When will this shit end?

[Toilet Duck]

So, vitamin D...

The study in the video from Dr C is unfortunately underpowered. We need better data from a large, adequately powered randomised trial to get a better indication of its therapeutic value. I stated previously that I myself have published on vitamin D and the vitamin D receptor in breast cancer, so I’d be very happy if it turned out to be useful (and full disclosure, I too am taking it!...just in case!).

As gizmo posted, there’s well established links between vitamin D, sunlight and immune function (indeed I posted a link to a study a while back on the impact of chronobiology on immune function and vitamin D levels played a key part in that...while chronobiology on the surface appears to be related to time, light is the meter it’s all measured by...it almost seems like science fiction, but the pioneers of the field won the Nobel prize a couple of years ago!)...It’s also well established now that patients with low vitamin D are those that do worst when admitted to hospital, but, correlation and causation are not the same. We still don’t know whether it has any use prophylactically or once you actually contract Covid. It has some drug interactions, so care is needed especially in older frail patients (younger folk, not so much, hence I’m taking some).

The other problem is that most studies have used high dose calcitriol (the active metabolite of vitD3) rather than over the counter vitamin supplements, so we also don’t know how they would work compared to a therapeutic dose even if it did turn out to be useful. I think the problem is that it feeds a narrative that there are easy answers to this that are being suppressed because it benefits somebody somewhere to keep this going and that if we all just took some vitamins, ate better and exercised a bit more, we’d be grand (do all those things, they are good for you, but don’t expect them to make you immune to Covid!).

The next part of that narrative is that big Pharma won’t fund trials into it as there’s no money to be made. On the contrary, vitamin supplements and cold remedies are a multi multi million dollar/euro/pound industry. Have a look at who makes them next time you are in the chemist. GSK make billions from their supplements and cough mixtures. They love them as since they are not therapeutics, but supplements, you don’t need randomised trial data to prove they work. They are tested as foods and only need to be shown to be non-toxic. So, there’s billions to be made selling the stuff. The scientists and clinicians that run the trials don’t care how much the drug costs, they just want to find something that works. So far, the two most successful results have been dexamethasone (cheap as chips, long off patent, generics available everywhere) and budesonide (ditto!...though AZ will be happy as they are still the innovator of that drug). So, cheap treatments haven’t been shunned, far from it, they are actually the ones being used, but they are being used based on sound, large scale, randomised trial data. There’s over 60 trials looking at vitamin D, if any of them turn up the same level of evidence as the others we are using, you’ll read about it in the New England Journal or the lancet and the next day patients will be treated with it (and i’ll be very happy if that’s the case!)...

edit: sorry, meant to tag @stuartbert two hats and @gizmoman on this!

Edited February 16, 2021 by Toilet Duck

[gizmoman]

"There’s over 60 trials looking at vitamin D, if any of them turn up the same level of evidence as the others we are using, you’ll read about it in the New England Journal or the lancet and the next day patients will be treated with it (and i’ll be very happy if that’s the case!)... "

Do you happen to know if any of them are funded by big pharma? lets hope they are big enough and well run so we get some good evidence.

This piece in the lancet hints that maybe we shouldn't wait for overwhelming evidence,

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00003-6/fulltext

it ends,

"additional evidence could come in just too late. In an ideal world, all health decisions would be made based on overwhelming evidence, but a time of crisis may call for a slightly different set of rules."

[Toilet Duck]

9 minutes ago, gizmoman said:

"There’s over 60 trials looking at vitamin D, if any of them turn up the same level of evidence as the others we are using, you’ll read about it in the New England Journal or the lancet and the next day patients will be treated with it (and i’ll be very happy if that’s the case!)... "

Do you happen to know if any of them are funded by big pharma? lets hope they are big enough and well run so we get some good evidence.

This piece in the lancet hints that maybe we shouldn't wait for overwhelming evidence,

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00003-6/fulltext

it ends,

"additional evidence could come in just too late. In an ideal world, all health decisions would be made based on overwhelming evidence, but a time of crisis may call for a slightly different set of rules."

I don’t have a particular problem suspending the precautionary principle here, so long as certain patients are protected (there unknown interactions with statins for example, some studies suggesting they augment them, others suggesting they impede them, either way it changes the pharmacological properties of the other drug). Also the big unknown is what dose and whether you need the active metabolite or just VitD itself. Big Pharma doesn’t really fund much in the way of trials other than those needed for the registration of their own drug (or a new use for it). Most other trials are investigator-led, so there’s many sponsors other than drug companies that can fund trials (we’ve run trials with EU money for example, means you aren’t beholden to any company when doing them!). 

