Commentary: Why the Bakersfield Doctors Should Not Be Believed

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by Robert Canning

Two physician-entrepreneurs who own a string of urgent care clinics in Bakersfield claim the data they have collected from testing for coronavirus proves that the current “stay-at-home” and physical distancing orders need to end, and that COVID-19 is “just like the flu.”  Their YouTube video interview from last week has been viewed more than five million times. It has garnered attention from the likes of Elon Musk who tweeted “Docs make good points” and Fox News host Laura Ingraham who played excerpts Monday night. But their claims have sparked wide controversy from experts in academia who say their assumptions are flawed, their sample biased, and their extrapolations “implausible.” The Kern County health office has stated it does not agree with their claims. And yesterday their original video was removed for what YouTube says are violations of its “community guidelines.”

The doctors claim their sample of 5,213 tests for coronavirus, in which they found 340 positives (6.5%), can be extrapolated to not only Kern County (population 700,000) but to the entire state of California (population 39.5 million). They claim that this shows that the coronavirus is more widely spread than previously thought, is less virulent, and is just like the flu. But experts like Carl Bergstrom, an evolutionary biologist and expert in modeling biological systems, say the physicians’ statements and assertions are flawed. Writing on Twitter, Dr. Bergstrom noted that estimating the proportion of infected patients from an urgent care clinic sample is a bit like “estimating the average height of Americans from the players on an NBA court.”

The doctors, using what they say is data from Norway and Sweden additionally claimed there is “no statistical difference” in deaths in the two countries, despite the differences in how Sweden and Norway have approached the pandemic. Norway has closed schools and businesses and mandated social distancing while Sweden has chosen to keep its businesses and society open. The data would suggest otherwise. Google searches for “Sweden COVID-19 cases” and “Norway COVID-19 cases” yielded the number of reported COVID-19 cases for each country along with the number of reported deaths as of April 28. The rate of deaths per capita in each country might shed some light on the doctors’ claim of no differences. For Norway and Sweden the per capita mortality rate for COVID-19 are 0.1% and 0.2% respectively. Epidemiologists estimate the severity of an outbreak by calculating the Case Fatality Rate (CFR) – dividing the number of deaths by the number of confirmed cases. Using the data from the Google search, Norway’s CFR is 0.3% (205 deaths / 7,599 confirmed cases) and Sweden’s is 1.2% (2,355 deaths / 19,621 confirmed cases) – four times higher. When statistical tests are used to compare these last two rates, they are very significantly different.

Beyond the implausibility of their calculations and extrapolations, the Bakersfield doctors make statements about statistical modeling that are false. They claim in one video that because the number of deaths and cases is lower than the models originally predicted, the models must have been wrong. This is a logical error in that models only model based on current conditions and the assumptions built in. Good modelers are aware of their assumptions, build them into the model and then when predicting biological processes that can change over time, adjust their models using new data. And this is exactly what the most commonly quoted models have been doing. The doctors in Bakersfield criticize modeling as divorced from reality because they treat patients every day thus they know what is “really” going on. (They also criticize Dr. Anthony Fauci saying that he has not seen a patient in twenty years.) It may be that they know some things the modelers do not, but since they only know who they see in their Bakersfield clinics, their observations may be biased and are small in number.

Finally, on a number of points in the video they assert that COVID-19 is “just like the flu.” They assert that because we don’t shut down the society because of the flu, ergo we should not be doing it for the coronavirus. But coronavirus is not the flu. The flu may kill upwards of 40-50,000 individuals in the U.S. annually, but that is over an eight month flu season. The COVID-19 pandemic has killed over 55,000 people in the U.S. in just over two months. The mortality rates for the flu have been suppressed by a combination of antiviral treatments, vaccinations, and the build-up of immunity in the community. Additionally, there is no evidence (like there is for the SARS-COV-2 virus) that the flu is spread by infected but asymptomatic individuals. And although experts believe that we may be “over the hump” in this wave of coronavirus deaths, we can still expect thousands more deaths before the fall. And some expect a second wave will hit this fall (on top of the beginning the next flu season), before we have been able to develop effective treatments and possibly a vaccine that will provide some increased level of immunity from infection.

So, in sum, the doctors in Bakersfield make irrational arguments and use their limited and biased sample to make arguments that should not be believed.


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22 thoughts on “Commentary: Why the Bakersfield Doctors Should Not Be Believed”

  1. Alan Miller

    yesterday their original video was removed for what YouTube says are violations of its “community guidelines.”

    RC, I believe your analysis and why these doctors are flawed.  I am disturbed by YouTube taking down their video.  I understand the desire not to spread ‘false’ information, and this probably is, but what a precarious road to start down — are ‘doctors’ at YouTube the judges of the ‘doctors’ in Bakersfield?

  2. Tia Will

    Alan

    I believe it was not the “doctors” at Youtube, but rather the rebuttal of the doctor’s “scientific” findings by the American College of Emergency Room physicians that likely caused the removal. The College made a public denunciation of their methods and conclusions in a resoundingly negative peer review.

    1. Alan Miller

      The College made a public denunciation of their methods and conclusions in a resoundingly negative peer review.

      As they should; it’s the removal from YouTube that troubles me.

      1. Richard McCann

        First, Youtube isn’t a government agency, but rather a private company. They are allowed to have more discretion about what they want to share publicly, and can use their judgement as to whether they find posted material problematic.

        Second, the Supreme Court ruled a century ago that free speech does not include “yelling ‘fire’ in a crowded theater.” The very badly done and misleading study is exactly this type of speech and even public officials would be allowed to restrict this stupidity.

