Conoravirus ...

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Re: Conoravirus ...

Postby Ajax » Fri Apr 03, 2020 12:21 pm

Oh yes, I just love cross-talk and mics cutting in and out. Praise be, that I don't attend too many meetings.
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Re: Conoravirus ...

Postby Benno von Humpback » Fri Apr 03, 2020 12:33 pm

I am finding the virtual meetings surprisingly enjoyable for the most part. It's kind of touching pleased people seem to be to have social contact even at routine stuff. I have even attended an international scientific conference where people were giving talks from their apartments. It was fine, even the discussion, because you could read peoples' questions in advance and think about them. Best of all I didn't have to waste two days traveling.

We are having our first Zoom cocktails with friends tomorrow. Daughter has been doing it with her buds right along.
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Re: Conoravirus ...

Postby Chris Chesley » Fri Apr 03, 2020 12:35 pm

Our company has always been a tele-commute, work from home company. One of our peeps shared this:

https://www.youtube.com/watch?v=DYu_bGbZiiQ
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Re: Conoravirus ...

Postby Jamie » Fri Apr 03, 2020 12:37 pm

We are fortunate in this one respect. My current firm been operating as a distributed company since inception, so working from home is very similar to being in the office. Everything is connected on a dedicated backbone and I can know the temps of the fridges in shanghai, who swiped into which lab and used which equipment as well as see the output real-time. Unfortunately we have to use a lot of MS stuff as Google doesn't work in China.

I have noticed I've been turning on the camera a lot less as time in quarantine goes on.
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Re: Conoravirus ...

Postby Ajax » Fri Apr 03, 2020 12:46 pm

Jamie, have you stooped to wearing a button-down shirt and tie with nothing but your banana hammock on the lower half?

My mother begged me to do a joint video chat with my kids for my father's birthday. I gritted my teeth and suffered through it.
Now, she wants to do them all the time, including tonight. I loathe with a capital "L" video chat.

Look...I'm not really feeling isolated during all of this. My level of social interaction hasn't really changed. About the only thing that quarantine has changed, is my number of trips to the hardware store, restaurants and my sailing is obviously on hold. I've been isolated since before it was cool.
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Re: Conoravirus ...

Postby Jamie » Fri Apr 03, 2020 1:17 pm

Ajax wrote:Jamie, have you stooped to wearing a button-down shirt and tie with nothing but your banana hammock on the lower half?


It's possible that I may have had a suit jacket and tie with boxers for a meeting with Japanese bankers.
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Re: Conoravirus ...

Postby LarryHoward » Fri Apr 03, 2020 2:08 pm

Chris Chesley wrote:Our company has always been a tele-commute, work from home company. One of our peeps shared this:

https://www.youtube.com/watch?v=DYu_bGbZiiQ


I’ve been on that meeting.
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Re: Conoravirus ...

Postby Tim Ford » Fri Apr 03, 2020 2:35 pm

Chris Chesley wrote:Our company has always been a tele-commute, work from home company. One of our peeps shared this:

https://www.youtube.com/watch?v=DYu_bGbZiiQ


I got a large charge out of that! Thanks for the link, soooo true! I almost blew beer out my nose when the dog barking started in.
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Re: Conoravirus ...

Postby Tigger » Fri Apr 03, 2020 2:37 pm

Ross Bligh, Beneteau 36.7 'Elision' (rhymes with 'collision', lol)
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Re: Conoravirus ...

Postby Ajax » Fri Apr 03, 2020 3:15 pm

LarryHoward wrote:
Chris Chesley wrote:Our company has always been a tele-commute, work from home company. One of our peeps shared this:

https://www.youtube.com/watch?v=DYu_bGbZiiQ


I’ve been on that meeting.


They're all "that meeting."
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Re: Conoravirus ...

Postby Ajax » Fri Apr 03, 2020 3:16 pm

This is Jamie's meeting:
https://youtu.be/2xPwfSL4Pw0?t=351
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Re: Conoravirus ...

