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Saturday, November 28, 2020

HIV patients and Covid; Covid patients and HIV

 JOHN WHYTE: Hi, everyone. I'm Dr. John Whyte, chief medical officer at WebMD. And today I want to talk about HIV and its relationship to COVID. So I've asked my good friend Dr. Virginia Banks, an infectious disease and HIV specialist in Youngstown, Ohio. Dr. Banks, how are you?


VIRGINIA BANKS: Thank you. Thank you for having me. I'm fine.

JOHN WHYTE: Let's start off with, we talk a lot about risk factors-- heart disease, diabetes-- perhaps putting you at increased risk for getting COVID. What about HIV?

VIRGINIA BANKS: Well, I'm happy to say we have an aging population with HIV now and a significant number of our population with HIV, they're over the age of 50, 55, which certainly puts them at increased risk for COVID. And many of them have comorbid illnesses like obesity, which we know now is a significant independent risk factor for acquiring COVID-- hypertension, diabetes, heart disease, and all of these. So that is what catapults them into being more susceptible, I believe, for COVID.

JOHN WHYTE: But HIV itself, if it's controlled, doesn't put one at increased risk for COVID.

VIRGINIA BANKS: That is correct. Having said that, having HIV and on highly active antiretroviral therapy, being under the care of your physician and taking your medication, and having an undetectable viral level, that seems to not put you at increased risk, which is why we continue to stress with those individuals make sure you continue to take your HEART therapy.

JOHN WHYTE: Do patients with HIV need to do anything differently to protect themselves. So let's assume they're taking their medicines as directed, they're seeing their doctor. Is it just the same as everyone else with the handwashing, the physical distancing, avoid the crowds?

VIRGINIA BANKS: It should be the exact same as everyone else, social distancing, as you said, washing your hands. One of the things that I would encourage is I would encouraged to any of my patients to make sure that your vaccinations are up-to-date, your influenza vaccination, your pneumococcal vaccines. So all of these things I would encourage my HIV patients to do just as I with my other patients.

JOHN WHYTE: Now, you and I talked briefly about early on, people may forget that some of the therapies that scientists and researchers were discussing for a possible COVID treatment were some of the HIV medicines that had been discovered a while back. Where are we on that? We're not hearing as much about them anymore?

VIRGINIA BANKS: Well, you have to remember these were all antiviral therapies, and coronavirus is a virus. And early on, we were using drugs like lopinavir getting some information from some of the other countries about using that. It hasn't gone away. They're still looking at drugs like lopinavir and some of the other antivirals, darunavir and tenofovir, as being possible therapeutics in treating COVID-19. But, thus far, we have no reason, at least at this juncture, to use them.

JOHN WHYTE: Now, there have been some reports of shortages of HIV medicines, perhaps related to this or other ideas, as well as PrEP treatment.

VIRGINIA BANKS: I've been doing some checking on that just because some of my patients have asked me about that. But, at least to date, I'm not aware personally of that with my patients, but what we have been encouraging our patients to make sure that they get at least a 30 to 90 day supply of their medications on hand. We certainly encourage them to do that.

JOHN WHYTE: Now, I wanted to ask you about this. I read an article recently that says some COVID-19 vaccines could increase risk of HIV, relating to adenovirus. Can you explain that? It's still very preliminary.

VIRGINIA BANKS: It is very preliminary. And, in fact, I was reading an article by Dr. Fauci a few days ago about this.

JOHN WHYTE: Always a good source, always a good source.

VIRGINIA BANKS: Always a good source. I'm not sure the mechanism of action with this. What we do know is that there are a couple of vaccines that are in the hopper where adenovirus is used as one of the organisms that's in the making of the vaccine as opposed to two of the others where messenger RNA is the mode of the substance is used for the vaccine. So today I don't have any information on it, it's just early information.

I don't even know whether it's anecdotal, because we certainly don't have a large population of patients. Right now none of those drugs have really been FDA-approved and I'm not really sure where we are in clinical trials with those drugs where the basis of the vaccine is adenovirus. But I think it is very interesting information, to just stay abreast of what's going on in terms of safety.

