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Discussion in 'The Mainboard' started by DUCKMOUTH, May 13, 2012.
Your posts seem smart but I think you dumb
ok, I'm done with that
It's funny that riner is citing time as a limitation for studying the efficacy of ivermectin when many of the ivermectin fanboys won't take the vaccine for the same reason
Not to stereotype, but I've found people who eat farm animal medication are not incredibly logically consistent.
Also just for the record here's the situation we have at play
Anti-science chodes refuse to take the vaccine for a variety of irrational, non-scientific reasons, political loyalties among them.
When criticized for it, they accuse others of making the situation political.
Just comical bad faith arguing
This is curious...and this really isn't the thread for it, but why do you think this way? Because the far left is without its warts and nutjobs? Convince me that the far left is great.
this is so stupid it hurts my soul, and it's in the rogan vein of EVERYTHING IS TRIBALISM NO ONE IS LOGICALLY CONSISTENT* so i shouldn't be shocked
*except me, the galaxy brained skeptic centrist and my friends
Perhaps galaxy brain centrism was the real tribalism all along
the degree to which right wingers have adopted post modernism while also screaming that its going to end the world is great
Hope your soul gets to feeling better soon, buddy.
Wonder if it has anything to do with reading and posting in a thread dedicated to The Joe Rogan podcast. Those algorithms are pretty savvy these days.
you are painting with broad strokes here. Not everyone who isn't taking the vaccine is refusing it for the same reasons. For example, the African-American community vaccination rate stands at about 43%. That's lowest of any racial group. I'd venture to guess most of those unvaccinated African-Americans are not anti-science chodes clinging to political loyalties.
You know who I'm talking about riner stop playing dumb
Everyone has warts and nut jobs, but one party has discredited and politicized some of our largely non-political institutions like the CDC or the post office for their own perceived gain
They are spiteful contrarians who constantly demonize people for doing what they are constantly caught doing behind close doors
They push policies that add more suffering to the most disenfranchised including their own constituents while lining their own pockets
They embrace and enhance anti-intellectualism
They embrace and enhance voter suppression
They follow a reality tv star as the second coming of Christ as he bumbles around fucking up every single thing he touch
A large group of them, after listening to said tv star speak, took it upon themselves to storm in the capital and call for the head of the sitting Vice President because he followed constitutional protocol
I could go on and on
Could you counter with a wart from the Democratic Party or the far left that approaches the magnitude of any of those items?
You can honestly say this doesn't apply to the left, in similar magnitude??
They are spiteful contrarians who constantly demonize people for doing what they are constantly caught doing behind close doors
there a bunch of anti-lbgtq democrats that get caught with people of the same sex I don’t know about?
Can you give me an example?
You guys have almost convinced him. It will only take a few more pages.
Other people read these post too you know
So you've used one example that does not apply, and think that means there are no examples that apply?
You aren't trying very hard here. This is what being disingenuous looks like
It absolutely applies
You expect anyone to believe that you can identify what disingenuous looks like?
No, I'm agreeing, that does apply. I'm saying it's a single example. You are acting as if finding that one valid example means there are no other examples.
Like....gosh I dunno....telling people they are killing grandma if they gather in large groups and don't wear a mask......then go to dinner with a bunch of people and not wear a mask?
Or being racist.....
"He was wowed by Obama's oratorical gifts and believed that the country was ready to embrace a black presidential candidate, especially one such as Obama — a 'light-skinned' African American 'with no Negro dialect, unless he wanted to have one,' as he said privately. Reid was convinced, in fact, that Obama's race would help him more than hurt him in a bid for the Democratic nomination."
Harry Reid had to apologize for his racism
"I deeply regret using such a poor choice of words," Reid said in a statement. "I sincerely apologize for offending any and all Americans, especially African Americans for my improper comments."
1. I would imagine that we all had moments where we just wanted to feel normal and took a risk
2. By and large our politicians have had access to testing through most of the pandemic, and thus have alternative means to mitigate risk compared to a lot of us
3. They have embraced vaccination and attempted to set a good example for their constituents and use mask at a much higher rate than their Republican peers
“Too often we judge other groups by their worst examples, while judging ourselves by our best intentions.”
This is not the same as creating red line laws, or attempting to make it more difficult for African Americans to vote
I didn't say it was. I think it's an example of someone doing something behind closed doors that he demonizes people for.
You really can't think of a single other example of from Democrats???
Again nothing you’ve pointed out begins to reach the magnitude of the problems with the Republican Party, I said in my post that Democrats are by no means perfect but at least they occasionally make an effort
Riner is doing this thing he always does where he digs really deeply into a specific detail in order to not engage with the larger point. It's exhausting and everyone should stop letting him do it
He's a fucking doctor. This is what he does for a fucking living.
and "you guys" are doing what you always do. making excuses for bad behavior, and re-defining the terms/moving goal posts.