Postby Olaf Hart » Fri Apr 03, 2020 4:08 pm

BeauV wrote:
Olaf Hart wrote:In an ideal situation, ventilation would achieve much better results if we had an effective antiviral medication.

The emphasis on ICU and ventilators is a red herring, the only effective management here is old school public health measures until then.


OH, thanks yet again for the straight facts on this. Like the rest, I hadn't thought much about the lung damage. In digging into this, the only analog we have for it is the World War 1 veterans who came home from the front with massive lung damage from gas attacks. This is really bad news for us all long term.

On a more positive note, reading has turned up a theory I'd like your thoughts on: If the "viral load" a person is subjected to is small enough, do they develop immunities without becoming seriously infected? I may be suffering from the fallacy of the converse here: knowing that a large viral load suffered by healthcare workers is bad, can a very small viral load allow someone to develop immunity slowly and safely??


That’s a great question Beau, one I have been thinking a lot about lately. As OM says, there is a dose relationship with viral infections, but they have a remarkable ability to replicate and spread rapidly.

My interest is more in where is the first immune response? If it is in the upper airways, it’s possible the virus is eliminated without too much host damage. If it is in the alveolae it’s largely game over.

Years ago I was a young Public Health Specialist in a large Legionella outbreak, and for the next year or so took a personal interest in the clinical data we accumulated on the 100 or so cases admitted to hospital. My initial interest was finding a link to a concurrent influenza and mycoplasma outbreak which the PCP’s in the area had reported, and their profligate use of antibiotics which were effective against both mycoplasma and legionella.

It’s a long story of the pitfalls of retrospective data, but was ultimately useful as there has been a massive drop worldwide in legionella as routine influenza vaccination has rolled out in the same risk groups.

However, there was another question I developed as the research went on, and I could never find any way to investigate from that outbreak, and that was binary nature of legionella infection. The majority of people who contact legionella have a transient 24 hour flu like illness, but a smaller number become catastrophically ill. They are so ill they present to ED’s simulating infarcts, acute abdomens, septic shock, a wide range of conditions apart from pneumonia.

In fact, there is a notion that this is often responsible for missing outbreaks, that they are only found when a clinician has the intelligence to test for legionella in these unusual presentations. The saying goes you only find a legionella outbreak when someone asks for the right test..

Long story, I personally developed an hypothesis that droplets ended up in the nose, and that was where the first immune response developed, while aerosols ended up in the alveolae and triggered a response there, which was responsible for the shock like presentations. Over the last thirty years, there has been more and more evidence of the dangerous nature of aerosol spread, such as asthma in children exposed to diesel fumes, and the aerosol nature of influenza contagion.

There are clear parallels here with COVID, so my personal hypothesis is related to droplet and aerosol spread, and mouth breathing. Wish there was some way to test this.
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Re: Conoravirus ...

Postby BeauV » Fri Apr 03, 2020 4:33 pm

OH,

You mean my Tenessee Grandfather's favorite insult: "You toothless mouth breathing bastard!" Might have some basis in fact?? ? :shock: :shock: :lol: :lol: :lol: :lol:

I have often heard that the nose can provide a level of defense for the lungs. You're the first medical person I've heard provide a rational reason for that. Perhaps all these nose hairs I'm developing in my late 60s are another defense measure. (I know TMI TMI!)

Thanks,

B
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Re: Conoravirus ...

Postby Olaf Hart » Fri Apr 03, 2020 4:54 pm

Unfortunately the COVID outbreak has led to outbreaks of another disease as well

http://thesciencepost.com/outbreak-of-d ... 50-states/
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Re: Conoravirus ...

Postby Olaf Hart » Fri Apr 03, 2020 5:23 pm

BeauV wrote:OH,

You mean my Tenessee Grandfather's favorite insult: "You toothless mouth breathing bastard!" Might have some basis in fact?? ? :shock: :shock: :lol: :lol: :lol: :lol:

I have often heard that the nose can provide a level of defense for the lungs. You're the first medical person I've heard provide a rational reason for that. Perhaps all these nose hairs I'm developing in my late 60s are another defense measure. (I know TMI TMI!)

