parresiazomai: September 2020

Monday, September 7, 2020

Problems with Socialism, Part 1 of Why I am Praying and Voting for the Republican Party to Win in 2020

But seek the welfare of the city where I have sent you into exile, and pray to the LORD on its behalf, for in its welfare you will find your welfare. (Jeremiah 29:7 ESV)

Until Jesus returns and establishes His Kingdom on Earth, in a sense we are all exiles here living in imperfect nations (1 Peter 2:11). While our deeper and higher goal is working and praying for God’s Kingdom to come, in the meantime it is right and good for us to also seek the welfare of the land we live in. That is what I am trying to do in my own small way with this blog post.

I am Planning to Vote Republican

There are many reasons that I am praying and voting for the Republican Party to win the 2020 election. At this time I intend to vote straight Republican, which for me includes voting for Donald Trump and Mike Pence to continue serving as President and Vice President, voting for Thom Tillis to continue representing North Carolina in the US Senate, and voting for Dan Forrest to become Governor of North Carolina. In this blog post I will share about one broad reason that I am voting and praying for Republicans to do well in this election.

In general, the Democratic Party wants to move the US in the direction of more socialism. Some very influential voices in the Democratic Party are openly in favor of socialism, and the Democrats in general lean that way.

What is Socialism?

In a broad sense, socialism is a form of government that puts government in charge of more resources and gives government greater control in order to solve various problems in our society and attempt to improve the living conditions in a nation. All governments do this to some extent. However, with socialism the portion of a nation’s resources controlled by government and the amount of control and authority they have over many spheres of life is vastly greater than with the type of government the US has had throughout our history up to now. I don’t see socialism as an all or nothing proposition. Giving government some amount of resources (mainly through taxation) and some amount of power to address problems is a good thing. However, I believe the US has already gone too far in the direction of socialism. The increased socialism that Democrats would bring would likely cause harm to our society including our poorest members and our children.

It must be remembered that socialism is based on force, or at least the threat of force. The government collects resources either by taxation, by taking control of industries and areas of life through increased regulation, and in some cases even by seizing property and directly taking over control of some industries. None of these ways of the government gaining resources are voluntary. If you don’t pay your taxes you will be fined, and if you still don’t pay, the government can put you in prison and seize your property, and if you attempt to resist being put in prison or having your property seized, you will find out that socialism depends on force. Men with guns will show up. The same will happen if you persist in resisting any government regulations. Socialism may begin with a smiling face and friendly voices, but it does not end that way. That’s why many of the most socialist states in history have also been known as police states (examples include Cuba, Venezuela, China, North Korea, and the former Soviet Union and former eastern bloc nations).

Problems with More Socialism

I believe that it is appropriate for government to collect taxes for some purposes like maintaining a police force to protect us from criminals and a military to protect us from hostile nations and terrorists. I also support the use of taxes to build infrastructure such as highways. These are among the most clear cut proper uses of government (which does depend on forced taxation). But I believe that socialism goes much too far in terms of how much of our resources are controlled by the government and how much power the government has. More government control of resources and more regulations means more of our lives are controlled by government force or threat of force at the end of the day. One of the most successful parts of the American political experiment has been seeking to have limited government. Socialism moves back towards tyranny.

History has proven that a system with more individual freedom and control of resources and limited government has produced more prosperity and wellbeing. That is why throughout modern history people from socialist nations have often sought to escape and flee to nations with less socialism and more freedom. Socialist nations have resorted to building walls and using guns to keep their own people from fleeing. Socialism will hurt our economy and when the economy is weak, the poor suffer most. Socialism hurts the poor.

Our government already has a massive amount of debt. The Democratic agenda is likely to increase our debt much more quickly than the Republican agenda. When nations add more and more debt, there is a predictable outcome. It has happened around the world repeatedly. Eventually the only way out is massive inflation. Not 10% or 20%, but 100% or 200% or more. Because the debt is dollar based (in the US), inflation will eventually increase the number of dollars in the economy and get us out of debt. But in the process, it ruins the life savings of many and it devastates the poor. The government survives. Everyone else loses. I don’t know when this will happen to the US. But it will likely happen sooner and be more severe if the Democrats gain power and pass some of their outrageously expensive agenda even as socialism stymies the economy. If we don’t pay for the debt, our children and grandchildren will. Socialism hurts our children and grandchildren.

