pause being not sure whether the contents would be sent immediately to the mothership. I then realized that when the printer was set up initially that I set up the router to prevent calls to the outside for this machine. But: although I configured the router, I would need to go to great lengths to actually verify that the printer can't phone home.
And don't get me started about quality (as in endurance and serviceability). It's a nightmare as price is not a deciding factor in my experience. Neither is brand.
Is that web cam sending pics of you to China? Is your fridge listening to your private conversations? Is your printer sending confidential PII to a poorly secured server somewhere? Is your car tracking you and selling the info to insurance companies? Is your home security device allowing a stalker to watch your every move?
It's pretty hard to answer any of those questions unless you are a security researcher with deep understanding of network protocols and systems and a good deal of time on your hands.
Yes, many more quacks would advertise services.
> Quackery is much easier than actual medicine. Quacks don't have to spend anything on R&D and quack medicines are a lot easier to manufacture (look up the synthesis pathways for popular pharmaceuticals!), so they can spend more on marketing and operate with much higher margins.
Good point!
> Pretty soon there will be little legitimate medicine left in the market.
I'm not so sure. Even the canonical example of this phenomenon, Gresham's Law, requires legal tender laws or some similar mechanism which requires the acceptance of the "bad" money on par with "good" money. It's not clear that a requirement would happen in laissez-faire medicine.
> Medicine has a unique and extreme case of the "uninformed consumer problem." In medicine it's incredibly difficult even for professionals to tell whether something actually works, let alone individuals. > > "Do your own research" doesn't work at all in medicine unless you have a billion dollars burning a hole in your pocket and can assemble your own research lab. Excluding emergency medicine and the most instantly and dramatically effective drugs, it's really hard as an individual consumer of health care to tell whether a treatment is working over the short term. Check out gwern.net and how much work he's put into trying to tell if various nootropics work and how much uncertainty remains.
Agree. "Do your own research" in medicine doesn't work very well for a host of reasons. Chief among them: physicians don't understand the complexity of the body as a system. Microbiologists don't even understand the complexity of a single cell. We (humans) understand human life in certain aspects, and it's remarkable what competent physicians can do with the knowledge they do have. But if even they have no idea what is going on beyond essentially sophisticated educated guess-and-check, what hope does the layperson have?
> The fact that individual discernment is so hard in medicine means defrauding people is incredibly easy. It's a market that is inherently vulnerable to massive fraud, and there is no easy way (that we know of) to fix this. Even with the FDA there is still a tremendous amount of quackery. Without the FDA and strict licensing and supervision there would be only quackery.
I'm not sure the FDA is the only way. We could have stronger laws that punish fraud in civil court, or make practitioners liable financially (or in severe cases, criminally) for ineffective or harmful treatments. Things like the Internet make the information problems less daunting than in the bad old days of patent medicine salespeople roaming from town to town (though today we have unregulated MLMs).
I also think that the regulation to which I refer is much broader than simply FDA regulation. Billing, electronic records, purchasing, distribution of medical equipment, pharmaceutical distribution, laboratory testing and just about everything else in the US medical system are regulated beyond belief. Many of these regulations were introduced with the goal of "improving efficiency," and have instead resulted in protected, rent-seeking firms with zero gains in efficiency. They've resulted in the death of the private practice, and have siloed practitioners into Kafkaesque organizations, each of which is a single point of failure.
I'm skeptical that the FDA should do much beyond determining the safety of treatments, but there is a host of other regulatory nonsense in health care that could be innovated around, including many of the things GP was talking about.
Right now most of the necessary equipment is siloed in research institutions and hospitals.
It seems medical quackery gets a disproportionate platform, I think in an attempt to educate people about how dangerous it can be. But go look online or even in a brick and mortar store: there's plenty of stuff designed to take your money that won't improve your life.
This is especially true for providers who aren't running the tests in-house. If your doctor takes a test and sends it out to an external lab like LabCorp, who is responsible if the complete process takes more than 24 hours?
