Hypernormal science and its significance

‘Hypernormal science’ has minimal potential for contestation on matters of principle and practice so that information exchange can be unproblematic. Sciences comprise hypernormal domains and more contestable ‘normal’ domains where knowledge diffusion, like acquiring linguistic fluency, depends on face-to-face interaction. Hypernormal domains belonging to molecular biology are contrasted with normal domains in gravitational wave detection physics. Sciences as a whole should not be confused with their typical domains. The analysis has immediate implications for proposed transitions out of the Covid-19 lockdown, proposed solutions to the replication crisis, and, perhaps, our understanding of the early development of social studies of science

Keeping the collectivity in mind?

The key question in this three way debate is the role of the collectivity and of agency. Collins and Shrager debate whether cognitive psychology has, like the sociology of knowledge, always taken the mind to extend beyond the individual. They agree that irrespective of the history, socialization is key to understanding the mind and that this is compatible with Clark’s position; the novelty in Clark’s “extended mind” position appears to be the role of the material rather than the role of other minds. Collins and Clark debate the relationship between self, agency, and the human collectivity. Collins argues that the Clark’s extended mind fails to stress the asymmetry of the relationship between the self and its material “scaffolding.” Clark accepts that there is asymmetry but that an asymmetrical ensemble is sufficient to explain the self. Collins says that we know too little about the material world to pursue such a model to the exclusion of other approaches including that both the collectivity and language have agency. The collectivity must be kept in mind! (Though what follows is a robust exchange of views it is also a cooperative effort, authors communicating “backstage” with each other to try to make the disagreements as clear and to the point as possible.

Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19 : a meta-analysis

IMPORTANCE Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect, and harm. OBJECTIVE To estimate the association between administration of IL-6 antagonists compared with usual care or placebo and 28-day all-cause mortality and other outcomes. DATA SOURCES Trials were identified through systematic searches of electronic databases between October 2020 and January 2021. Searches were not restricted by trial status or language. Additional trials were identified through contact with experts. STUDY SELECTION Eligible trials randomly assigned patients hospitalized for COVID-19 to a group in whom IL-6 antagonists were administered and to a group in whom neither IL-6 antagonists nor any other immunomodulators except corticosteroids were administered. Among 72 potentially eligible trials, 27 (37.5%) met study selection criteria. DATA EXTRACTION AND SYNTHESIS In this prospectivemeta-analysis, risk of biaswas assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I-2 statistic. The primary analysis was an inverse variance-weighted fixed-effects meta-analysis of odds ratios (ORs) for 28-day all-cause mortality. MAIN OUTCOMES AND MEASURES The primary outcome measurewas all-cause mortality at 28 days after randomization. There were 9 secondary outcomes including progression to invasive mechanical ventilation or death and risk of secondary infection by 28 days. RESULTS A total of 10 930 patients (median age, 61 years [range of medians, 52-68 years]; 3560 [33%] were women) participating in 27 trials were included. By 28 days, there were 1407 deaths among 6449 patients randomized to IL-6 antagonists and 1158 deaths among 4481 patients randomized to usual care or placebo (summary OR, 0.86 [95% CI, 0.79-0.95]; P =.003 based on a fixed-effects meta-analysis). This corresponds to an absolute mortality risk of 22% for IL-6 antagonists compared with an assumed mortality risk of 25% for usual care or placebo. The corresponding summary ORs were 0.83 (95% CI, 0.74-0.92; P <.001) for tocilizumab and 1.08 (95% CI, 0.86-1.36; P =.52) for sarilumab. The summary ORs for the association with mortality compared with usual care or placebo in those receiving corticosteroids were 0.77 (95% CI, 0.68-0.87) for tocilizumab and 0.92 (95% CI, 0.61-1.38) for sarilumab. The ORs for the association with progression to invasive mechanical ventilation or death, compared with usual care or placebo, were 0.77 (95% CI, 0.70-0.85) for all IL-6 antagonists, 0.74 (95% CI, 0.66-0.82) for tocilizumab, and 1.00 (95% CI, 0.74-1.34) for sarilumab. Secondary infections by 28 days occurred in 21.9% of patients treated with IL-6 antagonists vs 17.6% of patients treated with usual care or placebo (OR accounting for trial sample sizes, 0.99; 95% CI, 0.85-1.16). CONCLUSIONS AND RELEVANCE In this prospectivemeta-analysis of clinical trials of patients hospitalized for COVID-19, administration of IL-6 antagonists, compared with usual care or placebo, was associated with lower 28-day all-cause mortality