Socialism gives government more and more influence over more and more areas of our lives. In general, the same people who are in favor of more socialism are most opposed to godly values and Christian truth. The same people who want more and more government control, also support the immoral LGBTQ agenda, killing unborn babies, and teaching our children that natural forces without a Creator should get the credit for the universe we live in and the life that fills our planet. This means more socialism will in practice result in government power being used to promote immorality and suppress truth and persecute Christians.

The government does have an important role to play in some amount of regulation and policing of industry, health care, and many other parts of our lives. However, in socialism, the government itself becomes increasingly responsible and in control of these areas. Then government has to police itself. While some amount of self-policing works, in general it is more difficult for any organization to police itself. Thus, in more socialist governments there tends to be greater corruption. Power is more widely and easily abused in a socialist system.

All these issues are not merely theory. Look at the most socialist nations throughout the world today and in the last century. They have been miserable places to live where secret police and torture of political opponents was common, poverty was widespread, and there was intense hostility to religion and especially to Christianity. Do I think most Democrats want a nation like that? No, but I think their policies would move us in that direction.

The severe problems associated with moving in the direction of more socialism are one of the many reasons that I am praying and voting for the Republicans to win the 2020 election.

Why am I writing about this?

The election and politics are not the most important things I write about. Most of my blog posts are more directly about biblical truth, God, and Christian faith (see some examples below). God’s Kingdom will come whether the US does well or sinks further into darkness. I spend more time praying for revival and renewal and the advance of the gospel and for Christians to grow in Christ than I do praying for our government. But we don’t have to choose. We can (and should!) pray for all of those things: for our churches and families and private struggles as well as for the election and our government. The Apostle Paul did not only write about the most important things (like salvation through faith in Christ). He also wrote about lesser issues like how to decide whether or not to eat meat in a given social situation. God cares about all areas of our lives.

We in the US live in a democracy, and so to some extent every one of us IS the government. We all have a role to play. Even in dictatorships, Christians are called to pray for good government (1 Timothy 2:1-2). In a democracy, in addition to praying (most important!) we can and should also vote. And some of us should use our ability to write and speak to influence others to vote in ways that we believe will most bless our nation. I have been encouraged by the examples of others to do this (like this excellent article written by Wayne Grudem: Letter to an Anti-Trump Christian Friend). There are other ways we can be involved too, but I am focusing on what I can do. May God guide each of you and may He graciously bless our nation with good government. If you find this post helpful, please prayerfully consider sharing it with others.

Hebrews 13:16 And do not forget to do good and to share with others . . .

Some Related Blog Posts

A previous blog post about socialism that overlaps somewhat with this one, but frames the issue differently:

Bernie Sanders vs. John the Baptist

A post from 2016 explaining why I voted for Trump then. The situation in 2020 is similar except that (imho) Trump has not acted as badly as I thought he might and he has proven to be faithful to an overall conservative agenda. Thus, I feel much better and less hesitant about voting for Trump in 2020:

To Vote (for Trump) or Not to Vote (for Trump) that is the Question

A post about the problem of the national debt:

Are we a Hezekiah nation?

Some of My Blog Posts about Other Things

The Three Ways Jesus Saves Us from our Sins

How viruses strengthen the scientific case for a Creator

How the Smallest Cells Give BIG Evidence for God

Sunflowers and Sonpeople

Mark’s Resources on Hell

Create in Me a Clean Heart, O God

What does Paul Mean by a “Spiritual Body”?

A Model for Intercessory Prayer

Foot Theology

Practical Advice for Battles with Sin and Temptation

What’s so Great about the Great Commission?

Because the Days are Evil

Do we Kneel and Bow Down Enough?

The Book of Revelation is Practical and Applicable

Thursday, September 3, 2020

Why I am Thanking God for Convalescent Plasma Treatment of COVID-19

Disclaimer: This blog post is intended to help you understand the controversy and reporting around convalescent plasma treatment for COVID-19 and to give you reasons to thank God for this treatment. It is not meant to take the place of advice from your doctor if you or a loved one are sick.

Introduction

I’m writing on a topic that is admittedly out of my main fields of expertise (which would be biblical interpretation and living the Christian the life). I’ve been hesitant to do this, but have felt (subjectively) that the Spirit was nudging me to take this risk. I feel that many people are likely confused by the mixed signals that are in the news about convalescent plasma treatment of COVID-19 and I think maybe I can help a little. I am not an expert on medical therapies in general or on immunology in specific, but I am good at reading and studying so that I can understand complex subjects and gifted to write in such a way that helps other people understand them as well. God has often graciously used me in this way. My goal is to help you understand and sort out apparently conflicting statements in the news about convalescent plasma treatment for the coronavirus. In doing so, I hope to provide you with a little good news regarding progress in fighting the pandemic and give you one more thing to thank God for. I pray God will use this blog post for that purpose.

