3 ms·

Hey, thanks for your reply, it's clear that you're passionate about the topic and that we're on the same page. Your writing on the topic is lucid and convincing

by ak217 6y ago

Hey, thanks for your reply, it's clear that you're passionate about the topic and that we're on the same page. Your writing on the topic is lucid and convincing, I would only point out that it's liable to get lost in the noise here on HN. I would encourage you to write essays on this and post on a personal blog and link to it on social media, or similar - or contact journalists who you see writing on this topic.

hilbert42 6y ago
Thanks for your comments. First, I must admit to having a bad case of prolix disease so this reply will have to appear over two posts. ;-) My main concern is driven by the fact that corporate memory seems to have deserted so many important institutions these days, matters once long settled have been forgotten or depreciated in importance by the very institutions that are supposed to be upholding those ideas. Rigor, ethics and ideals have seemingly flown out the window. It seems very strange to me to chuck out ideas that have long since been proven to work but I accept it's part and parcel of the current zeitgeist to devalue ideas from the past without first evaluating them as to whether they're worthwhile or not. This wasn't the case until perhaps the late 1970s or early '80s, that's when postmodernist ideas began to take hold in a big way. I'm not against all postmodernist ideas per se but some have had a devastating effect on science and engineering: once facts were just that—facts—not just 'possible maybes' as so many people consider them to be nowadays. Reason, logic and logical argument just aren't fashionable these days. Now the public's faith in science seems badly mauled and I reckon that's a bad thing. Whilst cultural changes outside of science have largely contributed to its fall from grace, there's also little doubt that science has shot itself in the foot far too many times in recent decades for it not to have had a significant negative effect on public perception. There's been too many major scientific scandals that should never have happened, some scientists have much to answer for, and scientists generally have a great deal of PR work to do to clean up the mess: https://en.wikipedia.org/wiki/List_of_scientific_misconduct_incidents https://en.wikipedia.org/wiki/List_of_scientific_misconduct_.... Nevertheless, I strongly believe that science is still the best discipline we have to prevent us from returning to the dark ages. If you want to get an appreciation of how significantly the public's attitude to science has changed for the worse since the mid 1950s then it's worth looking at this short 1955 doco for school kids titled Why Study Science?. It's a bit trite and clichéd but there's no hiding the fact that back then the public held science in very high regard, it also shows that science and engineering held absolutely prominent and unquestionable places in society at that time: https://archive.org/details/WhyStudy1955_2 https://archive.org/details/WhyStudy1955_2. My, my how times have changed, it's a shame this doco doesn't get more of an airing by scientists (and in fact by everyone), as it seems to me to be a good reference point for comparison; moreover most scientist will be too young to have experienced how the public perceived their profession during its halcyon days, which alone is a good enough reason for them to view it. What is so damn annoying to me about this opioid crisis is that many of those who are implicated in its creation were trained in scientific disciplines, what they did was the antithesis of what science stands for. I would further add that I don't believe doctors and scientists would have been implicated to such a degree back half a century ago (that's not to say they were above reproach, far from it). Reading the above, I must appear to be an apologist for a past era but I'd insist it's not so. I haven't the time to expand and justify the last sentence in detail but I'll add this much. Whilst I was too young to be one of the targets of that 1955 doco, I did grow up somewhat later whilst that ethos was still current (as mentioned, things changed in the '80s and onwards). This meant that I not only learned science within that earlier culture but also I'm inculcated to think that way. Furthermore, as I'm writing this in October 2020, it means that I've witnessed the public's change in attitude towards science over these decades and, in my opinion, it's been nothing short of dramatic in the negative sense. It's not as if back then people were slaves to the scientific elite, that's definitely not so as that was the time of the Cold War and the Bomb so there was much criticism of those who developed and tested it. The disparity between then and now is that in those days most people had a much better understanding of the difference between scientific progress for the betterment of society and science that is used for nefarious purposes and I believe that the media had much do with this more positive attitude, as reporting was much more objective and balanced back then. Furthermore, we didn't have the internet full of millions of self-styled experts to criticize science (and for that matter criticize just about everything else, both good and bad). Unfortunately, internet's 'noise' now drowns out much worthwhile stuff. As I alluded to at the outset, there are many reasons for the opioid crisis, but I return to the fact that these days institutions such as the FDA simply do not have structures in place to remember the importance of why certain decisions were made in the past. The fact that opioid addiction has been high on the medical agenda for ≈150 years and very high on the agenda of both local and international politics for about a century and the fact that it has been effectively forgotten by the FDA says not only a great deal about said institution but also much about modern culture. [If all goes well, I'll provide you with some examples in a reply below.]
