Quotulatiousness

November 9, 2022

Liberal political fortunes ride “especially women in the suburbs of the Greater Toronto Area” … and those women are angry right now

Filed under: Cancon, Economics, Health, Media, Politics — Tags: , , , , , , — Nicholas @ 03:00

In The Line, Ashley Csanady has some advice for Justin Trudeau in the lead-up to the next federal election that he really needs to pay attention to:

Poll after poll has told us the Liberals lost white male voters a long time ago, and their electoral fortunes, especially in Quebec and suburban Ontario, rely on women, especially women in the suburbs of the Greater Toronto Area. This isn’t to say dads and other caregivers aren’t angry. Families take many shapes and anyone with small people at home has faced the same indignities over the past nearly three years. However, politically and demographically, it’s the Ontario moms who are going to make or break the next election. And when folks are angry, it doesn’t matter who the incumbent is, they are wont to vote them out.

Nor is it not just about the children’s pain meds.

It’s about the fact we can’t find antibiotic eye drops over-the-counter either (a shortage one pharmacist told me is even worse than the one for pain and fever meds for the wee ones). Another shortage that means we must then turn to an already over-burdened health-care system to get a prescription for a medicine that may or may not be in stock.

Oh, and if that respiratory virus going around turns nasty, we aren’t even certain there will be a hospital bed for our babies when they need it most.

Then there is the infuriatingly slow roll-out of affordable childcare in this province. Parents once again caught between the feds and the province in a battle that may drag out the process so long that many expecting relief will see their kids off to junior kindergarten before it arrives.

Grocery bills are skyrocketing, and while I admit I’m privileged enough to absorb the eye-popping increases, so many families simply cannot. Imagine telling a picky toddler they can’t have their favourite snack because you can’t afford the crackers.

Now, Ontario moms had to deal with yet another disruption to their kids’ schooling, which threw their work lives into chaos once again. More disruptions are possible should bargaining fail again. This just after many women who left the workforce or took a step back from their careers during the pandemic were just getting back into the swing of things.

I made this point — that Ontario moms are angry and much of that anger is directed at political leaders, but I don’t expect it to fall on Ontario Doug Ford — on Twitter a couple weeks back. For this, I was “reminded” — more like chided — that many of these challenges are Mr. Ford’s fault. Or global challenges no logical person could blame the prime minister for. The partisans in my mentions were right on both counts. But here’s what they got wrong:

It doesn’t matter if I’m being “unfair” to Mr. Trudeau, because politics is unfair.

And as for Mr. Ford’s share of the blame, voters punish who’s up next at the ballot box, especially in a crisis. They had a chance to take out their rage on the PCs in June. They didn’t. So who does that leave up next?

October 20, 2022

QotD: “Medical gaslighting”

Filed under: Bureaucracy, Health, Quotations, USA — Tags: , — Nicholas @ 01:00

“Medical Gaslighting” Is The New Term For When Doctors Tell People There’s Nothing Wrong With Them: “Medical gaslighting” is common, especially among women.

Of course, sometimes doctors will be wrong, because in my experience most of them are not great diagnosticians. And it will usually involve women because women visit doctors with complaints much more often than men. But “medical gaslighting” imports a notion of bad faith instead of error. It’s the medical version of “believe all women”, and you know how well that turned out …

Glenn Reynolds, Instapundit, 2022-07-17.

September 10, 2022

“Things have gone horribly wrong in American medicine; for example, ‘physicians are sharing ideas'”

Filed under: Bureaucracy, Government, Health, Science, USA — Tags: , , , , — Nicholas @ 03:00

Chris Bray on the American healthcare system’s descent into not just “rule by experts” — which you rather expect for a field like medicine — but the far worse “rule by government-approved experts”:

Our $3.7 trillion medical system is characterized by its fragility, the narrative says, with patients who can’t get treatment and doctors who can’t learn. So what’s gone wrong? Here’s the headline, with a whole universe of silly assumptions baked into every word:

Things have gone horribly wrong in American medicine; for example, “physicians are sharing ideas”.

