The Arrow #126

Hello friends.

Greetings from Montecito. My apologies for the lateness of the delivery, but here we go.

The Shred-a-Thon continues. The bride begs me to thank everyone who suggested just dropping them off at UPS or Costco or Office Depot. However, the issue is that most of the bulk of these boxes is clinic and study records and they have to be disassembled (time consuming) to make them shreddable.

So she has to open each of them first to harvest what must be shredded (many of the study records are in binders that can’t be shredded) and by the time she has done all that tedium, the actual shredding is not much of a deal at least in the cool temps we’re having right now in Montecito.

If it were just dropping the boxes off somewhere, we would have done that long ago… probably. If we weren’t just plain too lazy to dig them out of the mass of other stuff that was in there to haul them to the shredder. But trooper that she is, she’s gamely managing about 2 or 3 large stuffed-to-the-gills bankers’ boxes (or larger) a day and the pile is dwindling. At this rate most of these to-be-shredded boxes will be gone in another 4 to 5 weeks or so.

One of the piles pictured last week is noticeably smaller.

Cognitive Dissonance & Confirmation Bias #2

I mentioned at the end of last week’s Arrow that I had seen the perfect example of a resolution of political cognitive dissonance and promised to write about it in the next Arrow. Which is this one, so here goes…

In a previous edition, I wrote about how cognitive dissonance is the uncomfortable feeling we experience when we are presented with evidence of something that flies in the face of a strong belief we have. It comes into play often with politics, which is truly tribal. When those on one side of the political spectrum are confronted with news that one of their own has truly acted badly, and perhaps even unlawfully, cognitive dissonance sets in. The nabobs of the political party involved confab and determine how to spin the news to relieve the cognitive dissonance among their party faithful. Once the new spin hits the air, the cognitive dissonance dissolves, and the world is right again.

Mere moments after I had written about all this and sent out that issue of the Arrow, a prime example came to my attention. Had I not been burrowed away writing until the last minute, I could have included it in that issue where it would have been quite illustrative.

Last week the long-awaited (by some) Durham report was finally released. It did not make the FBI or Hillary Clinton look good.

In essence, Durham found that the Russia collusion premise was launched by the Hillary Clinton campaign to discredit Donald Trump. And after an investigation into the matter, the FBI realized it was a political strategy and not a matter of national security. When Hillary lost, the FBI in general, and its head, James Comey, in particular, felt they might be partially at blame. Hillary, who was not the poster girl for a good loser, continued, on all her subsequent media appearances, to imply her loss was a consequence of not her own terrible campaign, but Trump’s help from Putin.

According to what Durham found, the FBI knew her complaints to be false and that, she, herself, along with her campaign staff initiated the unfounded rumor. Durham states in a footnote to his report that

In other words, he says basically that Hillary’s actions were basically negative politics, a time-tested (and perfectly legal) way to discredit your opponent. The issue, however, is not Hillary’s negative campaigning, but the FBI’s knowledge that there was no substance to her allegations. The FBI knew the Russian interference was bullshit, yet they allowed the Mueller investigation, which ultimately came to the same conclusion, to proceed. They could have easily said, Look, we’ve already investigated this in detail, and there is no ‘there’ there.

But they didn’t. They allowed the new, fairly-elected Trump administration to operate under a huge cloud for its first two years. That was the real story Durham revealed.

When the report was made public, I’m sure it caused some cognitive dissonance in a lot of folks on the left. Most of the perpetrators in the FBI had already been fired. And most of them got jobs at left-leaning, if not far-left-leaning, media outlets. Heads didn’t roll, as heads had already rolled years earlier. But, still, Durham put a stench on how the FBI and other intelligence agencies had operated.

You would think the release of a report that was the culmination of a three-year investigation on an event that kept the US in turmoil for the first two years of a new presidency would be big news. Both the Wall Street Journal and the New York Times, the former the paper of record for the uniparty and the second the paper of record for the left, had small mentions on the front page, but certainly not headlines.

You had to go to page 6 of the Wall Street Journal to read about it and to page 26 if you wanted to see what the New York Times had to say.

