[conspire] When to get a covid test, brains, and a weird case, and a cardiology vs. immunology joke

[Ruben Safir]

On Thu, Aug 06, 2020 at 12:50:25AM -0700, Rick Moen wrote:
> Quoting Elise Scher (elise.scher01 at gmail.com):
> 
> > So Ruben, why don't you believe it?
> 
> I'm curious, too.  This was a peer-reviewed study in _The Lancet_, which
> (for any who really don't know) has been one of the most respected
> medical journals in the world, for just short of 200 years.

Sinlge peer reviewed articles are just datapoints, and not the basis for
concensus or diagnosis, especially when you are already experienced with
a few hundred patients, and no one suffers any congitive disorders.

Every undergraduate is no trying to make there reputations on COVID-19.

And peer review doesn't end with publication.  It actually more or less
starts with publication, assuming the data rises to the level of getting
someones attention.

That being said, non-specifically to COVID-19, any disease that puts a
patient in an ICU for 6 weeks, and triggers a cytokiene storm, will
produce a whole series of sequelue on all the bodies systems.  Added to
that, it would seem the main attack mode of WUHAN-19 is an imulogical
attack on the clotting system, so you can expect damage in the heart,
kidnies, eyes, central nervious system, everywhere and anywhere in the
body sensitive to obstruction of capulary and arteriolie functions.


> 
> That doesn't make them infallible:  In 1998, it published a paper by
> Andrew Wakefield and 11 co-authors suggesting the MMR vaccine is
> implicated in children's autism and colitis.  The paper was later proven
> to be fraudulent, although (predictably) it's still to this day cited by
> antivaxers as if it were credible.
> 
> _The Lancet_ formally retracted Wakefield & co.'s paper in 2010, and all
> of the other co-authors other than Wakefield (whois a crank, and the real
> source of the problem) have disavowed it and demanded that their names
> be removed from it.
> https://sciencebasedmedicine.org/lancet-retracts-wakefield-article/
> 
> So:  The peer review process is not infallible, and _The Lancet's_
> editors can be fooled once in a blue moon.  And yet...  _And yet_, if I
> voiced the view 'Don't believe that full study published in _The Lancet_', 
> I would expect people to need & require from me some really strong
> evidence.
> 
> And so, just posting a drive-by 'Don't believe it' seems pretty
> eyebrow-raising.

Actually, skeptism of all published reports at this juncture, is
normative, and healthy.  We are seeing a tidalwave of garbage being
published, and there is alots of funding now for such research and
EVERYONE and EVERY AREA of medicine has there angle.  The studies aren't
garbage because they aren't serious.  But they are garbage because they
are coming frome everywhere and cover everythihg, are tightly focused,
and overstate risks, and usually confirms what we know.  People are
trying to make there reputations on the backs of this epidemeic.

It will be years before it is settled out.

If there was serious neurological damage, we would expect to see it
boardly in patients, and we aren't.  The one thing we do see, which 
keeps being forgotten, is that most people seem to get this virus 
and either never have symptoms, or have on mild symptoms.  That is little 
comfort for the aged, who get hammered with the virus, or those with just 
an unlucky lotery ticket.  But it is the most substantiated and important clinical
fact with regard to COVID-19 to the present moment.  Pre-exisiting
conditions and age drive the morbity and mortality of this disease.  If
we all lived in the Dome of Logan's Run, we would barely notice this
epidemic.


ALSO, FWIW, I object to adding fuel to peoples anxiety, especially based
on peer reviewed publications, that is single articles.  In medicine
marketing, this is not allowed to be done.  You can not just pull
articles out of the literature and use them to promote medical
decisions.


In grand rounds and rounds, articles are presented within the context of
an entire presentation, among maybe dozens of research articles.
Occasionally, if research was done at an institution, a defense or
presentation of research is made, but this is more about the process
than practicing medicine.  And they are always presented as, "And so in
this study we have shown xyz... and we are looking forward to seeing
collaborating evidence... etc"


Now, that being said, 3 days ago or so, I was fishing with a gentleman
who was on a ventilator for  6 weeks at Elmhurst Hospital.  He not only
didn't suffer from any neurological disorder but the SOB caught 2
buckets of fish and outfished me for most of the afternoon.

He had just been released from the hospital and the family was out
celebrating his fortunate return.  He was lucky because, besides the
obvious, his sister worked at the hospital and visited him regularly.
I'm certain that emotional support was critical for his recovery.


> 
> But I'm not going to hold my breath waiting for thoughtful and measured
> commentary.  See also:
> http://linuxmafia.com/~rick/lexicon.html#second-idiot
> http://linuxmafia.com/~rick/lexicon.html#compromise
> https://en.wikipedia.org/wiki/Confirmation_bias
> https://en.wikipedia.org/wiki/Dunning–Kruger_effect
> 
> 
> There's a set of articles, as the author puts it 'a series on media,
> accountability, and the public sphere' that I'd like to call to people's
> attention, particularly the articles in that series by Danah Boyd, one
> of the sharpest minds I know of.  She has a lot to say about the modern
> Internet user's tendency to DoS their own minds with confirmation bias
> while 'doing research', decide that information sources that fails to
> confirm their priors is 'fake news', and a lot more.
> 
>   Anxious about the widespread consumption and spread of propaganda and
>   fake news during this year’s election cycle, many progressives are
>   calling for an increased commitment to media literacy programs. Others
>   are clamoring for solutions that focus on expert fact-checking and
>   labeling. Both of these approaches are likely to fail — not because they
>   are bad ideas, but because they fail to take into consideration the
>   cultural context of information consumption that we’ve created over the
>   last thirty years. The problem on our hands is a lot bigger than most
>   folks appreciate.
>   [...]
> 
> And no, Boyd doesn't have a finger-wagging solution.  Best to just read
> the series.
> 
> https://points.datasociety.net/did-media-literacy-backfire-7418c084d88d
> https://points.datasociety.net/why-america-is-self-segregating-d881a39273ab
> https://points.datasociety.net/when-good-intentions-backfire-786fb0dead03
> 
> 
> 
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