        I am not a medical doctor, but I am a doctor in economics which includes statistical analysis. (I may be MORE qualified on this than the vast majority of medical doctors.) The selection bias in this study is ragingly obvious from even a cursory review. Who do you think has been going to urgent care clinics during shelter-in-place? Right–people who think they might be infected with COVID-19!

        And finally, remember that the current pace for annual deaths is over 700,000 since the middle of April. That makes this the largest cause of death in the US. (Heart diseases causes about 650,000 deaths.) https://ourworldindata.org/coronavirus?country=USA

        1. Alan Miller

          Companies such as Facebook and YouTube may be private, but they are d*man near HOW people communicate today.  I have been very concerned about censored content for political reasons from such entities long before Covid-19.  “Science” has been used as cover for politics just as “God” has.  I am totally for an open discussion and criticism, it’s who gets to decide Ultimate Truth, Our God, and Real Science that disturbs me.

        2. Richard McCann

          Alan

          Again, this Youtube video was the equivalent of “yelling fire in a crowded theater.” Under ALL circumstances, that type of speech can be restricted. Are you saying that Facebook should have just left the live stream of the shooting in New Zealand running last year? Rights are not unrestricted EVER–they come with responsibilities (which we too often overlook.)

      2. Tia Will

        Alan,

        I know. However, I inferred you felt this was made on the basis of unqualified individuals at YouTube essentially playing doctor. I was making the point this may have been the source of their change of mind. If so, they acted in both a rational and ethical manner.

  3. Tia Will

    Alan

    Serious question for you. Do you believe that private companies should be compelled to print ( or leave standing ) information or postings that they only post-publication come to understand are not only erroneous but potentially dangerous bits of misinformation? If so, what is their obligation to ensure the public knows this is false information?

    1. Bill Marshall

      Good question… might well apply to the VG… there have been many…

      Perhaps the VG editorial board should take up the issue of false/misinformation posts, and how to deal with that… I’d recommend that consideration… will you join me in that effort?

  4. Tia Will

    Bill

    I think the issue with the Vanguard is slightly different. I have seen many posters claiming that a given article or post has inaccuracies. I have never seen an authoritative body such as the College of ER physicians weigh in on the accuracy or lack thereof of any particular article. Please correct me if I am wrong.

    1. Bill Marshall

      Moving ‘criteria’, based on your 8:43 P post from yesterday… you posed a question then, without the boundary conditions you’ve since added… OK.

      I cannot judge, nor correct, a floating premise… or statement based on that floating premise… you win…

  5. Keith Olsen

    People are all for the removal of content or information that they don’t agree with either political or otherwise until they start seeing their preferred biases removed.

  6. John Hobbs

    Lol. If Keith posts it, it is probably from some obscure conservative propaganda rag or Fox news so we may assume it is false or deeply flawed. Just like all other news blogs, papers, magazines, TV or radio, the owner has absolute control of what is published. They (Youtube, CNN, Fox,David) may choose to publish or censor whatever content suits them.

    The “transparent” and objective solution is to publish all and with reasonable editing and editorializing allow the audience to sort out the truffles from the pig scat.

    1. Richard McCann

      The fact is that surveys show that the viewers of Fox News are more often misinformed about provable factual information (e.g., scientific information, the status of other nations, current economic conditions) that those who rely on other mainstream news sources. It’s these type of outcomes that lead the rest of us to question the credibility of those type of sources.

      It is NOT the media’s job to just send out unfiltered garbage, which is exactly what the populist forces pushing for an autocracy want them to do. Most citizens are too busy to “sort out the truffles from the pig scat” and its unreasonable and even arrogant to demand that citizens do so. Do you demand that everyone haul their garbage to the dump individually? We have hand off specialized tasks in our complex society so that we can be more effective at our own tasks. Having the media sort through what is true, and analyze the impacts of events and policy proposals. Unfortunately for reactionaries, the truth is contrary to their world view, and people of that political persuasion are psychological even less prepared to have their world view challenged. (I can post the studies that show this point.)

  7. John Hobbs

    “Most citizens are too busy to “sort out the truffles from the pig scat””

    Then they need to re-prioritize. Being educated and informed are the responsibility of citizens in a democracy.

    “Unfortunately for reactionaries, the truth is contrary to their world view, and people of that political persuasion are psychological even less prepared to have their world view challenged. (I can post the studies that show this point.)”

    Careful! A couple of years ago I posted some studies from Cambridge and University of London showing that right-wingers are fear driven (and lower IQ) and Don and David sent me to the cornfield.

  8. Keith Olsen

    The doctors, using what they say is data from Norway and Sweden additionally claimed there is “no statistical difference” in deaths in the two countries, despite the differences in how Sweden and Norway have approached the pandemic.

    Today Sweden’s approach was lauded by the World Health Organization (WHO). Surprisingly, WHO has praised Sweden as a “model” for battling COVID-19.

      1. Keith Olsen

        Yeah but Democrats love and support WHO and are mad at Trump for defunding them.

        But more to the point, WHO seems to be backing some of the policies that these doctors were supporting.

        1. Keith Olsen

          I did a Google search on your website and found 10 pages (100 articles) where the World Health Organization came up.  I see where you often cited or quoted WHO.

          So do you support WHO?  Or do you consider yourself part of the progressive left and hate the WHO?

          1. David Greenwald

            I never really thought about it to be honest. I thought it was a rash move by Trump to defund it.

          2. David Greenwald

            A lot of the left opposing WHO are anti-vaxxers, and I’m not an anti-vaxxer. I’m a pro-vaxxer.

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