I’m just taking a moment to stare at my own sentence. Be right back.

Anyway, medicine is broken — doctors are thinking. Sick people show up to see them, and they try to figure it out themselves by using, like, evidence and diagnostic practice and their medical knowledge. Lacking government directives, physicians are living with a horrible system in which they have to assess sick people and come up with their own answers about their illnesses and the best course of treatment. And so, Politico reports, networks of doctors are gathering to share data and work collaboratively, a sure sign that things have gone horribly wrong:

    While the network is helping patients and doctors navigate the disease’s uncharted waters, long Covid doctors say there’s only so much they can do on their own. The federal government should be doing more, they say, to provide resources, coordinate information sharing and put out best practices. Without that, the doctors involved fear the condition, which has kept many of those afflicted out of the workforce, threatens to spiral.

Imagine what doctors will be like after two more generations shaped by the assumption that the federal government is the only proper source of “best practices”. The pathologization of socially and institutionally healthy behavior — professionals, confronted with a new problem, work together to gather evidence so they can analyze and apply it — speaks to the ruin inflicted by the pandemic, by the federal funding and steering of science, and by the Saint Anthonying of medicine: If government doesn’t tell you how, you can’t possibly know how. You expect your doctor to use a lifetime of education and experience to figure out what’s wrong with you; Politico expects your doctor to apply the government guidelines, but finds to its alarm that the government doesn’t offer any. How can you make a sandwich if the government hasn’t published a protocol on the application of condiments?

If you’ve felt rigidity and a lack of productive exchange in your conversations with your own doctor, we may have a suggestion here about the why part. I can’t assert that with total confidence, because the federal government hasn’t provided me with an analytical framework.

And so the debilitation of people who should have professional knowledge and competence becomes normal and expected. A scientist is someone who gets checks from the NIH, unless the scientist is one of the other kind and gets checks from the NSF, and ideological compliance is part of the deal. A doctor is someone who applies the government protocols. Federal agencies wear your doctors like a skin suit, and apply their medical solutions through the hands of others. If that’s not how it works — if your doctor works in creative and thoughtful ways to make sense of an illness and provide an effective treatment — something has gone wrong.

August 29, 2022

“Follow the science!”, “No, not like that!”

Filed under: Government, Health, Media, Science, USA — Tags: , , , , , — Nicholas @ 05:00

Chris Bray recounts his experiences when he “followed the science” over the Wuhan Coronavirus:

It’s happening again, and so is the response. It’s becoming our one persistent cultural cycle.

During the first availability of the Covid-19 “vaccines” — which don’t prevent transmission or infection, but we changed the meaning of that word, so shut up shut up shut up — I did what I usually do: I thought about the past to try to make sense of the present. If we’ve instantly produced safe and effective vaccines for SARS-CoV-2, I wondered, why didn’t we do the same for SARS-CoV-1? It took less than five minutes to answer that question:

So scientists did come up with a vaccine for SARS-CoV-1, but when they gave it to animals, it made the animals extremely susceptible to severe illness when they were “challenged” with the virus again — “suggesting hypersensitivity to SARS-CoV components was induced”. And so, the authors of that 2012 paper argued, “Caution in proceeding to application of a SARS-CoV vaccine in humans is indicated.”

Because I believe in science, I followed that advice, and I told my doctor that I was following that advice — and that I wasn’t terribly concerned about Covid-19 anyway, so whatever. I would be cautious about injecting a novel medical product into my body: I would wait, calmly. She assured me that there was no scientific shortcutting at all in the development of the vaccines for SARS-CoV-2, which were absolutely known to be 100% safe and effective, but she also agreed that there was nothing wrong with watching and waiting for a few months.

I meant it. At that point, I hadn’t refused the vaccines — I had just decided that I would wait for a bit to see how they played out once they’d been injected into a few billion human lab rats.