Thanks,

B


Interesting footnote on mouth breathing.

I was fortunate to spend half my intern year in a district hospital in western NSW, just me and a dozen specialists who were refugees from the English NHS in 1974.

They loved to teach and share information, and I was just a big sponge, it was a magic time for a young doctor.

Anyhoo, most of these guys had trained and practiced in the pre antibiotic era, so some of the information was historic gold.

Apparently, before penicillin, the standard first line treatment for recurrent tonsillitis in the UK was to encourage nose breathing, and I have had a lot of personal experience over the years to prove to me that this works.
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Re: Conoravirus ...

Postby Charlie » Fri Apr 03, 2020 5:47 pm

BeauV wrote:OH,

You mean my Tenessee Grandfather's favorite insult: "You toothless mouth breathing bastard!" Might have some basis in fact?? ? :shock: :shock: :lol: :lol: :lol: :lol:

I have often heard that the nose can provide a level of defense for the lungs. You're the first medical person I've heard provide a rational reason for that. Perhaps all these nose hairs I'm developing in my late 60s are another defense measure. (I know TMI TMI!)

Thanks,

B


So I get the value of the nose hair. But what’s the value of all this rampant ear hair growth I’m experiencing????
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Re: Conoravirus ...

Postby Jamie » Fri Apr 03, 2020 5:51 pm

Ajax wrote:This is Jamie's meeting:
https://youtu.be/2xPwfSL4Pw0?t=351


Thusly I am always paranoid about the camera and the mute button.
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Re: Conoravirus ...

Postby Jamie » Fri Apr 03, 2020 5:51 pm

Charlie wrote:
BeauV wrote:OH,

You mean my Tenessee Grandfather's favorite insult: "You toothless mouth breathing bastard!" Might have some basis in fact?? ? :shock: :shock: :lol: :lol: :lol: :lol:

I have often heard that the nose can provide a level of defense for the lungs. You're the first medical person I've heard provide a rational reason for that. Perhaps all these nose hairs I'm developing in my late 60s are another defense measure. (I know TMI TMI!)

Thanks,

B


So I get the value of the nose hair. But what’s the value of all this rampant ear hair growth I’m experiencing????


Have you had any ear infections recently?
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Re: Conoravirus ...

Postby Olaf Hart » Fri Apr 03, 2020 5:53 pm

Charlie wrote:
BeauV wrote:OH,

You mean my Tenessee Grandfather's favorite insult: "You toothless mouth breathing bastard!" Might have some basis in fact?? ? :shock: :shock: :lol: :lol: :lol: :lol:

I have often heard that the nose can provide a level of defense for the lungs. You're the first medical person I've heard provide a rational reason for that. Perhaps all these nose hairs I'm developing in my late 60s are another defense measure. (I know TMI TMI!)

Thanks,

B


So I get the value of the nose hair. But what’s the value of all this rampant ear hair growth I’m experiencing????


That’s to filter high frequency noises, so you can’t hear your wife anymore....
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Re: Conoravirus ...

Postby Benno von Humpback » Fri Apr 03, 2020 8:22 pm

Olaf Hart wrote:Unfortunately the COVID outbreak has led to outbreaks of another disease as well

http://thesciencepost.com/outbreak-of-d ... 50-states/

It's endemic here.
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Re: Conoravirus ...

Postby Chris Chesley » Fri Apr 03, 2020 8:34 pm

It is refreshing to hear common sense, reasoned thoughts and realistic questions to consider.

https://www.youtube.com/watch?time_cont ... e=emb_logo
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Re: Conoravirus ...

Postby Ajax » Sat Apr 04, 2020 4:52 am

Benno von Humpback wrote:
Olaf Hart wrote:Unfortunately the COVID outbreak has led to outbreaks of another disease as well

http://thesciencepost.com/outbreak-of-d ... 50-states/

It's endemic here.


Ha, if that were real Maryland would be blood red.
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Re: Conoravirus ...