- hilbert42 6y ago
  OK, here are the examples: <...> Let me illustrate what I mean with several examples. Probably the best one is about a wonderful woman named Frances Kathleen Oldham Kelsey, she was with the US FDA in the early 1960s at the time of the thalidomide crisis. She was the person who refused to authorize it for use in the US market because she had concerns about the drug's safety despite very considerable pressure on her (and the FDA) to do so from the drug's manufacturers. Moreover, she had strong backing† for her stance from senior execs within FDA. Her actions saved thousands of US children from birth defects: https://en.wikipedia.org/wiki/Frances_Oldham_Kelsey https://en.wikipedia.org/wiki/Frances_Oldham_Kelsey. † (Support for staff from execs who properly perform their jobs in the light of external criticism is sorely missing from today's corporate culture. Had this happened today, I'd bet she'd have been isolated and kids would have suffered the harrowing consequences!) It's hard to compare the FDA's virtuous and honorable action of some six decades ago with how it has totally fucked up both the approval and ongoing monitoring of OxyContin (Oxycodone) of recent years without becoming very upset. Moreover, it's hard to believe these two comparisons actually refer to the same organization. (That's the tragedy, they aren't the same except in name only!) The example of Frances Kelsey and the FDA's actions over thalidomide versus the FDA's present-day actions with respect to OxyContin has to be the quintessential example of its kind and this message ought to preached out loud from rooftops by all and sundry. Here's a current example: authoritative information about COVID-19/SARS-CoV-2 was unduly late—so late that many lives have been tragically lost through such negligence. Given the experience of past pandemics, the WHO and health departments worldwide should have acted much sooner than they did. Thus, the deliberate and wilful campaigns to spread disinformation about COVID-19 worldwide were not immediately quashed by governments, especially so in the US where some administrators and the President acted with outrageous negligence by suggesting the disinformation was actually true (or essentially so), thus aiding and abetting its spread. (In my opinion, they're culpable at law for the loss of many lives.) OK, with such sweeping statements, let's look at the facts (I'll try to keep them as short as possible): 1. Most people (including doctors and health administrators) have never seen a fully blown flu-like pandemic before so there's some excuse for the delay early on. That said, better protocols should have been in place as epidemiologists have been whingeing for decades that another pandemic was on its way. 2. Pandemics are not new; many have come and gone, thus, once recognized, health departments should have acted immediately from well-prepared and well-scripted emergency response procedures. That they didn't act so in response to the pandemic is yet another instance of corporate knowledge having gone walkabout from medical agencies/departments (after all, they had experience from many past pandemics to fall back upon—from the Spanish Flu through to MERS and Ebola—but they did not do so). 3. To make matters much worse, we've also had the truly amazing debacle over the wearing of facemasks. Given the supposed sophistication of our modern-day world, this example seems almost unbelievable except for the fact that we been actually watching it play out. It has so many truly rotten aspects to it that you'd be forgiven for thinking the story had been concocted by a bunch of novelists competing for the best plot. From the outset, many health professions lied to the public over whether masks were effective or not—which they are and there's never been any doubt about that—and they did so by vacillating around the truth. By lying, these medicos put doubt in everyone's minds (and, even now, tragically, many members of the public still have serious doubts as to the effectiveness of masks). Of course, the medico's reasons for lying was to ensure that they were first in line for the few N95 masks available (again, given past pandemics, the shortage of these masks was very foreseeable and should never have happened). Had pandemic protocols been in place, lying would have been unnecessary, as in the event of a shortage, medicos would have automatically been assured first preference! With many of the medical profession and the WHO not immediately coming out to give full support to the wearing of masks at the beginning of the pandemic, they gave the rabidly stupid libertarians a glorious opportunity to say their rights and freedoms had been violated. The difference between these idiots and other libertarians (especially the libertarian left) is that the latter recognize the difference between political freedoms and the necessity to obey laws when living in a civilized society. Stating the damn obvious: one obeys laws out of utilitarian necessity, which is another way of saying laws protect those of us who are minding our own business from others who would otherwise act contrary to our own best interests and safety. If people near me refuse to wear masks then, ipso facto, they are endangering my health and safety, thus during a pandemic I have every right to demand that they wear masks whenever they are near to me—and I expect the law to support me in upholding my stance. For