I completely agree. I work in computational neuroscience, and the memristor was basically the last thing left that brains can do that can't be implemented in silicon. Neuromorphic analog VLSI circuits are going to benefit from this a lot. However, there are still a number of issues that might not be trivial to implement, such as competition between different synapses in the same neuron, which are mathematically necessarily to prevent instabilities from occurring. I think the main point is that solving the nonlinear ODEs in the brain numerically, on a digital processor, is very inefficient compared to the brain. However, instantiating them in an analog circuit with internal state variables (i.e. memristor-like devices) will actually be much MORE efficient than the brain. Given that the rate-limiting steps in brain computation are basically stray capacitances dictating the membrane time constants, those stray capacitances are much easier to reduce in analog circuits, so these circuits should be able to operate orders of magnitude faster than biological ones. We'll make great pets someday.
Television shows like House, M.D. always make me chuckle, having been too close to the subject matter for suspension of disbelief to work. When something serious goes wrong with one's body that cannot be diagnosed with first-line test results and (revenue-generating) treatment prescribed in 8.5 minutes, you are no longer an asset to the healthcare industry. You are a liability. There is no genius physician who will ponder over your case in his or her downtime. There are no attractive residents who will hold conferences in well-appointed conference rooms where they will discuss your case and argue over the possible diagnoses on whiteboards and through video teleconferencing.
I'm sorry that your experience with medical care has left you so jaded, but the truth is that this sort of thing happens a lot more than you know, especially at academic hospitals. Most people who go into medicine are interested in the mystery cases, and if anything, I feel like the truth is the very opposite of what you're saying: people with simple presentations that look like routine cases often aren't given enough attention, and the mystery cases are ruminated over far beyond the point where anything productive results from it. The thing about House, MD that makes me chuckle is how bad the physicians on the show are. I guess that's part of the plot, though, that they can't make the diagnosis in the beginning, or else there wouldn't be a show.
As a physician, I agree with you that learning good people skills is a critical skill for most physicians. However, I think the whole situation is more complicated than you seem to acknowledge. First, there can be technically incompetent physicians who miss diagnoses or prescribe outdated treatments, but they're loved by their patients. On the other hand, I know a few technically excellent surgeons who are total jerks. So I agree with you that people skills and clinical skills are not totally separate and distinct, but they're not totally inseparable either. However, technical incompetence is a more serious problem than poor people skills. I agree, a doctor with poor people skills will never be truly excellent. But a technically incompetent doctor kills people.
A second, more subtle, issue is that sometimes being a good doctor requires you to do things that will make your patient unhappy. For example, a good primary care physician will bug his/her patients to quit smoking and lose weight. Those are things that annoy people, and I can tell you from first-hand experience that sometimes it's easier to make the patient happy than it is to do the right thing and come off looking like a bad guy. For example, people come in all the time demanding antibiotics for viral upper respiratory infections. Giving those patients antibiotics is doing them a disservice, as it breeds resistant organisms, but doctors that do it will be more popular, and primary care physicians do it all the time for that reason. Another example is building false hope in patients with a poor prognosis. As far as I'm concerned, that sort of pandering is cowardice pure and simple, but physicians are human too, and it's hard to be the bad guy.
Finally, posting random stuff on a web site is just not a reliable way to evaluate anyone. Mostly you'll just get a few posts from a tiny, disgruntled fraction of the patients a doctor sees. And in most of those cases, the complaint says more about the patient than the doctor. In fact, having more complaints most likely reflects the fact that the doctor is willing to accept more difficult patients, the same way that many surgeons with low success rates are the ones willing to accept the toughest cases. I agree that it's silly to try to make patients sign agreements that they won't post online, but it's even more silly to take online posts seriously.
"I can't tell you how tired I am of people getting modded insightful for misunderstanding then regurgitating something that most people who discuss this subject should understand at a base level." That's the part you should have been paying attention to, you totally missed my point.
I understood your point, but you missed mine. You may understand these issues on a level higher than the original poster, and sufficiently high to get modded up on/., but not on a level that is sufficient. In practice, controlling for confounding variables assumes that 1) those variables are measurable 2) you have a large enough sample size to be able to control for them without losing all statistical power, and 3) the method used to control will not introduce artifacts. There are plenty of correlational studies demonstrating all kinds of things, like correlations between diet soda and obesity, or daily multivitamin use with early death. Correlational studies on breastfeeding that attempted to control for every possible variable continued to show dramatic health benefits that were not replicated in randomized prospective trials. This stuff is all highly nontrivial--professionals have difficulty designing even randomized prospective trials that control for everything properly. You seem to think the original poster was wrong and you are right merely because you understand the concept of controlling for confounding variables. However, that's not worth much if it can't be performed in practice.
The real question is, how much of the health benefit of vegetarianism is actually due to diet, and how much is due to confounding variables? I would be willing to bet that vegetarians are wealthier and more educated than the average person, they probably exercise more, they probably see their doctor more often and don't "forget" to take their pills as often, etc.
I'm sorry, you're being somewhat inappropriately hostile. What you're saying is partially true in theory, but the problem with a study like this is that one would expect so many confounding variables a priori that no one could realistically hope to control for all of them in practice. I suppose they could get the easy ones...like gender. Or age. Or income. But really, it doesn't matter whether the original poster knows what confounding variables were controlled for...in practice, no amount of statistical analysis would turn any correlational study like this into convincing evidence of causation. Note that I'm not saying that there isn't causation going on, only that a study like this is unable to provide convincing evidence, particularly with the strong prior suspicion of confounds that are difficult to control for (e.g. personality traits). It may be true that stating "correlation is not causation" is not particularly insightful, but at least it's true. Most things people spout aren't even correct, so I don't think you should be complaining.
nobody has ever come up with anything that works better
I think it depends how you define "better." Wikipedia has a lot of advantages, with the primary one being that it covers such a wide range of topics. However, for more specialized topics, other models may work better. Scholarpedia is a good example of this. It's based on wikipedia, except with named curators who are experts in their field assigned to control individual pages. It doesn't have the breadth of wikipedia, and it doesn't claim to, but for what it does cover it's a superior resource.
What people obsessed with robotics forget is how limited a robot is compared to a human. Robots are fine when everything runs as expected, but when things fail, humans can adapt.
What you're forgetting is how much room robotics technology has to expand, as opposed to human space travel technology, which has basically run up against fundamental limits. 50-100 years from now, robots may very well be just as adaptable as a human, but keeping humans alive under such harsh conditions is going to be just as hard as it is today.
Philosophy seeks "truth" - science seeks understanding. Science is horseshoes - a better model wins points, even if it's still not exactly right. Newton's theories are demonstratably wrong (i.e., not the "truth") - but they greatly help me to understand how matter interacts because they are close enough for practical purposes. That's useful!
I think this isn't quite correct. Science seeks "truth" first, understanding second. For example, Newtonian physics is easier to understand than relativity or quantum mechanics, but it isn't as close to experimental observations (i.e. not as "true")...if science were about understanding over truth, modern physics would not have supplanted Newtonian physics, but it has. Science and philosophy have the same goals, but different methods, with the primary difference being that science uses experiments. Of course, the hot new thing in philosophy is "experimental philosophy," which is essentially just studying philosophical questions using science.
The second, more obvious, point is that in general, it's the Christians who think that evolution is non-Christian, not the evolution proponents. The fundamental reason why is because many Christians feel that evolution undermines the basis of the authority of their moral teachings, which is something that I can sympathize with. There are two strategies for Christianity to deal with this: either deny that evolution is true, or restructure the basis of their moral teachings to be compatible with evolution. Unfortunately, evolution is essentially indisputable fact at this point, meaning that Christianity isn't going to be able to take the easy way out, and they're going to have to change with the times in order to survive. This change will be difficult, but the good news is that this is actually going to improve Christianity in the long term.
Abiogenesis is chemistry, correct. But chemistry doesn't define what "life" or "alive" is. And that definition IS what Abiogenesis is.