[efcfanwirral]

53 minutes ago, Toilet Duck said:

GSK make billions from their supplements and cough mixtures. They love them as since they are not therapeutics, but supplements, you don’t need randomised trial data to prove they work. They are tested as foods and only need to be shown to be non-toxic. So, there’s billions to be made selling the stuff.

Are there false advertising laws around these things? As in, do they at any point in the process have to prove they actually contain the vitamins they say are in there? Because I'm not sure the consumer would know any differently...

Edited February 16, 2021 by efcfanwirral

[SheffJeff]

1 hour ago, Toilet Duck said:

So, vitamin D...

The study in the video from Dr C is unfortunately underpowered. We need better data from a large, adequately powered randomised trial to get a better indication of its therapeutic value. I stated previously that I myself have published on vitamin D and the vitamin D receptor in breast cancer, so I’d be very happy if it turned out to be useful (and full disclosure, I too am taking it!...just in case!).

As gizmo posted, there’s well established links between vitamin D, sunlight and immune function (indeed I posted a link to a study a while back on the impact of chronobiology on immune function and vitamin D levels played a key part in that...while chronobiology on the surface appears to be related to time, light is the meter it’s all measured by...it almost seems like science fiction, but the pioneers of the field won the Nobel prize a couple of years ago!)...It’s also well established now that patients with low vitamin D are those that do worst when admitted to hospital, but, correlation and causation are not the same. We still don’t know whether it has any use prophylactically or once you actually contract Covid. It has some drug interactions, so care is needed especially in older frail patients (younger folk, not so much, hence I’m taking some).

The other problem is that most studies have used high dose calcitriol (the active metabolite of vitD3) rather than over the counter vitamin supplements, so we also don’t know how they would work compared to a therapeutic dose even if it did turn out to be useful. I think the problem is that it feeds a narrative that there are easy answers to this that are being suppressed because it benefits somebody somewhere to keep this going and that if we all just took some vitamins, ate better and exercised a bit more, we’d be grand (do all those things, they are good for you, but don’t expect them to make you immune to Covid!).

The next part of that narrative is that big Pharma won’t fund trials into it as there’s no money to be made. On the contrary, vitamin supplements and cold remedies are a multi multi million dollar/euro/pound industry. Have a look at who makes them next time you are in the chemist. GSK make billions from their supplements and cough mixtures. They love them as since they are not therapeutics, but supplements, you don’t need randomised trial data to prove they work. They are tested as foods and only need to be shown to be non-toxic. So, there’s billions to be made selling the stuff. The scientists and clinicians that run the trials don’t care how much the drug costs, they just want to find something that works. So far, the two most successful results have been dexamethasone (cheap as chips, long off patent, generics available everywhere) and budesonide (ditto!...though AZ will be happy as they are still the innovator of that drug). So, cheap treatments haven’t been shunned, far from it, they are actually the ones being used, but they are being used based on sound, large scale, randomised trial data. There’s over 60 trials looking at vitamin D, if any of them turn up the same level of evidence as the others we are using, you’ll read about it in the New England Journal or the lancet and the next day patients will be treated with it (and i’ll be very happy if that’s the case!)...

edit: sorry, meant to tag @stuartbert two hats and @gizmoman on this!

Thanks as always TD... in place as of an upvote here's a pic of how I often feel navigating this shitstorm. 

[Toilet Duck]

6 minutes ago, efcfanwirral said:

Are there false advertising laws around these things? As in, do they at any point in the process have to prove they actually contain the vitamins they say are in there? Because I'm not sure the consumer would know any differently...

It’s actually interesting to see the difference in how cold remedies are advertised in the US versus over here. In the US, the same stuff that’s marketed to us as something that might make us feel a bit better (basically the paracetamol in them), in the US has you rock climbing and surfing later that day! Some things do actually work. Codeine is an excellent cough suppressant, but it’s bloody addictive so they took it out and replaced it with dextrometorphan which doesn’t work nearly as well, but doesn’t lead to people chugging bottles of cough mixture! The vitamin supplements do actually contain the amounts listed (unlike homeopathy which  is just water). However, it’s proven very difficult to show that they actually do much in many cases (vitamin C has been tested extensively to see if it does anything when you have a cold and it doesn’t seem to!). Replacing deficiency certainly has an impact and vitamin b injections have proven efficacy, but lots of the supplement market is based on correlations rather than proven efficacy. Even things like omega 3, which has great health benefits works much better in your diet rather than as a supplement (where it doesn’t work at all really). Fortified food is the best way to absorb supplements rather than tablets as our digestive process (and thus how we absorb nutrients) is completely different after we eat versus after we take a pill. Basically, if you get your vitamins in berocca, you pee most of it back out. I still do it though for some unknown reason!