those who don't know it, this is basic democracy 101—for demanding that people must wear facemasks in a pandemic is, at law, logically no different to any other law that protects me from any other form of assault. QED! 4. When advice finally came about keeping a safe distance from one another, it turned out to be essentially worthless. In most countries that advice was to maintain about 5, 6 feet, or 1.5 meters between one another. It turns out that in such circumstances one's protection is essentially non-existent unless one also wears a mask (even then, it's preferable that both parties wear masks as this effectively multiplies the protection between both of them). The reasons become clear when one reads a Hacker News link of several days ago. It took us to a particularly relevant article by Karen Kruse Thomas dated July 17, 2020 on the Johns Hopkins Bloomberg School of Public Health website with an unusually long title of 'The Experiment that Proved Airborne Disease Transmission'—'How Richard Riley’s findings about tuberculosis transmission inform our COVID-19 response today'. The article describes an old but very cleaver experiment carried out 64 years ago in 1956 that essentially proves beyond reasonable doubt that protection offered by such small separations of about 1.5 meters without facemasks are essentially ineffective, it then goes on to show from experiment that airborne transmission of disease over much greater distances is indeed possible: https://www.jhsph.edu/covid-19/articles/the-experiment-that-proved-airborne-disease-transmission.html https://www.jhsph.edu/covid-19/articles/the-experiment-that-... Again, there are several aspects about this article that are truly tragic; the first is that this critical information seems to have only become commonly available well into the pandemic; and second, top medicos including those at the WHO seem to have been unaware of the research until now. Here again, as with the opioid/OxyContin epidemic, critical corporate memory has been lost (or perhaps was never collated in the first instance). This is not only disgraceful; it's damn-well outrageous. It's little wonder that the public has lost faith in science when the custodians of science allow this sort of travesty to happen. What the hell has the WHO been doing all these many years, and why isn't this research already common knowledge among medicos? Frankly, I'm lost for adjectives to describe how annoyed I feel about this incompetence. (We really do need to go to 'war' over this given the fact that the key institutions that are charged with protecting our health have failed so miserably in doing so.) Let me add however, the fact that airborne transmission over much greater distances is possible has also been reported in other recent research carried out earlier on in the pandemic and it backs up the earlier 1956 research. Unfortunately, authorities never reported this newer in ways that were meaningful to the public. Why you may well ask. The cynic in me suggests that in the trade off between human life and economics here we may well have proof that economics is the real winner. From quite early on in the pandemic, I've assumed that airborne transmission was highly likely (given that I'd heard about it in association with other diseases long before COVID-19 arrived), so I've always worn a mask from the outset. (Luckily, I also had a box of N95 masks that I'd been using as dust protection on industrial sites pre COVID-19.) Incidentally, my personal criteria for safe-distancing is based on the typical distance over which one could smell a smoker's cigarette smoke in that that smoke had been actually breathed out by the smoker. As most will know, a non-smoker can easily detect the presence of a smoker across a very large room without the need to set eye on him or her. *(Note, is not a recommendation, it's just what I do.) With reference to your comment about me writing an essay on the subject, I must say that I don't consider myself sufficiently qualified to do so. Even though I'm passionate about the topic, I'm not a doctor so my criticisms of those responsible for the opioid/OxyContin epidemic are essentially limited to 'failures of process'. True, I do have some knowledge of the matter as early on, I was going to be a pharmacist and my better half works in the medical game, so I have understood the crux of the addiction problem long before OxyContin came along not to mention that I've also numerous books the matter. Another reason I feel strongly about the need for institutions to maintain a continuity of ideas across multiple generations is that over the years I've been on various standards committees and I have written a few standards (albeit not in this area), so the need to maintain standards is well ingrained upon my psyche. I'd add one final point, which is that earlier today I reread my posts here and to me they read as if they've been written with the zealotry of a reformed opioid addict! Very fortunately, I can assure you that this has never been the case. BTW, I agree with your point that my comments here on HN will easily get lost in the noise. Unfortunately, I killed off my personal web pages some years so I've no personal blog at the moment but I've been thinking about bringing it back in the near future. Of course, others if they so wish can always point journalists and other interested parties to these links. Methinks, that seems like a good idea.