Postby Benno von Humpback » Sat Apr 04, 2020 6:45 am

Ajax wrote:
Benno von Humpback wrote:
Olaf Hart wrote:Unfortunately the COVID outbreak has led to outbreaks of another disease as well

http://thesciencepost.com/outbreak-of-d ... 50-states/

It's endemic here.


Ha, if that were real Maryland would be blood red.

Well, we could be in Florida. Speaking of which, how are your parents doing?
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Re: Conoravirus ...

Postby BeauV » Sat Apr 04, 2020 7:06 am

From everything I can find out, Prof. Lioannindis is correct about a number of things:

1) We don't really know the fatality rate. Of course, as things have moved along we're getting more and more information. I looked for a LONG time for some indication of when this video was produced, I can't find a way to even find when it was posted on YouTube. This is critically important as the Professor's opinion on the specifics might have changed over the last month. I'm appalled that YouTube doesn't make this actual source, the date of the posting, and any revisions to the information available. But, as the prof. says the media (never forget YouTube is a media company) is exaggerating. This exageration has been obvious in BOTH directions.

I went hunting and found an article from March 17th on STAT HERE. It's worth reading and realizing that we knew very little about the epidemic in NY City on March 17th, and the Prof. probably wrote the article at least a week or two prior to the March 17th publication date. On March 10th, to follow the Prof. own logic, we didn't know much outside of China, only Italy was a reliable data source. Now, we have over 100,000 cases in NY state alone, we have much better data. We can simply ignore China and use the data we have. We need the Prof to update his opinion, publically.

2) Fortunately, SARS-CoV2 is not nearly as deadly as the measles. We've been lucky. If we are locking down the entire economy for a disease which is a tiny fraction of the problem of the measles, then why in the world isn't vaccination for measles mandatory? We are close to seeing a serious resurgence in measles, yet our decision making is so flawed that herd immunity is ignored by many for a proven disease that is about 18 times as deadly as SARS-CoV2. Obviously, Americans have an attitude that if you're so stupid that you don't vaccinate for measles and die, it's your own damn fault. But, what do we do with parents who are that stupid and their children die?

My point is: when we don't know how bad something is, we rightfully act as conservatively as we can until we know better. Personally, I wish we would act rationally with the data we do have, but we're opinionated (as opposed to informed) humans. So we let the measles come back while we crush the economy over something less deadly. I learned long ago that humans do NOT make decisions based on fact, in most cases. If they did, many many things would work far better. They make many of their most important decisions based on fear or greed - which are the primary reason they make such terrible investors.

3) Don't get me wrong. I'm well aware of the Professor's work and admire him tremendously. We should listen to him - continuously. He turned the cardiovascular world on its head by showing that the stents and statins don't increase lifespan. Source: HERE. Basically, statins reduce the number of small heart attacks you have but don't extend your life by any amount according to the data. Similarly, stents make you feel a lot better and increase the quality of life (I would certainly get one if I needed it for this reason), but they also do not extend your life. In both cases, the data was exactly opposite to the basis upon which billions of dollars are spent in the medical system worldwide. I'm actually a big fan of the Prof. Here's a very approachable article about what the Prof does: HERE

My point is we should continuously listen to the Professor and be willing to change our mind as he changes his. But, as far as I can tell after his initial article he has been silent on the issues he raises. That's terrible. I'm certain he's received a massive amount of flack for his article and he's a mild academic. But, when he changes his mind, and he will because he has intellectual integrity, he should tell us.

Sadly, science is getting buried in the business of making money. Fear gets people to pay. Fear gets people to vote. Fear gets people to give up their liberty. Fear is often entirely unjustified. But, as of early March, we didn't have accurate data on the facts the Prof uses. We do now. It's time for a new version of his research and thoughts.
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Re: Conoravirus ...

Postby kdh » Sat Apr 04, 2020 8:25 am

I just read the Atlantic article on Ioannidis's work.

1) Biostatisticians are, culturally, in the service of physicians and generally not appreciated. And medical training for doctors is not particularly hard-scientific or mathematical. Until the culture changes, evidence and scientific inference are going to be suppressed.