JOHN WHYTE: Dr. Banks, do you think COVID treatment may ultimately be like we treat HIV, that it will require multiple drug therapy as opposed to one drug or two drugs. Is that where we're headed you think with COVID?

VIRGINIA BANKS: I don't know. But as I was a witness to the evolution of drugs starting from AZT to what we have now, I would hope so. I'm hoping so because what we have now are drugs that are effective at different areas of the virus getting into the cell, drugs that effect the entrance of the vaccine into the cell, drugs that prevent replication in the cell. So I'm hoping that maybe we'll have a cocktail like we do with HIV. And I'm hoping that this disease will evolve like HIV has evolved.

JOHN WHYTE: What else do patients with HIV need to know when it comes to COVID-19.

VIRGINIA BANKS: Well, I think another thing that's being stressed, again, if you're taking your HEART therapy and you have an undetectable viral level, what we're also encouraging our patients to maybe look into telemedicine. That's a big thing now with patients and physicians. And if your health care facility has telemedicine, you might want to look into that as a means by which you can keep in contact with your physician and you don't have to come out into the open.

JOHN WHYTE: Well, Dr. Virginia Banks, I want to thank you for, again, sharing your insights about HIV. You said last time we've come--

VIRGINIA BANKS: A long way, baby.

JOHN WHYTE: Yes, we have that HIV is not even considered a risk factor for COVID, if it's being managed well. But we want to remind patients to make sure they take their medicines, see their doctor, as well as practice all the safeguards that everyone else is doing-- the mask wearing, hand washing, physical distancing, and avoiding large crowds. Thanks again for taking time.

VIRGINIA BANKS: Thank you for having me.

Feds on Pfizer COVID vaccine distribution: Dry runs predict 'very doable'

 What will it take to distribute the first 6.4 million doses of Pfizer’s COVID-19 mRNA vaccine, if all goes according to plan and they ship in mid-December?

Alex Azar, secretary of health and human services, acknowledged during a press conference Tuesday that the logistics—which include the need for ultra-cold storage—will be far from easy. But Azar and two other top officials running the government’s Operation Warp Speed effort to speed COVID-19 vaccine distribution did their best to boost the public’s confidence.

The FDA has scheduled a meeting to review Pfizer’s vaccine on December 10, and if it’s authorized as expected, it could start shipping within 24 hours, Azar said. In addition to speeding the vaccine to healthcare workers, “CVS Health has said they expect to be vaccinating residents of nursing homes, one of the top priority groups, within 48 hours of FDA authorization,” he said.

To pull off the ambitious plan, Warp Speed has enlisted Pfizer, which has been running “dry rehearsals” at more than 50 vaccine distribution sites across the country, said Gen. Gustave Perna, who is leading the effort, during the press conference. The company is running the sites through the process of receiving the vaccines, opening them, and administering them, even going so far as to create YouTube videos for staffers to consult along the way.

“As Pfizer has walked the administration sites through the execution, we see growing confidence in everybody,” Perna said. “I personally have gone through the process, and it is a very, very doable process.”


It’s no wonder Pfizer is going out of its way to get vaccine distributors comfortable with its product. The vaccine has created a logistical challenge in that it must be stored and transported at sub-freezing temperatures.

Moderna’s COVID-19 vaccine, which could come soon after Pfizer’s, also requires cold storage, but at temperatures equivalent to that of a “freezer that is most commonly found in most pharmacies,” Perna said. The easier logistics associated with that product “will enable us to get to many places throughout the country…from inner city out to rural America.”

After COVID-19 vaccines are distributed to priority populations, the government will allocate what’s left according to a “population-based formula” that hinges on the number of adults in each jurisdiction, Azar said, adding, “We thought it best to keep it simple.”


Whether large portions of the population will accept COVID-19 vaccines is clearly a matter of concern, both for Azar and Operation Warp Speed co-leader Moncef Slaoui. “Hopefully the majority of the U.S. will stay with an open mind in terms of accepting” vaccination, Slaoui said during the press conference. “Listen to all the data that will be shared transparently through the FDA reviews,” he urged.

Slaoui’s remarks came just days after trial data from a third vaccine candidate from AstraZeneca raised questions about efficacy. The company said that one of the dosing regimens was only 62% effective—a result that paled in comparison to the 95% efficacy bar set by Pfizer and Moderna.