And then the shaming started. I was uninvited from a family event, and ordered to stay away — and then, after a short pause, repeatedly shamed by email as a disgusting selfish pig who made the family sick with my ignorance and selfishness. (Distant family, thankfully.) The public sphere came alive with this message, and Joe Biden let me know that his patience was wearing thin for my kind. Social media was a daily fear bath, and consumed with shaming rituals.

It was exactly that message that turned my skepticism, my preference for watching and waiting, into a flat and permanent refusal. People said they were talking about science — in a vicious flood of hyperemotional shaming language, the hysterical tone and substance of which made it clear that they weren’t talking about science at all. They were talking about their fearfulness and their weakness; they were talking about their cowardice, and about the shame they felt at finding their fear of the air wasn’t shared. The shaming made me contemptuous; it secured my commitment to resist.

So now comes a new flood of shaming messages, assuring people that mere political disagreement is a sure sign of monstrous cruelty and hate.

August 20, 2022

Yes, you will end up owing your conspiracy theorist friend an apology at this rate …

Filed under: Government, Health, Media, Politics — Tags: , , , , , — Nicholas @ 05:00

Chris Bray re-enacts a few of the minor erasures, walk-backs, and out-and-out lies coming from organizations who’ve spent the last two-plus years spreading a line of medical “truth” that, day-by-day, appears a bit less “truth-y” all the time:

I can’t get this attack on Dr. Ryan Cole out of my head:

What’s becoming very clear is that the narrative is going to shift by inches, eventually ending up at the place where mRNA dissenters started, but. Let’s get through the first part, and I’ll get to that but in just a moment. Look at, for example, the recent stealth-edit on the CDC website that quietly removed the assurance about the spike protein from mRNA injection leaving your body in a hurry. So on Monday it’s disinformation to falsely claim that the spike protein lingers in your body, and you’re a dangerous extremist if you say it; on Tuesday, the simple fact of lingering spike protein was always known and never contested. That’s DISINFORMA— hold on, I’ve just been handed a new memo.

This is going to keep happening, in little pieces that move toward reality. There are ZERO mRNA deaths, you lying idiots, and you need to stop spreading disin— uh, hold on, it says here that, uh …

In a year, or in five years, the things that Ryan Cole and Clare Craig and Peter McCullough and Tracy Beth Hoeg and Robert Malone and all the other MONSTERS have been saying will be validated and acknowledged. We’ll know that the mRNA injections caused heart damage and a cancer spike, and we’ll know that mRNA-injected people get sick more often than the dirty unvaccinated. Look at the matter-of-factness with which Deborah Birx says that oh yeah, I always knew these vaccines — vaccines! — weren’t going to prevent infection. A year before she shrugged and said she’d always known that, you would have lost your social media accounts for saying exactly what she just said. Yesterday’s idiotic conspiracy theory disinformation nonsense is today’s “yeah, we always knew that”.

Now, here’s my big but: The narrative is going to turn, in a long series of tiny and unacknowledged shifts, until it matches what the heretics have always been saying — but my bet is that the heretics will not be rehabilitated. Ryan Cole, to stick with the opening example, will be proven correct, but he will not be vindicated. The YOU CAN’T SAY THAT, IT’S DISINFORMATION oh wait it’s totally true maneuver doesn’t rehabilitate the crimethinkers. You can think X when it’s time to think X; if you think X too early, you remain a thought criminal.

The truthtellers in medicine will be proved correct, but they’ll still be resented and excluded.