Speaking as a biologist, I think this statement is exactly incorrect. It's true, life is chemistry. The reason why chemistry does not define what "life" is is because anyone who really understands biochemistry understands that there is no meaningful distinction between "living" chemical systems and "nonliving" ones. The belief that there is some fundamental distinction between the two is called vitalism, and it was discredited a long time ago. Theories of abiogenesis attempt to explain how the chemical reactions we observe in "living" systems arose. Whether you or anyone else considers those chemical reactions to be "living" or not is totally irrelevant. Debating whether something is "alive" or not is similar to debating whether Greenland is a continent or not. It's a pointless, simplistic distinction applied post hoc for the purpose of justifying some sort of nonrigorous internal prejudices.
I can't say whether the drugs are good or bad (just that there is a lot of them and he takes them e-v-e-r-y--d-a-y) but I do know the drugs have changed his brain chemistry forever, I often wonder if the person I grew up with is still in there, occasionally I see a glimpse.
I'm sorry to hear about your situation, and I'm not disagreeing with most of what you're saying, but if someone's had documented manic episodes with psychosis, that's something along the lines of bipolar or schizoaffective disorder, which is an incurable (but treatable) life-long chronic disease that's totally different than major depressive disorder, even though depression is a component in both. Unfortunately, it's unlikely that the personality changes you're seeing are due to the drugs and more likely that you are witnessing the natural progression of the disease itself. I've never met your family member, but I say this because of the many patients I have met, as well as the data showing that the meds actually have a protective effect, slowing disease progression. There is evidence that going off meds and having a psychotic episode can actually cause irreversible brain damage, causing the disease to progress further. The most important thing for him is sticking to the meds religiously, having a regular sleep schedule, strictly avoiding alcohol and recreational drugs, etc. The disease has a strong hereditary component, and the newest data shows that one of the biggest risk factors is advanced paternal age at time of conception. In other words, accumulation of mutations in the sperm are the likely culprit in many cases. Assuming his psychiatrist's diagnoses are correct, he has a serious brain disorder, not simply a poor reaction to emotional stress, and he's lucky to have a supportive relative like you.
There isn't generally any reason why a mild case should be worth the side effects, expense and possible suicide risk of prescribing the pills. I've been a fervent believer for quite a while that unless a person is suicidal or debilitated to the point where they aren't functioning, that they should really think about whether the pills are the right solution or not.
Medication alone is almost never "the solution," but I disagree that such serious dysfunction is the only valid criterion for medication. The side effects of SSRIs are relatively minor, and the suicide risk is overblown. The time of highest suicide risk in depression is after the person hits bottom and starts to get better, regardless of why they start to get better. The data suggests that antidepressants actually decrease overall suicide risk, it's just that they tend to concentrate suicide risk in a certain time window after the person starts to take them (precisely because they're starting to get better). US national suicide rates were falling while SSRI prescriptions were climbing, until the FDA placed the black box warning on them; after that, SSRI prescriptions have been falling, and suicide rates have been going up. My perspective is that mild to moderate cases of depression should be treated with meds and CBT, while serious cases are refractory to meds and require ECT. I guess it depends how you define those words, though.
Szasz is an out-of-date dinosaur, and I don't know anyone well-informed who takes him seriously any more. There is some validity in the idea that some psychiatric "disease" is just the tail end of the curve of normal personality traits, when those personality traits become maladaptive. To some extent, that is culturally dependent. However, the idea that mental disease in general does not exist is simply ridiculous and empirically false. Is autism a disease? What about schizophrenia? We know all of the organs can malfunction, so why would the most complex organ be exempt? Depression, also, is a clear-cut example of brain dysfunction. I wouldn't say that depression is a disease per se, but more of a dysfunctional state. There are almost certainly different disease processes that lead to this dysfunctional state in different patients, but depression itself is unquestionably a very real phenomenon. It is true that some people have personality traits or maladaptive behaviors that may predispose them to depression, the same way that sleep deprivation can predispose to seizures, but that doesn't make the resulting depression or seizures any less real, or any less of a "disease." Also, note that any of the arguments Szasz makes can be applied equally to migraines.
I see how you could have interpreted it that way--that's not what I meant, and I should have worded it more clearly. However, I don't agree with your argument that the numbers show that smoking is relatively safe. If 25% of people smoke, and 20% of all deaths are directly attributable to smoking, then smoking is 80% likely to kill you or someone around you. That's pretty high! In reality, it's lower than that because it's more like 25% of people are smokers at any given time. Lots of people smoke for a while and then quit. If you're a lifelong smoker, the probability of cigarettes killing you is around 50% (I think the probability of getting lung cancer is only around 15%, and the rest of the mortality comes from vascular and pulmonary disease). Second-hand smoke deaths are a small percentage of total smoke-related deaths, being less than 10%, but even in spite of that, they still outnumber car accidents and guns, which I think is insane.
A big difference between being addicted to an iPhone and being addicted to tobacco is that iPhones do not kill you. 1/5 of all deaths in the US are directly attributable to tobacco, even though only 1/4 of people smoke. Second-hand smoke kills more people in the US each year than car accidents and gun violence combined. To put "addictive" tech toys in the same category as this deadly poison is simply ridiculous.
You see, I think that the only real purpose the government serves- to protect us from deranged people by keeping a police force/armed forces- effectively means that they need to hold a monopoly on power in the country.
This reminds me of an Onion headline I saw once: "Libertarian breaks down, calls fire department." Fire department, roads/bridges, etc. aside, I think a big difference between Libertarian-types like you (no offense--I hope that's a fair characterization) and former Libertarian-types like me is that you are not thinking globally. Universal health care is not just to restrict your freedoms or protect you from yourself, but to ensure the economic future of our nation (assuming you're from the US too), as well a to INCREASE the freedom and happiness of the 2/3 of the people last year who declared bankruptcy because of unforeseen medical illness. Government investment science/technology research is the same thing, and no, we can't simply turn that over to industry--not because they're "greedy," but because industry lacks the flexibility to invest in high-risk technologies that might not pay off.
Look, I agree with you about the abuse of power by police and so forth, but I don't think it's fair to link that to everything "the government" does as though it's a monolithic entity. Police brutality is terrible--down with mandatory public education for children! Sometimes that logic just doesn't make sense. I think the correct answer is more transparency and so forth, not simply reducing the powers of government as a whole. Here's a short essay on the role of government in protecting liberty, which I think explains this point better than I ever could.
Your argument is mostly correct, but I think it's a little misleading. First, it's true that we can't prove on theoretical grounds that cell phones can't cause cancer, but we do know that cell phones don't cause cancer through the same mechanism as ionizing radiation. Therefore, the uninformed layperson's idea that "radiation causes cancer," which is the basis for most of the fear over cell phones, is unfounded. Additionally, we do not know of any convincing mechanism by which cell phone use could lead to significantly increased cancer rates; this, combined with the lack of convincing epidemiological evidence, means that we don't have any good reason for thinking that cell phones do cause cancer. They might, and we can't prove that they don't, but there's no good reason to think that they do. Where do you think the burden of proof should lie on this?
A more significant argument is that lots of things are dangerous, but we have to think quantitatively about the risks. Epidemiological studies have shown that the risks of cell phone use, even if they were entirely real, are incredibly small. Even if cell phones increased risk of some rare head tumor by three-fold, it's going from one in a million to three in a million. As opposed to something like cigarettes, which kill ~50% of lifelong smokers and are single-handedly responsible for 18-19% of all deaths in the US (even though only 25% of Americans smoke). The proven cancer risk from eating smoked fish is much higher than cell phones, but few people have even heard of that. The risks of a poor diet and sedentary lifestyle are also much worse than cell phones could ever be. Even if cell phones increase cancer risk some tiny bit, is that risk really worth talking about?
Am I saying these things shouldn't be counted? No: certainly not. But it's important for people to be able to discuss with or without related factors, depending on intentional context. Mortality rate is without related factors. Morbidity rate is with external factors.
So yes, you're right. Diabetes' mortality rate is much lower than its morbidity rate, due to related considerations such as heart attack, stroke and other descendant complications. It's really just a question of grandparent poster using phrases such as "mortality rate" of whose implications he was unaware.
Wait a second, I didn't realize you actually don't understand the difference between morbidity and mortality. I assumed you did and didn't read your post closely enough. Morbidity is the rate of complications that don't result in death, while mortality is the rate of deaths. And the more I thought about it, I realized that regardless of whether epidemiology textbooks define mortality rates as involving complications or not, the actual medical literature does this all the time. There are clinical trials that calculate the mortality rates for people with a certain blood pressure level, for example, or the mortality rates of people with end stage renal disease on hemodialysis. Neither of those lead directly to death (well, rarely), but both predispose people to vascular disease.