Background

On August 23, the FDA issued an emergency use authorization for convalescent plasma to be used in the treatment of COVID-19. First, let me explain what convalescent plasma treatment is. When we get sick, our immune systems make antibodies to fight off the infection. After we get better, some of those antibodies remain in our blood, sometimes even for the rest of our lives. For more than a hundred years, doctors have used blood from people who have recovered from certain diseases to help treat people who are newly infected with the same disease. The newly infected person’s own immune system might not be making the right antibodies fast enough to beat the infection, especially if a newly infected person is especially vulnerable to the disease. So, giving them someone else’s antibodies can sometimes help a lot. These days, instead of simply giving blood from a recovered person, we have ways to separate out the part of the blood that contains the anti-bodies and just give that. This part of the blood is called plasma. It is called convalescent plasma because it comes from a person who has recovered from the disease.

Based on past experience with infections and antibody treatments, doctors wanted to try this treatment to help patients with COVID-19. . Due to the novelty of COVID-19, there was no specific evidence that this type of treatment would work, but historically convalescent plasma therapy has been effective in treating similar types of respiratory diseases. So in late March, with the approval of the FDA, they started what is called the Expanded Access Program (EAP). This program was overseen by one of the top hospitals and medical research centers in the world, the Mayo Clinic. Their main goal was to create a system where they could get plasma with antibodies to as many severely sick patients as possible as quickly and easily as possible in the midst of a pandemic. They focused on helping severely sick patients because they knew the supply of plasma would be limited. Basically, any hospital in the US that was willing to follow the program guidelines could sign up to be part of the program. Many hospitals (2,807, to be exact) did sign up.

Lots of people have received plasma with antibodies through the EAP. Over 35,000 people have received this treatment so far and the program continues! In addition to getting to plasma to them quickly, part of the EAP’s goal was to collect data. They wanted to use this data to determine first if the treatment was safe, and second if the treatment actually helps people. They did determine that that treatment is safe. There was a small chance that the antibodies would make things worse, but thankfully that has not happened. However, just because the treatment does not cause people harm, doesn’t mean that it works. That required additional research to answer the question: “Do the antibodies in the plasma help sick people?”

The group of top scientists and doctors associated with the Mayo clinic who were running the EAP examined data they had collected and they found evidence that the plasma was indeed helping sick people. They found evidence that indicates those antibodies in the plasma were working the way antibodies are supposed to work. They wrote a paper explaining this evidence in detail. This paper is a major reason that the FDA decided on August 23rd to grant an emergency use authorization (EUA) for convalescent plasma to treat COVID-19.

Now doctors and hospitals anywhere in the US can use this treatment. They do not have to be part of a specific program like the EAP. This emergency use authorization is likely to increase the use of plasma. Because of the additional publicity and additional confidence that FDA approval brings, it is likely that more patients who have recovered from COVID-19 will donate plasma, and more very sick patients will get that plasma. It is likely that the plasma will save the lives of some of those patients and will help others recover more quickly and have less severe symptoms and less suffering. This is something to celebrate! It is not a magic cure that completely and quickly heals everyone who gets it. It will not be available to everyone who gets diagnosed with COVID-19, but will likely continue to be given to those patients who are most at risk of dying from the disease. While it will not end the pandemic, or heal everyone, it is very likely to save lives and help many people.

Not Everyone is Celebrating

Surprisingly (or perhaps, predictably, in our broken society in 2020), quite a few scientists and pundits are not celebrating this important victory in the ongoing war against COVID-19. Some of them are instead focusing on criticizing the FDA and attacking President Trump, who made the announcement about the EUA. The language these critics use is likely to cause people to doubt whether convalescent plasma is a good, helpful treatment that we should be thankful for. Here are a few examples of negative comments and statements in the news:

1. Yesterday (September 2, 2020), CNN ran an article that began with these words:

“A National Institutes of Health panel said there's no evidence backing the use of convalescent plasma to treat coronavirus patients . . .”

In fact, as you will see below, there are multiple lines of strong evidence, provided by one of the top hospitals and medical research centers in the world, that convalescent plasma is an effective treatment.