Slaoui said AstraZeneca’s U.S. trial could generate more in-depth data soon, given the fact that the pandemic is raging again and “progressing so fast that it is very likely that not long from now…we may have enough evidence to assess the efficacy of the vaccine,” he said.

AstraZeneca has been touting the advantages of its vaccine over the mRNA contenders. It can be stored at normal refrigerated temperatures, easing the distribution logistics, for example. And AstraZeneca has promised to manufacture 3 billion doses of its mRNA vaccine in 2021—more than double what Pfizer and its partner BioNTech have said they could produce.

https://www.fiercepharma.com/pharma/feds-covid-19-mrna-vaccine-distribution-pfizer-s-dry-runs-predict-a-very-do-able-process

World's Biggest Vaccine Producer Supports AstraZeneca After Drugmaker Misstep

 Serum Institute of India (SII), which has partnered with Novavax, Inc 

NVAX 22.5% and AstraZeneca Plc AZN 0.02% for trials in India, believes the latter’s COVID-19 vaccine is “a very good one.”

What Happened: SII Chief Executive Adar Poonawalla praised the efficiency of AstraZeneca’s vaccine, called Covishield, during an online press briefing on Saturday, Reuters has reported.

“What we found with Covishield in its global trial is there were zero hospitalizations, which means even if you do get infected you’re not going to have a severe attack and secondly even those who got the disease were not infecting others,” he explained during the call.

Poonawalla also said the institute would apply for an emergency-use license in the next couple of weeks.

SII is the world's largest vaccine producer, according to Reuters.

The Serum Institute is also conducting trials for the Novavax vaccine but says that AstraZeneca has a competitive advantage over the rest of pharma companies.

“Both our vaccine candidates can be stored in 2 Celsius to 8 Celsius and India has a lot of storage and infrastructure for that temperature range. It has slightly less storage capacity for -20 C and almost nothing for -70 C,” Poonawalla said.

US pharma giants Pfizer Inc. PFE 2% and Moderna Inc (Moderna) are also working on COVID-19 vaccines and have recently shared positive trial results, but they would require storage at very low temperatures. Pfizer's product would need -70C, and Moderna's needs 2 to 8 degrees Celsius when stored for up to a month, but it falls to -20C temperature when storage for up to six months is needed.

The institute's statement might bring back some public goodwill for AstraZeneca, following criticism after a dosage mistake during trials was revealed.

https://www.benzinga.com/news/20/11/18562600/worlds-biggest-vaccine-producer-lends-support-to-astrazeneca-after-drugmaker-misstep

COVID-19 Prophylaxis? Lower incidence linked to prophylactic administration of Ivermectin

Author links open overlay panelMartin D.HellwigPh.D.Anabela Maia PhD


DOI: https://doi.org/10.1016/j.ijantimicag.2020.106248


PDF: https://www.sciencedirect.com/science/article/pii/S0924857920304684/pdfft?md5=6d00354636e246ac3a7a566a41950040&pid=1-s2.0-S0924857920304684-main.pdf

Highlights

Mass administration of Ivermectin is associate with lower COVID-19 incidence

Ivermectin has been shown to inhibit SARS-CoV-2 replication in vitro

The drug may have a prophylactic effect against COVID-19

A COVID-19 prophylaxis could help bridge the time until a vaccine becomes widely available

Abstract

As COVID-19 continues to rapidly spread throughout the world, incidence varies greatly among different countries. These differences raise the question whether nations with lower incidence share any medical commonalities that could be used to not only explain that lower incidence, but that could also provide guidance for potential treatments elsewhere. Such treatment would be particularly valuable if it could be used as a prophylactic against COVID-19 transmission, thereby effectively slowing spread of the disease while we await the wide availability of safe and effective vaccines. Here, we show that countries with routine mass drug administration of prophylactic chemotherapy including Ivermectin have significantly lower incidences of COVID-19. Prophylactic use of Ivermectin against parasitic infections is most common in Africa and we hence show that the reported correlation is highly significant both when compared among African nations as well as in a worldwide context. We surmise that this may be connected to Ivermectin's ability to inhibit SARS-CoV-2 replication which likely leads to lower infection rates. However, other pathways must exist to explain persistence of such inhibitory effect after serum levels of Ivermectin have declined. It is suggested that Ivermectin be evaluated for potential off-label prophylactic use in certain cases to help bridge the time until a safe and effective vaccine becomes available.