In reality, your doctor would simply stop testing for Coronavirus and instead refer you to a LabCorp collection center, where they could keep you waiting in line until they had enough testing capacity to take your sample and start the 24-hour clock. Everyone loses.
Not to mention all of effort required to retool billing and accounting systems to account for time-based costing. This alone would drive the cost of testing upward by huge amounts. Or more realistically, providers would simply not offer tests unless patients paid in cash to avoid this mess.
This is a great example of how regulation can end up making the situation worse, despite good intentions.
This kind of sounds like a semi-win. Eliminate the middle man between the patient and the lab. Provide visible backpressure by refusing to accept requests that can't be serviced in a timely fashion, allowing those requests that are serviced to be timely.
It doesn't help the problem of more demand for tests than supply of testing (or at least, not directly). But it's better to have all (or substantially all) results in 24 hours, than to have all results in a pipeline for a week.
Also, maybe start at 48 hours, if 24 hours is too restrictive.
There are of course also conspiracies that your brain gets damaged from the test...
I don’t know the precise number, but probably at least a dozen of these spit tests have been developed at Universities and approved by the FDA for emergency use. Some even use the LAMP protocol as opposed to RT-PCR, which saves on time and reagents.
Another thing I always think of is how we didn’t adopt the contact tracing protocol that Google and Apple developed. Obviously it was a trust issue, and maybe some logistical shortcomings, but contact tracing as we’ve implemented it is largely ineffectual in reducing spread. The serial interval in young people is likely less than the time it takes to get back a test, and certainly shorter than the time it takes to get a test and complete a contact tracing interview.
The US response to Covid is obviously a polarizing issue, but we’re all wrong to assume that we couldn’t have done better.
We have had 200k, so a 90% reduction.
Hopefully there is a vaccine soon
citation needed.
Here are many models that we can backcheck: https://projects.fivethirtyeight.com/covid-forecasts/
https://www.nytimes.com/2020/03/16/us/coronavirus-fatality-r...
If the graph keeps going like the way it looks, it will consume effectively the entire population by month X, with Y percent dying. While this was not a formal epidemiological model, it allowed two tentative conclusions:
1. If the curve (a straight line on a semi-log graph) shows signs of turning over, I will breathe a huge sigh of relief, the sooner the better.
2. The curve was a "sniff test" for whether more advanced predictions were believable, notably, any prediction that did not roughly follow this baseline needed a darn good explanation.
The CDC in February (back when they weren't compromised) did modelling that predicted between 200,000 and 1.7M deaths in total for the entire epidemic. This March piece from NYT has the details: https://www.nytimes.com/2020/03/13/us/coronavirus-deaths-est...
> without action by the government and individuals to slow the spread of coronavirus and suppress new cases, 2.2 million people in the United States could die
https://www.nytimes.com/2020/03/16/us/coronavirus-fatality-r...
30,000,000 to 40,000,000 have died from AIDS over the decades for some reference point.
For example, the graphs for COVID cases in my county reflect the county government working with no coordination at the state or federal level, the predictable effect of having a large public university in town, and private companies that are managing the production and analysis of COVID tests with no public policy guidance.
For example, Gates insists that people should be able to get test results within 24 hours no matter what and that it is unbelievable and inexplicable that the US isn't encouraging people without symptoms to get tested. There's an inherent trade-off between those two things - push people without symptoms to get tested and it overloads the testing capacity, impeding access to testing and contact tracing for everyone - which can't easily be fixed by expanding testing. There's an extremely limited global supply of everything needed to carry out testing, the US already has pretty much the biggest testing program out there excluding a handful of really small countries, and the availability of further supplies is not being helped by the fact that Europe is having major outbreaks right now and is trying to expand testing there up to US levels. You wouldn't know this from the article, which just makes it sound like the big bad government is doing these things to make this worse because they're big and bad.
