4 ms·

And we've had our own disease outbreak (measles) because of a refusal to remove actual false statements from the internet. There is no simple solution. The mec

by _bxg1 7y ago

And we've had our own disease outbreak (measles) because of a refusal to remove actual false statements from the internet. There is no simple solution. The mechanism that allows disinformation to be mitigated also opens the door for abuse.

breck 7y ago
I think we all need a little humility on how good our medical information is. It is bad. Very bad. We've had success with using math and science in domains like chemistry and manufacturing and think that we can apply it directly to human biology. Unfortunately it's not that simple. Human beings are far more complex than anything we make (look at how many cells your body produces every second, and how much information is in each one of those cells), and we don't have the luxury of massive, repeatable experiments. Our current data tools are nowhere near good enough for us to be so confident in most domains of medicine, such as vaccination. I get vaccines, but I support someone's write to abstain. It's a bit of a leap of faith and "authorities" have a long track record of giving terrible medical advice all the time. Here are 4 loosey goosey examples: currently 2 million opioid disorders with hundreds of thousands of deaths stemming from "prescriptions"; $100's of billions in revenue to depression drugs which have been terribly ineffective, and only now, after decades of banning them, is USGOV allowing psychedelic trials, which seem to cure people in a session, for next to nothing; the food groups—a lot of good nutrition advice has done; stress is a top of cause of medical problems and the top cause of stress is financial problems from health expenses! We don't need to "remove actual false statements from the internet". Instead we need to figure out how to actually put true statements on the internet. And no one I've seen is close to figuring that out.
- rotexo 7y ago
  I am curious about how exactly you go from observing biological complexity to doubting the biomedical community's confidence in vaccination as a safe and effective means of combating infectious diseases.
  - breck 7y ago
    The biological complexity warrants a lot more doubt on all biomedical topics. I think vaccines are a good bet and I myself get vaccinated and encourage it. But I don't think the response to anti-vaxxers should be vilification and censoring their content on the Internet claiming it is "false". Instead I think it should be doubling down on how pro-vaxxers can build better tools to give people access to truer data.
- robbiep 7y ago
  The disease of the modern age is the belief that ‘my opinion is better than your knowledge’. An anti-vaxer is standing in the way of true knowledge. Opiate prescribing was driven by pharmaceutical interests and lobbying, as well as a misguided notion that pain is something to be conquered and abolished. When I was in the US during medical school, I routinely saw people being discharged after simple procedures with bucketloads of opiates, things that I would discharge in Australia on simple analgesia (paracetamol and ibuprofen). The public health stance on vaccines is not in any way analogous to the opiate crisis, and whilst I understand the layman’s distrust of medical experts arises in part from this, the two are separate issues stemming from different causes
  - breck 7y ago
    > things that I would discharge in Australia on simple analgesia (paracetamol and ibuprofen). Good on you. I'm sure that's not the only thing amiss you saw in our system :). > The public health stance on vaccines is not in any way analogous to the opiate crisis, and whilst I understand the layman’s distrust of medical experts arises in part from this, the two are separate issues stemming from different causes To me the issue is part of the same problem: giving advice (or prescriptions) without giving access to good data. If it's so important to vaccinate, why not build a much better live data system that concerned individuals/parents can query in real time to see the true numbers behind the gamble they are taking? That would be the scientific thing to do. Not to remove what one deems "false" information from the internet. Of course, what I'm dreaming of is a lot harder to build than a censorship system but I think it would be worth it.
    - robbiep 7y ago
      every health system has flaws. You're talking about one of the most complex components of any economy - 10% of spending in Australia, up to 20c in every dollar in the US. there are no simple fixes. > If it's so important to vaccinate, why not build a much better live data system that concerned individuals/parents can query in real time I'm not sure what you mean. The evidence behind vaccination has been out there since Jenner in the late 1800s. The idea that this is an argument that needs rehashing every year or so, for what is undoubtedly an invention that has saved more lives than anything humanity has ever invented (with the possible exception of sanitation and sewerage) is in the first instance a victory to those who wish to sow doubt in an area where there is none. Now, having said that, you can get a bit more nuianced - for example, generally speaking the NNT to prevent a case of the seasonal flu (dependign on the prevailing strains of the year) is around 20-30. Ie. 20-30 vaccinations for one prevented case. Whereas, when it comes to Hep B and Smallpox, your NNT is effectively 1 (depending on the titre response