nopie
1yr ago
The point here is that when someone has psoriasis why does he need to get the approved medicine if Ngoko bean bean extract could be used instead without prescription? The reality is that we don't know if Ngoko bean extract (and thousands of other remedies offered by snake oil peddlers) works for psoriasis. Obtaining this information can be costly and I can see why no one wants to study Ngoko beans if they cannot be patented.
However, psoriasis is mostly auto-immune disease and if topical treatments do not work, specific monoclonal antibodies can be tried. They are not cheap but that's because the technology to make them is quite complicated.
nopie
1yr ago
The general overview states: Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low‐certainty evidence), but with high heterogeneity.
Covid as such is basically over now but respiratory illnesses remain. 11% is not much but it is at least something.
nopie
1yr ago
Rationality is actually about understanding the hierarchy of evidence strength. Yes, meta-analyses can be wrong too, but in this case Cochrane report is pretty solid. Even though it is not definitive, it makes no sense to reject it and value some anecdotal cases or even lab based evidence as higher evidence.
nopie
1yr ago
The old method didn't work for me. When I was learning a second language (Russian) at school I memorized perfectly all declension tables and all grammar rules and still wasn't able to form a single sentence. I only learned it later with immersion when I had to live among Russians and learn to communicate in Russian. Now I have forgotten all the grammar rules but I can speak almost fluently.
Then I wanted to live in Spain, so I started learning Spanish by Pimsleur method which starts by using real sentences in conversion. It was great and motived me a lot. I am not fully proficient in Spanish yet but it enabled me to be able to deal with all practical matters in Spanish.
My observation is that memorizing rules do not translate well into internalizing them and being able to use in practice. Those kids who were good in Russian actually had exposure to Russia on the street or by watching cartoons in Russian.
It is possible that with this method you eventually reach a limit. Probably you then need to learn more things and appropriate training should be prepared. Sometimes knowing the detailed rules are necessary. But let's remember that people create these rules in their native language without being literate. Even a small child can sometimes correct my grammar.
Most cars didn't have seatbelts then. Some of those cars are still running and it is legal to drive them without seatbelts.
RCT could be easily made by manufacturing a car with two models that are different only by presence of a seatbelt and randomly shipping to different dealers. If the car had a seatbelt, a dealer is obliged to explain a buyer how to use it properly. The car could have a mechanism installed that warns if the seatbelt is not in use and the dealer warns that defeating this measure will void the warranty. The compliance rate would be at least 50%. Then you just collect statistics from road accidents and related injuries. I am sure very soon this experiment would be stopped by an ethics committee because the seatbelt group would have huge difference that further studies would be unethical.
Maybe people who study road safety used a similar setup by comparing one model with a seatbelt to a different model without a seatbelt. It has some bias as assignment is not random and both groups can be different, for example, one model can be chosen by more careful drivers etc. It is very hard to control for all these factors afterwards. But even then they saw such a massive difference in injuries that could be explained only by seatbelt use, that it was made mandatory. It is easy to make mandatory rules in driving because most things in driving are mandatory, you have to stop at red light etc.
But the absence of RCTs and irrefutable evidence could be a minus because it was harder to explain people why seatbelts are protective. Many people said that seatbelts will protect you in minor accidents but in major crashes they would make you more likely to die. That's why we need a good evidence that seatbelts have a total protective effect from deaths although they won't protect in all possible cases. It would have improved adherence even without policing.
nopie
1yr ago
In medicines all such good reasons should be verified, with RCTs if possible. So many things that “just makes sense” were proven wrong.
As for spitting, it is how people have interacted with each other for thousands of years and it never bothered anyone except in some gross cases. To become concerned about it now would indicate that the person has too much anxiety.
Just for a note, I never masked as a pharmacist, except when administering vaccines. For vaccines it is a protocol that we have to strictly observe but for other interactions it is optional. I also noticed that in other countries covid vaccines are administered differently. For example, we do not clean the skin with alcohol wipe (unless visibly dirty) because the studies showed that it makes no difference.
You cannot separate “telling people to wear masks work” from “wearing masks work” in the intervention. It is the real life we are talking about.
The argument that maybe the results would be better if we apply efforts to improve the compliance is a real one and was raised by the Cochrane group reviewers. Their answer was that no one has studied it, so we don't know and cannot claim that it would have helped.
I was just learning about different contraceptive methods. Their reported results of effectiveness are not some best case values but real life results from studies. https://en.wikipedia.org/wiki/Pearl_Index Even that is being criticised that in studies people get better counselling and training and may not represent the real life values. I find interesting that fertility rhythm method has very high theoretical effectiveness (slightly worse than condoms – https://en.wikipedia.org/wiki/Comparison_of_birth_control_methods) and yet it is heavily criticized by all experts in the field. It is always more easier to take a pill than measure temperature daily plus all other behavioural aspects.
