The official "let's impeach Trump" thread
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The Thriller
Well-Known Member
If he weren’t president he’d be sued for defamation. I’m totally convinced that we need to rid ourselves of the DOJ policy of shielding presidents from criminal prosecution. Trump has proven ad nauseam the fallacy of that policy. If he were actually competent, imagine the damage he could do?
Political Jazz Fan
Well-Known Member
Nothing burgers
One thing I hadn’t clarified in the other thread (and perhaps I should post this there) was regarding the issue of side effects (i.e. risk for arrhythmia), as this has been the biggest thing that (in my personal opinion) has been blown out of proportion. The outcome measure regarding de-novo arrhythmias is the largest outcome variable that I feel is significantly skewed by selection bias and may lead to a distorted picture of what’s happening.
While I’m not a cardiologist, the largest thing I do on a regular basis that interacts with cardiology is the issue of QT prolongation, which is the major concern that’s been highlighted with hydroxychloroquine (and it’s combination with azithromycin). In short, what this means is that each time the heart beats, it’s precipitated by an electrochemical pulse that contracts the heart muscle. After each beat, the heart has to “recharge” (repolarize) and as the time increases for repolarization (as can be influenced by a number of drugs), it increases the risk of developing a specific arrhythmia (torsades de pointes) that can be fatal. The absolute risk of this is hard to quantify. If the QT interval gets beyond a certain threshold, it starts drastically increasing (as a multiplier, but not exponentially) that risk. A lot of this can be quite theoretical, and a measurement of QT interval isn’t static, so you’re really kind of looking at ballpark ranges when you evaluate this.
Okay, so back to the study. Both hydroxychloroquine (or chloroquine) and macrolide antibiotics are associated QT prolongation. This has been the big scare regarding this (both in the medical community, but even much more so in media). The study associates the treatment groups with much higher rates of de-novo ventricular arrhythmias. For this definition, they’re broadly using ventricular arrhythmias (including premature ventricular contractions) but not capturing torsades de pointes (the most relevant and correlated one). These range in severity. PVCs (premature ventricular contractions) are benign. They’re also common. They’re also going to be found in people without symptoms. But in any case, I’m a bit unclear on how some of this data is mined, because PVCs, present or not, is an unusual thing to end up getting tagged in a chart (but they don’t give a breakdown, so this very well could be inconsequential). But they even define the non-sustained ventricular tachycardia as being as short as 6 seconds.
If we’re talking about the differences in mortality, then this is a fair assessment (though there are a couple other things I can comment on in further detail, if desired), but if we’re talking about de-novo arrhythmias, then this would probably be the most limited part of the study from what I could observe. This would be the most obvious way in which the naturalistic and observational confounders come into play. Those who are being given any of the studied treatments, especially in light of public discussion regarding this in headlines, are going to be significantly more likely to be on telemetry (continuous heart-rhythm monitoring). I’d don’t have an exact figure on this, but I’d imagine that most (80-85%, conservatively, if not higher) are going to be on telemetry. Anyone not receiving any of the treatments would be fairly unlikely to be on telemetry (I’d honestly guess less than 10%, but this could be off if some places are being cautious and putting people on it as a protocol), unless there’s some other reason independent of COVID that would guide that decision.
If there’s a true mortality difference between groups, I’d be fairly skeptical of it being due QT prolongation (something that wasn’t a measure here, they just went to the next domino). If this were following a standardized protocol, I think you’d see a decent sized approximation in that particular outcome. Why this is important: hydroxychloroquine is a drug that’s still used for other purposes, and has been used for quite some time, and the highlighting of its cardiac effects has only come about as political collateral, which embeds deeply within society’s understanding of science and medicine, and will start weighing in to treatment decisions years from now, not because of any relevance to the issue being treated at hand or its risks and benefits, but because of emotional association. But that won’t be unique. Much of what transpires within medicine is embedded in cultural phenomena that what we think is or isn’t happening is actually far separated from reality, and has far more to do with our beliefs (as patients) and the larger context in trying to find meaning in suffering.
The Thriller
Well-Known Member
What would we be saying if another leader of a foreign country was threatening private companies like this? What would we be saying about a leader who is threatening to Regulate or shut down the Internet?
Has any republican spoken out about this? Is Mike Lee down with this? Chris Stewart? Are fellow Utahns down with this?
One Brow
Well-Known Member
Thank you very much for that post.
The Thriller
Well-Known Member
Lots of good stuff in this column .