>>Okay, there's one documented case of one person surviving rabies once with lots of medical intervention, but I think we can round up.
It's more like two a week in the United States. You really shouldn't lean on popular myth so hard. Misinformation is pernicious. Try looking it up before you cite it. Being plain, it's just part of being honest, citing only data you've verified. Anything else is lying.
If you really think I'm just making stuff up, fine. The reference is here. To clarify, rabies can be prevented after exposure through the use of vaccine and immunoglobulin, which is what you're referring to, but that's totally different than treating it once it makes it to the CNS. The guidelines say that you're supposed to vaccinate people within 72 hours of an exposure, but the mean time to vaccination in one study I read put it around 5 days, and I don't think there are any documented cases of anyone dying of rabies as long as they were vaccinated in the first week.
Death is defined as the cessation of systemic action. When your heart stops, you're dead. People can currently be brought back from death for several hours, depending on the nature of the cause.
I'm sorry, but the definition of "death" is not nearly so simple. Was Terri Schiavo dead? What about anencephalic babies with beating hearts? I bring this up not just to be a jackass, but to raise the point that there is by necessity a degree of uncertainty in the definition of death and, more to the point, in its cause. When a person "dies" of metastatic cancer, for example, there's usually a complicated multi-system picture going on. Or are they dying from associated complications of cancer? The point is that epidemiologists, statisticians, actuaries, etc. come up with imperfect ways to quantify these complex phenomena. I'm just arguing that it's somewhat pointless to get in heated arguments about technical definitions of what constitutes mortality from HIV, for example, when almost any disease can be said to kill by an indirect mechanism. And this is also nontrivial in the context of diabetes, for example, where there are interventions that can reduce mortality from associated complications.
Here's a hint, jackass: those textbooks are based on hundreds of years of real world experience. Get off the real world vs academia cross; it's tremendously arrogant and ill informed.
I am an academic, so it's unusual for me to be on the other end of that argument. Of course the textbooks are based on real world experience, but they simplify complex clinical phenomena, by necessity.
Seroconversion is the successful and final production of antibodies through the DA system in response to a foreign antigen. Once your immune system wins, you have seroconverted.
No, seroconversion is when antibodies are detectable in the serum. Success or failure of the immune response in clearing the pathogen is not relevant. If your textbook says otherwise, it's referring to acute viral infections that can be cleared, not HIV. In the context of HIV, patients frequently have a period of weeks where viral RNA is detectable, but antibodies are not. Interestingly their viral load can be in the millions, and they will often present with "acute retroviral syndrome," which can look a lot like mono, except it's often worse. Then once their immune system kicks in, they "seroconvert" to positive and their viral load drops down, and the long incubation period begins.
Status epilepticus' mortality rate is near zero.
I thought you just said with or without treatment. To clarify, I meant "Is status epilepticus 100% fatal without medical intervention?" I was making the same argument about rabies (which can have an incubation period of 7-10 years) and septic shock, which is not the same thing as sepsis, btw. What Bierce was describing was something closer to SIRS, not SIRS + bacteremia + distant organ failure + hypotension refractory to fluid resuscitation, which is closer to the definition of septic shock. The point I was making was that your assertion that "No disease has a 100 percent mortality rate over any time frame" is simply absurd. There are a huge number of diseases that are 100% fatal if not treated, and some that are 100% fatal even if treated.
HIV is the disease. AIDS is a syndrome, you mook. You can have the disease for ten years before you have the syndrome. And yes, everyone who works with AIDS patients knows AIDS isn't directly deadly, and it's a fundamental part of AIDS care, because AIDS care comes in the form of staving off all the deadly crap. You can't do anything about the AIDS, but you don't actually have to. All you have to do is stave off the related stuff. Understanding that difference in treatment and care is what's allowing people with the disease to stave off the syndrome for progressively longer times.
Sorry, a typo, but ultimately a minor one. This paragraph you just wrote, however, is incorrect
it's syndromes like AIDS and Smallpox... which have mortality rates. ...
The AIDS mortality rate is ZERO.
So AIDS does have a mortality rate, and that rate is zero? By that logic, diabetes has no associated mortality, it's just the heart attacks and strokes that go along with it. Heart attacks have no mortality, since it's the arrhythmias or heart failure that go along with them. Seizures have no mortality, it's the airway compromise that goes along with them. Drunk driving isn't dangerous--it's drunk CRASHING that's dangerous. You can make these arguments about anything.
How is death even defined anyway, and how reliably can cause of death be determined? If you're going to bitch someone out, you should at least be sure that what you're saying is valid, not just that it accurately describes what it says in your textbook.
Hell, there are two known people who have sero-converted so far (meaning their immune system fought back and won, and they're not even carriers anymore.)
That's not what seroconverted means.
No disease has a 100 percent mortality rate over any time frame.
Do you mean no disease, or no infectious disease? Do you mean with or without medical intervention? Because there are plenty of surgical emergencies, for example, that are 100% fatal without intervention. What about status epilepticus? Is that 100% fatal? Even among infectious diseases, are you counting rabies or septic shock? Okay, there's one documented case of one person surviving rabies once with lots of medical intervention, but I think we can round up. I'm pretty sure septic shock is 100% fatal over a very short timeframe in the absence of intervention...of course, that's tough to say, as it is defined in terms of lack of response to IV fluids and so forth, which is already an intervention.
If you're going to bitch someone out for being uninformed and quoting off wikipedia, you should at least get everything you're saying right. You're like those holier-than-thou grammar nazis who insist we should all use "datum, datums, and data" instead of just "data"--maybe they speak Latin, but their stance betrays a fundamental lack of understanding of how data is collected, analyzed, etc. No one who works with data for a living calls things "datums." Similarly, no one serious who works with AIDS patients thinks AIDS is not a deadly disease, just because the mechanism of killing is indirect.
One other important difference is that diabetes really is a huge class of diseases that share the feature of hyperglycemia. There's more than just type I and type II. Twenty years from now, there will probably be 6-7 or maybe 10 different subtypes. HIV/AIDS doesn't show anywhere near the same amount of heterogeneity.
This has been fun, but unfortunately I got stuck with a bunch of work and this will be my last post. As a response to this, I first have to state that even you should acknowledge that the second reference is so full of trivial logical fallacies as to not require a response. As for the first one, there are several important, more subtle flaws in it: first, selection bias. Women who agree to home births or seek out or even agree to be in a study are a highly nonrandom group of women, and this would be reflected in the quality of prenatal care they received. This could have been fixed by randomly sending half of the women to home birth and the other half to hospital birth, but instead they did home birth for everyone and compared the results to women who didn't go through the same selection process. This is not their "fault"--in general, women have strong preferences about these issues, and the vast majority wouldn't be willing to be randomized. And those that would represent a non-representative subset. However, only a random trial would offset selection bias, which one would expect to have a strong impact on outcomes. Second, negative obstetric outcomes in "low risk" women are, almost by definition, rare events. Even though their trial was relatively large in terms of absolute number, it wasn't nearly large enough to have any real statistical power. Third, the entire concept of this is based on the idea that women will be accurately stratified into risk categories by clinicians. Women in a research study are going to be screened much more carefully than women in clinical practice. I agree that for "low-risk" women, the risk is low. But how reliably can the average country doc assess that in advance? Obviously even the more-rigorous-than-normal criteria weren't all that successful considering that 12.1% of the women in the trial had to be rushed to the hospital for emergency procedures anyway. That's not an insignificant percentage, btw--it's higher than I thought it would have been.
The point is, some clinical phenomena are very difficult to study using the randomized trial paradigm, and birth complications is one of them. The kind of arguments I would make against home birth are not anecdotal or heart-felt as you suggest, but more based on general principles of medical practice that have been proven over and over again in other contexts. For example, why is there no movement to do any other major medical procedure at home? What if I got appendicitis and I wanted surgeons to take that out at home? Or maybe I want my wisdom teeth extracted at home? It just doesn't make sense. I'm not saying that hospitals per se are necessarily the answer, but major medical procedures should be executed at some sort of procedure center with adequate facilities for resuscitation in case of emergencies. Have you ever seen a vaginal delivery in real life? Did you know that the AVERAGE blood loss is around 1 liter, somewhere around 15-20% of the woman's total blood volume? The uterus and surrounding tissues are highly vascularized, and bleeding much more extensive than that can and does occur. There is no other medical procedure that anyone would be allowed to perform at home with an expected blood loss of 20% of total blood volume, with a 12.1% chance of having to rush the patient to a real hospital for emergent intervention even under ideal circumstances. If a doctor tried to do that in any other context, he/she would probably lose their license, and rightfully so.