August 9, 2022

When asking a simple, factual question is treated as a direct personal attack

Filed under: Books, Bureaucracy, Government, Health, Media, Politics, USA — Tags: , , , , , — Nicholas @ 05:00

Chris Bray explains why just asking for [certain] facts is enough to trigger people who think you’re somehow saying that they’re not “good people”:

Come back to the cultural sewer with me, just for a moment, because here’s the last time I’ll lay a quote on you from Klaus Schwab’s COVID-19: The Great Reset, from a discussion about public health measures to contain the pandemic:

    This is ultimately a moral choice about whether to prioritize the qualities of individualism or those that favour the destiny of the community. It is an individual as well as a collective choice (that can be expressed through elections), but the example of the pandemic shows that highly individualistic societies are not very good at expressing solidarity.

Now: Pharmaceutical products sometimes fail, and sometimes cause serious harm, and it frequently takes a while for reality to get out of the dugout and take the field, so keep taking your FDA-approved Vioxx. It’s safe and effective! I rarely give up on books, but I gave up on Ben Goldacre’s 2012 book Bad Pharma about halfway through — for the same reason you’d stop eating a skillfully prepared shit sandwich. I felt like, yes, I get the point: Sometimes a drug is ineffective, sometimes a drug is outright harmful, and the manipulation of science and of regulatory agencies is more common than you would ever have wanted to know.

But it’s different this time, even while “this time” fits a very long pattern. As much as Big Pharma course corrections are always hard, this one will be infinitely harder. We’re not currently debating the efficacy of a pharmaceutical product, or of a class of pharmaceutical products; instead, we’re debating self-conception, social status, and cultural position. The claim “I don’t think these mRNA injections are as safe as they’ve been made out to be” is a character attack that threatens to take people out at the core like dynamite under a bridge: Are you saying I’m not a good person?

Bad Cattitude has been on fire lately on the topic of elite self-hypnosis and the descent into an “entirely hallucinatory landscape”. Consistent with this shrewd feline analysis, look again at what Klaus Schwab said about lockdowns and the suppression of economic activity in the name of public health: He said that shutting down our open societies was a “moral choice” about “expressing solidarity”. (My mask is for you, your mask is for me!) The discussion isn’t about what works, and has never been about what works. It has never been a discussion about the efficacy of anything; it’s a posture about social character, and always has been. Are you a bad, selfish person, or are you a good person who believes in kindness? The subtext about social class strikes me as too obvious to explicate, because mean people belong in their trailer parks in flyover country, and kind people are high-status. Review the lawn signs if you doubt this.

So when you question the little vial of fluid that goes into a syringe to be injected into your body, you’re not asking questions about the way a medical product works — or at least, you’re not asking questions that are perceived, by advocates of the injections (or the lockdowns, or the masks), as a discussion about safety and efficacy. You say, “Does it work? Is it safe?” — but they process it as an attack on their moral choice to express solidarity:

Are you saying we should have stood up for selfishness? Which means, if we bring the subtext to the surface, Are you saying we should have engaged in low-status behavior?

May 20, 2022

QotD: Credentialism

Filed under: Bureaucracy, History, Quotations — Tags: , , — Nicholas @ 01:00

The minute a profession starts thinking of itself as a profession it’s finished, because henceforth “actually doing the job” will come second to “advancing the guild’s interests”. Not for everyone, of course. Most doctors, I imagine, just want to practice medicine. They probably even feel they’d be much better off without the elaborate apparatus of “the profession” — the American Medical Association, their specialty associations, the unique social status of “being a doctor” (there are a lot more downsides than upsides to this, if you really think about it). They no doubt feel this … until someone outside of it starts badmouthing the guild, or someone inside causes the profession to lose standing. Then they close ranks.

The reason for this — if you want to slap an academic-sounding label on it — is “the reification of the bureaucracy”. Even if 99 out of 100 doctors, say, just want to practice medicine, there’s that last guy who makes “being a doctor” his life’s work. He joins all the associations, and because that kind of guy is basically just Trigglypuff with better hygiene and lower BMI, he quickly rises to a position of influence in every organization. He lives for the bureaucracy. Which means he’s a politician, and there it is.

