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Saturday, October 31, 2020
Like Light From A Fire
Friday, October 30, 2020
Confusing The Author Of Nature With The Editor Of Nature
Wednesday, October 28, 2020
I stand corrected on convalescent plasma therapy
1. Sorry I haven't been blogging these days. Mainly for personal reasons that have led me to feeling quite burned out over the last year or so. And I'm afraid I don't expect to resume posting any time soon. This is just a one-off post in order to say something that I should say: mea culpa!
In the past, I touted convalescent plasma therapy as a viable "band-aid" to deal with SARS-CoV-2/COVID-19 until a vaccine was ready. However, I stand corrected about this. Convalescent plasma therapy doesn't really work for COVID-19. That's the main take away or bottom line if you don't wish to read further.
2. So please no need to read further if you don't wish, but here are more details in case you do:
My mea culpa is based on the recently published "PLACID trial". Its accompanying editorial is worth a read too. The PLACID trial involved 464 patients in 39 public and private hospitals across India (randomized, but not blinded): 235 patients received the convalescent plasma, while 229 did not (placebo). The study looked at two endpoints - a P/F ratio below 100 or death. All that's necessary to know is P/F ratio indicates low oxygen in the blood aka hypoxemia. (A normal P/F ratio is 400-500. A P/F ratio 100 or less is very impaired, to say the least. P/F stands for PaO2/FiO2, that is, the ratio of arterial oxygen partial pressure to fraction of inspired oxygen. It's also called the Horowitz index.) The study found the 235 patients in the convalescent plasma arm had a 19% chance of reaching a P/F ratio 100 or less or death, while the 229 patients in the placebo arm had an 18% chance of reaching the same endpoints. There's no statistically significant difference between 19% and 18% in this trial.
3. All that said, it's interesting to note the following from the editorial: "convalescent plasma did exactly what the investigators hoped it would do, yet there was no net clinical benefit to patients". It seems the reason may be because, on the one hand, the convalescent plasma is successfully neutralizing the SARS-2 coronavirus (via antibodies), but on the other hand, the convalescent plasma is making the patient's blood more easily able to form blood clots aka thrombi (via clotting factors). And COVID-19 itself is (as the editorial notes) "a life threatening thrombotic disorder".
As such, a potential way forward may be to keep the antibodies, but eliminate the clotting factors. In short: monoclonal antibodies.
4. Finally, a vaccine might be on the way soon - still a surprise to me how fast vaccines are being developed! - which, if so, might diminish the priority to further research other therapies including monoclonal antibodies. In any case, see what pharma companies AstraZeneca and Johnson & Johnson have been saying, for example.
Monday, October 26, 2020
Heaven's Logic In Romans 8:32
The point of Romans 8:32 is that this love of God for his one and only Son was like a massive, Mount Everest obstacle standing between God and our salvation. Here was an obstacle almost insurmountable: Could God - would God - overcome his cherishing, admiring, treasuring, white-hot, infinite, affectionate bond with his Son and hand him over to be lied about and betrayed and denied and abandoned and mocked and flogged and beaten and spit on and nailed to a cross and pierced with a sword, like an animal being butchered and hung up on a rack?...
Would he really do that? If he would, then we could know with full certainty that whatever goal he was pursuing on the other side of that obstacle could never fail. There could be no greater obstacle. So whatever he was pursuing is as good as done….
Therefore, in Paul's a fortiori argument, God has done the hardest thing to give us everlasting happiness. He did not spare his own Son but gave him up for us all. What does this guarantee? Paul puts it in the form of a rhetorical question (that means a question he expects us to immediately answer correctly): "how will he not also with him graciously give us all things?"…
I said that when I was twenty-three, this logic of heaven penetrated so deeply into my soul that it changed the way I think about everything - and that the change was full of hope….
I live my life every day by the promises of God. I owe every one of them to the logic of Romans 8:32….
Behind every one of those battles is the logic of heaven: "I did not spare my own Son; therefore, my promise to you cannot fail. I will help you. Go. Do what I have called you to do."
(John Piper, Why I Love The Apostle Paul [Wheaton, Illinois: Crossway, 2019], 186-89)