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Even I hadn't let my cynicism about our national discourse sink so low as to think medical treatments would be politicized. Ultimately, it was a new low point.

by gfodor 6y ago

Even I hadn't let my cynicism about our national discourse sink so low as to think medical treatments would be politicized. Ultimately, it was a new low point. Once it started it was clear where this was going. Many may have died from it if the worse case scenario turns out to be true: this treatment does in fact work, and was stalled or prevented due to politics. Similarly, the complete disregard by the medical community of playing their role in reminding others organizing protests to take steps to prevent participants from spreading the virus has been equally disturbing. I've heard literally nothing from the medical community about tips, methods, or instructions for ensuring protestors do not cause a new outbreak. There does not seem to be any innovation happening in helping people organize and protest while keeping social distancing in mind. I don't know what that would look like, but it's a moral failure that the problem hasn't been worked whatsoever. I haven't even heard stories of people just handing out masks. Things are quite dire.

crystalmeph 6y ago
>I've heard literally nothing from the medical community about tips, methods, or instructions for ensuring protestors do not cause a new outbreak. I think this is a typical example of the medical community's method of communicating with the public - until they've studied something to death, they're too afraid to say anything, and if pressed, will just tell you to keep doing what you're doing, even if emerging evidence to the contrary and widespread anecdotal counter-examples are starting to surface. Think about the whole mask fiasco at the beginning of this mess. The CDC actually told Americans that wearing masks might make them more likely to get the virus, despite masks being an effective preventive measure against all other known respiratory viruses to my knowledge, plus the widespread usage of masks by literally billions of people in Asia is a pretty good indicator that it can be done safely. During "normal" times, this general approach may be 100% right, you need to be very sure you understand even low-incidence side effects before you tell 8 billion people what is good for them and what isn't. But that's simply the wrong approach in the face of a fast-moving pandemic - you need to be able to do basic risk/reward analysis quickly and recommend the path that is most likely to work, even if you're not 100% sure, and you're operating on some educated guesses in the absence of hard data. Basically, they need to operate more like engineers and less like doctors, at least for a little while =)
- skeletor_999 6y ago
  The need for hyperrigour is one thing, but I think that unfamiliarity with the literature and poor science communication comes in play as well. I'm a biologist, so I have access to the scientific literature. When the mask debate came up, I did a small literature review to see what the science said. I was surprised to find that the science was pretty nuanced and subject to debate. Some papers suggested that masks are ineffective,but others suggested that they could play a role. Many of these studies had strong limitations and only provided insight for very specific scenarios. For example, some papers treated infections as a binary (they either prevent infections or not, rather than looking at reducing infections), many papers looked at preventing the mask wearer from getting infected, but not at reducing the spread by infected mask wearers, etc. Any scientist can tell you that it's hard to keep up with the literature, and it's very likely that many of them spoke out against make without reading the papers. I was taught as an undergrad that they don't work. Many of these things are passed down uncritically. This issue demonstrates that we need to improve science communication. Many scientists and public health professionals declared outright that make don't work. This shows that they are either unfamiliarity with the totality of the literature or that they feel the need to give definitive statements. When some people provided evidence in favour of masks, some of them switched to saying that make are needed by medical professionals and that improper usage can increase your risk. A better approach would be to acknowledge that there is uncertainty at that in their view the evidence against masks outweighs that in favour. If they took this approach, it wouldn't seem like they just flip flopped when they started recommending make. Also, it's not hard to train people to use them, and condescending to treat people as being too stupid to wear them.
  - gfodor 6y ago