2. The AP produced an article that was run by Fox News and other news outlets. Fox ran the article with this headline:

“FDA chief apologizes for overstating plasma effect on coronavirus: Scientists and medical experts have been pushing back against the claims about the treatment”

Technically, the FDA chief did misstate the effect and he did apologize. The specific mistake he made was that “Hahn and other Trump administration officials presented the difference as an absolute survival benefit, rather than a relative difference between two treatment groups.” This is a matter of detail that I would not care about if someone I loved was dying of COVID-19 and they were offered convalescent plasma. The headline, and especially the subtitle, is likely to cause people to doubt that the treatment is effective at all. This is especially true when the article includes lines like the one below. The bold emphasis is my own, is a statement I believe to be untrue, and one that I fear could cause people to doubt the effectiveness of this treatment.

“The FDA made the decision based on data the Mayo Clinic collected from hospitals around the country that were using plasma on patients in wildly varying ways -- and there was no comparison group of untreated patients, meaning no conclusions can be drawn about overall survival.” (You may read the article here for as long as the link works, or Google the above quote to quickly find it)

3. An article ran on the Politico news site had this headline:

“FDA authorizes plasma treatment despite scientists’ objections”

Would you want a treatment that scientists object to? The article is likely to discourage people from using this treatment, especially when it also includes quotes like this one:

“The data from the expanded access program is not a randomized controlled clinical trial, making it difficult for scientists to eliminate other factors in patients' recovery.” (The part of the quote in bold will be discussed in detail below. You may read the article here)

Looking at the Evidence

I wanted to look at the evidence for myself. So I searched for and quickly found the Mayo Clinic study that is available online (I’ve already provided a link above, but here it is again).

When I carefully read and reread the study, I thought the evidence for convalescent plasma being effective was quite strong. Since I am not professionally trained in this area, I asked a friend who is to read the Mayo Clinic article and also this blog post to see if he agrees with my understanding. My friend is a licensed veterinary doctor who graduated from the University of Maryland with a dual major in Biochemistry and Microbiology and then later earned his Doctor of Veterinary Medicine from VMRCM. He has an extensive background in research and analysis of technical papers. He has corroborated my understanding and has checked this blog post for any scientific errors or misstatements on my part.

Perhaps the most common criticism of the Mayo study is that it was not a randomized placebo control trial (RCT). But the Mayo study was very similar to a RCT and there is no good reason to reject its analysis. Let me explain the difference between a RCT and the Mayo study.

When someone gets sick there are a vast host of factors that can contribute to how severe their illness is and whether or not they recover. As with many infections, most people who get COVID-19 recover without needing hospitalization. Most people will probably recover even if they are given no treatment at all. Further, when doctors are trying to save someone’s life who is critically ill, they often give multiple medicines (have you ever known anyone in an ICU who only received one type of medicine or treatment?). If one of those many treatments is new or untested, it can be difficult to determine if that is actually the treatment that is helping the patient. If a patient is given convalescent plasma and they get better, how do you know they would not have gotten better anyways? How do you know that the antibodies in the plasma helped them? To deal with this issue, the very best method for testing new therapies, when possible, is to use a RCT.

In a RCT, you separate a population of sick patients into two groups. This is done randomly so that the two comparison groups are as similar as possible. Then you likewise treat both groups as similarly as possible with one important exception. One group gets the treatment you want to test. The other group gets a placebo. Further, neither the patients nor the doctors and nurses treating them know who is getting the placebo and who is getting the real drug (or the real antibodies). Then you see what happens. If more patients who received the real drug (or antibodies) get better than patients who received the placebo, that is evidence the drug, or treatment, works. Statistical analysis is done to make sure there was a big enough difference between the patients who got the real drug and the ones who got the placebo to prove that the difference was not just due to luck.

The Mayo Clinic agrees that a RCT is the very best kind of study for the purpose of precisely testing whether a new treatment works. They explain why they did not use a RCT. They had really good reasons that had to do with wanting to help as many people as possible as quickly as possible under the additional difficulties created by doing the study during a worldwide pandemic that is killing thousands of people every day. They explain these reasons in detail in their research paper. The reasons made a lot of sense to me.

Thankfully, there are some really smart people at the Mayo clinic who figured out two ways to test whether the convalescent plasma was helping even though they were not using a RCT. The first of these two methods I will explain is quite similar to a RCT in important ways.