by ak217 6y ago

hilbert42 6y ago

Thanks for your comments. First, I must admit to having a bad case of prolix disease so this reply will have to appear over two posts. ;-) My main concern is driven by the fact that corporate memory seems to have deserted so many important institutions these days, matters once long settled have been forgotten or depreciated in importance by the very institutions that are supposed to be upholding those ideas. Rigor, ethics and ideals have seemingly flown out the window. It seems very strange to me to chuck out ideas that have long since been proven to work but I accept it's part and parcel of the current zeitgeist to devalue ideas from the past without first evaluating them as to whether they're worthwhile or not. This wasn't the case until perhaps the late 1970s or early '80s, that's when postmodernist ideas began to take hold in a big way. I'm not against all postmodernist ideas per se but some have had a devastating effect on science and engineering: once facts were just that—facts—not just 'possible maybes' as so many people consider them to be nowadays. Reason, logic and logical argument just aren't fashionable these days. Now the public's faith in science seems badly mauled and I reckon that's a bad thing. Whilst cultural changes outside of science have largely contributed to its fall from grace, there's also little doubt that science has shot itself in the foot far too many times in recent decades for it not to have had a significant negative effect on public perception. There's been too many major scientific scandals that should never have happened, some scientists have much to answer for, and scientists generally have a great deal of PR work to do to clean up the mess: https://en.wikipedia.org/wiki/List_of_scientific_misconduct_incidents https://en.wikipedia.org/wiki/List_of_scientific_misconduct_.... Nevertheless, I strongly believe that science is still the best discipline we have to prevent us from returning to the dark ages. If you want to get an appreciation of how significantly the public's attitude to science has changed for the worse since the mid 1950s then it's worth looking at this short 1955 doco for school kids titled Why Study Science?. It's a bit trite and clichéd but there's no hiding the fact that back then the public held science in very high regard, it also shows that science and engineering held absolutely prominent and unquestionable places in society at that time: https://archive.org/details/WhyStudy1955_2 https://archive.org/details/WhyStudy1955_2. My, my how times have changed, it's a shame this doco doesn't get more of an airing by scientists (and in fact by everyone), as it seems to me to be a good reference point for comparison; moreover most scientist will be too young to have experienced how the public perceived their profession during its halcyon days, which alone is a good enough reason for them to view it. What is so damn annoying to me about this opioid crisis is that many of those who are implicated in its creation were trained in scientific disciplines, what they did was the antithesis of what science stands for. I would further add that I don't believe doctors and scientists would have been implicated to such a degree back half a century ago (that's not to say they were above reproach, far from it). Reading the above, I must appear to be an apologist for a past era but I'd insist it's not so. I haven't the time to expand and justify the last sentence in detail but I'll add this much. Whilst I was too young to be one of the targets of that 1955 doco, I did grow up somewhat later whilst that ethos was still current (as mentioned, things changed in the '80s and onwards). This meant that I not only learned science within that earlier culture but also I'm inculcated to think that way. Furthermore, as I'm writing this in October 2020, it means that I've witnessed the public's change in attitude towards science over these decades and, in my opinion, it's been nothing short of dramatic in the negative sense. It's not as if back then people were slaves to the scientific elite, that's definitely not so as that was the time of the Cold War and the Bomb so there was much criticism of those who developed and tested it. The disparity between then and now is that in those days most people had a much better understanding of the difference between scientific progress for the betterment of society and science that is used for nefarious purposes and I believe that the media had much do with this more positive attitude, as reporting was much more objective and balanced back then. Furthermore, we didn't have the internet full of millions of self-styled experts to criticize science (and for that matter criticize just about everything else, both good and bad). Unfortunately, internet's 'noise' now drowns out much worthwhile stuff. As I alluded to at the outset, there are many reasons for the opioid crisis, but I return to the fact that these days institutions such as the FDA simply do not have structures in place to remember the importance of why certain decisions were made in the past. The fact that opioid addiction has been high on the medical agenda for ≈150 years and very high on the agenda of both local and international politics for about a century and the fact that it has been effectively forgotten by the FDA says not only a great deal about said institution but also much about modern culture. [If all goes well, I'll provide you with some examples in a reply below.]

