Throwaway05
3mo ago
Actual quote from my last time talking to a patient in the ED:
"A shelter, why the fuck would I go to a shelter doc? It's fucking filled with homeless people, besides they won't let me get high on crack!"
In order to fix the problem you need to be willing to violate some people's rights and to discriminate, the former is something that you do sometimes see flexibility on in the left but the later...
Throwaway05
3mo ago
Additionally vaccine authorities will also try and bundle vaccines because it's easier for everyone to get them all done while people are thinking about it instead of catching up later when it becomes more of a risk factor.
Their may also be an immunologic argument but I'm not an expert on that.
Throwaway05
3mo ago
Two case studies in government waste:
As you can likely imagine right now a lot of people in medicine are sharing tales and taking sides in the great DOGE debate. Two that popped up on my radar and stuck out to me:
- One of my medical school classmates is a psychiatrist at redacted city hospital. He has been informed that the state Medicaid will no longer pay for psychiatric emergency room visits if the patients do not go to their aftercare appointments within 30 days. They have been informed that they could lose their government funding if enough patients fail to do this.
Some problems: -As an emergency room most of their patients have no insurance or Medicare or Medicaid, meaning the facility often get paid less than cost. They only stay open at all because of their state grants.
-Many of the patients are drug addicts or malingering (because of homelessness for example). Every day you’ll hear something like “you’ve been here every day for the last three weeks” or “have you considered stopping using PCP? You always seem to fight with the police when you do” and “here’s your follow-up appointment, will you go? No? Fuck me? Okay thank you have a nice day.”
-Many of the patients who do actually have mental illness are in denial about it, or have some sort of limitation that prevents them from attending aftercare appointments.
-The “best” solution is probably to violate patient rights and involuntarily commit them to make someone else be on the hook for making sure they go to their aftercare.
-In the meantime, the hospital has hired several additional staff to manage some of the administrative complexities associated with this change (for example hammer calling the patients to remind them to come to the appointment). They have also hired night staff whose job is to sit in an office overnight purely to schedule appointments with an outpatient program (otherwise no patient could be discharged overnight because they wouldn’t have an appointment to go to…).
- One of the residents I mentor is about to do a rotation at the VA. This is pretty common for residents. His rotation starts in a few weeks. A few months ago, he got an email that included the instructions “it is imperative that you start your onboarding process for the VA right now otherwise your onboarding may not be finished by the time of your rotation” and “it is important that you not start your onboarding right now as it is too early to start onboarding and your onboarding may not be valid if you complete it too early.” This is not a joke or an exaggeration.
Anyway, he dutifully completed his requirements in a timely fashion (which were all pointless! Ex: what is the motto of the VA???). So, months later his rotation is starting soon. He begins the process of emailing the education team once every 2-4 business days. You have to email them multiple times before they respond. The conversation goes something like this over the course of multiple weeks, “I think I’ve completed my onboarding do I have to do anything else?” “no” “okay is my onboarding done” “no” “okay when can I pick up my ID card” “when your onboarding is done” “I thought my onboarding was done” “yes” “okay what I am waiting on” “nothing.” I have seen the emails; it really looks like this.
At this point his program tells him to CC the chief of medicine at the VA hospital, at which point the person responds with “okay we put in a ticket for this a month ago, your training is complete but your training is marked as incomplete.” A screenshot has been attached that shows the request and an automatic response that says something about high ticket volume and that they will get to it at some point. The chief of medicine replies “….does the trainee need to do anything?” (we are here).
The resident will be able to rotate but will not be able to do any work without computer access.
It’s worth noting that the VA is paying for this resident to be there, despite the fact he will in fact not be able to do anything. At his last VA rotation (yes they go through this for every resident every time) he was six weeks into an eight week rotation before he got access.
Throwaway05
3mo ago
Doctors weren't the source of the liberal media establishment brain download they were a recipient, just like everyone else.
In addition, most of what happened was a political problem and just like all other political problems the correct facts were arranged.