https://www.sciencedirect.com/science/article/pii/S0924857920304684


Lockdown Addicts

 For the lockdown-weary, a brief window of hope opened after the presidential election. With Joe Biden victorious, Democratic politicians and their media allies lost their incentive to weaken Donald Trump’s economy and stoke Covid-19 panic among voters. And with Republicans well-positioned to retain the Senate, governors and mayors in blue states could no longer count on a windfall from a Democratic Congress to rescue them from the consequences of their lockdowns. Finally, cooler heads could prevail—right?

So much for that fantasy. Instead of reconsidering their policies, local officials are restricting more businesses and closing more schools, as New York City has just done. Journalists continue treating Covid deaths as the only ones that matter, while ignoring the mounting medical and social toll from lockdowns. Promising more restrictions, Biden has created an advisory board comprised of individuals who favor stricter lockdowns and foresee restrictions continuing until late next year, even if a Covid vaccine is quickly approved.

Biden and other leaders claim to be following “the science,” but that obviously doesn’t include the research showing the high costs and low benefits of lockdowns and school closures. Closing schools was a dubious move in the spring, when the Centers for Disease Control and Prevention warned that it would likely do little to stem the pandemic (and noted that school closings in other countries had failed to make a discernible impact). Today it makes even less sense in light of the accumulated evidence.

For young students, the risk of dying from Covid is lower than the risk of dying from the flu, and researchers have repeatedly found that children do not easily transmit the virus to adults. The clearest evidence comes from Sweden, which did not close elementary schools or junior high schools during the spring Covid wave, and which did not reduce class sizes or encourage students and teachers to wear face masks.

Not a single child died, and there was little effect beyond the schools, as a team of Swedish economists reports after analyzing records of Covid infections and medical treatment for the entire Swedish population. The researchers, from the universities of Stockholm and Uppsala, took advantage of a natural experiment in Sweden by comparing hundreds of thousands of parents at the junior high schools (for students aged 14 to 16), which remained open, against those at the senior high schools, which switched to online instruction for two months in the spring.

There was scant danger from the schools that remained open. The parents at those schools were 15 percent more likely to test positive for the virus than the parents whose children stayed home, but they were no more likely to be treated or hospitalized for Covid. The classroom teachers were twice as likely as the online teachers to test positive, but their infection rate was nonetheless lower than the rate among parents at either type of school. Just 0.2 percent of the classroom teachers were hospitalized for Covid, lower than the rate among parents. The Swedish researchers suggest additional protections for classroom teachers, like encouraging them to start wearing masks or allowing the older, more vulnerable ones to teach online. But after calculating that a closure of all the junior high schools would have reduced the Swedish national rate of Covid infection by a mere 1 percent, the economists conclude that closing schools is “not a particularly effective way” to stop the spread of the virus.

The chief effect of school closures is to hurt students. In St. Paul, Minnesota, where schools have been mostly closed since March, 40 percent of the students are failing this quarter—double the normal rate. In the Dallas public schools, which closed in March and reopened late this fall, recent tests revealed that half of the students have regressed in mathematics since last year, and that’s probably typical of the “learning loss” that will have long-lasting effects on students around the world. Economists at the World Bank estimate that the spring closures will ultimately reduce the affected students’ lifetime earnings by 5 percent—a loss totaling $10 trillion worldwide. Extrapolating from the well-established effects of education and income on life expectancy, another team of researchers calculates that the springtime school closures in the United States will shorten students’ lives by a cumulative total of more than five million years—more years of life than were lost to the pandemic in the spring.

But those considerations don’t carry much weight with teachers’ unions—and the politicians who depend on them for reelection. Governors and mayors kept many schools closed or only partially open at the start of the fall, and this month they’ve been ordering further shutdowns. Since New York City reopened its schools in September, there has been a minuscule rate of infection among students and staff members—just two cases per thousand. But Mayor Bill de Blasio is so in thrall to the teachers’ union that he closed schools this week even though the city’s positivity test rate is well below the threshold used for closing schools in the rest of the state.