If you want more examples, look no further than the original guilds, the craft associations of the Middle Ages. Any settlement big enough for actual cash money to change hands in it soon had an exquisitely class-conscious group with lots of actual, but no formal, power. Your smart tyrant co-opted the politicians from the merchant guilds, made them de facto nobility and bade them act like it — that gave you the Renaissance. Your dumb (or merely nonexistent) tyrant let the merchants’ resentments fester — that gave you the Reformation, and the whole catalog of ideological murder that followed.

Severian, “Credentialism Ruins Everything”, Rotten Chestnuts, 2019-03-22.

May 2, 2022

Rome’s Wonder Medicine: Cabbage

Filed under: Europe, Food, History — Tags: , , , , — Nicholas @ 02:00

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December 10, 2021

QotD: The media and the replication crisis

Filed under: Health, Media, Quotations, Science — Tags: , , , , — Nicholas @ 01:00

Here is the iron law of medical — in fact all scientific — studies in the modern world: most do not replicate. This has always been true of studies that supposedly find some link between doing [thing we enjoy] and cancer. This of course does not stop the media from running with initial study results based on 37 study participants as “fact”. The same is true for studies of new drugs and treatments. Most don’t pan out or are not nearly as efficacious as early studies might indicate. We have seen that over and over during COVID.

Warren Meyer, “A Couple of Thoughts on Medical Studies Given Recent Experience”, Coyote Blog, 2021-08-31.

October 6, 2021

Did Penicillin Win World War Two? – WW2 Special

Filed under: Britain, Health, History, Military, Science, USA, WW2 — Tags: , , , , — Nicholas @ 04:00

World War Two
Published 5 Oct 2021

We all know that penicillin is a wonder drug, it shortened the war, and assured Allied victory. Or did it, is that just a myth? The Allies are certainly much further ahead than the Axis, but even with accelerated wartime development, will it come into service quick enough to make a difference?
(more…)

August 7, 2021

Ancient and medieval medicines

Filed under: Europe, Health, History — Tags: , , — Nicholas @ 03:00

In the latest Age of Invention newsletter, Anton Howes considers the medicinal knowledge of our ancestors and suggests that the mockery we usually heap on them is at least somewhat misplaced:

Portrait of Aelius Galenus or Claudius Galenus, generally known as Galen of Pergamon from The Lancet.
Engraving by Georg Paul Busch via Wikimedia Commons.

We’re very used to mocking the obscure-sounding remedies of our distant ancestors. It’s hard to take them seriously when their go-to remedies were to remove some blood or take a horoscope. Or, if you were wealthy, to swallow concoctions containing emeralds, sapphires, or obscure animal parts. With the benefit of hindsight, the trajectory of medical improvement seems obvious and linear, as we became attuned to the benefits of hygiene, introduced anaesthetics, and identified the real causes of disease.

But in some ways hindsight is misleading. Our ancestors may not have always understood why things worked, but they were often surprisingly good at finding things that actually did work — but which were discarded prematurely by the onward march of science, when everything we thought we knew was put to the test. Some sixteenth-century alchemy actually got results. The mechanical ventilation of confined spaces, albeit invented by following the erroneous idea that noxious airs caused disease, appears to have inadvertently saved lives. And long before germ theory became the dominant model of disease, many cities on the Mediterranean had special areas or islands — Lazarettos — to quarantine arrivals from plague-ridden ports.

Even the most outrageous of remedies could have something to them. Physicians once prescribed mercury to treat syphilis, effectively the HIV/AIDS of the early modern world, which in the late eighteenth century may have affected one in five Londoners. But mercury, albeit poisonous, appears to have worked along the same lines as chemotherapy, hopefully killing the disease before the cure killed the patient. It could be effective, though probably only under certain conditions. In the 1880s mercury was switched out for bismuth salts, which worked similarly — bismuth is a heavy metal, but far less toxic to humans than it was to the disease. Even the anti-syphilitic wonder drugs of the early twentieth century, Salvarsan and Neosalvarsan, were toxic compounds of arsenic, albeit far less unpleasant. Treating the disease successfully was often a matter of picking the right poison.