Flu and HPV do not have the same problems (at least not right now), but again look at the primary source data! Actually research! It doesn't take much effort to see that a lot of what was stated with COVID was shaky or speculative.
Meanwhile the research base for the other stuff is robust and transparent.
Throwaway05
3mo ago
That was written before I realized how adversarial this was going to be.
The argument for the flu shot is:
-Risks are nearly zero. RNs are often actually very resistant to getting the flu shot. MDs roll our eyes at them because the reasoning is always "I'm a bitch" type complaints. Typically saying that they don't like shots for instance, or that the injection site hurts. I don't think I've ever met any physician who has treated a patient who has had an actual adverse reaction. Some people do get an immune response (aka feel a little sick). If you feel a little sick from the flu shot that's good evidence that you would feel even worse with the actual flu. The response to feeling a little sick should not be whining, I admit this is some boomer energy on my part.
-The flu shot can potentially help save you. If you have significant risk factors it can save your life. Not every person with significant risk factors knows they have significant risk factors. Diabetes for instance can go a long time without getting diagnosed if their primary care follow-up is poor.
-The flu shot can potentially help you out a lot. Evidence is a bit more squishy on this but that's because "I felt like ass for a three days" vs. "I felt mildly bad for one day" is extremely expensive to research and not worth it from a public health perspective, but I know personally not needing to call out work and be miserable for a few days is worth the mild inconvenience of other people.
-You can potentially help other people. If you getting less virulent in some way prevents you from transmitting it to someone else than that is a good thing. Especially in general plague sources like children.
-Research shows that the flu shot still has some utility even when we get the mix wrong for that year, it just isn't as much.
-Even when we get the mix wrong the right mix for the vaccine you still have is still going around in the population getting people ill.
TLDR: You should get the flu shot, the risks to you are near zero and if you are healthy and well the expected benefits are also low but your health is the most important thing most people own so you should take appropriate gambles.
However it is a known problem that people are willing to be lazy about their personal health in a way that they aren't with say their personal finances. Shrug
Throwaway05
3mo ago
The solution to "our experts can't be trusted when the topic is political" is not to always ignore experts, that's going to result in more incorrect decision than listening to experts even when they are wrong.
Throwaway05
3mo ago
I don't disagree that the approach was mangled but I think the science is settled now and for adults its something like benefits outweigh the risks for everyone except for very young men (I don't know kids though).
This was a unique situation though where people very publicly turned off their brains because of politics. That doesn't happen very often, and it's always pretty obvious when it's happening (still the case with any medical content that is significantly woke adjacent).
Most of public health this caveat does not apply.
Throwaway05
3mo ago
Context
I did tell him at first that I didn't mean to accuse him of being generally anti-vaxxers, I do think their was some confusion at that point, but then he went on and did drop an anti-vaxxer talking point "And I don't believe vaccine risks are as low as they say they are."
That's the kind of thing anti-vaxxers say!
Elsewhere he says he will just have a chicken pox party instead of getting the vaccine!
Even if it wasn't intended as anti-vax that's another talking point they use and a terrible idea.
Guy is saying he doesn't want to get vaccines and appears to have some basic misunderstanding of facts and to repeat anti vax talking points...... like what do you want?
All the medical stuff is more complicated than anyone wants to tolerate dealing with (like the discussion about the efficacy of a flu vaccine) but people are resistant to both being told they are incorrect by an expert and to actual doing research to understand the considerations, like what do you want?
Throwaway05
3mo ago
Sure, that is a potential limitation for the COVID vaccinate at this time, other vaccines have mostly been around long enough to feel good about this, it is worth noting that while what you are suggesting is a hypothetical risk their isn't a good explanation for how that would biologically happen however.
Sometimes we do miss on things where there is initially no good biological explanation but it is extremely rare.
I'm trying to not get deep into the weeds of defending the COVID response though because it's far from the matter at hand however.
Throwaway05
3mo ago
HPV
I don't know what McGill is smoking.
https://www.cdc.gov/cancer/hpv/cases.html
The rate changes are a bit odd as sexual habits change (go men on finally eating women out!) and at the same time its getting a bit more controlled as more people are vaccinated. However some of the other causes (like smoking) are going down.