from the vaccine). As a result, we have eliminated Smallpox from the wild and massively reduced the disease burden of Hepatitis B. But we don't force every person to have the flu vax every year. As a healthcare worker, I consider it my responsibility to have mine, because I am constantly exposed to the elderly and young and others with compromised immune systems, where infection poses a very real risk to their lives. Other communicable diseases (ie the childhood vaccination ones) that are really what the anti-vaxxers are all about being 'pro choice' on, are significantly more deadly than the flu (which, depending on your stats and year of illness, probably rate somewhere around the 0.005% death rate and 0.01-0.02 severe infection/needing hospitalisation rate). Against the numbers of lives saved and morbidity avoided by vaccinating for these severe diseases, the risks of vaccination are basically the same as that of crossing the street and getting hit by a bus. Let's keep in context that The current wave of anti-vax hysteria was kicked off by (Former Doctor) Andrew Wakefield's false study that claimed that the MMR vaccine caused Autism. The death toll from his bullshit propaganda, just in Samoa in the last 6 months, is 83. Whilst there is a non-zero rate of harm from vaccination (ranging, at the worst end, apparently 1-2 deaths per million vaccinations for Smallpox back in the day, down to just rashes and fevers on the low end, but including Guillian-Barre Syndrome which may mean a patient needs ventilator support for a while), the discussion around risk-benefit is not an equivocal one - the evidence is literally littered in journals and around the web from publications stretching back over 150 years
- _bxg1 7y ago
  > Our current data tools are nowhere near good enough for us to be so confident in most domains of medicine, such as vaccination. I think you're conflating things like nutrition with the whole of biology. There are lots of things we understand quite well, and have mountains of data on, and vaccines are one of the best examples of those. Nutrition science is famously unreliable, but there are reasons for that beyond just the intrinsic complexity of the domain itself: - It grabs headlines because it's something individuals can control themselves, and because it has a direct relationship to mass-market priorities like physical appearance. So the media jumps at every opportunity to sensationalize a study that may not actually be making any bold claims. - Billions of dollars are funneled by megacorps into sham studies that pollute the discourse, for their own profit-seeking motives. All three factors can also apply to drugs, especially mental-directed ones (because the human psychology is a whole other layer of complexity). The opioid crisis had nothing to do with the science, but with greed and addiction. The drugs themselves were safe; you can overdose on anything. But none of these apply to vaccines. Their relationship to the human body is comparatively simple. They aren't a home-remedy. They aren't (relatively speaking) a big business. They also aren't some new, unproven technology. They are one of the most widely-deployed and successful medical inventions ever created by man. There are few things in the world that we have so much conclusive data around. There's plenty of true information on the internet. The past several years have made it abundantly clear that true information does not win out against false information rooted in fear. Don't be part of the problem.
  - breck 7y ago
    > There are lots of things we understand quite well, and have mountains of data on, and vaccines are one of the best examples of those. Point me to this "mountains of data" in a usable form. There should be a site right, that contains a simple big table of all vaccinations administered worldwide and how the results went? I don't want to see some static PDF with a paltry 10,000 data points. We are all savyy programmers here and know that a relatively simple table could be created so any parent can do a simple single query against all the world's medical live data to see if vaccines are safe, right? That would be science. That would be Six Sigma. But I can't do that. So I need to take a bet on who to believe: scientists pushing non-science or non-scientists. I recently talked to some doctors here who recently were in Samoa helping the Measles outbreak there. Two children died from getting vaccines there in 2018 (https://www.immune.org.nz/hot-topic/infant-deaths-samoa-tragic-outcome-error-preparing-mmr-vaccine https://www.immune.org.nz/hot-topic/infant-deaths-samoa-trag...). Clearly those deaths shouldn't have happened. Where's the push to bring Six Sigma to the medical world? Instead it's "vaccines are safe", read the PDF. We can't be so confident until we actually have clean, accessible, usable databases. Our medical data infrastructure is very very bad. > They are one of the most widely-deployed and successful medical inventions ever created by man I agree in the ranks of medical inventions vaccines are amazing. But still, not the best comparison group. How effective was the flu vaccine this year? Surely I should be able to see that information in a single query. But I can't. (the rough answer from doctors I've sampled is about 30%, or 70% ineffective). People are right to be skeptical of medical advice until some dramatic innovation comes to the space.
dang 7y ago
(We detached this subthread from https://news.ycombinator.com/item?id=22302081 https://news.ycombinator.com/item?id=22302081)