Syphilis, along with a host of other bacterial diseases, was finally conquered with the use of newly-discovered antibiotics like penicillin in the 1940s. But antibiotics actually have a much longer history — even if nobody understood how exactly they had worked.

May 25, 2021

QotD: Doctors and individual freedom

Filed under: Government, Health, Liberty, Quotations — Tags: , , — Nicholas @ 01:00

The medical attitude, and the reason why doctors are so vulnerable to this anti-liberty political agenda, is that doctors typically see people at their weakest, at times when they are positively begging to be told what to do by the god-almighty doctor. Doctors are thus pre-disposed to neglect the distinction between them advising people what to do, and simply telling them, for their own good.

Brian Micklethwait, “Curbing liberty — except when they should”, Samizdata, 2005-10-10.

April 10, 2021

Galen of Pergamon

Filed under: Europe, Health, History, Science — Tags: , , — Nicholas @ 03:00

Scott Alexander asked some of his readers to submit book reviews that he’ll be publishing anonymously to allow the rest of the readership to vote on. Friday’s submission was a review of the work of Galen of Pergamon … to help determine if he deserves all the kicks he’s received from other writers over the last two millennia:

Portrait of Galen from The Lancet.
Engraving by Georg Paul Busch via Wikimedia Commons.

Aelius Galenus or Claudius Galenus (henceforth “Galen”) was born in Pergamon, a town in modern-day Turkey, in 129 CE. At the time, it was a part of the Roman empire, and a major intellectual center. Galen’s father was an architect; while rich, he was not considered to be particularly high status. Since there was little pressure for his son to go into a traditional career, instead of the “safe” subjects of literature and rhetoric that most Romans studied, Galen got an unusual education in mathematics and geometry.

(His father’s patient encouragement has its foil in his mother, who “flew into rages and bit her servants, a practice of which Galen disapproved.”)

When Galen was a teenager, however, his father had a dream where the god of medicine appeared and told him that his son should study medicine, so Galen started training as a doctor.

During this training Galen became familiar with the writings of Hippocrates, who had lived about 600 years earlier. Hippocrates had introduced the idea of the four humors to medicine — four fluids that congeal together to form our flesh and organs, and which co-mingle in our veins in their liquid form. Hippocrates came up with this system, but Galen would be the one to make it world-famous.

I could try to describe the theory myself, but actually Hippocrates does a great job on his own:

    The Human body contains blood, phlegm, yellow bile and black bile. These are the things that make up its constitution and cause its pains and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with others.

All disease and illness, in this system, were the result of an imbalance in the four humors. From this perspective, treatments like bloodletting make perfect sense. By opening up the veins, the excessive humors drain away, leaving the patient more balanced — in better humors.

Long-term trends towards any of the humors were responsible for what we would call personality. Hence the terms sanguine, phlegmatic, melancholy and so on for different personal traits and emotional conditions.

This is the theory that he would put his weight behind, and which he would eventually be responsible for bringing to the majority of the western world.

When Galen was 19, his father died, leaving him independently wealthy. Hippocrates wrote that a good doctor should travel, so Galen ended up spending a decade studying with medical experts from various schools in cities all around the Mediterranean, including Alexandria.

After this, he came back to Pergamon where he got a job as the doctor treating the gladiators of the city. This was an unusual step for someone of his wealth and education, because despite their popularity as a form of entertainment, gladiators at the time were considered extremely low-class.

It’s not clear why he took this job, but it seems likely that it influenced how he thought about medicine. Spending long hours stitching gladiators back together gave him a detailed knowledge of human anatomy, which other doctors of the time lacked. It sounds like he did a great job, too, because only five of the gladiators died during his time there — compared to 60 under the guy who had the job before.