Corrine Brown's charity scam, Rham Emanuel covering up the shooting of a black teenager, Jerry Brown laundering big oil money, DNC rigging their own primaries, Cuomo being a pussy hound, Eliot Spitzer being into hookers, David Paterson's domestic abuse, Anthony Weiner sexting with high school girls....
Come on guys, this isn't that hard, add some to the list
Fucking fuck, man. Might want to talk to the doc and get some blood pressure meds.
The man said in the Joe Rogan thread...
For real though, what's everyone's favorite JRE episode?
I haven't done any of the things you described.
And fuck all those people. But again you're hyper-focusing on one example of the multitude of things listed and doing so as a means to distract from the initial point that was being made. Stop playing dumb.
In the future. The last one, at which point the world will immediately become a better and safer place until the next dumb guy fills the void.
Ah yes, the safe space that will be created for however small amount of sweet, sweet time.
Not a closet republican though
Can always hope it’s more cult of personality than sad ethos.
Cool, thank you.
I prescribe stuff off-label all the time, of course. But that certainly doesn't mean that's without any basis of clinical evidence. Benefits/risks and all that. And I do have a pretty high bar for what I consider solid enough clinical evidence. Oftentimes, there is room for reasonable debate re: off label uses for stuff. A good example of a practice I employ with sorta shruggy clinical evidence, given your example of arthritis, is corticosteroid joint injections. The evidence is somewhat mixed. But one way or the other, there's a whole lot of it, and decades of practice/experience with it, such that we pretty well know where the line is as to how to hone and educate our patient's expectations of efficacy and risk. We just don't have that volume of data re: things like ivermectin.
I've also got plenty of experience with patients on organ transplant lists, and (should spoiler this) dead kids from just tylenol and ibuprofen. Some pretty reasonable doses of ibuprofen have precipitated some pretty awful problems. Even labeled use of aspirin has resulted in a patient of mine losing half his colon. I agree that ivermectin, taken according to direction, has a "reasonably good safety profile." Certainly better than HCQ. I've Rx'd for parasitic infections many times. But that does not mean "totally safe." Colonoscopy has an excellent safety profile. And I've also coded a patient who later died from her colonoscopy.
Additionally, while you prescribe medicine for a particular condition, at a specific dose/frequency/duration, you're also then responsible for that medication landing in the patient's hands, and therefore to some degree (even if not legally) responsible for what happens as a result, even if it is taken improperly. What if they heard something from some "expert" on Joe Rogan that it needs to be taken in higher than normal doses? What if they give it to their kid? Hey I know that's not strictly on me if it's misused, but boy does it ever feel that way when something bad happens. That needs to be weighed too.
All things told, sometimes doing nothing is absolutely better than a kitchen sink approach. Had too many patients die under their kitchen sinks. It's hard to swallow hard and do nothing sometimes when the person on front of you is suffering, but in your science brain, you know "just trying something" likely won't help. "First do no harm" is a tough but infinitely wise guide to clinical practice. In blackjack, sometimes you just gotta stand on 15.
So for ivermectin, my stance, and the stance of the OVERWHELMING majority of my colleagues, there is just no current clinical justification for its use. YET. Probably ever, but certainly not yet. That's not just Dr. Cryna$ty, MD, Ratt enthusiast of the internet's take. That's the professional guidance/opinion of every major infectious disease organization. They're the geniuses, I'm just smart enough to listen to them.
Now, shifting gears a bit, I see from your questions that a lot of the scientific and ethical dots re: covid treatments just aren't connecting. And that's very fair. And you're not nearly alone. Specifically:
Dot #1: hundred of thousands of people in this country have died from covid, with untold measures of morbidity and suffering in addition
Dot #2: medical community seems stodgy and slow in their willingness to employ experimental treatments
Dot #3: Usually takes years to arrive at a preponderance of clinical evidence favoring use of a novel treatment
Dot #4: why aren't we trying shit!? Holy shit see #1!
Hey, these are logical dots, and curious people will see them and wonder about them. I'm glad you see and accept them as true. There are seemingly vast gaps between them that just don't seem to make sense, and it's human nature to want to make sense out of stuff.
I assure you, there are logical, and better yet, wise, connections between those dots. However, I can't do what you'd like me to do, which is to draw out those connections here and now so they make perfect sense. The logical connections between those widely spaced dots are truly only drawn with years and years of study and practice in medical science. There is simply no way to completely fulfill your desire for a complete understanding to the questions you're asking with a discussion on TMB. The gaps between those dots come to light when you sell pretty much your entire life to the study of medicine, and even then, gaps remain.