Quoting from the column:
In the last week, Trump didn’t just make a false accusation of murder. He also praised one of the United States’ most virulent anti-Semites as a man who bestowed “good bloodlines” on his descendants. He retweeted a man who called Hillary Clinton, the first woman to be a major-party candidate for president, a “skank.” Trump shared an image with Nancy Pelosi, the first woman to serve as House speaker, with duct tape over her mouth and then mocked her physical appearance. And he repeatedly fabricated lies about voter fraud.
If Joe Biden behaved like that, it would destroy his career. But when Trump does it, it has no significant impact on his support. His depravity is now just widely assumed. It’s baked in.
[Yet] Trump’s approval rating has remained pretty much the same.
...
Heck, during the pandemic 100,000 Americans have died and nearly 40 million Americans have become unemployed. And still Trump’s approval rating has moved up and down a few percentage points at most. How is that possible?
...
First, Trump gets away with it because the previously unthinkable has become routine. As a species, we are drawn to fresh and surprising information — something we could call “novelty bias.”
...
That’s why this week’s Sunday morning shows focused on Joe Biden’s recent bungled joke (for which he quickly apologized). Meanwhile, Trump’s praise of a well-known anti-Semite and his false accusation of murder weren’t mentioned.
Second, it’s not easy for humans to admit when we are wrong. It produces a feeling called cognitive dissonance. That has always been true. But for Trump voters, who have, by now, stuck with him despite him boasting about sexual assault, countless scandals and a steady stream of racism, the psychological cost of breaking ranks has soared. His supporters would have to say to themselves: “All of Trump’s previous conduct was acceptable, but this is the final straw!” There is a ratcheting effect. The more you were willing to accept, the harder it is to let go.
Third, U.S. politics is now defined by a phenomenon called “motivated reasoning,” the tendency to see reality through the lens of desired outcomes. For many Trump voters, reality stretches to fit a prior worldview. Every Trump scandal proves that the “deep state” exists. Every new revelation about Trump’s unfitness for office proves that he’s the victim of “fake news.”
...
But let’s be frank: American democracy is badly broken if few people change their minds about a president who falsely accuses someone of murder or boasts about his TV ratings while 100,000 Americans lose their lives and nearly 40 million lose their jobs. And that says as much about the dysfunctional state of our country as it does about Trump.
Quoting from the column:
In the last week, Trump didn’t just make a false accusation of murder. He also praised one of the United States’ most virulent anti-Semites as a man who bestowed “good bloodlines” on his descendants. He retweeted a man who called Hillary Clinton, the first woman to be a major-party candidate for president, a “skank.” Trump shared an image with Nancy Pelosi, the first woman to serve as House speaker, with duct tape over her mouth and then mocked her physical appearance. And he repeatedly fabricated lies about voter fraud.
If Joe Biden behaved like that, it would destroy his career. But when Trump does it, it has no significant impact on his support. His depravity is now just widely assumed. It’s baked in.
[Yet] Trump’s approval rating has remained pretty much the same.
...
Heck, during the pandemic 100,000 Americans have died and nearly 40 million Americans have become unemployed. And still Trump’s approval rating has moved up and down a few percentage points at most. How is that possible?
...
First, Trump gets away with it because the previously unthinkable has become routine. As a species, we are drawn to fresh and surprising information — something we could call “novelty bias.”
...
That’s why this week’s Sunday morning shows focused on Joe Biden’s recent bungled joke (for which he quickly apologized). Meanwhile, Trump’s praise of a well-known anti-Semite and his false accusation of murder weren’t mentioned.
Second, it’s not easy for humans to admit when we are wrong. It produces a feeling called cognitive dissonance. That has always been true. But for Trump voters, who have, by now, stuck with him despite him boasting about sexual assault, countless scandals and a steady stream of racism, the psychological cost of breaking ranks has soared. His supporters would have to say to themselves: “All of Trump’s previous conduct was acceptable, but this is the final straw!” There is a ratcheting effect. The more you were willing to accept, the harder it is to let go.
Third, U.S. politics is now defined by a phenomenon called “motivated reasoning,” the tendency to see reality through the lens of desired outcomes. For many Trump voters, reality stretches to fit a prior worldview. Every Trump scandal proves that the “deep state” exists. Every new revelation about Trump’s unfitness for office proves that he’s the victim of “fake news.”
...
But let’s be frank: American democracy is badly broken if few people change their minds about a president who falsely accuses someone of murder or boasts about his TV ratings while 100,000 Americans lose their lives and nearly 40 million lose their jobs. And that says as much about the dysfunctional state of our country as it does about Trump.
I think the most insightful part to me was this phrase, "The more you were willing to accept, the harder it is to let go." That explains so much.