Wouldn’t it be wonderful if there was a single blood test that could pick up not just one, but dozens of early cancers, allowing early treatment, and countless lives to be saved? According to an auspiciously named American high tech company, GRAIL, Inc., just such a goal might be in reach. It claims it’s Galleri blood test, which uses clever technology to detect fragments of tumour DNA in the blood, can detect many common cancers in the early stages, with a false positive rate below 1%. On the back of this, it has secured a ‘commercial partnership program‘ with the NHS to pilot the test in around 165,000 people, starting next year. Hatt Mancock, the health secretary who increasingly resembles a schoolboy who has just shot his neighbour’s dog with a poison dart, can hardly contain his excitement. ‘We are building a world-leading diagnostics industry in the UK — not just for coronavirus, but for other diseases too,’ he gushed. Could this be the ‘exciting and ground-breaking new blood test’ Mancock says it is, or is it another world-beating Operation Bonfire of taxpayers’ money?
There has been much fuss over the question of whether covid–19 is a truly exceptional event that justifies the draconian restrictive measures imposed by decree that our governments have freely, even wantonly, applied, or whether it is just another seasonal flu like illness. Dr No, readers of this blog will know, is inclined to the latter view. One way of attempting to get closer to a definitive answer to this question is to compare the Spring 2020 covid spike in deaths with previous spikes, and see how it measures up. There are problems, though, in doing this: not only has the population grown in size (so pro rata, all other things being equal, we expect more deaths), but it has also changed in age structure (more older people, so again we expect more deaths). And if that wasn’t enough, underlying health and medicine’s capabilities have also changed — hopefully for the better — over time, so we might expect less deaths.
Bad mental picture of the week so far is an image of Boris Johnson in a Santa Claus outfit stuck upside down in a fireplace chimney chortling ’tis the season to be jolly careful. In the recurring nightmare Dr No endured last night, all attempts to light a fire under the bastard ended in failure, and Dr No drifted off into fitful sleep only to wake again with a fresh box of Bryant and May’s in his hand, for the whole ghastly cycle to repeat itself. If the nightmare comes back tonight, Dr No will be up on the roof with a vat of boiling oil. Simple, but effective.
One of the things that has intrigued Dr No with increasing trigue during the covid pandemic has been the mechanics of how a state becomes at first authoritarian, and then totalitarian. He is not after some waffling account of putative prose impenetrable by man on ethno-hegemonic constructs pertaining to a pandemic dialectric, but rather a sort of physical mechanics, an e = mc2, or rather t = mc2, where, for instance, t = totalitarianism, m = the mob and c = something that is squared to get the answer. What he is particularly interested in is the tipping point, the point at which the gradient on the slippery slope becomes sufficient for gravity to take over, and nudges are no longer required; or, in quantum terms, the point at which we are sucked unwittingly through a putative quantum key hole all too penetrable by man into Schrödinger’s covid cage, where Geiger’s dissident counter crackles over a vial of totalitarian poison.
There’s not much to be said yet about the Pfizer vaccine study itself. It’s still early days, the case numbers are small, and there is still more than enough oppatoonity as they say Stateside left for it to fall over. But hidden within the interim results released last week is a rather interesting accidental study, which does bear having something said about it. Though not set up as such — and normally this would be a serious objection — the study is, in its placebo arm, as near as can be to a prospective covid–19 incidence study. Healthy patients have been enrolled, and assiduously followed up for months, to see, among other things, whether they develop covid–19. That is exactly what a prospective incidence study does. What does the study so far tell us about covid–19 incidence, and how does the study’s incidence compare with other estimates? Might we at last get a better idea of real incidence, and so a better idea of whether we are over or under reacting to the pandemic?
This last week, another rapid covid–19 test hit the fan. The story is becoming boringly familiar. A company announces a new covid–19 test, and puts a high gloss on the test’s performance. Ministers respond by placing large orders. Later, it turns out the company has been polishing a turd, as real world studies show the test’s performance is, err, crap, and ministers find that instead of getting more bang for their buck, they have got more crap for their cash. Such are the rewards for ministers who admire their reflections on the faces of polished turds. What made this particular turd/fan disintegration situation more notable than some is the suggestion, made by the BMJ and denied by the DHSC, that the government had known all along it was buying a polished turd, but deliberately suppressed the information, because it would get in the way of procurement.
Only in Liverpool could it be done. Announced with a fanfare fit for a king, Liverpool has become the first city in the UK to organise mass covid super-spreader events, all in the name of public health. All covid symptom free Liverpudlians are being urged to gather at multiple sites across the city over the coming days in a pilot study to assess whether residents of the city famous for its identikit citizens really are thick enough to congregate in groups of a hundred or more to facilitate rapid covid spread across the community. Speaking to the BBC, Matt Ashton, the city’s Director of Public Health said, “This is a fantastic locally led national opportunity to get hundreds of uninfected people to mingle with infectious but asymptomatic super-spreaders, and spread covid far and wide, using rapid lateral flow infection. It’s not for nothing we say in Liverpool, you’ll never walk alone!”
Dr No first came across Stanley Milgram’s now infamous but fascinating obedience to authority experiments as a disobedient undergraduate keen to understand why so many of his fellow students seemed willing to toe the line to authority, even when authority had got things wrong. The Great Secret, it turned out, was for authority to dress things up as being for the greater good, add some cuckoo science, and ideally put the public facing authoritarians in uniform. Faced with this diabolic trident, ‘normal’ — Dr No uses quotes because one of the criticism’s of Milgram’s work was that his sample was small and in no way representative — Americans would, despite most showing evident anguish, and even great distress, and occasionally infantile giggling, administer what they believed to be dangerous electric shocks to fellow citizens, because they wanted to do the right thing.