What I am asking, instead, is for you to accept faith as a substitute for a complete understanding. It's ok to trust people who know the most about them, have questions about how/why they arrive at the conclusions they do, but ultimately exercise faith. It's what I, and really all doctors, have to do sometimes too. There's just too much to know for any of us. It takes a lot of humility to say, "ok, here's something that doesn't make complete sense to me, but I know there are likely a lot of things I don't know that this person who's done years of research and practice in infectious disease knows, and I think the best thing for me and my patients is to faithfully integrate their interpretations into my understanding and practice." Here's the ESSENTIAL place where Joe Rogan's "question everything" mantra runs into a catastrophic wall for the human soul. Faith is ok sometimes, too.
What I'd also like from you is this: the understanding that these are hard conversations for myself and other physicians/medical experts to have in front of an audience on the internet and, speaking only for myself, I'd appreciate hearing your curiosities and questions without the starting assumption that there's some nefarious liberal agenda driving what I think/say/do. I'll do my best to meet you at fairness and open-heartedness, and I know I fail there sometimes too. TMB ain't exaclty where I go to polish the most sophisticated parts of my essence all the time. That being said, I'm also, on a personal note, sensitive to my voice here, and last thing I want to sound like is an up-in-the-clouds arrogant AF physician, cuz I hate them. So I am open to any "hey wait a second, man" alerts when you feel I'm straying into that voice.
That one area was where I saw an obvious issue with what was being claimed. I didn't question the others because they specifically targeted Republicans, and are accurate.
Anyone could make a similar list for Democrats though. It all generally speaks to immoral behavior, saying one thing and doing another, shady behavior for political gain. In short, being a politician. Part of the mindset, on every side, is that "they" do all of this awful stuff and "we" don't. Not being willing to accept or even consider that your side isn't squeaky clean is a problem. (que the "yea, but not AS bad!" comments).
Look how IV responded. He didn't say - yea, the mask thing was a really bad look, and is a pretty good example of politicians scolding people for doing something, then doing that literal exact same thing... Nah, he made excuses. Here is why it's ok for my side to do it!
hand waving away anti-democratic voter suppression and pandemic denialism that has caused millions of deaths as if it's just politics as usual is tipping your hand to the fact that you only really care about being a contrarian dickhead and the real world consequences are totally beyond your ability to even fathom caring about.
FWIW, my point about testing applies to Republicans too, look at how long it took for Trump to get Covid without taking any precautions, just because everyone around him was tested.
Your example refers to a one off example of poor behavior as opposed to a consistent pattern of poor behavior
The Republicans, following Trump's lead, pattern of rejecting science and failing to adapt to new evidence is different than making a mistake.
I could be wrong but I would say a overwhelming majority of the time democrats wore their masked and encouraged other people to wear their mask.
Please respect my safe space, sir.
Censorship in hack rwnj podcast threads is out of control!
I appreciate your response. Allow me to ask for a little more detail and clarity
When you say we don't have decades of practice/experience with Ivermectin, you mean as it relates directly to C19? Because we clearly have decades of experience and large volumes of data with it for other treatments. And that relates specifically to the level of safety we can expect, right? To be clear, you've only prescribed off-label drugs that have undergone clinical trials for the usage, as you are prescribing them? Never had a drug that underwent trials for treatment A, then you prescribed it for treatment B?
It's interesting where responsibility starts and ends, and I understand the idea that you bear some responsibility when writing a prescription, even if it's taken differently than prescribed. But with the demonization of Ivermectin, it's pushing less intelligent people to take it on their own, in odd dosages, or some even eating horse paste. While it's easy to say - fuck them, they should do what I recommend and not go rouge - you can take the same approach with the patient who doubles her dosage for a prescription you actually prescribe her. So, of course, doing something and doing nothing both have consequences, intended or not.
How do you weigh that? I realize you don't have personal responsibility for anyone eating farm animal medications, but is there a better way to approach this subject that will reach those people and prevent them from undertaking in dangerous behavior? Does media bear some responsibility here? There are all shades of understanding and influence, but I think there are definitely groups outside of the medical community that, if you told them you prescribed Ivermectin for any reason, would think you were a quack/Trumper/etc. They'd think it was dangerous, that these people are going to end up in the ICU, and we shouldn't take horse dewormer. And this is what, I think, Brand was trying to address. Not the pros and cons of Ivermectin, specifically, but the power of the media to create sometimes false narratives, and how that affects all of us in one way or another, and has a tendency (perhaps intended) to push us to one side or the other.