[Toilet Duck]

5 minutes ago, SheffJeff said:

Thanks as always TD... in place as of an upvote here's a pic of how I often feel navigating this shitstorm. 

😂 

[Toilet Duck]

2 hours ago, Fuzzy Afro said:

Found out recently that I’m severely vitamin D deficient myself (been having regular blood tests due to a recently diagnosed medical issue - the deficiency was a totally incidental find)

 

Not sure whether it actually makes a difference re: Covid but I will say this. There is something VERY odd about the IFR in this country compared to other similar European countries. If you look at case numbers compared to the number of deaths, a Brit who catches covid is far more likely to die than someone who catches it elsewhere.

 

Possible explanations:

 

- Unhealthy population (more obesity etc)

- More vitamin D deficiency

- Are we not optimally treating patients? Seems unlikely though given we are at the forefront of scientific research. 
 

1 and 2 I would wager are part of if, 3 I wouldn’t think so for the reasons you have outlined. Recovery is leading the way in trialling new treatments. The UK also has a more ethnically diverse population than other parts of Europe, which is probably a big factor too...

[zahidf]

https://www.theguardian.com/world/2021/feb/16/bars-pubs-still-pose-covid-risk-despite-safety-efforts-experts

NERDSSSSS

 

[RobertProsineckisLighter]

6 minutes ago, zahidf said:

https://www.theguardian.com/world/2021/feb/16/bars-pubs-still-pose-covid-risk-despite-safety-efforts-experts

NERDSSSSS

I'm fairly sure you could write a similar article for any sort of 'destination'. 

[Guest]

This looks like a nice idea. 

 

[MrBarry465]

As I've been saying for weeks, the government will not be rushing out of this lockdown. They want to do it once and not have to go backwards again. I would expect some restrictions to be in place for most of year.

https://www.theguardian.com/world/2021/feb/15/boris-johnson-very-low-covid-case-rates-key-easing-lockdown-england

[eFestivals]

Just now, MrBarry465 said:

I would expect some restrictions to be in place for most of year.

in which case those restrictions will be until next spring/summer. Personally, I can't see that as in any way politically sustainable.

From the leaks already it definitely looks like un-distanced crowd events are going to be allowed, with the first ones (if not all of them) relying on mass testing. They'll probably be mask-free too.

 

[Fuzzy Afro]

9 minutes ago, eFestivals said:

in which case those restrictions will be until next spring/summer. Personally, I can't see that as in any way politically sustainable.

From the leaks already it definitely looks like un-distanced crowd events are going to be allowed, with the first ones (if not all of them) relying on mass testing. They'll probably be mask-free too.

 

Having events go ahead but with LFT testing for those who have not been vaccinated is still a “restriction”

 

People who say there will still be restrictions don’t necessarily mean we will still be in lockdown, although I really wish such people would outline exactly what restrictions they’re talking about. Restrictions can mean anything from a simple mask and 1m rule to a full blown stay at home order 

[MrBarry465]

17 minutes ago, eFestivals said:

in which case those restrictions will be until next spring/summer. Personally, I can't see that as in any way politically sustainable.

From the leaks already it definitely looks like un-distanced crowd events are going to be allowed, with the first ones (if not all of them) relying on mass testing. They'll probably be mask-free too.

 

Somewhat hyperbolic here isn't it? Have you actually read the article? My whole point is that in order to make it politically sustainable the government don't want to take a backward step. You keep moving forward but are being driven by data and science at the same time. 

How sustainable would it be if in say May, the government said 'ok back to normal everyone!' and then within 4 weeks a national lockdown had to be imposed again? It's much easier for people to stomach slow but forward moving progress, rather than this constant in and out cycling.

This is a marathon not a sprint to the finish line now. 

Have you got any concrete evidence/articles on those events? Not saying I don't believe you, I just have friends in the industry and they have not indicated this as yet. 

Edited February 16, 2021 by MrBarry465

[MrBarry465]

4 minutes ago, Fuzzy Afro said:

Having events go ahead but with LFT testing for those who have not been vaccinated is still a “restriction”

 

People who say there will still be restrictions don’t necessarily mean we will still be in lockdown, although I really wish such people would outline exactly what restrictions they’re talking about. Restrictions can mean anything from a simple mask and 1m rule to a full blown stay at home order 

I've said many times, this will be out last lockdown - as long as we come out of this properly and don't try too rush things. People kept saying 'oh the government won't have that they need the economy going', but all indications for months now was that they wanted to come out of this cautiosly. 

With regards to restrictions, you do the math. Do I expect people should wear masks throughout the year when in a shop yes, do I expect pubs will be closed by May - no. Do I expect people should be encouraged to work from home where possible for most of the year, yes.

