Munchausen’s syndrome is the popular name for the ICD (International Classification of Diseases) 10 diagnosis F68.1: Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]…with the aim of adopting the sick role. In rather less leaden language, a patient with Munchausen’s syndrome pretends to be ill to gain medical attention, which distinguishes the condition from malingering, in which an individual pretends to be ill to gain practical benefit, for example being excused from work. It takes it’s name from the protagonist in the 1785 novel Baron Munchausen’s Narrative of his Marvellous Travels and Campaigns in Russia, in which the fictional Baron narrates a series of impossibly tall stories, based on exaggerated exploits of one Hieronymus Karl Friedrich Freiherr von Münchhausen, a real life German baron known more recently for a habit of adding extra lard to his porkies, though in life he appears to have had ridicule of the credulous more in mind.
What are the three most important things for human life? The first is fuel, an umbrella term for the food water and oxygen, without which we soon perish. Cut off the oxygen, and we are dead within minutes, cut off food and water, and we are dead within days or weeks. The second, Dr No suggests, is shelter. We are the naked ape, and without shelter, we soon find ourselves in harms way. Without shelter, we are at the mercy of the sun’s burning rays and winter’s icy blasts, and again, sooner or later, we will perish. We need shelter to sleep, and to recuperate from illness and injury. These two things, fuel and shelter, are tangible external things, that we get from our environment, and give us our physical health. The third most important thing could not be more different. It is, in its pure form, intangible and utterly abstract, and in this form, uniquely human, because we alone of all the species on earth have a name for it. It is called freedom.
There has been some conflation and confusion recently over ONS’s initially intriguing but ultimately infuriating deaths by vaccination status reports. They intrigue because they offer a possible route to the paired holy grails of vaccine effectiveness and vaccine safety. A number of bloggers, including Dr No, have gleefully thrown eye of newt and toe of frog into the bubbling cauldron, only to be rewarded with a poke in the eye from a howlet’s wing. A couple of tyros have even added time warps to try and make sense of the data, only to reach uncertain conclusions. Throughout the melee, the focus has at times shifted from numbers to rates and back to numbers again, at others, from covid deaths to non-covid deaths and even all deaths, but the data has work-hardened as it has been worked back and forth, and cracks have begun to appear. Perhaps the cracks were always there, we just couldn’t see them.
When the facts change, we’re supposed to change our minds, but what do we do when the facts don’t make any sense? If we followed the doctrine often attributed to John Maynard Keynes, we should probably stop making any sense, and go mad. Such thoughts occurred to Dr No as he contemplated another silent but deadly dataset released by ONS a couple of weeks ago. It extends the previous release of covid deaths by vaccination status, which ran from January this year to early July, to late September, and so covers a period of considerable interest. Just as before, the published report only covers covid deaths1, and needless to say, the vaccines are shown to be wonderfully effective. Tractor production continues to rise. But, again just as before, buried in the underlying dataset are the weekly numbers for all cause mortality. All cause mortality, as readers familiar with these things will know, is normally the most unadulterated mortality data there is, unfogged by distractions about diagnostic fudgery. A stiff is a stiff is a stiff, the whole stiff, and nothing but the stiff. What all cause mortality lacks in detail, it gains in robustness.
“Even the perpetrators had to go one step at a time, completing each step before the realised that the next one was possible.” Clive James, Review of Holocaust (BBC1), 1978 Whither Covid Vaccines? Yesterday, Secretary of State for Health Sajid Jabbit confirmed in the Commons that Covid vaccination will be compulsory for all frontline NHS staff in England by next April. Rumour has it that J-Day will be set for the 1st April, an unfortunate choice, raising the question of whether Jabbit is a joker, or a fool, or perhaps even both. Certainly the Royal Colleges and Unions are up in arms, pointing out that banning qualified healthcare workers from working — a sure fire way to make enemies and alienate people — at a time of NHS crisis is foolish in the extreme. Many, including Dr No, have questioned the ethics of mandatory healthcare worker vaccination, but this is a tricky one, because of vaccine precedents in healthcare, even if those precedents were, and remain, a condition of employment, rather than a legal requirement. And then, last but by no means least, there is the prickly question of the medical evidence: do covid vaccines reduce the risk of covid transmission?