We've managed to allow the messaging to be questioned, haven't we? Faucci admitting to lying about masks opened the floodgates of doubt. Then saying the vaccines work, if you get vaccinated, no mask, do the right thing and you can live a normal life! Then ehhh actually mask up even if vaccinated. So that allowed people to ask...the vaccines work? or they don't? or...? And the recent studies about how robust the immunity from previous infection is, yet those people still need 2 doses of vaccination to go to dinner in some areas AND are now going to be federally mandated to be vaccinated? Is that what the science says?? If you have any doubts, do you think that approach alleviates your concern? And on and on. And none of that is right or left, or at least it shouldn't be. All of that is just science, and messaging, and facts, and honesty.
I'm vaccinated. I encourage others to get vaccinated. I'm not anti-vax or eating horse paste. But I understand these questions, I understand the doubt. And I see how we've fucked it up and allowed for that doubt and mistrust. There was always going to be doubt, but we could have limited it to the flat earthers and not allowed "normal" folks to have to ask these questions. Discussions like this, with people like you, would go much farther to convincing people and increasing vax rates.
I would disagree, a bit, that we didn't "just try shit". I don't mean that in a bad way. I think under the pressure of piles of body bags, doctors and professional made educated choices, and tried some shit they thought would work, because they did the risk/benefit math and it worked out, at that time. I know those decisions were made logically and with the best intentions. And early on, anecdotal evidence, being the only readily available evidence, became the guide. Now, a year and a half later, we have better evidence, some trials, some better evidence beyond the anecdotal.
Message boards are not exactly an ideal place to have any conversation, much less a serious one. I'm certainly quick to respond negatively, and you also were not exactly kind and respectful (which I get....). I'll try to do better.
Can’t believe how long it took to get to low AA vaxx rates. That’s Rogan 101.
its such a funny tell from the identity politics bad! crowd when they bring these things up
I don't have a ton of time left to really get after this, but I'll try to clarify a couple things.
Should really never practice medicine X way because otherwise the patient will just go Y. Comes up all the time with opioids: " I'm in pain! If you won't give me oxy I'll just have to get it off the street." You offer safe treatment options that have an evidence base. That's it.
Yeah should only offer off-label treatments that demonstrate efficacy as well as safety. If it's not studied at all for a specific indication, there's no way I'm offering that, no matter how safe it is for another indication. That's just an unscientific wild ass guess. Reckless medicine. Again, "very safe" does not mean "completely safe."
I would argue against your observations that hospitals just started trying stuff for covid when bodies started piling up. Most of the treatments you saw tried early were offered as part of a study protocol. Which is the only way ivermectin is being offered in our institution. Unethical to offer untested treatments outside of a clinical trial. Most of those have been scratched off the list of effective treatments. A couple still have merit.
As to "the media" and "the messaging" man idk who that encompasses and who has to answer for what. Easily discernable problem I see is that:
1. People seek medical info outside of reliable medical institutions
2. Plenty of terrible sources willing to give irresponsible medical advice in a sexed up way that draws lay people in as opposed to the boring scientists
3. That people even think they need to "do their own research" or have their own, complete understanding of these things. That's literally wtf people used to go to the doctor for.
Last thing and then I'll prolly have to step away, re: medical ethics/research. Here's an anecdote that might kinda explain the Oxford rct thing. I spent 6 months before med school enrolling/carrying out a protocol for a large, multi-center RCT assessing the efficacy of induced hypothermia after pediatric cardiac arrest (primary outcomes being mortality, and neurologic outcome). There was some small studies previously that indicated it MIGHT be beneficial, and well known but frankly managable risks of controlled hypothermia. That said, you CANNOT ethically perform an RCT if there's significant evidence of treatment effect already, because you'd essentially be witholding a likely efficacious treatment from half of your patient population. You have to be able to start with a null hypothesis.
It's like pulling teeth trying to get consent from parents in this study, whose child is on the verge of death. Trying to communicate that the reason you're doing the study is that there MIGHT be some benefit, but too much scientific uncertainty to just do the treatment. A lot of parents would consent, get randomized to the control arm, and pull out of their consent. Was very, very hard for this trial to get done. Ultimately, somehow it got done, and done well. No significant difference in primary outcomes.
I say this because it's very hard to convey how important it is to study things well. How much has to go right. And how much is lost when we miss an opportunity to do a good study. Outside and beyond the "will it/ won't it work" debate over ivermectin, the widespread use of it very well could jeopardize our ability to ever know if it'll work. That sorta happened with convalescent plasma early on when Mayo shot their load too early and we had to rely on foreign data
Thanks for the conversation, hope the perspective adds something.