Week 25: Appalling behaviour at the Committee for Disease Control

 Written 5th September 2020

 The Committee for Disease Control (CDC) is the leading national organisation in the US for tracing, and containing epidemics, wherever they occur in the world. Before Mr Trump became president it was usual for the Chief Executive of the CDC to be a distinguished scientist, usually an epidemiologist.  Before appointing the present CE, Mr Trump had appointed Brenda Fitzgerald to the CDC, but after accepting the appointment she bought shares in a tobacco company, and this necessitated terminating her, and finding someone else. 

 

He found a new CE in Robert Redfield, but it was not long before he also was found to be problematic. He was described as a “sloppy scientist with a long history of scientific misconduct and an extreme religious agenda” by Mr Lurie, of the Center for Science in the Public interest. In 1985, after mandatory HIV testing of the military, many with positive tests were dismissed from the service, while in the 1990ies an experimental trial of an HIV vaccine produced ‘sloppy and possibly deceptive data analyses overstating the results’.

 

In the FT of 2nd September 2020, Mr Redfield is recorded as having written to all state governors to speed up the opening of new vaccine distribution centres, with plans to launch the new distribution centres before the November election for a new President. ‘The CDC urgently requests your assistance …. and asks you to consider waiving requirements that would prevent these facilities becoming fully operational by November 1st.  The normal time needed to obtain permits for such new facilities presents a significant problem to the success of the urgent public health barrier’. (italics added)

 

Well, not quite: this is an entirely political problem, and is aimed at the convenience of Mr Trump, and par excellence it  ignores basic public health protections. It is a deeply outrageous thing for the CDC to be doing – but there are very good precedents for such behaviour in Mr Redfield’s past.

 

Could the USA have produced similar useful findings to that produced by the UK?

 

In a recent New York Times report, the authors compare the high quality of the research produced on Covid-19 in the UK, and regret the poor quality and lateness of US equivalent findings. Researchers in the UK found no benefits from the use of hydroxychloroquine in hospitalized Covid-19 patients, nor from the lopinavir-ritonavir drug combination to benefit patients. On the other hand, dexamethasone, an inexpensive steroid, was found to reduce mortality by up to one-third in hospitalized patients with severe respiratory complications. Each of these results was conclusive and went against the expectations of many clinicians, guideline writers and lay advocates. The results demonstrated the critical need for randomized trials to separate drugs we hope work from treatments we know work.

 

The researchers in the UK enumerated some fundamental differences between the two countries, and emphasised that recovery trials were designed to be easy to take part in, that the protocol was quickly approved at national level, that background patient data was already recorded and data like age, race and other health problems is already built into the hospital systems for all patients, and post discharge mortality is also built into the system. Support from leaders in government health care was assumed, and a national system of research nurses were available.

Here, slow down – isn’t there a quicker way of saying all this? In the UK we have a National Health Service. When the author spent sabbatical years in Philadelphia (1970) and South Carolina (1978) the feelings among colleagues in the US were highly hostile to the NHS, and I was looked upon as a deviant because I wanted to return to it. Even if opinions among US doctors may have softened since the 1980ies, those who prefer to watch Fox News seem to be little different from their predecessors. Just imagine how Messrs Trump and Pompeo would describe the UK system – if it were in China! Can you credit it – the Chief Medical Officers of England, Wales, Scotland and Ulster all supported the way thing were being done?  Had they been Chinese little need be said to discredit such a system. (Of course, the NHS is different from the Chinese health system , in that we are all free to say what we want about our system, and doctors who blow a whistle are not publicly humiliated as occurred in Wuhan). 

To return to the NYTimes, the authors acknowledged the availability of excellent researchers in the US, and America has health networks with comprehensive patient data on a meaningfully large scale. Though networks don’t encapsulate the full population, they cover enough patients to provide background data for large clinical trials. Unfortunately, unlike Britain, the United States has lacked a clear, unified message from government health care leaders, major insurance companies and hospital systems to put in place large, simple randomized trials that are considered the standard of care for Covid-19 treatment.

Conclusion

Everything hinges on the outcome of the US election: we can agree about that on both sides of the Atlantic. It is highly disturbing that sober experts think perhaps Mr Trump will win, and we note that most Republicans favour Mr Trump. The United States has been a massive force for good, and the checks and balances of your constitution have survived despite some appalling moments since the end of WW2. Should Mr Biden lose, the world will drift into a state of populist governments that are no longer truly democratic – the new alignments will not be confined to major players like Donald Trump, Vladimir Putin and Mr Xi Jinping, in addition to the many minor players like Narendra Modi, Recep Tayip Erdogan, Viktor Orban and AlexsandraLukashenko, as well as far right extremists wherever they are to be found. I’d rather be dead, wouldn’t you?

 

David Goldberg

5th September 2020, the future for oldies still quite uncertain. We live on hope, damn it.