Eventually all roads lead to Rome, of course, and Galen arrived in 162 CE. His lectures and demonstrations made such an impression, and ruffled so many feathers, that he was afraid of getting poisoned by the Roman doctors and eventually left to save his life. In 169 CE, however, a great plague (probably smallpox) broke out, and Marcus Aurelius summoned him back to Rome to serve as court physician. Marcus Aurelius died the next year (according to some sources, of the plague), but Galen ended up with a longterm post in Rome as physician to the new Emperor, Commodus.

Galen himself died some time between 199 and 216 CE, at the the ripe old age of between 70 and 87.

February 6, 2021

“WebMD is the Internet’s most important source of medical information. It’s also surprisingly useless”

Filed under: Bureaucracy, Health, Technology, USA — Tags: , , , , — Nicholas @ 05:00

Scott Alexander discusses why WebMD is not the be-all and end-all of internet medical resources:

WebMD is the Internet’s most important source of medical information. It’s also surprisingly useless. Its most famous problem is that whatever your symptoms, it’ll tell you that you have cancer. But the closer you look, the more problems you notice. Consider drug side effects. Here’s WebMD’s list of side effects for a certain drug, let’s call it Drug 1:

    Upset stomach and heartburn may occur. If either of these effects persist or worsen, tell your doctor or pharmacist promptly. If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, difficulty hearing, ringing in the ears, signs of kidney problems (such as change in the amount of urine), persistent or severe nausea/vomiting, unexplained tiredness, dizziness, dark urine, yellowing eyes/skin. This drug may rarely cause serious bleeding from the stomach/intestine or other areas of the body. If you notice any of the following very serious side effects, get medical help right away: black/tarry stools, persistent or severe stomach/abdominal pain, vomit that looks like coffee grounds, trouble speaking, weakness on one side of the body, sudden vision changes or severe headache.

And here’s their list of side effects for let’s call it Drug 2:

    Nausea, loss of appetite, or stomach/abdominal pain may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. This medication can cause serious bleeding if it affects your blood clotting proteins too much. Even if your doctor stops your medication, this risk of bleeding can continue for up to a week. Tell your doctor right away if you have any signs of serious bleeding, including: unusual pain/swelling/discomfort, unusual/easy bruising, prolonged bleeding from cuts or gums, persistent/frequent nosebleeds, unusually heavy/prolonged menstrual flow, pink/dark urine, coughing up blood, vomit that is bloody or looks like coffee grounds, severe headache, dizziness/fainting, unusual or persistent tiredness/weakness, bloody/black/tarry stools, chest pain, shortness of breath, difficulty swallowing.

Drug 1 is aspirin. Drug 2 is warfarin, which causes 40,000 ER visits a year and is widely considered one of the most dangerous drugs in common use. I challenge anyone to figure out, using WebMD’s side effects list alone, that warfarin is more dangerous than aspirin. I think this is because if WebMD said “aspirin is pretty safe and most people don’t need to worry about it”, people might use aspirin irresponsibly, die, and then their ghosts might sue WebMD. Or if WebMD said “warfarin can be dangerous, be careful with this one”, people might refuse to take warfarin because “the Internet said it was dangerous”, die of the stuff warfarin is supposed to treat, and then their ghosts might sue WebMD. WebMD solves this by never giving the tiniest shred of useful information to anybody.

This is actually a widespread problem in medicine. The worst offender is the FDA, which tends to list every problem anyone had while on a drug as a potential drug side effect, even if it obviously isn’t. This got some press lately when Moderna had to disclose to the FDA that one of the coronavirus vaccine patients got struck by lightning; after a review, this was declared probably unrelated. For the more serious version of this, read Get Ready For False Side Effects. Why does the FDA keep doing this if they know it makes their label information useless? My guess is it’s because they don’t want to look like cowboys who unprincipledly consider some things but not other things. What if someone accused the person deciding what things to consider of being biased? So the FDA comes up with a Procedure, and once you have a Procedure it has to be “take everything seriously”, and then it falls on random small-fry people who aren’t the FDA to pick up the slack and explain which side effects are worth worrying about or not, and then those small fries don’t do that, because they could get sued.

