nopie
1d ago
Indeed, in the UK we admit that capability to make informed decisions does not start at some arbitrary birthday but is more fluid and depends on maturity of a person. This is mostly about some minor treatments such as morning-after-pill or HPV vaccine which is for their own benefit. I expect that a healthcare professional would be more strict in cases when a minor is asking for treatment that has great potential of harm. Then it would go to the court and the court most likely would say that wanting a treatment that harms is the evidence that the person does not have the capability to make an informed decision or something like that :)
nopie
1d ago
Mental health is a part of medicine. The treatments we have in this area are less effective, less evidence-based, even controversial but part of current medicine nevertheless.
Some issues are clearly related to biologic disorders like autism or schizophrenia. Sometimes we are not even sure what it is.
nopie
1d ago
Without new evidence you might see some governments abolish or discourage it specifically for children, but others will continue to feed a fraction of every new generation into the trans pipeline and even places that get rid of it could easily flip back in a generation.
I don't think that this is going to happen. The progress can be slow at times but following evidence-based practice is not a partisan thing, it is just a way forward. Takes a lot of work, hard work assessing evidence, figuring it all out, learning who can you trust since no one person is able to do fully etc.
It is said that currently about 50% of medical practices are not strictly evidence based. It takes time to re-evaluate everything, do high quality studies and so on. Many doctors have their own biases and can be very resistant to change. Maybe it will never be that their recommendations are 100% or even 99% based on good evidence. But I expect that it will become better with time as it is much better than it was 50 or 100 years ago. Maybe there will be some temporary setbacks in some places. That is also expected and in a way it is also good as it will provide a control group :)
nopie
19d ago
Obviously the support for Zelensky is high. The fact that we cannot know the percentage with high precision doesn't mean that we don't know the percentage with error margin that is less than ±10%.
Is his course good for Ukrainian people? Who knows. I personally think that Ukrainians are too obstinate to consider they could ever get Crimea and other territories back. It prevents them thinking more about how to protect the rest of Ukraine. But that's their choice. Ignoring this will not be productive. Suppose the US forces Ukraine to do elections and Zelensky is again elected. Then what? Or someone else is elected with the same aspirations as Zelensky.
And forcing to elect a certain leader that yields to the US will lead to a new Maidan. Ukrainians want free elections not some US or Russian stooge.
nopie
20d ago
I think that a lot of young people today are very sympathetic to communist ideas especially in Latin America. I don't understand why, probably due to lack of growth, high unemployment, especially among young people.
For me it is unimaginable because I grew up in the USSR and we all hated it. Yet, a lot of old people are nostalgic towards the Soviet times. They had hard time to adapt to competitive system. I can understand that. Transition had to be done in more thoughtful manner. In Russia it is probably even worse due to widespread corruption and inequality.
We had to study communist ideology, read Marx and other works already at the primary school. It was very boring. I don't understand how people can find them inspiring at all. At the same time other teachers let us know, in short passages, what was wrong about the Soviet system. Biology teacher told about Lysenkoism, others mentioned deportations and so on. I think that we all grew up more like Kolgomorovs, knowing well what to say to authorities to survive, while retaining a different perspective in private. When Gorbachev started his glastnost (openness), the gates opened and the Soviet system could not survive.
I don't believe that this is a case with all communistic countries today. Maybe Cuba is similar but in North Korea people are probably too brainwashed and not sufficiently educated to be willing to reject communism.
nopie
20d ago
While I would say that both Stalin and Hitler were very bad, Stalin was less bad. However, he was baddier in a different aspect. Communism as an ideology while trying to safeguard the equality (theoretically), destroys people's aspirations. In long term, it is very bad for people and also bad for progress of humanity.
I think that HIV is rather irrelevant in the US because most people, including drug addicts have correct beliefs about it. They will try to use clean needles when injecting to avoid getting infected and so on.
I just look at this from public health point of view – if beliefs are causing people to make wrong health choices, then how can we change those beliefs?
Atul Gawande writes in detail how polio vaccination programs worked in India. The organizers knew that some people have beliefs that polio vaccine is causing disease or making people infertile etc. They also knew that shaming people or forcing vaccine doesn't work. If someone refuses, calmly explain why vaccine is beneficial and move on. In one episode the supervisor who otherwise was calm about all problems, got angry to vaccinator who berated a mother for refusing to vaccinate her child. He said, “she was listening to you before but now she will not listen at all”.
This approach was slow but successful, polio was eradicated in India. One has to be very stoic by allowing people to make wrong choices and then empathising with them when bad things happen without the slightest reproach.