It's an interesting question why this arises solely in the context of birth and childcare. No one wants to use the "natural" methods of setting fractured bones at home like the cro magnons did successfully for thousands of years. There's a cult surrounding home birth, and a cult surrounding breast feeding as well. The cult of breast feeding is another interesting one--now don't get me wrong, breast feeding is best, but a small but significant fraction of women (especially first-time mothers) can't produce enough milk for their ba
Just to clear this up, and granted no one understand the exact details yet, but as I now understand it, a nursing mother's immune system is always scanning the environment for threats.
The whole process really is much more well-understood and less mysterious than you seem to think. The issues you're describing are complicated--the main reason why mothers need to provide antibodies to their children is because the children can't produce their own, and the reason why they can't produce their own is because there fundamentally has to be a period of immunologic self vs. other learning occurring. But it doesn't take three years. That's probably just a recommendation based on contaminated drinking water, or if you want to be more cynical, attempts to decrease the birth rate in third-world countries.
And once a pathogen's frequency is driven down so low that it is not encountered during nursing, this knowledge of how to defeat it can not be passed on that way (and yet, as you point out, with airplanes an outbreak from a normally very low level almost extinct pathogen can easily spread worldwide, especially if a minor mutation makes it more virulent somehow). Also, presumably, a vaccinated mother can not mount the same level of defense to a pathogen as a mother who encountered the real thing.
It's not true that antibodies are not present in the mother's milk if she hasn't been recently exposed to the antigen. The thing is, even if what you were saying were entirely true, there's a big calculation you have to do from a public health perspective. Even if vaccination decreased some sort of collective immunological subconscious, how large is the effect of the decreased exposure probability? My mom was vaccinated against polio, so she probably didn't give me as many antibodies as an infant as someone who had contracted it naturally. Isn't that more than outweighed by the fact that I was probably never even exposed to polio because everyone had been vaccinated? It's not like these ideas are new or anything--there are people whose entire career is spent figuring these things out, and they pretty much all fall on the side of vaccination.
Of course, if a mother gives birth in a hostile biological environment like a hospital, with many possible threats the mother's immune system has never experienced before, then the mother's immune system is going to be delayed in a response. That's one reason why a place like the Netherlands, with about 30% home births, has a lower infant mortality than the USA (only higher risk births are suggested to go to hospital). A home may actually be far dirtier than a hospital, but the mother's immune system already knows the home's dirt and so can easily assist the newborn in learning about it.:-)
I think you're not conceptualizing things correctly. It's true that dirt and germs are everywhere, but serious infectious disease is really caused by an extremely, extremely small subset of those, and the primary factor determining whether or not you get sick is your exposure to the pathogen. Viruses and bacteria are like little tapeworms. The main difference between someone who has tapeworms and someone who doesn't is not usually the strength of their immune system, it's whether or not they ate tapeworm eggs. Also, suggesting that the infant mortality difference between the Netherlands and the US is due to home births is a bizarre, bizarre idea, particularly if you have ever been exposed to real poverty in the US or seen the quality of prenatal care that uninsured mothers get here. As an aside, I do not personally think that home births are responsible. First worlders seem to forget that giving birth is actually very dangerous, and there are simply too many things that can go wrong requiring emergency intervention. I almost died being born because I was at a rural hospital that lacked the capacity to perform a C-section--fortunately, I survived the ambulance ride to the other hospital. Women with placental a
I think it almost doesn't matter whether the videos are for or against vaccination--based on your summaries, neither one presents a convincing case for or against vaccination. I'm not sure that any video on youtube ever would. I agree with you that there is always room for debate, but the problem is that people have to be informed of the facts first, and for politically charged scientific issues it's very difficult for laypeople to know what sources to trust. Even you, a biological scientist who has obviously spent some time reading up on this, have been subjected to a substantial amount of misinformation. I think this is a tough situation when there are issues that affect large numbers of people, but only a relatively small number of people are really qualified to debate them in an informed way. Honestly, I'm not sure that pseudoinformed debate is really any better than cultish devotion and mudslinging. There are issues like quantum mechanics--I believe in quantum mechanics because I trust the scientific process and well-informed people who tell me it's true, but I don't really have enough training to weigh all the evidence and decide by myself. Does that mean by defending it against someone who says it's not true, I would be showing cult-like devotion? I really don't know the answer to that, I'm just putting it out there.
And Polio vaccine (unknowingly contaminated with Simian Virus 40) was called safe and effective.
I feel the need to comment on this. Take a quick look at this picture. Have you ever seen anything like that in real life? I work in a hospital, and I've never seen even one iron lung before. When we do our armchair cost-benefit analyses, it's easy to forget what things were like before we had these vaccines. If I were a parent in 1953 knowing what I know now, I would have gladly given my child an injection of polio vaccine even if I had known it had SV40 virus in it.
You also ignore the whole ethical side of the issue, which is my main concern
You're correct, I'm ignoring that aspect of it. I agree that there are lots of interesting issues there, and I don't necessarily disagree with you on those--I disagree with you on the immunological aspects of your argument, which contain factual errors.
Much of vaccination just addresses the low hanging fruit, while potentially creating huge problems down the road. This is the same as with the use of agricultural pesticides which wipe out normal predator-prey cycles in the environment
I'm not dismissing the entire ecological approach you're using to every pathogen--it's appropriate for some, but not others. This is a huge can of worms that I don't feel like opening right now. But what is the mechanism by which vaccination causes problems later on? You mean like it did with smallpox and polio? The analogy between vaccination and pesticides or antibiotic resistance simply doesn't make sense, and there are specific immunological reasons why it doesn't make sense.
collective community memory of disease passed on from mother-to-child (the point being to assist the child while they develop their own natural immunity to a variety of things), and other aspects of immunity -- including the mind-body connection which a more typical path of infection may interact with versus injections (which you apparently just dismiss without understanding, but clearly at least the placebo effect exists).
I'm not sure exactly what you're saying here--if you think the mother's immunity is permanently passed on to the child, you're simply mistaken, that's a temporary phenomenon. There are obviously links between the nervous system and the immune system, but it's not obvious why you think immunization is worse than natural infection in that regard. As far as the placebo effect, the placebo effect exists primarily in studies where the outcomes are subjectively measured. Things where they give the drug vs. placebo and ask the patient how much pain they feel, how sick they feel, etc. When objective parameters are measured, such as survival time after cancer diagnosis, rate of infection with a given pathogen, etc., the placebo effect typically drops to zero or very close (depending on the condition--there are a few exceptions).
You do have a good point about the increasing challenges of today's society. But on the other hand, it is undermined by your argument we are already exposed to lots of pathogens in the natural world. So which is it?:-) I feel if you think deeply about this contradiction in your rebuttal you may come to some new insights about the nature of the vaccination debate.
There's not a contradiction there--let me rephrase: your body is exposed to a huge number of potential pathogens, the vast majority of which it fights off. My point is that your argument that vaccinating people will somehow "overload" their immune system just doesn't make sense. Adding a few tens of antigens to a system that's already been naturally exposed to tens of thousands just doesn't matter. To understand my argument, you have to distinguish between dangerous pathogens and minimally dangerous ones that typically cause subclinical infections in immunocompetent people.
This "just-in-time" medicine is related to healing (like using drugs to boost the immune system or directly stop specific viral replication). It also diverts attention from an emphasis on proven effective techniques of wellness which include extended nursing, a balanced diet free of too much artificial gunk, managing stress, improving the mind-body connection like via Yoga, getting a good night's sleep, and so on.