    In this case, simple risk management should have ruled the day. Regardless of research, it seems fairly obvious (though perhaps not?) that mask wearing has effectively zero negative health risks. It doesn't take a genius to realize that blocking just a single sneeze confers benefits. Given the risk/reward, and the high stakes nature of what we were about to go through, stating "no comment" on masks was pants-on-head stupid, because when medical folks say "there is no evidence to support" the press inevitably spins it to mean "this doesn't work." It highlights just how behind the medical field is when it comes to understanding how to incorporate human psychology, risk management, and other areas mastered by other industries to minimize harm.
Nursie 6y ago
>it if the worse case scenario turns out to be true: this treatment does in fact work, and was stalled or prevented due to politics. There are two worst case scenarios here - Firstly, politicians pushing unproven drugs on the general population, causing unnecessary deaths. Secondly, treatments which may have some efficacy being abandoned because of a reaction against those politicians, potentially causing a failure to bring an effective treatment to bear. Both of these can be true at the same time.
- gfodor 6y ago
  Yup agree. In this case, with this particular drug, the risks from the first seemed incredibly overstated though. The number of times I heard of people claiming taking this drug could cause heart issues was countless, yet when one looked into it, this was only the case after extremely prolonged use. So the spin was everywhere.
- DataWorker 6y ago
  But did we actually have “politicians pushing drugs”? “Push” sounds to me like “suggest people take.” I’m certain that the president didn’t tell anybody to take anything. He said almost verbatim what dr fauci was saying elsewhere at that same point in time. (See dr fauci on the jama podcast earlier that same week.) I won’t argue that the president has not oversold optimism at every juncture, but to say he “pushed” people to take plaquinil (illegally?) is either delusional or dishonest.
  - Nursie 6y ago
    It's beyond optimism to latch on to an a specific treatment that has no real evidence attached, and say things like "what have you got to lose?" from your podium, speaking as president. It's deeply inappropriate. Where you personally draw the line between "authority figure spouting off about something in official capacity" and "pushing" is up to you, but it's hardly delusional. It's also a hypothetical worst case scenario, if you read what I actually wrote.
- razius 6y ago
  We have to be careful with the "unproven" part, it was first approved for medical use in 1955 so it's side effects and safety are well known. It's "unproven" as a treatment for COVID but pascal's wager would say that there is no harm in taking it.
lazyasciiart 6y ago
Really? Perhaps you should blame the people who present news to you, because the medical community is saying it - https://publichealthinsider.com/2020/06/01/answering-questions-about-protests-and-covid-19/ https://publichealthinsider.com/2020/06/01/answering-questio...
- deleted 6y ago
  [deleted]
- gfodor 6y ago
  Yes, this is the extent of the framing. It's weak at best. What ought to be said: - It is truly agonizing that one must choose between civil disobedience and protecting the health of your loved ones, but that is a choice we are now all forced to make. - Large public gatherings, even if outdoors, have heightened risk of transmission, especially if people are gathered together closely as they are certain to be at most protests. - As such, the risk of contracting COVID-19 is high at protests, if the disease is present in the local population. Here is data to help you decide if that is the case for your local area: XXXX - To understand the risks involved, based upon your own circumstances, here is data on the mortality and other health risks to those who you may transmit the disease to: XXX. If you choose to protest, consider adjusting other factors to minimize your exposure to these individuals. If you cannot, try to find ways to participate in the protest that minimize your own risk of becoming a vector. Or, if possible, quarantine your self for at least 7 days or at most 14 days from friends and family members who are at the highest risk. Of course, stuff like this hasn't been written, and it takes not being paranoid of being labelled as not supporting the protests to write it. It should be culturally acceptable to say clearly and without risk that if you see your actions as a potential risk of killing your relatives, perhaps the right choice is in fact to participate in the protests without physically gathering. Given this message was not shared, we are basically relying for the most part on luck and on-site countermeasures, vs people choosing to not go, since the response so far implies that is not a moral choice to make.
Lammy 6y ago
> Even I hadn't let my cynicism about our national discourse sink so low as to think medical treatments would be politicized. I'd say you should ask somebody who lived during the AIDS epidemic denial years of the early–mid '80s, but most of them are no longer with us for some reason.