General
You believe doctors because it's retarded to throw out the entire field of medicine because of one misstep.
I could respect it if it was "okay fine I will never listen to a doctor again, clearly everything they say is wong" but the situation is very clearly picking and choosing what things to be mad about purely depending on how someone feels about it.
General vaccinations are already different enough from what happened with COVID, but now you are saying "lets just not listen to any public health recommendations in general," "why anyone would believe doctors about this sort of thing?" <- your own quote.
Great now go light up using somebody with Ebola's vomit as bong water.
No? That doesn't seem reasonable? Well it's also a public health recommendation!
At best people are using uninformed opinions and intuitions as laymen without doing any research at all to decide when to listen to expert advice, and ignoring it otherwise, and as we see elsewhere in this thread those opinions and intuitions are absolutely trash and often can be invalidated with the slightest, minimum possible research. See in other subthreads here the comically ill-informed takes on hepatitis, chickenpox.
Throwaway05
3mo ago
HPV for boys
Hold up. Below covered it but HPV related cancers are absolutely skyrocketing in men.
Throwaway05
3mo ago
Unless you're already sick, immunocompromised, or old, I think you wouldn't really notice the difference between getting a shot and not bothering.
Clearly I'm in this description and I don't like it.
Throwaway05
3mo ago
Imagine for a second you belief the vaccines are safe.
Great, even if fatality rates for kids from COVID were super low....well what's the harm? Plus you get the added benefit of herd immunity!
This sounds like a wonderful idea.
Now we know now that the benefits don't seem to outweigh the risks in a few specific populations - but the problem was that the acute nature of the situation and the politics (as well as some considerable stress) broke a lot of people's brains. Lots of stuff does that - see both pro and anti Trump people.
None of that applies to the general issue of vaccines.
Lots of people had questions and concerns about COVID related decision making. They were forcibly muzzled.
The most right wing pediatrician I know who puts on a MAGA hat after work, his response to general vaccine hesitancy is to imagine the parents alone with him in a dark room.
Their isn't any credible debate for most of the vaccine schedule and what exists (ex: Rotavirus) is quite healthy.
Throwaway05
3mo ago
Hepatitis A is an STD in the same way Chickenpox is. Yes it can spread that way but that's not generally how it happens.
Just because Hep A is a Hep virus doesn't mean it is what you think it is. Chickenpox is a herpes virus.
....like come on man.
Throwaway05
3mo ago
The initial don't wear masks this was absolutely a lie and with very good reason - lots of healthcare providers ended up dying due to lack of PPE.
But it was a lie.
The masks work bit is not a lie it's just complicated and still has a ton of debate today. That's picking and choosing which evidence base to use in public policy messaging.
Moving the goalposts on herd immunity is a political and not medical question and not really a lie no matter how well or ill advised it was.
No shit politicians lie (and Fauci is a doctor), but don't mix that up with the medical side of things.
Throwaway05
3mo ago
and the motivation for that (encourage people who don't really need some vaccine to take them in protection of the elderly, opposite sex, etc)
Do you have evidence for this?
What about alternative explanations like "this shit is complicated to study and testing was done on initial more virulent strains with more vulnerable populations?"
Throwaway05
3mo ago
1
So you probably didn't see all the people who died, maybe because they weren't in your social group, maybe you lived away from inner city squalor for instance. It was bad, it really was.
2
COVID vaccine into culture war. I don't know a single republican, anti-woke, fuck the establishment doctor who has anything negative to say about non-COVID vaccines at all. These people do exist and one of the biggest eventually recanted but nobody takes them seriously.
It's like trying to get Toyota's banned because a BMW ran over your dog. Nothing about them is similar.
3
Medical research certainly has its problems but their is an immense world of difference in consideration between things like "get your fucking MMR shot" "here's a complicated discussion about the value of the Rotavirus vaccine" and "here's a retrospective study of complication rates using an N of 600,000.
