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

[Rick Moen]

Quoting Ruben Safir (ruben at mrbrklyn.com):

> My favorite was preventing patients from being discharged with TD from
> the hospital which directly resulted in resistant TD spreading into the
> community killing perhaps millions of innocent people, many of whom
> never even suffered from AIDS.

I'm empathetic with your dyslexia problem, Ruben, and applaud you being 
articulate in public anyway.  However, given that obstacle, you probably
would be better off writing out words like tuberculosis rather than trying
to abbreviate them.

I had fun trying to picture Tardive Dyskinesia (the only medical
condition generally abbreviated as 'TD') being released into the
community as a 'resistant' condition.  (Tardive Dyskinesia is not, of
course, infectious, nor is Haldol.)  In all likelihood, this was
unintentional comedy on your part, as you intended to namedrop the
abbreviated term for (antibiotic-resistant) tuberculosis, and screwed it
up.

In friendship, I'll say:  You should try to avoid that sort of outcome.

I'm also really extremely unclear on how preventing people with
tuberculosis from being discharged from institutions was the fault of
unnamed 'people [who] had a pet paper in their pocket' about AIDS, and
why this would not be the responsibility of the clinicians who made that
bad decision.

Basically, even though you were just getting warmed up for throwing
rhetoric around, you were already leaving logic in the dust.  But 
you weren't done, of course:


> Any paper that is not supported by clinical observation on the floors is
> a worthless peice of garbage in a crisis.

What's amazing is that you think this piece of rhetoric is going to
impress anyone, let alone that the rest of your overheated rhetoric
would.

Science is done by a long conversation among scientists.  Obviously,
clinical data is vital towards medical judgements, but the notion that
it's valueless unless done via clinical observation on the floors is
absurd, and I'll not be buying it.

Briefly, the authors of the _Lancet_ study found disturbing patterns in
medical imaging, revealing strong evidence of numerous structural brain
changes in COVID-19 patients studied.

The authors also point out that the SARS virus is known to have been
neuro-invasive, so it's not a stretch for its relative SARS-CoV-2 to be,
as well.  Morever, they cite to the literature for clinical evidence
that 1/3 of COVID-19 patients in Wuhan presented neurological symptoms
during treatment, with those symptoms being more severe in more-severe
COVID-19 patients.  Also, they cite to the literature for clinical
evidence in European hospitals of statistically high incidence of sundry
neurological conditions:  encephalitis, stroke, hemorrhage, cerebral
embolisms, etc.  Moreover, they also cite to the literature for clinical
evidence of other nerve damage.

These observations will either be found to be well founded and their
methods and findings to be replicable, or they will not, and if the
observations are replicated, the damage will either be long-term or not
-- but your declaring ex-cathedra[1] that it cannot have merit is
obvious bushwah, and you are frankly wasting your time and everyone
else's, attempting it.


> You know we have patients to treat here, not just stroke the egos of
> acamedemic researchers and research centers.

Um... since you mention it, about that:

> I'm trying to teach you something here, Dedrie.  I'm not debating this
> with you because I'm the one that sees the patients, and treats them,
> and writes the statistics that you largely consume.  It is not the other
> way around.
> 
> You do not make medical decisions based on published papers... NEVER.

Deirdre can certainly speak for herself.  However, I wish to mildly
observe:

1.  Deirdre isn't making medical decisions at all, for anyone, not even
herself.  This is why we have medical doctors, who can as required
consult specialists who are also medical doctors or highly qualified
medical scientists (usually both, but see footnote 2) for advice.

2.  With great respect for the professional skils of pharmacists such as
your good self, to my knowledge you are not a medical doctor let alone
an pulmonologist, cardiac specialist, neurologist, or any other relevant
physician specialty, seeing that to my knowledge you are not a medical
doctor at all[2].  In that light, and in the conventionally accepted
sense of the terms, you do not 'see and treat patients'.

Point being, you are _really_ out of line.

You have a mailing list with, among its members, some NYC-area people on
it who work in generally unspecified capacities doing some
medical-somethings, plus you, a hard-working pharmacist.  I'm glad you
have that, and I wish you great success in trying to sort through lots
of diverse sorts of purported information about the pandemic.  But
neither your profession nor the unspecified professions of your
acquaintances entitles you to pull rank on, e.g., readers of preprint
medical journal articles and make some ludicrous attempt to shame them
for making a good layman's effort at understand the current and evolving
state of scientific knowledge.  You are not the boss of anyone, here.
Don't even think of acting that way.


Turning to (part of) your separate note to me:

> Sinlge peer reviewed articles are just datapoints, and not the basis
> for concensus or diagnosis.

Yeah, we know that.

Ruben, guess what?  We have the privilege of discussing articles in 
_The Lancet_ without having an obligation to beat to death the necessary
and ongoing role of replicability.

Get used to that.

> especially when you are already experienced with a few hundred
> patients, and no one suffers any congitive disorders.

But we know this is _not_ true.  ICU psychosis is a well established
thing, the encepalitis and meningitis are things, brain fog is _very_
much a thing.

And no, I'm not going to dig out a pile of studies.

> Actually, skeptism of all published reports at this juncture, is
> normative, and healthy.  

(Normal, not normative.)

Ruben, one of us was variously President or Secretary of Bay Area
Skeptics for a couple of decades, and it's not you.  So, don't teach
grandma to suck eggs, please.

> 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.  

As I already said, you would need a lot of persuasive evidence to
support the assertion that a full study that made it into the pages of
_The Lancet_ is garbage.  We know that their editors and reviewers
aren't fallible, e.g., the Wakefield fraud and the ridiculously
defective datasets from Surgisphere (about which I won't state my full
views because I'm careful about the defamation statutes) caused
publication of papers that had to be retracted, but the editors and
reviewers are really good.

> It will be years before it is settled out.

Of course.  _That's how science works._

Eggs and grandmothers, Ruben.


> If there [were] serious neurological damage, we would expect to see it
> boardly in patients, and we aren't. 

I'm not at _all_ sure you have competent, relevant data to support your
conclusion ('we aren't') -- unless mayhap you move the goalposts by
setting the term 'serious' stategically high:  I'm not a neurologist any
more than you are, _but_ I do know that significant neurological damage
can manifest in subtle and unexpected ways, and sometimes do so later
rather than immediately.  

And, I'm sorry, but the clinical reports have been rather disturbing,
and I have grave doubts that you can just wave your arms and call them
'garbage', like the study out of Minnesota that reported acute
demyelenating encephalomyelitis in three patients.  That's a small
study, but I'm not prepared to say it's garbage.  This involve the
patients' immune systems demylinating their spinal cords. 

Gosh, I really do hope that was a clinician fantasy or error, because
it's totally nightmare fuel for me, given that my dad's younger brother,
my Uncle Ray (Reidar Moen) suffered and deteriorated from 1941 until his
death in the 1970s from progressive-remitting multiple sclerosis, a
disease that centrally involves demyelinating of neural chains.

But clinician fantasy or error doesn't strike me as the way to bet.
Yell and scream all you want, but that doesn't make it so (and frankly, 
having had a sister who, until age 18 when she moved out (but then never
again) was accustomed to getting her way by throwing tantrums, I'm
utterly unmoved when I see tantrums on a mailing list).


[1] I've found that, even without being Pope, or Catholic, or Christian,
that it's possible to speak ex cathedra.  Use that knowledge wisely
(preferably while sitting in a chair).

[2] Nor a relevantly qualified non-physician scientist ('relevantly
qualifed' meaning something like an immunologist or epedemiologist).