by _bxg1 7y ago

breck 7y ago

I think we all need a little humility on how good our medical information is. It is bad. Very bad. We've had success with using math and science in domains like chemistry and manufacturing and think that we can apply it directly to human biology. Unfortunately it's not that simple. Human beings are far more complex than anything we make (look at how many cells your body produces every second, and how much information is in each one of those cells), and we don't have the luxury of massive, repeatable experiments. Our current data tools are nowhere near good enough for us to be so confident in most domains of medicine, such as vaccination. I get vaccines, but I support someone's write to abstain. It's a bit of a leap of faith and "authorities" have a long track record of giving terrible medical advice all the time. Here are 4 loosey goosey examples: currently 2 million opioid disorders with hundreds of thousands of deaths stemming from "prescriptions"; $100's of billions in revenue to depression drugs which have been terribly ineffective, and only now, after decades of banning them, is USGOV allowing psychedelic trials, which seem to cure people in a session, for next to nothing; the food groups—a lot of good nutrition advice has done; stress is a top of cause of medical problems and the top cause of stress is financial problems from health expenses! We don't need to "remove actual false statements from the internet". Instead we need to figure out how to actually put true statements on the internet. And no one I've seen is close to figuring that out.

rotexo 7y ago
I am curious about how exactly you go from observing biological complexity to doubting the biomedical community's confidence in vaccination as a safe and effective means of combating infectious diseases.
- breck 7y ago
  The biological complexity warrants a lot more doubt on all biomedical topics. I think vaccines are a good bet and I myself get vaccinated and encourage it. But I don't think the response to anti-vaxxers should be vilification and censoring their content on the Internet claiming it is "false". Instead I think it should be doubling down on how pro-vaxxers can build better tools to give people access to truer data.
robbiep 7y ago
The disease of the modern age is the belief that ‘my opinion is better than your knowledge’. An anti-vaxer is standing in the way of true knowledge. Opiate prescribing was driven by pharmaceutical interests and lobbying, as well as a misguided notion that pain is something to be conquered and abolished. When I was in the US during medical school, I routinely saw people being discharged after simple procedures with bucketloads of opiates, things that I would discharge in Australia on simple analgesia (paracetamol and ibuprofen). The public health stance on vaccines is not in any way analogous to the opiate crisis, and whilst I understand the layman’s distrust of medical experts arises in part from this, the two are separate issues stemming from different causes
- breck 7y ago
  > things that I would discharge in Australia on simple analgesia (paracetamol and ibuprofen). Good on you. I'm sure that's not the only thing amiss you saw in our system :). > The public health stance on vaccines is not in any way analogous to the opiate crisis, and whilst I understand the layman’s distrust of medical experts arises in part from this, the two are separate issues stemming from different causes To me the issue is part of the same problem: giving advice (or prescriptions) without giving access to good data. If it's so important to vaccinate, why not build a much better live data system that concerned individuals/parents can query in real time to see the true numbers behind the gamble they are taking? That would be the scientific thing to do. Not to remove what one deems "false" information from the internet. Of course, what I'm dreaming of is a lot harder to build than a censorship system but I think it would be worth it.
  - robbiep 7y ago
    every health system has flaws. You're talking about one of the most complex components of any economy - 10% of spending in Australia, up to 20c in every dollar in the US. there are no simple fixes. > If it's so important to vaccinate, why not build a much better live data system that concerned individuals/parents can query in real time I'm not sure what you mean. The evidence behind vaccination has been out there since Jenner in the late 1800s. The idea that this is an argument that needs rehashing every year or so, for what is undoubtedly an invention that has saved more lives than anything humanity has ever invented (with the possible exception of sanitation and sewerage) is in the first instance a victory to those who wish to sow doubt in an area where there is none. Now, having said that, you can get a bit more nuianced - for example, generally speaking the NNT to prevent a case of the seasonal flu (dependign on the prevailing strains of the year) is around 20-30. Ie. 20-30 vaccinations for one prevented case. Whereas, when it comes to Hep B and Smallpox, your NNT is effectively 1 (depending on the titre response from the vaccine). As a result, we have eliminated Smallpox from the wild and massively reduced the disease burden of Hepatitis B. But we don't force every person to have the flu vax every year. As a