Now it's you who's making a contradiction;) You're promoting the "just-in-time" medicine approach, but complaining that vaccination is diverting resources from preventative medicine approaches. But vaccination IS a preventati
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I completely agree. I work in computational neuroscience, and the memristor was basically the last thing left that brains can do that can't be implemented in silicon. Neuromorphic analog VLSI circuits are going to benefit from this a lot. However, there are still a number of issues that might not be trivial to implement, such as competition between different synapses in the same neuron, which are mathematically necessarily to prevent instabilities from occurring. I think the main point is that solving the nonlinear ODEs in the brain numerically, on a digital processor, is very inefficient compared to the brain. However, instantiating them in an analog circuit with internal state variables (i.e. memristor-like devices) will actually be much MORE efficient than the brain. Given that the rate-limiting steps in brain computation are basically stray capacitances dictating the membrane time constants, those stray capacitances are much easier to reduce in analog circuits, so these circuits should be able to operate orders of magnitude faster than biological ones. We'll make great pets someday.
Television shows like House, M.D. always make me chuckle, having been too close to the subject matter for suspension of disbelief to work. When something serious goes wrong with one's body that cannot be diagnosed with first-line test results and (revenue-generating) treatment prescribed in 8.5 minutes, you are no longer an asset to the healthcare industry. You are a liability. There is no genius physician who will ponder over your case in his or her downtime. There are no attractive residents who will hold conferences in well-appointed conference rooms where they will discuss your case and argue over the possible diagnoses on whiteboards and through video teleconferencing.
I'm sorry that your experience with medical care has left you so jaded, but the truth is that this sort of thing happens a lot more than you know, especially at academic hospitals. Most people who go into medicine are interested in the mystery cases, and if anything, I feel like the truth is the very opposite of what you're saying: people with simple presentations that look like routine cases often aren't given enough attention, and the mystery cases are ruminated over far beyond the point where anything productive results from it. The thing about House, MD that makes me chuckle is how bad the physicians on the show are. I guess that's part of the plot, though, that they can't make the diagnosis in the beginning, or else there wouldn't be a show.
As a physician, I agree with you that learning good people skills is a critical skill for most physicians. However, I think the whole situation is more complicated than you seem to acknowledge. First, there can be technically incompetent physicians who miss diagnoses or prescribe outdated treatments, but they're loved by their patients. On the other hand, I know a few technically excellent surgeons who are total jerks. So I agree with you that people skills and clinical skills are not totally separate and distinct, but they're not totally inseparable either. However, technical incompetence is a more serious problem than poor people skills. I agree, a doctor with poor people skills will never be truly excellent. But a technically incompetent doctor kills people.
A second, more subtle, issue is that sometimes being a good doctor requires you to do things that will make your patient unhappy. For example, a good primary care physician will bug his/her patients to quit smoking and lose weight. Those are things that annoy people, and I can tell you from first-hand experience that sometimes it's easier to make the patient happy than it is to do the right thing and come off looking like a bad guy. For example, people come in all the time demanding antibiotics for viral upper respiratory infections. Giving those patients antibiotics is doing them a disservice, as it breeds resistant organisms, but doctors that do it will be more popular, and primary care physicians do it all the time for that reason. Another example is building false hope in patients with a poor prognosis. As far as I'm concerned, that sort of pandering is cowardice pure and simple, but physicians are human too, and it's hard to be the bad guy.
Finally, posting random stuff on a web site is just not a reliable way to evaluate anyone. Mostly you'll just get a few posts from a tiny, disgruntled fraction of the patients a doctor sees. And in most of those cases, the complaint says more about the patient than the doctor. In fact, having more complaints most likely reflects the fact that the doctor is willing to accept more difficult patients, the same way that many surgeons with low success rates are the ones willing to accept the toughest cases. I agree that it's silly to try to make patients sign agreements that they won't post online, but it's even more silly to take online posts seriously.
"I can't tell you how tired I am of people getting modded insightful for misunderstanding then regurgitating something that most people who discuss this subject should understand at a base level."
/., but not on a level that is sufficient. In practice, controlling for confounding variables assumes that 1) those variables are measurable 2) you have a large enough sample size to be able to control for them without losing all statistical power, and 3) the method used to control will not introduce artifacts. There are plenty of correlational studies demonstrating all kinds of things, like correlations between diet soda and obesity, or daily multivitamin use with early death. Correlational studies on breastfeeding that attempted to control for every possible variable continued to show dramatic health benefits that were not replicated in randomized prospective trials. This stuff is all highly nontrivial--professionals have difficulty designing even randomized prospective trials that control for everything properly. You seem to think the original poster was wrong and you are right merely because you understand the concept of controlling for confounding variables. However, that's not worth much if it can't be performed in practice.
That's the part you should have been paying attention to, you totally missed my point.
I understood your point, but you missed mine. You may understand these issues on a level higher than the original poster, and sufficiently high to get modded up on
The real question is, how much of the health benefit of vegetarianism is actually due to diet, and how much is due to confounding variables? I would be willing to bet that vegetarians are wealthier and more educated than the average person, they probably exercise more, they probably see their doctor more often and don't "forget" to take their pills as often, etc.
I'm sorry, you're being somewhat inappropriately hostile. What you're saying is partially true in theory, but the problem with a study like this is that one would expect so many confounding variables a priori that no one could realistically hope to control for all of them in practice. I suppose they could get the easy ones...like gender. Or age. Or income. But really, it doesn't matter whether the original poster knows what confounding variables were controlled for...in practice, no amount of statistical analysis would turn any correlational study like this into convincing evidence of causation. Note that I'm not saying that there isn't causation going on, only that a study like this is unable to provide convincing evidence, particularly with the strong prior suspicion of confounds that are difficult to control for (e.g. personality traits). It may be true that stating "correlation is not causation" is not particularly insightful, but at least it's true. Most things people spout aren't even correct, so I don't think you should be complaining.
nobody has ever come up with anything that works better
I think it depends how you define "better." Wikipedia has a lot of advantages, with the primary one being that it covers such a wide range of topics. However, for more specialized topics, other models may work better. Scholarpedia is a good example of this. It's based on wikipedia, except with named curators who are experts in their field assigned to control individual pages. It doesn't have the breadth of wikipedia, and it doesn't claim to, but for what it does cover it's a superior resource.
What people obsessed with robotics forget is how limited a robot is compared to a human. Robots are fine when everything runs as expected, but when things fail, humans can adapt.
What you're forgetting is how much room robotics technology has to expand, as opposed to human space travel technology, which has basically run up against fundamental limits. 50-100 years from now, robots may very well be just as adaptable as a human, but keeping humans alive under such harsh conditions is going to be just as hard as it is today.
Philosophy seeks "truth" - science seeks understanding. Science is horseshoes - a better model wins points, even if it's still not exactly right. Newton's theories are demonstratably wrong (i.e., not the "truth") - but they greatly help me to understand how matter interacts because they are close enough for practical purposes. That's useful!
I think this isn't quite correct. Science seeks "truth" first, understanding second. For example, Newtonian physics is easier to understand than relativity or quantum mechanics, but it isn't as close to experimental observations (i.e. not as "true")...if science were about understanding over truth, modern physics would not have supplanted Newtonian physics, but it has. Science and philosophy have the same goals, but different methods, with the primary difference being that science uses experiments. Of course, the hot new thing in philosophy is "experimental philosophy," which is essentially just studying philosophical questions using science.
The second, more obvious, point is that in general, it's the Christians who think that evolution is non-Christian, not the evolution proponents. The fundamental reason why is because many Christians feel that evolution undermines the basis of the authority of their moral teachings, which is something that I can sympathize with. There are two strategies for Christianity to deal with this: either deny that evolution is true, or restructure the basis of their moral teachings to be compatible with evolution. Unfortunately, evolution is essentially indisputable fact at this point, meaning that Christianity isn't going to be able to take the easy way out, and they're going to have to change with the times in order to survive. This change will be difficult, but the good news is that this is actually going to improve Christianity in the long term.
Abiogenesis is chemistry, correct. But chemistry doesn't define what "life" or "alive" is. And that definition IS what Abiogenesis is.