I think the same concern motivates WebMD diagnosing everything as cancer. If they said something other than cancer, then people might sigh with relief, not bother to get a cancer screening, die from some weird cancer that doesn’t present the way normal cancers do, and then their ghosts might sue WebMD.

Of course, WebMD and other online medical information sites didn’t invent hypochondria, they merely made it easier to do to yourself what Jerome K. Jerome did one fine London morning in 1888:

I remember going to the British Museum one day to read up the treatment for some slight ailment of which I had a touch — hay fever, I fancy it was. I got down the book, and read all I came to read; and then, in an unthinking moment, I idly turned the leaves, and began to indolently study diseases, generally. I forget which was the first distemper I plunged into — some fearful, devastating scourge, I know — and, before I had glanced half down the list of “premonitory symptoms,” it was borne in upon me that I had fairly got it.

I sat for awhile, frozen with horror; and then, in the listlessness of despair, I again turned over the pages. I came to typhoid fever — read the symptoms — discovered that I had typhoid fever, must have had it for months without knowing it — wondered what else I had got; turned up St. Vitus’s Dance — found, as I expected, that I had that too, — began to get interested in my case, and determined to sift it to the bottom, and so started alphabetically — read up ague, and learnt that I was sickening for it, and that the acute stage would commence in about another fortnight. Bright’s disease, I was relieved to find, I had only in a modified form, and, so far as that was concerned, I might live for years. Cholera I had, with severe complications; and diphtheria I seemed to have been born with. I plodded conscientiously through the twenty-six letters, and the only malady I could conclude I had not got was housemaid’s knee. […] I had walked into that reading-room a happy, healthy man. I crawled out a decrepit wreck.

February 4, 2021

QotD: The (as-yet-unfulfilled) promise of “personalized medicine”

Filed under: Health, Quotations, Science — Tags: , , , — Nicholas @ 01:00

A more useful lesson might be skepticism about personalized medicine. Personalized medicine – the idea that I can read your genome and your blood test results and whatever and tell you what antidepressant (or supplement, or form of therapy) is right for you has been a big idea over the past decade. And so far it’s mostly failed. A massively polycausal model would explain why. The average personalized medicine company gives you recommendations based on at most a few things – zinc levels, gut flora balance, etc. If there are dozens or hundreds of things, then you need the full massively polycausal model – which as mentioned before is computationally intractable at least without a lot more work.

(You can still have some personalized medicine. We don’t have to know the causes of depression to treat it. You might be depressed because your grandfather died, but Prozac can still make you feel better. So it’s possible that there’s a simple personalized monocausal way to check who eg responds better to Prozac vs. Lexapro, though the latest evidence isn’t really bullish about this. But this seems different from a true personalized medicine where we determine the root cause of your depression and fix it in a principled way.)

Even if we can’t get much out of this, I think it can be helpful just to ask which factors and sciences are oligocausal vs. massively polycausal. For example, what percent of variability in firm success are economists able to determine? Does most of the variability come from a few big things, like talented CEOs? Or does most of it come from a million tiny unmeasurable causes, like “how often does Lisa in Marketing get her reports in on time”?

Maybe this is really stupid – I’m neither a geneticist or a statistician – but I imagine an alien society where science is centered around polycausal scores. Instead of publishing a paper claiming that lead causes crime, they publish a paper giving the latest polycausal score for predicting crime, and demonstrating that they can make it much more accurate by including lead as a variable. I don’t think you can do this in real life – you would need bigger Big Data than anybody wants to deal with. But like falsifiability and compressability, I think it’s a useful thought experiment to keep in mind when imagining what science should be like.

Scott Alexander, “The Omnigenic Model As Metaphor For Life”, Slate Star Codex, 2018-09-13.

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