Somehow we forgot all this and during covid acted very irresponsibly by forcing people to get vaccinated, by shaming them officially etc. Child vaccination rates predictably are going to fall and it will be hard work to improve them again.
With HIV beliefs in Africa, it's probably because we don't have vaccine against HIV so they never had contacts with field workers like that. Those people with HIV in Africa who happen to be involved in programs that provide treatment, quickly understand how all this work. But there is no a systemic reach like going from home to home to vaccinate or treat everyone.
The leaders could do that but they are tribal leaders. They have no capabilities to think or act rationally. It requires deep political scheming to entice them to implement such programs. The WHO is often accused to be working for China and other dictators but I don't see a way how they could not be. Otherwise those dictators are not going to listen to them.
nopie
21d ago
To me it is interesting why Kennedy while believing the scientific evidence, delves so much into speculations that are known to be without strong evidence?
In a way, it could be healthy skepticism. We can benefit by examining our beliefs once in a while. Science changes, new evidence appears and sometimes people forget to update. But it doesn't seem what is happening here.
Maybe it is just that his tribal consciousness has become stronger with age that now it supersedes his rational thinking.
Most people are very tribal. They don't think deeply and just repeat what their tribe leaders tell them. Only a rare person is looking for truth. That is a hard work and requires to be in constant defiance towards the rest of the society who is very tribal. At the end you get tired and decide to live like everybody else, have an easier life and even make some profit.
nopie
22d ago
Definitely. Communication in both ways is very important.
But even outsiders should learn some basic principles of evidence. Otherwise they would just demand placebos and snake oil.
I just had a thought about demographics. We all know that in the west (but realistically the whole world is going in the same direction) not enough children are being born. No one knows how to reverse that. And yet, in political discourse we hear people who are so sure that if only they could implement their policies, it would all be solved.
I don't know all about these political details. I think they are irrelevant. What is relevant is that we follow scientific process. Initially with new ideas, things, it is common that practice does not follow scientific evidence but gradually there is a demand for evidence-based practice and that what happened with transgender therapies in the UK. Science is never settled in the stone, however. I expect more studies and more reviews etc., all moving towards more evidence-based practice. And obviously, evidence can change with time with better studies and reviews.
As for ivermectin, we get a lot of prescriptions in the UK, both for tablets and cream, for parasite treatment. I have never seen it prescribed for covid. Why would someone do that? Not risky but unnecessary. It is irrelevant if someone gets it for covid. Those are rare cases, just expensive placebo.
What to speak of ivermectin, even Paxlovid was a dud. Maybe helped some half-dead elderly people. The UK had a scheme to dispense it in the pharmacy without needing a prescription. But that lasted only a couple of months because the further evidence was not good. The US, however, under Biden's administration spent 10 billion on this medicine. Total waste of money.
nopie
24d ago
Even more interesting that you mentioned Cass Review. It is a high quality review that states that the evidence we have is of low quality. Anyone can see that. A lot of people try to argue against it by saying that the review is of low quality but I can only see (at least in 99% of conversation) bias and/or intellectual laziness.
Why am I obliged to engage in conversion with those people? I don't want to and I don't need to. It is not a productive use of my time. I would better discuss this with my peers who have put a lot of work to learn how to evaluate evidence.
I have not participated in discussions about Cass Review but certain groups of experts have. They certainly didn't start with consensus. The fact that puberty blockers in the UK were prescribed to minors shows that. But eventually experts have cooperated and come to the conclusion that based on current evidence or rather due to lack of good evidence we cannot allow puberty blockers to minors except for clinical studies.
This was brought to the attention of the UK government which now has made a law based on recommendation of experts. My duty is only to follow the law, otherwise I will be breaking the law, I could be held criminally liable and lose my pharmacist licence etc.
Again, I can participate in discussions but I don't see what's the point. The expert group suggestion seems reasonable and the law is reasonable. That's how it works. In fact, I had a case when I had to approve dispensing of puberty blocker in a pharmacy and it immediately reminded me of Cass Review.
Maybe you mean that sometimes experts need to sell their ideas to the politicians and society who are not able to evaluate anything. But that is a completely different thing from what I am doing here. I am not trying to convince anyone to vote for me or even spread my ideas. I mostly want to learn something interesting and insightful and share the same to others (if I have something to share).
nopie
24d ago
Low quality is low quality. Not much point to consider such evidence. I understand that when we have nothing else, we catch to straws but we shouldn't really.
nopie
24d ago
In medicine the evidence is assessed by quality. I don't often do it myself because it takes a lot of time. We work in groups and we have to rely on groups that do good job assessing the quality of the evidence.
If you read the link and go deep, you will find that a lot of evidence about ivermectin is discarded because it was of very low quality.