 

[Ryan1984]

18 minutes ago, eFestivals said:

in which case those restrictions will be until next spring/summer. Personally, I can't see that as in any way politically sustainable.

From the leaks already it definitely looks like un-distanced crowd events are going to be allowed, with the first ones (if not all of them) relying on mass testing. They'll probably be mask-free too.

 

Zahawi was talking about rapid testing on the news this morning. Seems confident that’s how they’ll get people back into theatres etc.

[Guest]

2 minutes ago, MrBarry465 said:

I've said many times, this will be out last lockdown - as long as we come out of this properly and don't try too rush things. People kept saying 'oh the government won't have that they need the economy going', but all indications for months now was that they wanted to come out of this cautiosly. 

With regards to restrictions, you do the math. Do I expect people should wear masks throughout the year when in a shop yes, do I expect pubs will be closed by May - no. Do I expect people should be encouraged to work from home where possible for most of the year, yes.

 

To be fair to them all signs so far apart from article show that they going to go about this slowly. I’m slightly worried that Johnson said ‘irreversible’ but generally speaking he’s suggesting they will go slowly and go by the data. 

[MrBarry465]

Just now, Ryan1984 said:

Zahawi was talking about rapid testing on the news this morning. Seems confident that’s how they’ll get people back into theatres etc.

Those tests are still only 40% accurate, they seriously need to get that ramped up in accuracy before allowing that. 

[MrBarry465]

3 minutes ago, Ozanne said:

To be fair to them all signs so far apart from article show that they going to go about this slowly. I’m slightly worried that Johnson said ‘irreversible’ but generally speaking he’s suggesting they will go slowly and go by the data. 

Yes, irreversible seems a bit of a silly comment to make at this early stage as there are many unknowns. However, the reasons I am confident it can be irreversible

1. Clamping down on new variants entering the country

2. Data driven approach to coming out of lockdown, instead of last years finger in the air attempt

3. Vaccine rollout pace

Unfortunatley it just means this summer is unlikely to be the swinging 20's that some people were imagining, but we will all have a massive weight off our shoulders by the end of it. I personally think 2022 and 2023 summers will be off the scale in terms of energy. 

Edited February 16, 2021 by MrBarry465

[Ryan1984]

5 minutes ago, Ozanne said:

To be fair to them all signs so far apart from article show that they going to go about this slowly. I’m slightly worried that Johnson said ‘irreversible’ but generally speaking he’s suggesting they will go slowly and go by the data. 

Johnson says a lot of things. I think that was either an off-the-cuff comment or possibly a way of trying to meet the death-hungry CRG halfway? Having said that, it is good to have a plan to follow/targets to aim for.

[Guest]

2 minutes ago, Ryan1984 said:

Johnson says a lot of things. I think that was either an off-the-cuff comment or possibly a way of trying to meet the death-hungry CRG halfway? Having said that, it is good to have a plan to follow/targets to aim for.

Yeah I think you are right, it probably won’t mean anything as later in the day he did say he can’t guarantee anything. 

 

9 minutes ago, MrBarry465 said:

Yes, irreversible seems a bit of a silly comment to make at this early stage as there are many unknowns. However, the reasons I am confident it can be irreversible

1. Clamping down on new variants entering the country

2. Data driven approach to coming out of lockdown, instead of last years finger in the air attempt

3. Vaccine rollout pace

Unfortunatley it just means this summer is unlikely to be the swinging 20's that some people were imagining, but we will all have a massive weight off our shoulders by the end of it. I personally think 2022 and 2023 summers will be off the scale in terms of energy. 

Good points and yeah I think the summer could be a bit more like that than maybe I anticipated a few weeks back. Which isn’t a bad thing we’ll still have plenty more we are able to do. 

[xxialac]

On Monday morning, Scotland insisted that all arrivals from outside the Common Travel area (UK + Ireland) must go into 11 nights of hotel quarantine, even if they had travelled via London, Manchester or Dublin.

Last night that policy was ditched. Now only direct international arrivals must quarantine in hotels. 

So anyone can get to Scotland just by flying to England first, in the process increasing contacts and travel.

Slow hand clap.

[xxialac]

17 minutes ago, MrBarry465 said:

Those tests are still only 40% accurate, they seriously need to get that ramped up in accuracy before allowing that. 

And the price needs to fall as well.

More than £20 and not enough tickets will get sold for events that usually operate on small margins anyway

I suspect the accuracy will improve by the Summer and the cost will fall though.

Accuracy will be far from perfect but perhaps considered good enough.

[zahidf]

19 minutes ago, MrBarry465 said:

Those tests are still only 40% accurate, they seriously need to get that ramped up in accuracy before allowing that. 

I think they are testing more accurate versions. Hopefully those will be ready soon!