Those from the left were not disappointed by what the NYT had to report. The snotty (IMHO) article did not discuss the findings of the Durham report. The article discussed not the actual report, but how those from the right were ecstatic over the findings, which they were blowing completely out of proportion. Which is, of course, catnip to those on the left.

For those on the far left, anything Trump or anyone on the right would agree with must be blasphemous, so it was a pretty easy sell to get them to blow off any commentary on the Durham report. Cognitive dissonance resolved.

Here is a sampling (the entire article is written in the same vein) of what the NYT had to say about Durham’s report.

Let’s look at the bolded lines above.

First, the description of the report as “providing no startling revelations” is disingenuous. I guess it assumes that no one cares that the FBI knew the whole thing was bunk generated by the Hillary campaign and let the Mueller team continue burning taxpayer money when the outcome was already known.

Let’s leave the second bolded line about the FBI lawyer altering the email to a bit later.

Finally, look at the last bolded line, which is two parts put together. If you read the two bolded parts as a single sentence, it says “In their view (the vile right wingers), it (the Durham report) was a political vendetta concocted by Hillary Clinton and her willing accomplices in federal law enforcement”

That is precisely what it was. You can read it in the actual report linked above and here. (So you don’t have to scroll back.)

The addition of the words “In their view…” implies the “vendetta concocted by Hillary…” is just so much right wing BS, when in reality it is what the report actually says.

Now, whether you—or I for that matter—believe any of this or not is immaterial. I am just using it as an example of how cognitive dissonance can be resolved. If anyone developed cognitive dissonance as a result of the Durham report, it would all go away with one reading of the NYT article above. Oh, nothing to it. Just the Trumpers making a big deal out of nada. Whew! And here I was dreading there might be something to it.

See how it works?

Before we look at the FISA situation mentioned above, let’s consider the big attitudinal change that has taken place between the left and the right over the various intelligence agencies.

Before Trump’s election the left was openly hostile to both the FBI and the CIA. And those leaning to the right embraced them. There was a bit of chagrin on the right against Obama for killing US citizens outside the US with drone attacks, but that was mainly against Obama, not the various intelligence agencies.

Prior to Trump’s election, the left hated the intelligence agencies. Bush used CIA intelligence to justify his war on Iraq. Although the left endorsed the war at the start, they didn’t for long. And they correctly blamed the CIA for the faulty data that led them to vote for Bush’s incursion.

Before that, as far as I can remember, the left has been highly suspicious of the FBI, CIA, NSA and the entire alphabet soup of intelligence agencies, while the right, by and large, has been the protector of the intelligence agencies. No more. The roles have reversed.

The left’s suspicions hit a high point culminating in the Church hearings in 1975, which took the various intelligence agencies to task for snooping on US citizens. As it turned out, the CIA had been listening to phone calls and actually opening the mail of US citizens along with a host of other violations. The FBI also received its share of opprobrium. The whole thing ended up with the firing of James Angleton, the secretive and powerful head of CIA counterintelligence, who had held that position since the founding of the CIA.

Another outcome of the Church committee was the passage of the Foreign Intelligence Surveillance Act (FISA) in 1978. This act created the Foreign Intelligence Surveillance Court (FISC) designed to rule on warrants sought to spy on US citizens by various law enforcement and intelligence agencies. Whereas before, these agencies just spied on US citizens willy nilly, the new court required them to provide a warrant (called a FISA warrant) showing probable causes as to why a given citizen should be spied on. The federal judges on the FISA court would determine whether or not the probable cause shown in the FISA warrant rose to the level of permitting the requested spying on a US citizen.

Like many other government agencies originally created to prevent overzealous government agents from hassling citizens, the FISA court has turned out to be just a rubber stamp for the overzealous government agents to hassle citizens. The only difference being that now they can do it legally.