hilbert42 6y ago
OK, here are the examples: <...> Let me illustrate what I mean with several examples. Probably the best one is about a wonderful woman named Frances Kathleen Oldham Kelsey, she was with the US FDA in the early 1960s at the time of the thalidomide crisis. She was the person who refused to authorize it for use in the US market because she had concerns about the drug's safety despite very considerable pressure on her (and the FDA) to do so from the drug's manufacturers. Moreover, she had strong backing† for her stance from senior execs within FDA. Her actions saved thousands of US children from birth defects: https://en.wikipedia.org/wiki/Frances_Oldham_Kelsey https://en.wikipedia.org/wiki/Frances_Oldham_Kelsey. † (Support for staff from execs who properly perform their jobs in the light of external criticism is sorely missing from today's corporate culture. Had this happened today, I'd bet she'd have been isolated and kids would have suffered the harrowing consequences!) It's hard to compare the FDA's virtuous and honorable action of some six decades ago with how it has totally fucked up both the approval and ongoing monitoring of OxyContin (Oxycodone) of recent years without becoming very upset. Moreover, it's hard to believe these two comparisons actually refer to the same organization. (That's the tragedy, they aren't the same except in name only!) The example of Frances Kelsey and the FDA's actions over thalidomide versus the FDA's present-day actions with respect to OxyContin has to be the quintessential example of its kind and this message ought to preached out loud from rooftops by all and sundry. Here's a current example: authoritative information about COVID-19/SARS-CoV-2 was unduly late—so late that many lives have been tragically lost through such negligence. Given the experience of past pandemics, the WHO and health departments worldwide should have acted much sooner than they did. Thus, the deliberate and wilful campaigns to spread disinformation about COVID-19 worldwide were not immediately quashed by governments, especially so in the US where some administrators and the President acted with outrageous negligence by suggesting the disinformation was actually true (or essentially so), thus aiding and abetting its spread. (In my opinion, they're culpable at law for the loss of many lives.) OK, with such sweeping statements, let's look at the facts (I'll try to keep them as short as possible): 1. Most people (including doctors and health administrators) have never seen a fully blown flu-like pandemic before so there's some excuse for the delay early on. That said, better protocols should have been in place as epidemiologists have been whingeing for decades that another pandemic was on its way. 2. Pandemics are not new; many have come and gone, thus, once recognized, health departments should have acted immediately from well-prepared and well-scripted emergency response procedures. That they didn't act so in response to the pandemic is yet another instance of corporate knowledge having gone walkabout from medical agencies/departments (after all, they had experience from many past pandemics to fall back upon—from the Spanish Flu through to MERS and Ebola—but they did not do so). 3. To make matters much worse, we've also had the truly amazing debacle over the wearing of facemasks. Given the supposed sophistication of our modern-day world, this example seems almost unbelievable except for the fact that we been actually watching it play out. It has so many truly rotten aspects to it that you'd be forgiven for thinking the story had been concocted by a bunch of novelists competing for the best plot. From the outset, many health professions lied to the public over whether masks were effective or not—which they are and there's never been any doubt about that—and they did so by vacillating around the truth. By lying, these medicos put doubt in everyone's minds (and, even now, tragically, many members of the public still have serious doubts as to the effectiveness of masks). Of course, the medico's reasons for lying was to ensure that they were first in line for the few N95 masks available (again, given past pandemics, the shortage of these masks was very foreseeable and should never have happened). Had pandemic protocols been in place, lying would have been unnecessary, as in the event of a shortage, medicos would have automatically been assured first preference! With many of the medical profession and the WHO not immediately coming out to give full support to the wearing of masks at the beginning of the pandemic, they gave the rabidly stupid libertarians a glorious opportunity to say their rights and freedoms had been violated. The difference between these idiots and other libertarians (especially the libertarian left) is that the latter recognize the difference between political freedoms and the necessity to obey laws when living in a civilized society. Stating the damn obvious: one obeys laws out of utilitarian necessity, which is another way of saying laws protect those of us who are minding our own business from others who would otherwise act contrary to our own best interests and safety. If people near me refuse to wear masks then, ipso facto, they are endangering my health and safety, thus during a pandemic I have every right to demand that they wear masks whenever they are near to me—and I expect the law to support me in upholding my stance. For