Speaking as a biologist, I think this statement is exactly incorrect. It's true, life is chemistry. The reason why chemistry does not define what "life" is is because anyone who really understands biochemistry understands that there is no meaningful distinction between "living" chemical systems and "nonliving" ones. The belief that there is some fundamental distinction between the two is called vitalism, and it was discredited a long time ago. Theories of abiogenesis attempt to explain how the chemical reactions we observe in "living" systems arose. Whether you or anyone else considers those chemical reactions to be "living" or not is totally irrelevant. Debating whether something is "alive" or not is similar to debating whether Greenland is a continent or not. It's a pointless, simplistic distinction applied post hoc for the purpose of justifying some sort of nonrigorous internal prejudices.
I can't say whether the drugs are good or bad (just that there is a lot of them and he takes them e-v-e-r-y--d-a-y) but I do know the drugs have changed his brain chemistry forever, I often wonder if the person I grew up with is still in there, occasionally I see a glimpse.
I'm sorry to hear about your situation, and I'm not disagreeing with most of what you're saying, but if someone's had documented manic episodes with psychosis, that's something along the lines of bipolar or schizoaffective disorder, which is an incurable (but treatable) life-long chronic disease that's totally different than major depressive disorder, even though depression is a component in both. Unfortunately, it's unlikely that the personality changes you're seeing are due to the drugs and more likely that you are witnessing the natural progression of the disease itself. I've never met your family member, but I say this because of the many patients I have met, as well as the data showing that the meds actually have a protective effect, slowing disease progression. There is evidence that going off meds and having a psychotic episode can actually cause irreversible brain damage, causing the disease to progress further. The most important thing for him is sticking to the meds religiously, having a regular sleep schedule, strictly avoiding alcohol and recreational drugs, etc. The disease has a strong hereditary component, and the newest data shows that one of the biggest risk factors is advanced paternal age at time of conception. In other words, accumulation of mutations in the sperm are the likely culprit in many cases. Assuming his psychiatrist's diagnoses are correct, he has a serious brain disorder, not simply a poor reaction to emotional stress, and he's lucky to have a supportive relative like you.
There isn't generally any reason why a mild case should be worth the side effects, expense and possible suicide risk of prescribing the pills. I've been a fervent believer for quite a while that unless a person is suicidal or debilitated to the point where they aren't functioning, that they should really think about whether the pills are the right solution or not.
Medication alone is almost never "the solution," but I disagree that such serious dysfunction is the only valid criterion for medication. The side effects of SSRIs are relatively minor, and the suicide risk is overblown. The time of highest suicide risk in depression is after the person hits bottom and starts to get better, regardless of why they start to get better. The data suggests that antidepressants actually decrease overall suicide risk, it's just that they tend to concentrate suicide risk in a certain time window after the person starts to take them (precisely because they're starting to get better). US national suicide rates were falling while SSRI prescriptions were climbing, until the FDA placed the black box warning on them; after that, SSRI prescriptions have been falling, and suicide rates have been going up. My perspective is that mild to moderate cases of depression should be treated with meds and CBT, while serious cases are refractory to meds and require ECT. I guess it depends how you define those words, though.
Szasz is an out-of-date dinosaur, and I don't know anyone well-informed who takes him seriously any more. There is some validity in the idea that some psychiatric "disease" is just the tail end of the curve of normal personality traits, when those personality traits become maladaptive. To some extent, that is culturally dependent. However, the idea that mental disease in general does not exist is simply ridiculous and empirically false. Is autism a disease? What about schizophrenia? We know all of the organs can malfunction, so why would the most complex organ be exempt? Depression, also, is a clear-cut example of brain dysfunction. I wouldn't say that depression is a disease per se, but more of a dysfunctional state. There are almost certainly different disease processes that lead to this dysfunctional state in different patients, but depression itself is unquestionably a very real phenomenon. It is true that some people have personality traits or maladaptive behaviors that may predispose them to depression, the same way that sleep deprivation can predispose to seizures, but that doesn't make the resulting depression or seizures any less real, or any less of a "disease." Also, note that any of the arguments Szasz makes can be applied equally to migraines.
I see how you could have interpreted it that way--that's not what I meant, and I should have worded it more clearly. However, I don't agree with your argument that the numbers show that smoking is relatively safe. If 25% of people smoke, and 20% of all deaths are directly attributable to smoking, then smoking is 80% likely to kill you or someone around you. That's pretty high! In reality, it's lower than that because it's more like 25% of people are smokers at any given time. Lots of people smoke for a while and then quit. If you're a lifelong smoker, the probability of cigarettes killing you is around 50% (I think the probability of getting lung cancer is only around 15%, and the rest of the mortality comes from vascular and pulmonary disease). Second-hand smoke deaths are a small percentage of total smoke-related deaths, being less than 10%, but even in spite of that, they still outnumber car accidents and guns, which I think is insane.
A big difference between being addicted to an iPhone and being addicted to tobacco is that iPhones do not kill you. 1/5 of all deaths in the US are directly attributable to tobacco, even though only 1/4 of people smoke. Second-hand smoke kills more people in the US each year than car accidents and gun violence combined. To put "addictive" tech toys in the same category as this deadly poison is simply ridiculous.
You see, I think that the only real purpose the government serves- to protect us from deranged people by keeping a police force/armed forces- effectively means that they need to hold a monopoly on power in the country.
This reminds me of an Onion headline I saw once: "Libertarian breaks down, calls fire department." Fire department, roads/bridges, etc. aside, I think a big difference between Libertarian-types like you (no offense--I hope that's a fair characterization) and former Libertarian-types like me is that you are not thinking globally. Universal health care is not just to restrict your freedoms or protect you from yourself, but to ensure the economic future of our nation (assuming you're from the US too), as well a to INCREASE the freedom and happiness of the 2/3 of the people last year who declared bankruptcy because of unforeseen medical illness. Government investment science/technology research is the same thing, and no, we can't simply turn that over to industry--not because they're "greedy," but because industry lacks the flexibility to invest in high-risk technologies that might not pay off.
Look, I agree with you about the abuse of power by police and so forth, but I don't think it's fair to link that to everything "the government" does as though it's a monolithic entity. Police brutality is terrible--down with mandatory public education for children! Sometimes that logic just doesn't make sense. I think the correct answer is more transparency and so forth, not simply reducing the powers of government as a whole. Here's a short essay on the role of government in protecting liberty, which I think explains this point better than I ever could.
Your argument is mostly correct, but I think it's a little misleading. First, it's true that we can't prove on theoretical grounds that cell phones can't cause cancer, but we do know that cell phones don't cause cancer through the same mechanism as ionizing radiation. Therefore, the uninformed layperson's idea that "radiation causes cancer," which is the basis for most of the fear over cell phones, is unfounded. Additionally, we do not know of any convincing mechanism by which cell phone use could lead to significantly increased cancer rates; this, combined with the lack of convincing epidemiological evidence, means that we don't have any good reason for thinking that cell phones do cause cancer. They might, and we can't prove that they don't, but there's no good reason to think that they do. Where do you think the burden of proof should lie on this?
A more significant argument is that lots of things are dangerous, but we have to think quantitatively about the risks. Epidemiological studies have shown that the risks of cell phone use, even if they were entirely real, are incredibly small. Even if cell phones increased risk of some rare head tumor by three-fold, it's going from one in a million to three in a million. As opposed to something like cigarettes, which kill ~50% of lifelong smokers and are single-handedly responsible for 18-19% of all deaths in the US (even though only 25% of Americans smoke). The proven cancer risk from eating smoked fish is much higher than cell phones, but few people have even heard of that. The risks of a poor diet and sedentary lifestyle are also much worse than cell phones could ever be. Even if cell phones increase cancer risk some tiny bit, is that risk really worth talking about?
Am I saying these things shouldn't be counted? No: certainly not. But it's important for people to be able to discuss with or without related factors, depending on intentional context. Mortality rate is without related factors. Morbidity rate is with external factors. So yes, you're right. Diabetes' mortality rate is much lower than its morbidity rate, due to related considerations such as heart attack, stroke and other descendant complications. It's really just a question of grandparent poster using phrases such as "mortality rate" of whose implications he was unaware.
Wait a second, I didn't realize you actually don't understand the difference between morbidity and mortality. I assumed you did and didn't read your post closely enough. Morbidity is the rate of complications that don't result in death, while mortality is the rate of deaths. And the more I thought about it, I realized that regardless of whether epidemiology textbooks define mortality rates as involving complications or not, the actual medical literature does this all the time. There are clinical trials that calculate the mortality rates for people with a certain blood pressure level, for example, or the mortality rates of people with end stage renal disease on hemodialysis. Neither of those lead directly to death (well, rarely), but both predispose people to vascular disease.