Why do I say this? All you have to do is look at the data. Since the founding of the FISC in 1978, the judges have received 41,222 FISA warrant requests, which allow spying on US citizens. How many would you guess have been denied by the FISA judges? How about 85. Just 85 out of 41,222 requests have been denied. Talk about rubber stamping. That means 41,137 of us (US citizens) have had our phones tapped, our mail opened, our bank accounts gone through, etc. without our knowledge.

So, that’s the lead up to the second bolded sentence in the NYT piece above. The one that says “A former F.B.I. lawyer pleaded guilty to altering an email to help prepare a wiretap application.”

Here is what happened.

In their quest to determine if the Trump campaign colluded with Russia, the FBI sought information on Carter Page, a minor, minor player in the whole Trump campaign saga. The FBI agent responsible for getting this information wrote up a FISA warrant, but before signing and submitting it, he heard rumors that Carter Page had been working in some capacity for the CIA. He contacted a low-level FBI attorney named Kevin Clinesmith and asked him to find out if Page did work for the CIA. Clinesmith, who was anti-Trump to the max (not my opinion—you can look it up), emailed his counterpart at the CIA and asked if Page had done work for them. His counterpart emailed back in the affirmative. Carter Page had indeed worked with the CIA.

Instead of informing the agent doing the FISA warrant that Page had worked for the CIA, which would have doubtless meant the FISA warrant would not have been filed, Clinesmith told the agent he (Clinesmith) had heard back from the CIA via email that Page did not work for them. The agent then asked Clinesmith for a copy of the email for his (the agent’s) file. I’m sure Clinesmith’s bowels dissolved when he heard this, because he knew he was screwed. Instead of calling the agent back and saying something along the lines of, ‘Hey, I just reread the email before sending it to you, and I guess I misread it. Page did work for the CIA,’ Clinesmith altered the email to conform with what he had told the agent. The agent then submitted the FISA warrant and had it granted.

Clinesmith’s alteration came out after it was revealed that Page did work for the CIA. Clinesmith was fired from the FBI, had his law license suspended, and had to do several hundred hours of community service. His law license has now been reinstated. I’ve tried to figure out where he works now, but have been unsuccessful. I suspect it is back with some other government agency. They take care of their own.

Unless Clinesmith had lied in defense of Trump. Had he done that, he would doubtless still be behind bars and without a law license.

You may wonder why I get so worked up about all this. It’s because I’m a 1st Amendment kind of guy. There is a reason the amendment ensuring freedom of speech was first instead of way down the line. The founders wrote the constitution to protect the citizens from the government, not the other way around. They’d been victimized by an overzealous government, and they wanted to protect the citizens against it.

As it has turned out, the left, which had always been the biggest defender of free speech, freedom of assembly, and freedom of the press somehow transmogrified during the Trump administration to be just the opposite.

In my view, we’re cooked as a country if we can’t turn that around.

James Comey’s New Novel

I can’t leave the FBI without reporting one of the funnier book reviews I’ve ever read. [The bride remarked it was her fervent prayer never to get a review like this one for any novel she’d written.]

Matt Taibbi wrote about how all the left wing media were gushing over Comey’s new book. Instead of cornering him on his screw ups as the head of the FBI in the Russia-collusion investigations, they all tossed him softball questions about his book.

Taibbi did purchase and read the book. His commentary on it was priceless.

He starts by describing the media’s groveling before Comey

He then goes in for the kill in his review of the book

Okay, from fawns dying at roadside to the biggest (though probably not the best) news of the day.

Novo Nordisk Comes Out With Oral Wegovy

Just yesterday the Danish pharmaceutical company Novo Nordisk issued a press release in which they made public the results of their Phase 3 study of an oral version of their bestselling injectable weight-loss drug semaglutide.

The results are pretty fantastic, at least for an oral weight-loss drug. Here is what the study shows according to Novo Nordisk.

Here are the details.

You may be wondering what they mean when they talk about the two different results. In the second paragraph they write that “if all the people adhered to treatment” they lost 17.4% of their weight. In the last paragraph above, they discuss what happened when they applied the treatment policy estimand, subjects lost 15.1% of their weight. Why the difference? And what is estimand?