Now, if some other group wants to change and say that it was actually better than we think, I need to see their reason. I need to see how they arrived to that conclusion, I need to be sure that they did a good job.
Unfortunately in most of the cases they didn't. Even Scott Alexander or Zvi, Hananiah and others do poor job many times. Sometimes they provide reasoning that would even get a poor mark at a university. And I did sometimes get low marks at uni and learned a lot from my mistakes.
My advice is – do your own research but learn to do it properly. Internet is not a good classroom. But some people can be very good with independent study so I don't want to exclude anyone beforehand.
nopie
25d ago
Doctors will update their views with the latest guidelines. I don't worry about them.
Politicians are always sleezy homos. I am not surprised that they made populistic but wrong choices.
But I am very disappointed about rationalist community who should have known better or at least figure it out sooner.
Some of them did. Here are some prolific writers on motte. Scott Locklin was also right (https://scottlocklin.wordpress.com/2021/08/12/things-the-establishment-got-wrong-about-wuhan-coof/). But otherwise anytime I tried to talk about lockdown harms, I was hated and laughed at.
nopie
25d ago
Almost everybody panicked at the start of pandemic. I don't blame people for that because we all are humans, prone to fear and panic.
Doctors are humans too, I don't blame them if they thought that lockdowns were justified and vaccine mandates good.
I blame politicians though. They are the ones to be brave in face of adversity. They should have listened to experts. For example, Boris Johnson initially was against lockdowns. But at some point he rejected advice of public health experts and started to listen some quacks. I understand that for lay people it is hard to understand where scientific paradigm is and who is exactly the expert about public health. And yet, good governments should be more scientifically sophisticated.
Doctors had no so say about lockdowns or vaccine mandates. Their views about these things don't really matter. It is just that people think them to be experts in everything related to health.
nopie
25d ago
You ignored that doctors are more like auto mechanics and not scientists. Scientists in public health are very few in numbers.
I actually took a course in public health at uni before pandemic but it is not typical for most students. Maybe 5% of medical students take this course, probably even less and maybe only 0.1% actually work in this field.
nopie
25d ago
The paradigm is in the link I provided with clear and detailed evidence – exactly which studies and how they showed that both groups (ivermectin and placebo) had no statistical differences. It is your homework now to see that other group is outside this paradigm.
nopie
26d ago
I mentioned philosophy of science and the fact that most scientists haven't read it.
The question here is why would you believe the Flat earth society that has done studies to prove their point and not that the earth is round without any systematic proof?
I haven't done my own meta study about ivermectin. That would take too much time and energy. I just read expert group rationale, in this case NICE (https://www.nice.org.uk/guidance/NG191/chapter/4-therapeutics-for-covid-19#ivermectin) guidelines. It seems that they are accessible only from UK IP address however, therefore you might not be able to access them. But sure you have your own country guidelines.
Science works in paradigms, it also works in groups. The real question is not about your particular beliefs about ivermectin but understanding what is the current paradigm and which scientists work within that paradigm. Then many things will become easier. Those groups will have disagreements, that's how science progresses. But if you those disagreements are outside the parameters of the current paradigm, then that is either not science, or some revolution is going to happen that will change our understanding substantially.
As for ivermectin, I don't see anyone breaking the paradigm.
nopie
26d ago
Medical profession is a wide term. Most doctors are not scientists, not even engineers, they are more auto mechanics who fix your car. If the manufacturer provides false information, they cannot independently check this. Think about diesel exhaust scandal where biggest Germany companies were involved.
The part that would be responsible for lockdowns is called public health. That is a small part of all medical field. And most of them actually knew that lockdowns and masks were ineffective. Somehow they were ostracized due the initial panic and had suck up to the politicians or be fired just as happened with Jay Bhattacharya.
nopie
26d ago
Yes, a lot of people supported my idea that lockdowns are wrong and that vaccine mandates are wrong etc.
But if those people start repeating stories that are not based on facts, without any critical thinking, for example, that covid vaccines are poison, will shorten your life, cause turbo cancers (take your pick), I will not agree with them. Some even go as far as declaring this about all vaccines, good or bad.
In fact, the viewpoint that vaccines mandates are bad are almost universally interpreted as viewpoint that vaccines are bad. I don't know how to deal with that. People are not perceptive to details. But details are very important here.
nopie
27d ago
First, Ukrainians, at least, the ones I spoke with mostly don't think it was intentional. Just a bad policy for which they blame Russians.
Second, it is not relevant. My argument is to show what Ukrainians feel and not if their feelings are morally justified.
Third, you are trying to be inflammatory. I refuse to discuss like that. I like motte. I can find really good information here, good gems. But please, avoid biting like that with lazy remarks.
nopie
27d ago
I think you are trying to troll the discussion.