The school closures are disproportionately harming African-American and Hispanic students, and other lockdown measures fall hardest on low-income workers who can’t do their jobs from home, as was repeatedly pointed out by Trump and the researchers he consulted, like Scott Atlas of the Hoover Institution. Atlas, whose calculations show that the social costs of lockdowns exceed the benefits, calls them “a luxury of the rich.” But despite Biden’s professed concern for reducing inequality, he has not urged schools and businesses to remain open. While he says that he will not impose a national lockdown, his advisory board is dominated by public-health professionals eager to impose still more costly restrictions.

One board member, Ezekiel Emanuel of the University of Pennsylvania, used to be renowned for his devotion to cost-benefit analysis. He was an architect of Obamacare, including its controversial board (denounced by critics as a “death panel”) empowered to contain medical costs by limiting expensive treatments. He has advocated allocating medical resources according to a “complete lives system” that “prioritizes younger people who have not yet lived a complete life.” In a 2014 essay, written when he was 57, Emanuel said that once he reached 75 he would refuse most medical treatments, even simple ones like antibiotics, because he did not want to endure the diminished quality of life that comes with old age.

But once Covid became a campaign issue this year, he quickly recalibrated. The median age of Americans dying of Covid is close to 80, but Ezekiel wants to protect them with what is surely the most expensive (and least proven) medical intervention in history. The lockdowns so far have cost trillions of dollars, but Ezekiel dismisses them as inadequate because they have lacked “staying power.” He has advocated an eight-week national lockdown and a national mandate to wear masks, and he doesn’t expect vaccines to make a difference anytime soon. If all goes well, he says, schools might reopen next fall.

Another member of the board, Michael Osterholm of the University of Minnesota, warned in March that lockdowns and school closures could do more harm than good, but he soon joined the chorus of Democrats criticizing Trump for wanting to keep schools and businesses open. In July, he warned against reopening schools too hastily, and by August he was calling for a national lockdown “as comprehensive and strict as possible,” so that people would be allowed to leave home only for food shopping and visits to doctors and pharmacies.

Osterholm also singled out New York governor Andrew Cuomo for praise, calling the state “a model for the rest of the United States.” This seemed rather bizarre, given that the Covid mortality rate in New York is the nation’s second-highest (exceeded only by New Jersey’s), and that infections peaked before Cuomo ordered a lockdown in March. Cuomo also famously justified the lockdown by declaring, “If everything we do saves just one life, I’ll be happy.” This just-one-life rationale has traditionally been considered a prime fallacy in making public policy, which is supposed to be based on rational consideration of the common good. Now it apparently constitutes “the science” guiding the next president.

https://www.city-journal.org/bidens-covid-advisors-ignore-high-costs-of-lockdowns

The Age of Cant

 Cant, or humbug, is far worse than hypocrisy: for if by hypocrisy, we mean a failure to live up to our professed moral ideals, most of us are hypocrites, and thank goodness for it. A society in which everyone lived up to his moral principles unswervingly would be intolerable, regardless of whether those principles coincided. Apart from the fact that no mesh of such principles could ever be fine enough to catch all of life’s infinitely variable exigencies, a person of no moral weakness whatever, while perhaps admirable in the abstract, would be an uncomfortable, even frightening, person to meet. It is good not to be a liar; but never to lie is to be an unsocial being, with as much feeling as an automaton.

Without hypocrisy, there would be no gossip; without gossip, there would be no literature and precious little conversation. The dose of hypocrisy necessary to maintain social intercourse is a matter of judgment, for while many individual instances of hypocrisy are reprehensible and properly the subject of adverse comment, and some instances are beyond the pale, hypocrisy is as necessary to human existence as love or laughter. We should never forget La Rochefoucauld’s dictum that hypocrisy is the tribute that vice pays to virtue: but at least he knows that there is a difference. The only effective way to eliminate hypocrisy entirely from human affairs is to have no moral standards.