Some argue that it still makes sense for their elderly relative to wear mask to protect themselves. Maybe, but I don't know your elderly relative. The statistical chances are that they are as much non-compliant as any other member of the population. Telling all hundred or thousand of them (how many readers do we have?) to wear a mask will statistically yield the same result as in those studies.
nopie
1yr ago
We haven't done RCTs with seatbelts, but I can easily imagine them being very positive in favour of seatbelts even in case of some occasional non-adherence in the intervention group.
nopie
1yr ago
If it was found in RCT trials that the drug does not treat the illness in the treatment group (whatever the reason), it would not get approved.
nopie
1yr ago
I can trust the evidence of the medicine with understanding that it is not 100% certainty.
That's not what the word "trust" means: "assured reliance on the character, ability, strength, or truth of someone or something".
I can trust that the evidence is truthfully reported which includes that the evidence of benefit is, let's say 70%. Don't confuse it with absolute guarantee that the medicines will help in 100% of cases.
You have zero idea what I'm talking about.
Exactly. I have hard time correlating it with what you are saying. I don't have a theory all. I am just saying that my trust increases when I understand the subject matter more.
nopie
1yr ago
This is just to show what mistake rationalists made about masks. Some still are trying to claim that “masks work despite the evidence that they don't” whatever that is supposed to mean.
Some may use Bayesian method (my favourite). In my view, Cochrane report strongly decreases the odds. Whatever way you go, the threshold for mask mandates was never reached.
nopie
1yr ago
Exactly this. Don't even try to think seriously about articles that claim that masks work despite evidence that says they don't. It is a big fail for rationalists to even think in this way.
nopie
1yr ago
The Cochrane report came out just now but the policy for mask mandates was made without it. The policy was wrong not because in hindsight we have the report but because it encroached on our freedoms without sufficient evidence that it was necessary.
nopie
1yr ago
The problem with “let's try masks because they might help” is that there are countless potential interventions without any benefit. For example, you could regulate humidity in buildings because the belief is that dry air favours viral adhesion to airways. It would be moderately expensive but the evidence that it would help with anything is zero.
Most of low-hanging fruit in public health is already picked and any progress towards better medicines is painstakingly slow and requires good and thorough evidence. It is ok to be sceptical of any media reports about new game-changing drugs or interventions. Only very few of them will be finally approved and even fewer of them will have good effectiveness.
nopie
1yr ago
Maybe masks filter things efficiently (just for the sake of argument) but it doesn't matter in practice because people cannot wear them 24 hours without stop and will get exposed to unfiltered air at some time. If the end result is that mask wearers get respiratory infections at almost the same rate as the rest, what is the point?
Also we are supposed to see the big picture, not just some technical point. Mask mandates would be wrong even if they were effective.
nopie
1yr ago
I decided not to wear masks because I had no evidence that I could trust. Sometimes I was wearing masks anyway because the state compelled me.
I was ok with taking first 2 covid shots because I trusted the evidence that I had about its effectiveness. I did not trust the evidence about booster shot effectiveness but took it anyway because the state required it for me to travel within the EU. I didn't take any subsequent boosters because the state didn't require them and I didn't trust the evidence.
That's how I operate. I don't understand about rolling a die. I can trust the evidence of the medicine with understanding that it is not 100% certainty. Especially if I know that the medicine works, for example, in 80% or 60% people taking it.
Medical decisions are not black swans because they are completely different things. Black swans are unpredicted events. Medical decision is not an event but a decision. I don't know how to compare them.
nopie
1yr ago
No, my medical decisions are not like asking a woman out.
Of course, you can make them like rolling a dice but that's not the best way. The whole medical history has led us to this point that we don't.
nopie
1yr ago
No, I need something to trust before I make a voluntary decision.
I mean, I can be forced to make a decision. If someone threatens me, I would comply. But to make a decision, for example, get a covid booster or not, is based on my understanding and trust in the benefit or absence of any benefit.
nopie
1yr ago
Probably not. Ukrainians would have started resistance and it would be very bloody and violent.
I would expect every country to fight if its existence was threatened, and asking for help is just natural too.
I don't see how Ukraine successfully fighting back Russian aggression escalates anything though.
nopie
1yr ago
That doesn't always work because you have to make decisions sometimes. For example, to get covid vaccine or not. You may not trust doctors but without vaccine you could be fired from your job. That would make you even less to trust doctors even if you don't trust antivax particularly. Not an easy decision to make.
nopie
1yr ago
To be honest, I don't know how to classify your message. Scott has written a long article that media rarely lies. I believe that this is also not a lie. However, thinking that the whole medical establishment just haven't used this wonderful treatment method out of ignorance is too far fetched. It took time to realize that overactive immune system is killing covid patients but by now we have several approved monoclonal antibodies to treat exactly that. It helps in some cases but overall it is not only about the effectiveness of the drug but diagnosing that it is exactly the case of overactive immune system causing damage in particular cases and the timing etc. Medicine is very complex.
Just because you criticized rationalist community now will not get you any points from me. Rationalists may be sometimes misguided but they are not that bad to believe any story like this without more evidence.
No, we don't know if ngoko bean extract don't cause harm. They could easily make psoriasis actually worse.
It is unbelievable today but merely 50 years ago cigarettes were recommended for treating asthma and were sold by pharmacists. Today we know that cigarette smoke actually harm airways and make asthma attacks worse.
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