COP26 — what a load of old baloney and hot air! The world’s largest collective public relations jamboree, where world leaders arrived at a climate conference in private jets. Our glorious leader, the prime minister, rose to the occasion, as a Yorkshire pudding rises in the oven. Other leaders followed suit, each one rising to the occasion, until there was enough hot air to launch an airship. Which brings us conveniently to the first climate change fallacy: that hydrogen will solve our green house gas woes. Domestic gas boilers, we are told, are already hydrogen ready, or will only need minor tweaks to burn hydrogen. Perhaps those promoting hydrogen as the solution might care to reflect on what happened to a hydrogen ready airship in the 1930s, the Hindenburg. It didn’t end well. But even if modern technology can prevent your neighbour’s new loft conversion — hydrogen, like hot air, rises — from doing a Hindenburg, and we punters can be persuaded to use rocket fuel to heat our homes, the fact remains we are a long way from being able to use hydrogen to heat our homes.
Dr No was going to call this post Habeas Virus, a stab at applying the legal principle of Habeus Corpus — roughly, bring me the body, or the accused must be brought before the court, though that is not a literal translation — to say that we need to see SARS-CoV-2, the virus accused of causing covid–19, before the court of scientific enquiry, if we are to determine its guilt. The trouble is, Google translate has habeus virus mean ‘have virus’, which conjures up Have Virus — Will Replicate, which won’t do at all. Other translations suggest ‘you have the stench’, which might work on some levels, but not on others. It is all too ambiguous. Instead, Dr No went with Schrödinger’s Virus, aiming to suggest an experiment in which you have a box said to contain pure, isolated SARS-CoV-2, but until you open the box, there is no way of telling not so much whether the virus is dead or alive, as whether it even exists. When you do open the box, you find Macavity’s not there!
“And when you reach the scene of crime — Macavity’s not there!
You may seek him in the basement, you may look up in the air —
But I tell you once and once again, Macavity’s not there!”— T. S. Eliot, “Macavity: The Mystery Cat”, Old Possum’s Book of Practical CatsPerhaps the greatest problem facing modern science isn’t the corrupting influence of power and money, but an even deeper one of incomprehensibility. Dr No has touched before on how increasing super-specialisation means that increasingly scientists from one discipline are unable to make sense of another discipline, because the language and theory in each discipline have become so dense as to be impenetrable to all but initiates in that discipline. It is as if science has become a broad church spreading its wings over a vast array of cults and sects, each one swearing allegiance to the Greater God of Science, but each with its own rules and creeds, an impenetrable vista of numberless caverns of knowledge meaningless to man.
With the barrage of political and mainstream media talk of rising covid cases, new scariants and the urgency of vaccinating all, and then some — soon there will be talk of syringe drivers, pumping in covid vaccine in 24/7 — and not to mention Tuesday’s nodding through, not so much on a song and a prayer as on a laugh and a wink, by the blind horses in Westminter, of another six month extension of the Coronavirus Act, there can be little doubt that government is limbering up to implement Plan B. No doubt there is already a Plan C in draft, and so on, to pile Pelion on Ossa, forever and ever, world without end. But how are we really faring with covid these days?
A recent paper, published at the end of last month, did the obvious, a scatter plot of covid vaccination rates against recent cases for 68 countries, and got the sort of plot that looks like a loo pan after it has been used by a person with a particularly bad case of gas powered Montezuma’s revenge. Dots everywhere, but very little focus. Such a scatter plot suggests there is no connection between the variables, or in the case of covid vaccination, it has no discernable effect on case numbers, despite the fact the authors fitted a trend line that suggests a slight increase in case numbers in countries with higher vaccination rates. As ever, we have to remember that cases is a misnomer: they are merely positive PCR tests, that may or may not also be cases, and of course, just as correlation is not proof of causation, so too is the opposite true: lack of correlation is not necessarily proof of no connection. This applies particularly in a cross sectional study such as this, where the epidemiologist’s sword has cut a slice through a single moment in time.