2) It's easier to criticize than create. Finding flaw in a scientific argument is easy, especially when an exception can be held up as refutation in a statistical analysis.

We've invented a new way to describe statisticians--"data scientists." It's helped our cred and in clearly meritocratic industries like my own temporarily adopted field of finance we've taken over--the nerds are inheriting the earth. I would consider working in medicine but I won't until doctors on the whole get a better attitude.
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Re: Conoravirus ...

Postby Jamie » Sat Apr 04, 2020 9:07 am

BeauV wrote:From everything I can find out, Prof. Lioannindis is correct about a number of things:

1) We don't really know the fatality rate. Of course, as things have moved along we're getting more and more information. I looked for a LONG time for some indication of when this video was produced, I can't find a way to even find when it was posted on YouTube. This is critically important as the Professor's opinion on the specifics might have changed over the last month. I'm appalled that YouTube doesn't make this actual source, the date of the posting, and any revisions to the information available. But, as the prof. says the media (never forget YouTube is a media company) is exaggerating. This exageration has been obvious in BOTH directions.

I went hunting and found an article from March 17th on STAT HERE. It's worth reading and realizing that we knew very little about the epidemic in NY City on March 17th, and the Prof. probably wrote the article at least a week or two prior to the March 17th publication date. On March 10th, to follow the Prof. own logic, we didn't know much outside of China, only Italy was a reliable data source. Now, we have over 100,000 cases in NY state alone, we have much better data. We can simply ignore China and use the data we have. We need the Prof to update his opinion, publically.

2) Fortunately, SARS-CoV2 is not nearly as deadly as the measles. We've been lucky. If we are locking down the entire economy for a disease which is a tiny fraction of the problem of the measles, then why in the world isn't vaccination for measles mandatory? We are close to seeing a serious resurgence in measles, yet our decision making is so flawed that herd immunity is ignored by many for a proven disease that is about 18 times as deadly as SARS-CoV2. Obviously, Americans have an attitude that if you're so stupid that you don't vaccinate for measles and die, it's your own damn fault. But, what do we do with parents who are that stupid and their children die?

My point is: when we don't know how bad something is, we rightfully act as conservatively as we can until we know better. Personally, I wish we would act rationally with the data we do have, but we're opinionated (as opposed to informed) humans. So we let the measles come back while we crush the economy over something less deadly. I learned long ago that humans do NOT make decisions based on fact, in most cases. If they did, many many things would work far better. They make many of their most important decisions based on fear or greed - which are the primary reason they make such terrible investors.

3) Don't get me wrong. I'm well aware of the Professor's work and admire him tremendously. We should listen to him - continuously. He turned the cardiovascular world on its head by showing that the stents and statins don't increase lifespan. Source: HERE. Basically, statins reduce the number of small heart attacks you have but don't extend your life by any amount according to the data. Similarly, stents make you feel a lot better and increase the quality of life (I would certainly get one if I needed it for this reason), but they also do not extend your life. In both cases, the data was exactly opposite to the basis upon which billions of dollars are spent in the medical system worldwide. I'm actually a big fan of the Prof. Here's a very approachable article about what the Prof does: HERE

My point is we should continuously listen to the Professor and be willing to change our mind as he changes his. But, as far as I can tell after his initial article he has been silent on the issues he raises. That's terrible. I'm certain he's received a massive amount of flack for his article and he's a mild academic. But, when he changes his mind, and he will because he has intellectual integrity, he should tell us.

Sadly, science is getting buried in the business of making money. Fear gets people to pay. Fear gets people to vote. Fear gets people to give up their liberty. Fear is often entirely unjustified. But, as of early March, we didn't have accurate data on the facts the Prof uses. We do now. It's time for a new version of his research and thoughts.


My experience is scientists like to be scientists and often don’t think about squishy things like the political ramifications of the science they generate. I’d be very scared if they did. Sadly, the unwashed masses, particularly in environments where there is a high level of skepticism towards science, often take scientific work out of context because they don’t bother to understand it in the first place or the context under which it was generated. Sadly his work is being leveraged by the “ let it run its course” crowd that are worried about the economic impacts of quarantine/ social distancing to argue that we are over reacting. Of course, a bad economy creates damage to people and society of its own, but there are ways to manage that don’t require us to sacrifice a portion of our population.
Last edited by Jamie on Sat Apr 04, 2020 12:05 pm, edited 1 time in total.
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Re: Conoravirus ...