by gfodor 6y ago

crystalmeph 6y ago

>I've heard literally nothing from the medical community about tips, methods, or instructions for ensuring protestors do not cause a new outbreak. I think this is a typical example of the medical community's method of communicating with the public - until they've studied something to death, they're too afraid to say anything, and if pressed, will just tell you to keep doing what you're doing, even if emerging evidence to the contrary and widespread anecdotal counter-examples are starting to surface. Think about the whole mask fiasco at the beginning of this mess. The CDC actually told Americans that wearing masks might make them more likely to get the virus, despite masks being an effective preventive measure against all other known respiratory viruses to my knowledge, plus the widespread usage of masks by literally billions of people in Asia is a pretty good indicator that it can be done safely. During "normal" times, this general approach may be 100% right, you need to be very sure you understand even low-incidence side effects before you tell 8 billion people what is good for them and what isn't. But that's simply the wrong approach in the face of a fast-moving pandemic - you need to be able to do basic risk/reward analysis quickly and recommend the path that is most likely to work, even if you're not 100% sure, and you're operating on some educated guesses in the absence of hard data. Basically, they need to operate more like engineers and less like doctors, at least for a little while =)

skeletor_999 6y ago
The need for hyperrigour is one thing, but I think that unfamiliarity with the literature and poor science communication comes in play as well. I'm a biologist, so I have access to the scientific literature. When the mask debate came up, I did a small literature review to see what the science said. I was surprised to find that the science was pretty nuanced and subject to debate. Some papers suggested that masks are ineffective,but others suggested that they could play a role. Many of these studies had strong limitations and only provided insight for very specific scenarios. For example, some papers treated infections as a binary (they either prevent infections or not, rather than looking at reducing infections), many papers looked at preventing the mask wearer from getting infected, but not at reducing the spread by infected mask wearers, etc. Any scientist can tell you that it's hard to keep up with the literature, and it's very likely that many of them spoke out against make without reading the papers. I was taught as an undergrad that they don't work. Many of these things are passed down uncritically. This issue demonstrates that we need to improve science communication. Many scientists and public health professionals declared outright that make don't work. This shows that they are either unfamiliarity with the totality of the literature or that they feel the need to give definitive statements. When some people provided evidence in favour of masks, some of them switched to saying that make are needed by medical professionals and that improper usage can increase your risk. A better approach would be to acknowledge that there is uncertainty at that in their view the evidence against masks outweighs that in favour. If they took this approach, it wouldn't seem like they just flip flopped when they started recommending make. Also, it's not hard to train people to use them, and condescending to treat people as being too stupid to wear them.
- gfodor 6y ago
  In this case, simple risk management should have ruled the day. Regardless of research, it seems fairly obvious (though perhaps not?) that mask wearing has effectively zero negative health risks. It doesn't take a genius to realize that blocking just a single sneeze confers benefits. Given the risk/reward, and the high stakes nature of what we were about to go through, stating "no comment" on masks was pants-on-head stupid, because when medical folks say "there is no evidence to support" the press inevitably spins it to mean "this doesn't work." It highlights just how behind the medical field is when it comes to understanding how to incorporate human psychology, risk management, and other areas mastered by other industries to minimize harm.

Nursie 6y ago

>it if the worse case scenario turns out to be true: this treatment does in fact work, and was stalled or prevented due to politics. There are two worst case scenarios here - Firstly, politicians pushing unproven drugs on the general population, causing unnecessary deaths. Secondly, treatments which may have some efficacy being abandoned because of a reaction against those politicians, potentially causing a failure to bring an effective treatment to bear. Both of these can be true at the same time.

gfodor 6y ago
Yup agree. In this case, with this particular drug, the risks from the first seemed incredibly overstated though. The number of times I heard of people claiming taking this drug could cause heart issues was countless, yet when one looked into it, this was only the case after extremely prolonged use. So the spin was everywhere.
DataWorker 6y ago
But did we actually have “politicians pushing drugs”? “Push” sounds to me like “suggest people take.” I’m certain that the president didn’t tell anybody to take anything. He said almost verbatim what dr fauci was saying elsewhere at that same point in time. (See dr fauci on the jama podcast earlier that same week.) I won’t argue that the president has not oversold optimism at every juncture, but to say he “pushed” people to take plaquinil (illegally?) is either delusional or dishonest.
- Nursie 6y ago
  It's beyond optimism to latch on to an a specific treatment that has no real evidence attached, and say things like "what have you got to lose?" from your podium, speaking as president. It's deeply inappropriate. Where you personally draw the line between "authority figure spouting off about something in official capacity" and "pushing" is up to you, but it's hardly delusional. It's also a hypothetical worst case scenario, if you read what I actually wrote.
razius 6y ago
We have to be careful with the "unproven" part, it was first approved for medical use in 1955 so it's side effects and safety are well known. It's "unproven" as a treatment for COVID but pascal's wager would say that there is no harm in taking it.

lazyasciiart 6y ago

Really? Perhaps you should blame the people who present news to you, because the medical community is saying it - https://publichealthinsider.com/2020/06/01/answering-questions-about-protests-and-covid-19/ https://publichealthinsider.com/2020/06/01/answering-questio...

deleted 6y ago
[deleted]
gfodor 6y ago
Yes, this is the extent of the framing. It's weak at best. What ought to be said: - It is truly agonizing that one must choose between civil disobedience and protecting the health of your loved ones, but that is a choice we are now all forced to make. - Large public gatherings, even if outdoors, have heightened risk of transmission, especially if people are gathered together closely as they are certain to be at most protests. - As such, the risk of contracting COVID-19 is high at protests, if the disease is present in the local population. Here is data to help you decide if that is the case for your local area: XXXX - To understand the risks involved, based upon your own circumstances, here is data on the mortality and other health risks to those who you may transmit the disease to: XXX. If you choose to protest, consider adjusting other factors to minimize your exposure to these individuals. If you cannot, try to find ways to participate in the protest that minimize your own risk of becoming a vector. Or, if possible, quarantine your self for at least 7 days or at most 14 days from friends and family members who are at the highest risk. Of course, stuff like this hasn't been written, and it takes not being paranoid of being labelled as not supporting the protests to write it. It should be culturally acceptable to say clearly and without risk that if you see your actions as a potential risk of killing your relatives, perhaps the right choice is in fact to participate in the protests without physically gathering. Given this message was not shared, we are basically relying for the most part on luck and on-site countermeasures, vs people choosing to not go, since the response so far implies that is not a moral choice to make.

Lammy 6y ago

> Even I hadn't let my cynicism about our national discourse sink so low as to think medical treatments would be politicized. I'd say you should ask somebody who lived during the AIDS epidemic denial years of the early–mid '80s, but most of them are no longer with us for some reason.