- no deeper insights
- not even relevant to what I was trying to say
I ask you to avoid remarks like this.
As for intellectual laziness, I work in healthcare sector and try to absorb current consensus that I use to form my beliefs.
Covid pandemic made many people scared. I do not blame if someone overreacted but gradually we have to come to common understanding what it all was instead of holding our biases forever.
My beliefs are as follows:
- Pandemic started either due to escaping from lab in Wuhan (50%) or naturally from somewhere (50%). If escaped from lab, it is more of a politic issue (lab security and scientific practices) than scientific because it doesn't change how we should have reacted to it.
- Masks have no evidence of effectiveness. Even real life mechanical models don't indicate effectiveness. Don't confuse with lab studies. Probably because, in real life means people don't put them on properly, simply it is not possible. People engage in wish-thinking and ignore this just like native speakers are unaware that they omit certain sounds.
- Lockdowns, school closures were bad policies and should not have been introduced. Sweden was the proper way how the world should have reacted. Australia had a moderate success but the cost was too high anyway.
- Covid vaccines were only moderately effective in elderly and risk groups. Were mostly useless for young people and children.
- We learned that covid vaccines don't stop infections in May 2021, full studies published on August, 2021. Most vaccine mandates introduced in October, 2021. It was a big unenforced policy error that didn't improve uptake in elderly and only caused resentment, unnecessary controversy and reduction of child vaccination rates.
- Politicians and public equally are very unwilling to admit all above.
- WHO does a good job in poor countries but they have to suck up to dictators. It is a big moral problem.
- The same in developed countries. Experts in public health are smart but they have to suck up to democratically elected politicians. It is a big moral problem. When Tegnell told the truth, he was called a nazi by politicians. Jayanta Bhattacharya was demonized etc. Most other experts yielded to the pressure of non-expert politicians and told them what they wanted to hear. Now people can laugh at those experts and distrust them but basically they themselves (via their elected officials) demanded experts tell the lies about masks and lockdowns etc.
nopie
27d ago
It is mostly done with tribal mentality. It is common for people to have an idea, then search on pubmed scientific articles that support their idea.
I have to explain and again why this doesn't work. Mostly because you even start searching with keywords to support your idea. If you tried to search with keywords that would reject the idea, you would get articles that reject theses ideas.
The correct way is to start with neutral assumption and do real meta study. It is hard, very hard, take a lot of time. In most cases you are not able to do that. You have to admit that at some point that you don't have that much time, energy and probably even understanding to properly read even one study. Then you have to learn how to use secondary sources that summarizes meta studies, evaluate those sources, assign how much you trust them.
“Do your own research” is a good thing, but the problem with that is that you need to do your own research, correctly and not some half-assed version of it. Maybe laziness it is not the correct word. To me it is like building a house, you need to work hard, do it properly. Some people might just stick some wood in the ground, put a cover on top and call it a house. He just build a hut and even that was not good. You need an honesty to admit that you didn't do a good job. I don't know how to teach that. For me first it took 2 weeks to read one simple study. Even when it seems I understand it all, it wasn't the case. The scientific studies are written in a peculiar language and not a way that can be easily understood.
At university I started with simple assignments, like is polymorphism of beta-2 adrenoreceptors relevant for differentiating asthma treatments. Read a lot of studies, many positive. But the final conclusion, at current level of knowledge it cannot be done. You have to get used that most such searches will have negative result. It is easier if you start with null hypothesis. It is a hard work to find something. Scott Alexander is doing fantastic work with such reviews but I am afraid that even he doesn't have enough time and substitutes quality with quantity. I trusted his review of mask studies but it was incomplete. Cochrane review overturned his conclusions. But it wasn't possible for him to do in a few days what a group of dedicated and paid experts did during several months.
Contrarians sometimes challenge – how can you prove that earth is flat? It is actually a very good question in epistemology. You have limited resources to do actual experiments, travel to space and look at earth from outside. You only have access to the library. What are the methods to judge which information you can trust and why and which is not trustable. It opens whole philosophy of science, all about scientific paradigms and so on. Even scientists and engineers studying the actual things very deeply, like those who create and manage GPS system, haven't thought about these things. They are inside the paradigm but cannot describe it outsiders. Just like a native speaker often is unable to explain even simple phonetics of their own language. They have internalized them so deeply that they are unable to under realize that. Once I asked a native Japanese speaker, a linguist in fact, why I hear that in certain words they omit one sound. And his reaction was what? They never realized this omission.
Maybe it is the other way around – deontology is a veiled utilitarianism when precise evidence is hard to get or understand. :)
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