Cant is more destructive than hypocrisy because it is harder to expose and because a humbug deceives himself as well as others, while a mere hypocrite retains some awareness; he is a rogue rather than a villain. Cant is the vehement public expression of concern for others, or of anger at an opinion casting doubt on some moral orthodoxy that is not, and cannot be, genuinely felt, its vehemence being a shield for insincerity and lack of confidence in the orthodox opinion. Doctor Johnson defined cant as “a whining pretension to goodness, in formal and affected terms.” Cant is contagious, and, when widespread, it creates an atmosphere in which people are afraid to call it by its name. Arguments then go by default; and if arguments go by default, ludicrous, bad, or even wicked policies result.

I think that we live in an era of cant. I do not say that it is the only such age. But it has never been, at least in my lifetime, as important as it is now to hold the right opinions and to express none of the wrong ones, if one wants to avoid vilification and to remain socially frequentable. Worse still, and even more totalitarian, is the demand for public assent to patently false or exaggerated propositions; refusal to kowtow in such circumstances becomes almost as bad a sin as uttering a forbidden view. One must join in the universal cant—or else.

Wherever people are punished, legally or socially, for expressing an opinion contrary to some recently adopted orthodoxy, or for failing to express the tenets of that orthodoxy, cant is bound to flourish; further, people who begin with an awareness that they are uttering cant come to believe that it is true because no one likes to think that he has spoken only from mere conformity or pusillanimity, or to avoid unpleasantness and the ruination of reputation. Hence, cant spreads rapidly once it takes hold in a society, and it becomes difficult to challenge, let alone eradicate.

Cant also has a built-in tendency to inflation. When it becomes generalized, it’s necessary for anyone who desires to distinguish himself from the majority of people in some way to go even further in his own cant. It is like fundamentalism in Islam: you can always be outflanked by someone more orthodox than thou. Once a new canting doctrine becomes orthodox, it will, in turn, be outflanked.

Leaders in cant are not inquirers after truth but seekers of power, if only the power to destroy, which is often a delight in itself. Cant is the weapon of the ambitious mediocrity, a class of person that has become much more numerous with the extension, but also dilution, of tertiary education. Such people believe that social prominence is their due.

Britain has long been a world leader in cant. The historian Macaulay said that nothing was so ridiculous as the British in one of their fits of morality, by which he meant cant rather than obedience to the moral law or genuine reflection on the ethical basis of action. Dickens memorably portrayed characters whose main feature was cant: Pecksniff, Uriah Heep, Mrs. Jellyby, Mr. Podsnap. Clearly, cant is not a new invention. Often accused of caricature, Dickens replied (in his preface to Martin Chuzzlewit) that what seemed like caricature to some was to him the unvarnished reality. And I think it true that the habit of canting can reduce people to a single, or highly predominant, characteristic. It makes people’s opinions seem like a scratched record that causes the needle to jump and replay again and again the same snatch of song.

Cant takes over minds and reduces their ability to consider other points of view, take in contradictory evidence, or sympathize with anyone not in total and unconditional agreement. It is therefore, in its essence, intolerant. It promotes monotony and eradicates subtlety, nuance, and irony; it does not recognize a tragic dimension to life. It is inherently utopian because it assumes that perfection, especially moral perfection, can be reached. It is boring. It achieves its victories over others by use of what Napoleon called the only effective rhetorical technique—namely, repetition (though frightening vehemence also plays its part). It intimidates by gathering crowds, by anathema, and excommunication. It is devoid of humor, one of the saving graces of human existence; indeed, humor is its enemy, perhaps its greatest enemy. That is why jokes are the particular object of its obloquy.

Unlike hypocrisy, then, one can say nothing whatever in favor of cant; but where having the supposedly right opinions is taken as the larger part of virtue—much larger a part than actual conduct—cant has little to oppose its spread and much to encourage it.

Cant rots institutions from the inside. The case of Sir Timothy Hunt, the Nobel Prize–winning researcher, is instructive in this respect. In 2015, he was asked to give an impromptu toast at a lunch in South Korea for scientific journalists, mostly women. In the course of his brief remarks, he said:

Let me tell you about my trouble with girls [in scientific research]. Three things happen when they are in the lab: you fall in love with them, they fall in love with you, and when you criticize them they cry. Perhaps we should make separate labs for boys and girls?