Well, I didn’t know what estimand was myself till I looked it up. I thought it was a different terminology than what I was used to, which is intention to treat analysis (ITT). I was correct. That’s what it is, just under a different name.

What is ITT?

I had no idea until I was schooled on it by my biochemist professor friend Richard Feinman. I had seen it a thousand times while reading papers, but just assumed it was a statistical analysis technique. And it is, in a way.

A typical study might start with 200 subjects randomized into two similar groups of 100 (one a study group; the other the control or placebo group). The study group then receives the intervention while the control group gets a placebo. Typically, neither the researchers nor the subjects know who got what, which makes it difficult to fudge the results.

If all 200 subjects complete the study, the researchers are damn lucky. In most studies there are dropouts—sometimes many of them—along the way.

How do you account for them?

That’s where ITT or estimand comes in.

Here’s how it works.

Let’s say you have 100 subjects with high blood pressure getting a blood-pressure lowering drug and 100 subjects with high blood pressure getting a placebo. The drug has some nasty side effects, which result in 25 subjects dropping out of the study. Ten people drop out of the placebo arm of the study not because of side effects (they’re getting a placebo), but because people just drop out of studies. They move; they have side effects or other study-polluting issues; they just don’t want to keep going. How do you figure the results?

Let’s say that of the 75 subjects who stuck it out till the end of the study dropped their diastolic blood pressure (the bottom one in a reading) by an average of 10 mmHg. You would think that would be the difference the study would use in its report. But not according to ITT. Using ITT, which almost every journal now demands, researchers would have to average the 10mmHG found in the patients who completed the study with the average of, say, 3mmHg drop in BP on the last visit of those who didn’t complete the study.

Same with the placebo, but that doesn’t really matter, because the placebo group shouldn’t have much of a change anyway.

In the imaginary study I described above, the results brought about by the real drug used in the control group would be diminished by all those who dropped out.

The ITT really screws things up in dietary weight loss studies. If you’re interested, I wrote about it at length here.

What you really want to know is, If I take this drug, or if I follow this diet, what will my results be based on what others who took the drug or followed the diet ended up with.

I’m glad to see Novo Nordisk using this format in their press release. I hope they use it in the paper they ultimately publish. It will get rid of the ITT BS while at the same time adhering to its use. Researchers just need to publish results both ways. One in which they report the results of faithful adherers; another in which they report according to ITT or estimand.

Okay, back to the original study.

Oral semaglutide has been available as a diabetic drug under the name Rybelsus for almost four years. The doses are significantly lower than the 50 mg used in this study, however. Rybelsus comes in 7 mg and 14 mg doses. One would have to take 7 of the 7 mg doses to get close to the 50 mg used in the study above.

I just ran a quick check on pricing, and it looks like the average price of 30 of the 7mg tabs runs around $1,065. The interesting thing is the price for 30 of the 14 mg tabs is about the same, so pricing obviously isn’t a consequence of cost of goods. Given this pricing, I would bet the cost of the 50 mg tabs as used in the study will probably be around $1,200-$1,300 per month. That’s about equivalent to the shots, and I’m sure most people would rather take a pill than jab themselves once a week.

In its notice of approval for Rybelsus, the FDA included this warning:

In the press release I quoted from at the top of this section, I bolded the following sentence: Both treatment arms were in conjunction with lifestyle intervention.

What this means is that both the subjects on semaglutide and those on placebo were on a diet and exercise regimen as well. Which means the results shown come from a combination of diet, exercise, and the semaglutide. They can’t say it is all from the semaglutide. Looking at the results of the subjects on placebo, it appears that ~2 percent of the weight loss came from the diet and lifestyle changes. Until we see the actual study, we won’t know what these lifestyle changes are, but my bet is that they are a low-calorie diet and mild exercise.

Aside from the high price of the drug and the side effect profile, we don’t know what happens when folks quit taking it. I suspect that—just like with the injectable version—the lost weight will come screaming back on. I showed these charts in a previous issue of The Arrow, but here they are again.