those who don't know it, this is basic democracy 101—for demanding that people must wear facemasks in a pandemic is, at law, logically no different to any other law that protects me from any other form of assault. QED! 4. When advice finally came about keeping a safe distance from one another, it turned out to be essentially worthless. In most countries that advice was to maintain about 5, 6 feet, or 1.5 meters between one another. It turns out that in such circumstances one's protection is essentially non-existent unless one also wears a mask (even then, it's preferable that both parties wear masks as this effectively multiplies the protection between both of them). The reasons become clear when one reads a Hacker News link of several days ago. It took us to a particularly relevant article by Karen Kruse Thomas dated July 17, 2020 on the Johns Hopkins Bloomberg School of Public Health website with an unusually long title of 'The Experiment that Proved Airborne Disease Transmission'—'How Richard Riley’s findings about tuberculosis transmission inform our COVID-19 response today'. The article describes an old but very cleaver experiment carried out 64 years ago in 1956 that essentially proves beyond reasonable doubt that protection offered by such small separations of about 1.5 meters without facemasks are essentially ineffective, it then goes on to show from experiment that airborne transmission of disease over much greater distances is indeed possible: https://www.jhsph.edu/covid-19/articles/the-experiment-that-proved-airborne-disease-transmission.html https://www.jhsph.edu/covid-19/articles/the-experiment-that-... Again, there are several aspects about this article that are truly tragic; the first is that this critical information seems to have only become commonly available well into the pandemic; and second, top medicos including those at the WHO seem to have been unaware of the research until now. Here again, as with the opioid/OxyContin epidemic, critical corporate memory has been lost (or perhaps was never collated in the first instance). This is not only disgraceful; it's damn-well outrageous. It's little wonder that the public has lost faith in science when the custodians of science allow this sort of travesty to happen. What the hell has the WHO been doing all these many years, and why isn't this research already common knowledge among medicos? Frankly, I'm lost for adjectives to describe how annoyed I feel about this incompetence. (We really do need to go to 'war' over this given the fact that the key institutions that are charged with protecting our health have failed so miserably in doing so.) Let me add however, the fact that airborne transmission over much greater distances is possible has also been reported in other recent research carried out earlier on in the pandemic and it backs up the earlier 1956 research. Unfortunately, authorities never reported this newer in ways that were meaningful to the public. Why you may well ask. The cynic in me suggests that in the trade off between human life and economics here we may well have proof that economics is the real winner. From quite early on in the pandemic, I've assumed that airborne transmission was highly likely (given that I'd heard about it in association with other diseases long before COVID-19 arrived), so I've always worn a mask from the outset. (Luckily, I also had a box of N95 masks that I'd been using as dust protection on industrial sites pre COVID-19.) Incidentally, my personal criteria for safe-distancing is based on the typical distance over which one could smell a smoker's cigarette smoke in that that smoke had been actually breathed out by the smoker. As most will know, a non-smoker can easily detect the presence of a smoker across a very large room without the need to set eye on him or her. *(Note, is not a recommendation, it's just what I do.) With reference to your comment about me writing an essay on the subject, I must say that I don't consider myself sufficiently qualified to do so. Even though I'm passionate about the topic, I'm not a doctor so my criticisms of those responsible for the opioid/OxyContin epidemic are essentially limited to 'failures of process'. True, I do have some knowledge of the matter as early on, I was going to be a pharmacist and my better half works in the medical game, so I have understood the crux of the addiction problem long before OxyContin came along not to mention that I've also numerous books the matter. Another reason I feel strongly about the need for institutions to maintain a continuity of ideas across multiple generations is that over the years I've been on various standards committees and I have written a few standards (albeit not in this area), so the need to maintain standards is well ingrained upon my psyche. I'd add one final point, which is that earlier today I reread my posts here and to me they read as if they've been written with the zealotry of a reformed opioid addict! Very fortunately, I can assure you that this has never been the case. BTW, I agree with your point that my comments here on HN will easily get lost in the noise. Unfortunately, I killed off my personal web pages some years so I've no personal blog at the moment but I've been thinking about bringing it back in the near future. Of course, others if they so wish can always point journalists and other interested parties to these links. Methinks, that seems like a good idea.