One of those present, Connie St Louis, not a science journalist but a university teacher of science journalism in London, reported these remarks on Twitter, saying that they had ruined the event, so dreadfully sexist were they. This went viral; in short order, no libel on Hunt’s name was too extreme to be repeated, and the effervescence of indignation against him was so great that he felt constrained to resign from his honorary posts (he was 72 at the time) at University College, London, the Royal Society (one of the oldest and most venerable scientific societies in the world), and the European Research Council, which he had helped set up. University College had demanded that he resign—his wife was a professor at the college—or face being fired.

Hunt’s apologies for his remarks, according to the Royal Society, were not as abject as it thought necessary; but it turned out, on a little investigation that none of his detractors waited for, that the woman who started the storm was a habitual exaggerator, whose only known accomplishment was self-advancement based on almost no real achievement—a common type these days in academia. According to at least some witnesses, Hunt prefaced his allegedly awful remarks as follows:

I say something about the importance of women in science. I also pay tribute to the capable female scientists I know, by saying some nice things about them. And I now acknowledge the contribution made by female science journalists. It’s strange that such a chauvinist monster like me has been asked to speak to women scientists.

No full transcript of the speech exists, but it is likely that Hunt said something that indicated to any person of normal intelligence—at least one not looking for a career-boosting opportunity to be outraged—that his ill-fated remarks were meant ironically. What virtually proves it are his concluding words, of which a recording exists: “So congratulations, everybody, and I hope—I hope—I really do hope there is nothing holding you back, especially no monster like me.” Connie St Louis, the teacher of future science journalists, omitted to mention this, though she must have heard it. A fine corrupter of youth!

Several eminent women scientists whom Hunt had trained came forward to defend him as always having behaved well toward them, but neither his actual conduct nor his eminence as a scientist was enough to save him. University College, demonstrating its close attention to the teachings of Uriah Heep, issued a statement: “UCL was the first university in England to admit women students on equal terms to men, and the university believes that this outcome [Hunt’s resignation] is compatible with our commitment to gender equality.” With all the courage of its own cowardly cant, it stuck by its decision even after the further evidence emerged, saying that Hunt’s reinstatement would be “inappropriate”—inappropriate being the nearest they could come to the word “wrong.”

Hunt and his wife left England for Japan. There is thus room in English academic life for unscrupulous apparatchiks of cant but not for Nobel Prize winners in science who make a few relatively innocent remarks that do not even rise to the level of being off-color. Poor Tim Hunt—by all accounts, a decent person. Self-stimulated outrage by an evident mediocrity was enough to bring down an eminent man of evident distinction.

One swallow doesn’t make a summer, but unfortunately, there is more than one swallow. Consider the cases of Germaine Greer and J. K. Rowling, now the objects of obloquy and excommunication for having dared to utter a truth so obvious that it would not long ago have been derided as a cliché—namely, that sex-change men are not women simpliciter. Their wealth and fame have protected the two women to a large extent from the consequences of their outspokenness, though Rowling, for example, has had to endure being disowned by actors and actresses who owe their good fortune to her creations.

For those neither famous nor in a position to ignore their own economic interests, and who do not wish to be martyrs to an outcry by the canting Twitterers, fear of repercussion has now entered into anything that they say about an increasing number of subjects. Even conversations in private are constrained, due to fear of denunciation to the relevant authorities. As the Soviets and the Nazis found, private denunciation was one of the pleasures of totalitarianism.

A 73-year-old part-time lecturer in engineering in Southampton had a conversation in the university cafeteria with a colleague: a private conversation that led to his dismissal, subsequently upheld by a cowardly minor judge. Stephen Lamonby had met his superior, Janet Bonar, in the cafeteria. During their discussion, he said that Jews were the cleverest people in the world, though they were much maligned for it, and that Germans were good at engineering, which he ascribed to their being part of a society that had long valued and promoted engineering. Bonar was so offended by what he said, even though it was not in a public forum, that, according to Lamonby, she started to shout. In an act worthy of the NKVD, she subsequently reported him to the authorities.