>>Okay, there's one documented case of one person surviving rabies once with lots of medical intervention, but I think we can round up.
It's more like two a week in the United States. You really shouldn't lean on popular myth so hard. Misinformation is pernicious. Try looking it up before you cite it. Being plain, it's just part of being honest, citing only data you've verified. Anything else is lying.
If you really think I'm just making stuff up, fine. The reference is here. To clarify, rabies can be prevented after exposure through the use of vaccine and immunoglobulin, which is what you're referring to, but that's totally different than treating it once it makes it to the CNS. The guidelines say that you're supposed to vaccinate people within 72 hours of an exposure, but the mean time to vaccination in one study I read put it around 5 days, and I don't think there are any documented cases of anyone dying of rabies as long as they were vaccinated in the first week.
Death is defined as the cessation of systemic action. When your heart stops, you're dead. People can currently be brought back from death for several hours, depending on the nature of the cause.
I'm sorry, but the definition of "death" is not nearly so simple. Was Terri Schiavo dead? What about anencephalic babies with beating hearts? I bring this up not just to be a jackass, but to raise the point that there is by necessity a degree of uncertainty in the definition of death and, more to the point, in its cause. When a person "dies" of metastatic cancer, for example, there's usually a complicated multi-system picture going on. Or are they dying from associated complications of cancer? The point is that epidemiologists, statisticians, actuaries, etc. come up with imperfect ways to quantify these complex phenomena. I'm just arguing that it's somewhat pointless to get in heated arguments about technical definitions of what constitutes mortality from HIV, for example, when almost any disease can be said to kill by an indirect mechanism. And this is also nontrivial in the context of diabetes, for example, where there are interventions that can reduce mortality from associated complications.
Here's a hint, jackass: those textbooks are based on hundreds of years of real world experience. Get off the real world vs academia cross; it's tremendously arrogant and ill informed.
I am an academic, so it's unusual for me to be on the other end of that argument. Of course the textbooks are based on real world experience, but they simplify complex clinical phenomena, by necessity.
Seroconversion is the successful and final production of antibodies through the DA system in response to a foreign antigen. Once your immune system wins, you have seroconverted.
No, seroconversion is when antibodies are detectable in the serum. Success or failure of the immune response in clearing the pathogen is not relevant. If your textbook says otherwise, it's referring to acute viral infections that can be cleared, not HIV. In the context of HIV, patients frequently have a period of weeks where viral RNA is detectable, but antibodies are not. Interestingly their viral load can be in the millions, and they will often present with "acute retroviral syndrome," which can look a lot like mono, except it's often worse. Then once their immune system kicks in, they "seroconvert" to positive and their viral load drops down, and the long incubation period begins.
Status epilepticus' mortality rate is near zero.
I thought you just said with or without treatment. To clarify, I meant "Is status epilepticus 100% fatal without medical intervention?" I was making the same argument about rabies (which can have an incubation period of 7-10 years) and septic shock, which is not the same thing as sepsis, btw. What Bierce was describing was something closer to SIRS, not SIRS + bacteremia + distant organ failure + hypotension refractory to fluid resuscitation, which is closer to the definition of septic shock. The point I was making was that your assertion that "No disease has a 100 percent mortality rate over any time frame" is simply absurd. There are a huge number of diseases that are 100% fatal if not treated, and some that are 100% fatal even if treated.
HIV is the disease. AIDS is a syndrome, you mook. You can have the disease for ten years before you have the syndrome. And yes, everyone who works with AIDS patients knows AIDS isn't directly deadly, and it's a fundamental part of AIDS care, because AIDS care comes in the form of staving off all the deadly crap. You can't do anything about the AIDS, but you don't actually have to. All you have to do is stave off the related stuff. Understanding that difference in treatment and care is what's allowing people with the disease to stave off the syndrome for progressively longer times.
Sorry, a typo, but ultimately a minor one. This paragraph you just wrote, however, is incorrect
it's syndromes like AIDS and Smallpox ... which have mortality rates.
...
The AIDS mortality rate is ZERO.
So AIDS does have a mortality rate, and that rate is zero? By that logic, diabetes has no associated mortality, it's just the heart attacks and strokes that go along with it. Heart attacks have no mortality, since it's the arrhythmias or heart failure that go along with them. Seizures have no mortality, it's the airway compromise that goes along with them. Drunk driving isn't dangerous--it's drunk CRASHING that's dangerous. You can make these arguments about anything.
How is death even defined anyway, and how reliably can cause of death be determined? If you're going to bitch someone out, you should at least be sure that what you're saying is valid, not just that it accurately describes what it says in your textbook.
Hell, there are two known people who have sero-converted so far (meaning their immune system fought back and won, and they're not even carriers anymore.)
That's not what seroconverted means.
No disease has a 100 percent mortality rate over any time frame.
Do you mean no disease, or no infectious disease? Do you mean with or without medical intervention? Because there are plenty of surgical emergencies, for example, that are 100% fatal without intervention. What about status epilepticus? Is that 100% fatal? Even among infectious diseases, are you counting rabies or septic shock? Okay, there's one documented case of one person surviving rabies once with lots of medical intervention, but I think we can round up. I'm pretty sure septic shock is 100% fatal over a very short timeframe in the absence of intervention...of course, that's tough to say, as it is defined in terms of lack of response to IV fluids and so forth, which is already an intervention.
If you're going to bitch someone out for being uninformed and quoting off wikipedia, you should at least get everything you're saying right. You're like those holier-than-thou grammar nazis who insist we should all use "datum, datums, and data" instead of just "data"--maybe they speak Latin, but their stance betrays a fundamental lack of understanding of how data is collected, analyzed, etc. No one who works with data for a living calls things "datums." Similarly, no one serious who works with AIDS patients thinks AIDS is not a deadly disease, just because the mechanism of killing is indirect.
One other important difference is that diabetes really is a huge class of diseases that share the feature of hyperglycemia. There's more than just type I and type II. Twenty years from now, there will probably be 6-7 or maybe 10 different subtypes. HIV/AIDS doesn't show anywhere near the same amount of heterogeneity.
This has been fun, but unfortunately I got stuck with a bunch of work and this will be my last post. As a response to this, I first have to state that even you should acknowledge that the second reference is so full of trivial logical fallacies as to not require a response. As for the first one, there are several important, more subtle flaws in it: first, selection bias. Women who agree to home births or seek out or even agree to be in a study are a highly nonrandom group of women, and this would be reflected in the quality of prenatal care they received. This could have been fixed by randomly sending half of the women to home birth and the other half to hospital birth, but instead they did home birth for everyone and compared the results to women who didn't go through the same selection process. This is not their "fault"--in general, women have strong preferences about these issues, and the vast majority wouldn't be willing to be randomized. And those that would represent a non-representative subset. However, only a random trial would offset selection bias, which one would expect to have a strong impact on outcomes. Second, negative obstetric outcomes in "low risk" women are, almost by definition, rare events. Even though their trial was relatively large in terms of absolute number, it wasn't nearly large enough to have any real statistical power. Third, the entire concept of this is based on the idea that women will be accurately stratified into risk categories by clinicians. Women in a research study are going to be screened much more carefully than women in clinical practice. I agree that for "low-risk" women, the risk is low. But how reliably can the average country doc assess that in advance? Obviously even the more-rigorous-than-normal criteria weren't all that successful considering that 12.1% of the women in the trial had to be rushed to the hospital for emergency procedures anyway. That's not an insignificant percentage, btw--it's higher than I thought it would have been.
The point is, some clinical phenomena are very difficult to study using the randomized trial paradigm, and birth complications is one of them. The kind of arguments I would make against home birth are not anecdotal or heart-felt as you suggest, but more based on general principles of medical practice that have been proven over and over again in other contexts. For example, why is there no movement to do any other major medical procedure at home? What if I got appendicitis and I wanted surgeons to take that out at home? Or maybe I want my wisdom teeth extracted at home? It just doesn't make sense. I'm not saying that hospitals per se are necessarily the answer, but major medical procedures should be executed at some sort of procedure center with adequate facilities for resuscitation in case of emergencies. Have you ever seen a vaginal delivery in real life? Did you know that the AVERAGE blood loss is around 1 liter, somewhere around 15-20% of the woman's total blood volume? The uterus and surrounding tissues are highly vascularized, and bleeding much more extensive than that can and does occur. There is no other medical procedure that anyone would be allowed to perform at home with an expected blood loss of 20% of total blood volume, with a 12.1% chance of having to rush the patient to a real hospital for emergent intervention even under ideal circumstances. If a doctor tried to do that in any other context, he/she would probably lose their license, and rightfully so.