The above is a chart showing the weight loss over 68 weeks on Wegovy. It also shows the regain after loss. After 52 weeks, the weight almost returns to the starting point. Had weight-regain part of the study lasted 68 weeks instead of 52, I’m relatively sure the subjects would have regained all their lost weight during those extra 16 weeks.

And, as I never tire of reminding folks, all of the weight you lose from these drugs will not be fat. Since Wegovy reduces appetite, you’ll eat less and, consequently, lose muscle mass. If you’re over ~30 years old, you’ll have difficulty reclaiming that lost muscle. The more over 30, the more difficulty you will have.

I don’t think any physician will keep you on Wegovy (or Rybelsus or whatever they plan to call this new pill form for weight loss) for life, so at some point, you will have to go it on your own. Which means diet and lifestyle changes.

In my view, it would be easier to make those changes on the front end and avoid the expense, side effects (some of them not so good), inconvenience, and ultimately risk of regain. And the disappointment that goes along with that.

I’ve been in this business for a long, long time. And I’ve seen a whole lot of patients. No one after losing a lot of weight ever thinks he/she will gain it back. But almost all of them do. They don’t realize or understand that the diet that helped them lose all the weight is almost like a drug. It needs to be continued indefinitely or the effect will be lost.

If your blood pressure were sky high, I would put you on a drug to lower it. [Actually, I’d probably put you on a sound low carb diet first, and if any blood pressure remained after that since not all blood pressure responds to a low carb diet, I’d put you on a drug to lower it. But for the sake of argument, let’s say I just put you on a drug to lower your blood pressure.] When it finally got down to the normal range, you wouldn’t say, Oh, my blood pressure is cured, I can go off this drug now. Or if you did decide to quit the drug, you wouldn’t be surprised if your blood pressure went back up. At least I hope you wouldn’t.

Weight loss is the same way. And weight-loss drugs work the same. If you go off of them, you regain the weight.

If you lose on a diet, then say, Whoa, I’ve reached my goal weight; my diet is over; I can finally eat whatever I want. You’re screwed. Just as sure as God made little green apples.

On to the continuing statin comedy.

Statin ‘Misinformation’

A funny article crossed my digital desk this week. It was a summary of a study on statin misinformation. It came via the Medscape Diabetes & Endocrinology summary emails doctors get. Most of it is hidden, but you can register and get it free. I’ll quote the hidden parts of interest, but feel free to subscribe if you want.

Here’s what the study researchers did. They combed the web in general and Reddit in particular to see what people were saying about statins.

The lead author from Stanford University was trying to figure out what people were discussing online about statins. Since statins are such wonderful drugs, the research team thought it would be important to “quantify the information in topics that people think are important.”

They, being statinators of the deepest dye, assumed people would be discussing side effects of the drugs. But to their astonishment, they discovered that what people were really doing was “refuting the idea that increased levels of LDL were detrimental.”

As one of the researchers remarked, “Our findings show how widespread this misinformation is.” She goes on to say

Here is what the researchers found.

Here is my favorite line in the whole article. It fairly hums with idiocy. And a pretty fatal admission.

Let’s unpack this one. The researchers are stunned that people might distrust “the hypothesis that LDL-C has a causal association with heart disease.”

It’s a frigging hypothesis by their own admission. An hypothesis. Not a fact. I’ve often quoted in these pages Pief Panofsky, the founder of the Stanford Linear Accelerator Center and Manhattan Project physicist, who said, “if you throw money at an effect and it doesn't get bigger, that means it's not really there."

God only knows how many hundreds of millions of dollars have been spent trying to validate the lipid hypothesis. And it’s still an hypothesis. I know what Pief Panofsky would say about it. I suspect he would be correct.

She goes on to say

The sentiment is correct. Many people, including me, think HDL and triglycerides are far more important.

It fairly beggars belief that random bros on Reddit have a better grasp of the science than do professors at a highly prestigious major medical school.

Here is another classic line.

Maybe that’s because the people engaging in intelligent discussions on social media understand that the medical journals, in many cases, are touts for the pharmaceutical industry. There are a dozen ways, if not more, for medical journals to reap money from Big Pharma.