In the university hearing into the matter, the vice chancellor, Julie Hall, said that Lamonby did not understand that what he had said was offensive, and he was dismissed for “gross misconduct”—gross, mark you, not minor. Bonar said that she was “concerned” about students being taught by someone with his “entrenched racist views.” It was not alleged, however, that he was incompetent in his teaching, nor even that he was anti-Semitic: he was not one of those conspiracy theorists who will grant that the Jews are clever but use their cleverness to take over the world.

The judge later said, in turning down Lamonby’s appeal: “For the avoidance of doubt, I find that it is at least potentially racist to group nationalities, races, ethnic or religious groups, by entire categories and to ascribe certain abilities or talents (or the opposite) to them, when, of course, as with any such group, talents or abilities will vary widely from individual to individual.” He rejected Lamonby’s argument that he was employing a positive stereotype. With an astonishing lack of logic or attention to the meanings of words, the judge ruled that a Jewish physicist might take offense at his success being ascribed to the fact that he was Jewish rather than to his own individual ability or hard work. But since being Jewish and working hard are not mutually exclusive—indeed, eminence in most fields is inconceivable without hard work, such that Mozart, a genius if ever there was one, worked and studied extremely hard—no one worth worrying about would ascribe brilliance in physics simply to the fact of being Jewish. The judge said that the positive stereotype—he did not deny that it was positive—was nevertheless “potentially offensive to the recipient.”

Note here the use, for the second time, of the word “potentially” in what the judge said in finding that Lamonby was rightly dismissed. Potentially, this use of the word “potentially” could usher in full-blown totalitarianism, for it implies no requirement for any harm to have been caused by a person for him to be punished but only the potential for him to have caused harm. As Kafka put it, “Someone must have traduced Josef K., for without having done anything wrong he was arrested one fine morning.” And what is the harm that Lamonby potentially caused, in the judge’s opinion? In addition to any offense to Jews, non-Jews might also be offended, even “grossly” offended, because they might feel that some characteristic—presumably undesirable, though the judge didn’t specify what—was being ascribed to them.

The judge was enunciating what might be called the eggshell theory of the human psyche. If someone takes offense against something someone says, that is sufficient to be a justiciable harm. Gone is the “reasonable man” of traditional English jurisprudence, in assessing whether behavior is threatening or so insulting as to constitute mitigation for a loss of temper: one is threatened, bullied, insulted, offended if one says that one is, and that is enough to be actionable at law. Feelings become legislators.

In his final sally against freedom of speech, this greatest judge since Pontius Pilate said of Lamonby’s views that anyone might be offended because he spoke about things that “were none of his business.” The judge appeared not to realize that, if people were to be denied employment for saying something that was none of their business, the world unemployment rate would be close to 100 percent, except perhaps in North Korea. Nor did he make any distinction between what is said in public and what in private.

In a world ruled by the judge, no generalizations about people would be possible, not even such as, say, that the Dutch are the tallest people in the world. To him, it is irrelevant whether such generalizations are true. That Jews are clever, for whatever reason, seems to be borne out by the disproportionate number of Nobel Prizes they win. That Germans are good at engineering seems to be borne out by their cars, machine tools, and other products requiring engineering skill. But mere facts, however obvious, must not interfere with the expression of the right sentiments and the suppression of the wrong ones.

The woman who informed on Lamonby; the vice chancellor of the university; the employment tribunal that said that the university had a duty to its multicultural student body to “protect it from potential acts of racism”; and the judge who rejected Lamonby’s appeal—all had substituted cant or humbug for thought. It is natural to speculate on why. I think, ironically, that the answer can be found in a word: racism. They were furious with Lamonby because, if what he said were true (for whatever reason)—that Jews were clever and that Germans were good at engineering—it must be true also that other people were less clever and less good at engineering, an impermissible thought. Why impermissible? Because, in their heart of hearts, they fear the possible explanations of inequality of outcome. That is why they do not want a society with no legal impediments to anyone, where everyone is left to find his own level.

Cant is, among other things, a defense against unwelcome thoughts. “Clear your mind of cant,” said Doctor Johnson. “It is a mode of talking in Society: but don’t think foolishly.” Easier said than done, especially nowadays, when the instillation of cant, as well as the prevention of anything else, is the main business of education.