healthcare worker, I consider it my responsibility to have mine, because I am constantly exposed to the elderly and young and others with compromised immune systems, where infection poses a very real risk to their lives. Other communicable diseases (ie the childhood vaccination ones) that are really what the anti-vaxxers are all about being 'pro choice' on, are significantly more deadly than the flu (which, depending on your stats and year of illness, probably rate somewhere around the 0.005% death rate and 0.01-0.02 severe infection/needing hospitalisation rate). Against the numbers of lives saved and morbidity avoided by vaccinating for these severe diseases, the risks of vaccination are basically the same as that of crossing the street and getting hit by a bus. Let's keep in context that The current wave of anti-vax hysteria was kicked off by (Former Doctor) Andrew Wakefield's false study that claimed that the MMR vaccine caused Autism. The death toll from his bullshit propaganda, just in Samoa in the last 6 months, is 83. Whilst there is a non-zero rate of harm from vaccination (ranging, at the worst end, apparently 1-2 deaths per million vaccinations for Smallpox back in the day, down to just rashes and fevers on the low end, but including Guillian-Barre Syndrome which may mean a patient needs ventilator support for a while), the discussion around risk-benefit is not an equivocal one - the evidence is literally littered in journals and around the web from publications stretching back over 150 years
_bxg1 7y ago
> Our current data tools are nowhere near good enough for us to be so confident in most domains of medicine, such as vaccination. I think you're conflating things like nutrition with the whole of biology. There are lots of things we understand quite well, and have mountains of data on, and vaccines are one of the best examples of those. Nutrition science is famously unreliable, but there are reasons for that beyond just the intrinsic complexity of the domain itself: - It grabs headlines because it's something individuals can control themselves, and because it has a direct relationship to mass-market priorities like physical appearance. So the media jumps at every opportunity to sensationalize a study that may not actually be making any bold claims. - Billions of dollars are funneled by megacorps into sham studies that pollute the discourse, for their own profit-seeking motives. All three factors can also apply to drugs, especially mental-directed ones (because the human psychology is a whole other layer of complexity). The opioid crisis had nothing to do with the science, but with greed and addiction. The drugs themselves were safe; you can overdose on anything. But none of these apply to vaccines. Their relationship to the human body is comparatively simple. They aren't a home-remedy. They aren't (relatively speaking) a big business. They also aren't some new, unproven technology. They are one of the most widely-deployed and successful medical inventions ever created by man. There are few things in the world that we have so much conclusive data around. There's plenty of true information on the internet. The past several years have made it abundantly clear that true information does not win out against false information rooted in fear. Don't be part of the problem.
- breck 7y ago
  > There are lots of things we understand quite well, and have mountains of data on, and vaccines are one of the best examples of those. Point me to this "mountains of data" in a usable form. There should be a site right, that contains a simple big table of all vaccinations administered worldwide and how the results went? I don't want to see some static PDF with a paltry 10,000 data points. We are all savyy programmers here and know that a relatively simple table could be created so any parent can do a simple single query against all the world's medical live data to see if vaccines are safe, right? That would be science. That would be Six Sigma. But I can't do that. So I need to take a bet on who to believe: scientists pushing non-science or non-scientists. I recently talked to some doctors here who recently were in Samoa helping the Measles outbreak there. Two children died from getting vaccines there in 2018 (https://www.immune.org.nz/hot-topic/infant-deaths-samoa-tragic-outcome-error-preparing-mmr-vaccine https://www.immune.org.nz/hot-topic/infant-deaths-samoa-trag...). Clearly those deaths shouldn't have happened. Where's the push to bring Six Sigma to the medical world? Instead it's "vaccines are safe", read the PDF. We can't be so confident until we actually have clean, accessible, usable databases. Our medical data infrastructure is very very bad. > They are one of the most widely-deployed and successful medical inventions ever created by man I agree in the ranks of medical inventions vaccines are amazing. But still, not the best comparison group. How effective was the flu vaccine this year? Surely I should be able to see that information in a single query. But I can't. (the rough answer from doctors I've sampled is about 30%, or 70% ineffective). People are right to be skeptical of medical advice until some dramatic innovation comes to the space.

dang 7y ago

(We detached this subthread from https://news.ycombinator.com/item?id=22302081 https://news.ycombinator.com/item?id=22302081)