(There also seem to be some pretty fundamental limitations as to how useful testing potentially-exposed people without symptoms can even be in the first place. Test them too early and it'll likely give a false negative. Test them too late and you'll only find out they're positive after they've been contagious for some time, plus they may also test negative too. I've also seem it claimed that the optimal time to test people is about 3 days after the peak in infectiousness, which probably doesn't help - though without symptoms it's not like there's really any way to tell when the optimal time is anyway. This really fundamental reason why what he's calling for wouldn't work as described is just ignored, even though the CDC's literal stated reason for discouraging it is that it would lead to false negatives which would cause people to think they're in the clear and go out and spread the virus.)
Imagine a virus so unpredictable that you might take anywhere from 0 to 14 days to become infectious, and you could end up anyhwere from unknowingly and asymptomatically shedding the virus to dead from it. Imagine that.
You mean like HIV?
Journalism’s Gates keepers: https://www.cjr.org/criticism/gates-foundation-journalism-fu...
If you are wondering why someone like Michael Levitt [1] doesn't get wall to wall coverage by media (including outfits like RT) [as an 'expert voice on pandemic response'], the above article has a few clues.
[1]: He's just one example. There are many others.
https://twitter.com/mlevitt_np2013?lang=en
https://en.wikipedia.org/wiki/Michael_Levitt
-- p.s. relevant pull quote asking the timely question --
During the pandemic, news outlets have widely looked to Bill Gates as a public health expert on covid—even though Gates has no medical training and is not a public official. PolitiFact and USA Today (run by the Poynter Institute and Gannett, respectively—both of which have received funds from the Gates Foundation) have even used their fact-checking platforms to defend Gates from “false conspiracy theories” and “misinformation,” like the idea that the foundation has financial investments in companies developing covid vaccines and therapies. In fact, the foundation’s website and most recent tax forms clearly show investments in such companies, including Gilead and CureVac.
> In March, the Los Angeles Times reported that Levitt correctly forecasted in February that the COVID-19 pandemic in China would soon peak and that China would end up with around 80,000 cases and 3,250 deaths from COVID-19.[41] However, it has been noted that Levitt actually made a number of predictions, including incorrect forecasts, in February about China's COVID-19 trajectory[42], including one on February 7, 2020 claiming that "by 14-Feb. we will have reached 95% of the eventual death count of 928".[43] Levitt also has stated his belief that achieving natural herd immunity to the virus is possible[44] and has spoken against lockdown orders.[45]
> Levitt also wrongly predicted that Israel would suffer no more than 10 COVID-19 deaths[46]. On July 25, 2020, Levitt predicted that COVID-19 in the United States would be over "in 4 weeks with total reported deaths below 170,000".[47] However, this prediction about the reported death count also ended up being wrong as the number of reported deaths from COVID-19 in the United States exceeded 170,000 on August 16, 2020, only 3 weeks after Levitt's prediction.[48]
Sounds like he does get some coverage. As for why it’s not wall-to-wall? Maybe his predictions have been wrong too many times?
Track records don't seem to matter. The famous Imperial College model was by a worker with a rather alarming track record. How is the track record of Bill and Melinda Gates foundation, btw? Or the unqualified man currently serving as head of WHO? His C.V. is alarming enough.
So side arguments aside, the question remains as to why Bill Gates, are granted such a global megaphone. The article from Columbia Review of Journalism tells us why that may be the case.
I find it entirely irrational and unreasonable that decisions that will affect the entirety of humanity today, and will definitively alter the course of human development are to be made by individuals such as Bill Gates, and that other input by far more qualified individuals is entirely ignored, if not blackwashed.
It not unreasonable to seek a second opinion even for relatively minor health matters. And here we are talking about metaphorical open heart surgery on the very nature of society: how we are governed, how we interact, and how we make collective decisions.
There has never been a more timely moment to ASK QUESTIONS.