When a pill is made by a pharmaceutical company, the dose in the pill is tightly controlled so that every patient who takes that pill gets the same dose of the medicine. But convalescent plasma is not made in a pharmaceutical facility. It is made in human bodies. It turns out that some people who have recovered from COVID-19 and who donate plasma have a lot of antibodies in their plasma, and some have relatively few antibodies. You cannot tell by looking at a person how many antibodies are in their plasma. A small sample of each plasma donation was sent to labs to measure the amount of antibodies in the plasma. However (this is important!) neither the doctors and nurses administering the plasma nor the patients receiving it knew whether they were receiving a bag of plasma with a lot of antibodies or with relatively few antibodies. But the researchers overseen by the Mayo clinic knew because they used a coding system to keep track of this. Then, they compared how many patients who received a low number of antibodies got better to how many patients who received a high number of antibodies got better (getting better for this research simply meant that they did not die, which is probably important to them and their families). It turns out that more people who got the higher number of antibodies recovered compared to people who got the lower number of antibodies. They did statistical analysis and it indicated that this was not the result of pure chance. The antibodies were really working. (Thank God, a little good news in this long pandemic.)

I hope you notice how similar the Mayo study was to the “gold standard” RCT. To reinforce this, here are two graphics comparing the two research methods:

Notice how closely the Mayo Clinic study approximates the “gold standard” RCT. In an emergency, in a pandemic killing thousands of people each day, until RCTs can be completed, doesn’t it make sense to use the promising, encouraging results of the Mayo study? That is what the FDA did. That is what Trump announced (without giving all the details, which are available publicly online). Why are pundits being so critical of the FDA and this announcement? Shouldn’t we be celebrating and thanking God for a treatment that, while it does not cure everyone, appears to be saving many lives? Shouldn’t we want to promote this so that more people who have recovered will be eager to donate their plasma and more sick people will be saved?

The Mayo clinic used a second method to test whether the antibodies were working. They knew based on history and medical experience that if antibody treatments for respiratory illnesses like COVID-19 work at all, they usually work best if the treatment is given earlier in the illness rather than waiting. If the antibodies do not work, it should not matter if they are given early or late. If they do work, it should matter. They found that giving the antibodies early did matter. This is additional evidence that supports the evidence found by comparing those who received low doses to those who received high doses. All the data points in the same direction: the antibodies in the convalescent plasma treatment help sick people.

So why are some people, including some medical professionals, so negative towards this treatment? I don’t know. Perhaps some just honestly do not understand the nature of the research. Perhaps some are politically motivated (consciously or subconsciously) and do not want to see any victory for the efforts of the Trump administrations to combat the pandemic. You decide.

Conclusions, Praise, and Prayer

Convalescent plasma is not a miracle cure. Some people who get it still die (this is true for many proven treatments for many diseases). We still need better treatments and vaccines. The pandemic is not over. But we can thank God that there is good evidence that one treatment that has already been used for tens of thousands of patients is working. It is saving lives and helping sick people get better.

In today’s climate, it feels like everything is politicized. We need to pray for wisdom and be discerning to sort out the truth.

We should keep praying for even better treatments and the scientists and doctors working on them and the FDA and other agencies involved in evaluating and approving treatments. One very promising treatment is called monoclonal antibodies. Our bodies produce many antibodies when fighting an infection like COVID-19. Scientists work to determine which of these many antibodies work the best. Then, instead of waiting for them to be produced in human bodies, they produce them in labs and similar facilities. They can produce consistently high doses of the very best antibodies. They are doing this today. These treatments are currently in phase 3 human testing. The fact that the Mayo study provided good evidence that antibodies from convalescent plasma are effective, gives us hope that these artificially produced monoclonal antibodies will work even better. Keep praying!

And while we are praying, let’s give God thanks for our immune systems. Our immune systems are amazing. Convalescent plasma treatment makes direct use of antibodies produced by human immune systems. Monoclonal antibodies can be mass produced to supplement the work of the immune system. If vaccines are developed that work, they will work because they have successfully equipped our own immune systems to fight the disease when it shows up.

I hope you will join me in thanking God for one treatment that is helping people in this pandemic: convalescent plasma.

Hebrews 13:16 And do not forget to do good and to share with others . . .

For further reading, thought, and edification:

1. Blog posts specifically related to the coronavirus:

How viruses strengthen the scientific case for a Creator

The Coronavirus and the Lord’s Prayer

7 Ways the Lord may use the Coronavirus Pandemic for Good.

2. Blog posts about scientific evidence for God as our Creator:

God Created the Earth to be Inhabited

How the Sun glorifies the Son

Nuclear Submarines and Living Cells

Octopi from Outer Space