Postby SemiSalt » Sat Apr 04, 2020 11:54 am

I'm a less-than-PhD mathematician, and not really a statistician beyond the confidence limits and multiple regression level, but I've seen a lot of medical statistics that make my skin crawl. What I did learn back when I read math books was that some of the problems that arise in medical trials are really hard, and many decisions are made on not enough data.

Analogies are not really my thing, but picking the best therapy is about as scientific as picking the fastest boat based on PHRF results.
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Re: Conoravirus ...

Postby Olaf Hart » Sat Apr 04, 2020 4:36 pm

kdh wrote:I just read the Atlantic article on Ioannidis's work.

1) Biostatisticians are, culturally, in the service of physicians and generally not appreciated. And medical training for doctors is not particularly hard-scientific or mathematical. Until the culture changes, evidence and scientific inference are going to be suppressed.

2) It's easier to criticize than create. Finding flaw in a scientific argument is easy, especially when an exception can be held up as refutation in a statistical analysis.

We've invented a new way to describe statisticians--"data scientists." It's helped our cred and in clearly meritocratic industries like my own temporarily adopted field of finance we've taken over--the nerds are inheriting the earth. I would consider working in medicine but I won't until doctors on the whole get a better attitude.


Keith, in defence of doctors, we would happily rely on data if it worked.

The gap between medical data and reality extends throughout medicine, but it is widest in Primary Care.

I would tell my students that if they found one new condition that was in a textbook a day, it was a good day.

Most of the problems people take to their doctor are not adequately described or researched, only the ones with drugs or procedures and they are overanalysed with suspect data, like Beaus example of statins.

The conditions required to get reliable data don’t exist in real life, single variable results aren’t a lot of help when every presentation has a large number of variables, and every patient is unique.

So we tend to use the data we have for a best fit, and take a “suck and see” approach, relying on continuity and availability to modify our course..very much like navigation before GPS.

Don’t get me wrong, I am a big fan of data and clinical guidelines, it’s just they didn’t make patients who fit their models...

The data I found most useful came from the few long term longitudinal population studies.
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Re: Conoravirus ...

Postby kdh » Sat Apr 04, 2020 5:23 pm

I hear you, OH. I was blunt and overly simplistic. I apologize. I'm sorry I put you on the defensive.

And I think dealing with data is messy in many contexts. Making inferences or getting anything useful is often a challenge.
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Re: Conoravirus ...

Postby BeauV » Sat Apr 04, 2020 5:24 pm

All,

I agree with the remarks above. I'd only add one thing which is distinctly different between most of the population of scientists and many of the rest of us.

For many of us, changing one's mind is a sign of weakness. It is viewed as showing disloyalty to those who share your opinions, a form of abandoning the tribe to which one belongs. Tribes are defined and delimited by their belief set. One could say the same thing of religions.

For a scientist, changing one's mind is a sign that they learned something new and moved forward towards the truth. Indeed, they are in the business of setting up a list of beliefs and then either proving or disproving those beliefs so they can turn them in to "knowledge".

A good litmus self-test for which side of this divide one is on is to make a list of 10 things you were certain of and yet changed your mind because of new information. If there aren't many times you've changed your mind, then you ought to re-read paragraphs 2 and 3 above. You may not be a scientist, or at least think like one.

Sadly, we've now changed many people's views of political parties into something more like religions or sports teams. To change one's mind about an issue of political party dogma is to abandon one's tribe or baseball team. This makes rational decision making terribly difficult.

To make matters even more difficult, as OH points out, we have highly imperfect data; which is obvious to anyone who has ever tried to run a clinical trial or study. So those who do practice medicine on the front lines get humbled over and over again by situations that don't fit any pattern known to medicine.
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