It's an interesting question why this arises solely in the context of birth and childcare. No one wants to use the "natural" methods of setting fractured bones at home like the cro magnons did successfully for thousands of years. There's a cult surrounding home birth, and a cult surrounding breast feeding as well. The cult of breast feeding is another interesting one--now don't get me wrong, breast feeding is best, but a small but significant fraction of women (especially first-time mothers) can't produce enough milk for their ba
Just to clear this up, and granted no one understand the exact details yet, but as I now understand it, a nursing mother's immune system is always scanning the environment for threats.
:-)
The whole process really is much more well-understood and less mysterious than you seem to think. The issues you're describing are complicated--the main reason why mothers need to provide antibodies to their children is because the children can't produce their own, and the reason why they can't produce their own is because there fundamentally has to be a period of immunologic self vs. other learning occurring. But it doesn't take three years. That's probably just a recommendation based on contaminated drinking water, or if you want to be more cynical, attempts to decrease the birth rate in third-world countries.
And once a pathogen's frequency is driven down so low that it is not encountered during nursing, this knowledge of how to defeat it can not be passed on that way (and yet, as you point out, with airplanes an outbreak from a normally very low level almost extinct pathogen can easily spread worldwide, especially if a minor mutation makes it more virulent somehow). Also, presumably, a vaccinated mother can not mount the same level of defense to a pathogen as a mother who encountered the real thing.
It's not true that antibodies are not present in the mother's milk if she hasn't been recently exposed to the antigen. The thing is, even if what you were saying were entirely true, there's a big calculation you have to do from a public health perspective. Even if vaccination decreased some sort of collective immunological subconscious, how large is the effect of the decreased exposure probability? My mom was vaccinated against polio, so she probably didn't give me as many antibodies as an infant as someone who had contracted it naturally. Isn't that more than outweighed by the fact that I was probably never even exposed to polio because everyone had been vaccinated? It's not like these ideas are new or anything--there are people whose entire career is spent figuring these things out, and they pretty much all fall on the side of vaccination.
Of course, if a mother gives birth in a hostile biological environment like a hospital, with many possible threats the mother's immune system has never experienced before, then the mother's immune system is going to be delayed in a response. That's one reason why a place like the Netherlands, with about 30% home births, has a lower infant mortality than the USA (only higher risk births are suggested to go to hospital). A home may actually be far dirtier than a hospital, but the mother's immune system already knows the home's dirt and so can easily assist the newborn in learning about it.
I think you're not conceptualizing things correctly. It's true that dirt and germs are everywhere, but serious infectious disease is really caused by an extremely, extremely small subset of those, and the primary factor determining whether or not you get sick is your exposure to the pathogen. Viruses and bacteria are like little tapeworms. The main difference between someone who has tapeworms and someone who doesn't is not usually the strength of their immune system, it's whether or not they ate tapeworm eggs. Also, suggesting that the infant mortality difference between the Netherlands and the US is due to home births is a bizarre, bizarre idea, particularly if you have ever been exposed to real poverty in the US or seen the quality of prenatal care that uninsured mothers get here. As an aside, I do not personally think that home births are responsible. First worlders seem to forget that giving birth is actually very dangerous, and there are simply too many things that can go wrong requiring emergency intervention. I almost died being born because I was at a rural hospital that lacked the capacity to perform a C-section--fortunately, I survived the ambulance ride to the other hospital. Women with placental a
I think it almost doesn't matter whether the videos are for or against vaccination--based on your summaries, neither one presents a convincing case for or against vaccination. I'm not sure that any video on youtube ever would. I agree with you that there is always room for debate, but the problem is that people have to be informed of the facts first, and for politically charged scientific issues it's very difficult for laypeople to know what sources to trust. Even you, a biological scientist who has obviously spent some time reading up on this, have been subjected to a substantial amount of misinformation. I think this is a tough situation when there are issues that affect large numbers of people, but only a relatively small number of people are really qualified to debate them in an informed way. Honestly, I'm not sure that pseudoinformed debate is really any better than cultish devotion and mudslinging. There are issues like quantum mechanics--I believe in quantum mechanics because I trust the scientific process and well-informed people who tell me it's true, but I don't really have enough training to weigh all the evidence and decide by myself. Does that mean by defending it against someone who says it's not true, I would be showing cult-like devotion? I really don't know the answer to that, I'm just putting it out there.
And Polio vaccine (unknowingly contaminated with Simian Virus 40) was called safe and effective.
I feel the need to comment on this. Take a quick look at this picture. Have you ever seen anything like that in real life? I work in a hospital, and I've never seen even one iron lung before. When we do our armchair cost-benefit analyses, it's easy to forget what things were like before we had these vaccines. If I were a parent in 1953 knowing what I know now, I would have gladly given my child an injection of polio vaccine even if I had known it had SV40 virus in it.
You also ignore the whole ethical side of the issue, which is my main concern
:-) I feel if you think deeply about this contradiction in your rebuttal you may come to some new insights about the nature of the vaccination debate.
;) You're promoting the "just-in-time" medicine approach, but complaining that vaccination is diverting resources from preventative medicine approaches. But vaccination IS a preventati
You're correct, I'm ignoring that aspect of it. I agree that there are lots of interesting issues there, and I don't necessarily disagree with you on those--I disagree with you on the immunological aspects of your argument, which contain factual errors.
Much of vaccination just addresses the low hanging fruit, while potentially creating huge problems down the road. This is the same as with the use of agricultural pesticides which wipe out normal predator-prey cycles in the environment
I'm not dismissing the entire ecological approach you're using to every pathogen--it's appropriate for some, but not others. This is a huge can of worms that I don't feel like opening right now. But what is the mechanism by which vaccination causes problems later on? You mean like it did with smallpox and polio? The analogy between vaccination and pesticides or antibiotic resistance simply doesn't make sense, and there are specific immunological reasons why it doesn't make sense.
collective community memory of disease passed on from mother-to-child (the point being to assist the child while they develop their own natural immunity to a variety of things), and other aspects of immunity -- including the mind-body connection which a more typical path of infection may interact with versus injections (which you apparently just dismiss without understanding, but clearly at least the placebo effect exists).
I'm not sure exactly what you're saying here--if you think the mother's immunity is permanently passed on to the child, you're simply mistaken, that's a temporary phenomenon. There are obviously links between the nervous system and the immune system, but it's not obvious why you think immunization is worse than natural infection in that regard. As far as the placebo effect, the placebo effect exists primarily in studies where the outcomes are subjectively measured. Things where they give the drug vs. placebo and ask the patient how much pain they feel, how sick they feel, etc. When objective parameters are measured, such as survival time after cancer diagnosis, rate of infection with a given pathogen, etc., the placebo effect typically drops to zero or very close (depending on the condition--there are a few exceptions).
You do have a good point about the increasing challenges of today's society. But on the other hand, it is undermined by your argument we are already exposed to lots of pathogens in the natural world. So which is it?
There's not a contradiction there--let me rephrase: your body is exposed to a huge number of potential pathogens, the vast majority of which it fights off. My point is that your argument that vaccinating people will somehow "overload" their immune system just doesn't make sense. Adding a few tens of antigens to a system that's already been naturally exposed to tens of thousands just doesn't matter. To understand my argument, you have to distinguish between dangerous pathogens and minimally dangerous ones that typically cause subclinical infections in immunocompetent people.
This "just-in-time" medicine is related to healing (like using drugs to boost the immune system or directly stop specific viral replication). It also diverts attention from an emphasis on proven effective techniques of wellness which include extended nursing, a balanced diet free of too much artificial gunk, managing stress, improving the mind-body connection like via Yoga, getting a good night's sleep, and so on.
Now it's you who's making a contradiction