Many of the people discussing these drugs on social media are also aware that much of what is published in the medical press is incorrect.

Here is how she winds it up.

We need to combat this misinformation.

Where have we heard that before?

Paleo Gender Dysphoria

As anyone who is a regular reader of The Arrow knows, I read a lot of stuff. All the time. And on all sorts of subjects. I read a lot of, shall we say, woke writing as well as more serious stuff.

I read something yesterday on a très left leaning site that sends me stuff daily, and I just had to post about it. Here is the title.

See what you can infer from that title. I tried before I broke and read the article. I didn’t have a clue. “Icky?” I thought maybe they were talking about eating nose to tail. But no, it was something else.

Here is the opening paragraph.

Okay, you know something is coming. We can’t have a gendered division of labor, now, can we?

It goes on.

I hadn’t even noticed the name of the author until I got to this part. When I read the last line, I knew the author had to be a woman. And, sure enough, she is.

I suspected she was woke. After reading the next paragraph, suspected flew out the window. I knew she was woke.

My guess is that 99.9 percent of people reading this article wouldn’t have thought a thing about it had she just used the term “woman” as it has been used forever. But a little woke virtue signaling never hurts an academic among zher peers.

Anyway, once I read this, I pretty much knew I was in for a kettle of bullshit, but I soldiered on for no other reason than to find out what part of a Paleolithic diet might be considered “icky” by an academic anthropologist.

She goes on trying to make the point that hunting is dangerous. Or at least more dangerous than harvesting plants of various kinds. The historical implication is that the men undertook the more dangerous hunting while the women tended to the less dangerous gathering.

You can tell by the tone of writing that this just doesn’t set well with our author. Despite the fact that men are bigger and stronger than women—a fact that I think would figure strongly in deciding who went out to track and kill large animals—she believes women must have taken part in the hunts. They don’t just gather stinkin’ plants; they go in for the kill with sharpened sticks, just like the men do.

She thinks that plants are a necessary part of the human diet (another misconception on her part), so to fuel her misbegotten notions about who were the real hunters, she had to come up with a way that hunting could provide the absolutely essential nutrients that can come only from plants.

She asks the question

If they could do that, then women wouldn’t have to demean themselves by gathering. They could By God join the hunt. They could get vegetables that way.

She finally reveals the “icky.”

So when hunters kill ruminant herbivores, their stomachs contain partially digested food. We’ve known that about the Inuit forever. Why wouldn’t it apply to the rest of the early hunters? The Inuit got a bit of plant food from the stomachs of caribou.

She continues.

Which is absolutely true. Probably the truest statement in the whole article.

She follows with

IF past peoples ate digesta?!?! We know the Inuit did. Why would others not?

She digs in and performs a bunch of calculations based on USDA recommended daily averages and figures out that a large bison plus its stomach contents could reasonable meet the USDA requirements for 25 people for three days.

Then she speculates.

Then she notes that with hunting, everyone is screwed if the hunters don’t bring home the Paleolithic bacon. As a survival tactic, the women were thought to reduce the odds of starvation by gathering plant foods that can’t run away or fight back to serve as a backup to the hunting.

But that can’t really be, because women are as fierce and large and strong and brave as men. So somehow they just had to be a part of the hunt, at least in her just-so version of Paleolithic life.

She resolves the whole issue thus:

Pretty weak sauce if you ask me.

At the very end of the article, she does admit that the Inuit ate digesta. But what she doesn’t admit to is that hunting done by the Inuit was the male’s job. Which kind of blows her entire hypothesis.

Video of the Week

Okay, no music this week. But I did come across a great video showing many people who were dead wrong about Covid, the vaccines, and the lockdowns. This is a must watch, so that we can all remember these people and what they did.

That’s about it for this week. Sorry it was so late. I’ll be back next Thursday. I missed on having the Quiver out this past week due to some unexpected events that popped up. I should have one out in a few days.

Thanks for reading all the way to the end. This post is public, so feel free to share it as you like.

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