As a sidebar their weren't a lot of lies during the pandemic, their was a lot of bad messaging. Things like "the fatality rate will go down overtime as the virus burns through the available tinder and mutates to be less deadly" were stated loudly and often but people didn't listen.
Stuff like the initial mask messaging was a lie and I was annoyed by it but it was well meaning.
Unforced errors sure but most of it wasn't lies and a lot of things are still true (yes it is dangerous), were found to be true (no Ivermectin didn't actually work the research that said it did had big flaws), or involve ongoing complicated debates (lab leak).
Throwaway05
3mo ago
I've long suspected that the problem is that the files hold some still relevant procedural detail that the US doesn't want people knowing (my theory: just how long JFK was "dead" before the announcement was made - in his case they officially continued life saving measures for awhile despite clear futility, likely to allow for succession planning related stuff).
Throwaway05
3mo ago
Don't know if we have data on this (because it's ultimately small potatoes by expensive research standards) but healthcare lore and anecdote in the U.S. is that the flu vaccine 100% reduces severity of illness and down time.
Worth it in my book for a mild owie.
All it takes is one real visit by the flu and then you get the point.
Throwaway05
3mo ago
Flu: -PMID: 37247308 for a citation that disagrees with your conclucion. Outside those at high risk it does reduce symptomatic burden, as someone who has gotten real flu and vaccinated flu.....that's a big difference.
Hepatitis: Use Chesterton's fence. Why is it there? Is it because of risk of vertical transmission? Is it because it's safe to be given at that time and that's simply the best time to get it done because of logistics. Also, were you aware that the various hepatitis viruses are transmitted in different ways?
Understand why before getting made about it.
From other comments you made:
Safe Vaccines: -What's the rate of actual problems beyond mild stuff like headache? All medications have side effects. Nothing is truly safe. You can randomly die from anything. How many actual serious problems have happened. It looks like the rate of true allergy is somewhere around one in a million (1 in 900k per UK vaccine website I found which was the first google hit). The odds of getting any of these conditions are much much much higher than that.
General Dissatisfaction with Medicine Comments: -So like, are you just not going to seek medical care now because they bungled some parts of COVID? That's stupid. For anything related to COVID? Or politics? More reasonable. The "normal" vaccines are settled science. It's apples and oranges.
I don't think "I'm going to do my own research" is unreasonable but I don't think many people are actually doing that, they are just reading biased online commentary and throwing things into chat GPT.
People with a lot more knowledge than either of us very very carefully and very very publicly consider the risks and benefits of putting something on the vaccine schedule and have removed things before that were "worth it" because of disgruntled public optics.
General anti-vaxxer is a conspiracy theory level take and has been for a long time - see the whole vaccines and autism thing.
Throwaway05
3mo ago
I'm not asking people to blindly trust the medical establishment I'm asking people to actually research the thing they want to do.
You can find papers with actuarial analysis, side effect rates and presentations, justification for the schedule and so on.
So do it.
With respect to COVID the whole thing was stupidly complicated and while I don't support the rights restrictions except in very narrow cases a great deal of it was correct and just poorly implemented/messaged.
Their is also a huge problem with outright conspiracy theories that got a lot of mileage because trust was so low but that doesn't make those things not effectively insane conspiracy theories, it just hampers people getting them cleared up.
Throwaway05
3mo ago
anti-vaxxer
I mean, you said you didn't want to get some vaccines?
And you said it was because risks whatever that means and because you don't trust experts?
What is it you think that anti-vaxxers say?
Throwaway05
3mo ago
Yes and I'm aware of that risk and I think about it and I take steps to mitigate it when appropriate.
You are choosing risk for no reason. That's the issue.
Furthermore you need to be responsible. Engage with the rest of the comment. The ask is to actually do your homework instead of being mad about COVID.
That should be easy.
Throwaway05
3mo ago
People are becoming vaccine hesitant because the medical system flushed its credibility down the toilet over a cold from China.
Yes and it's idiotic.
-
COVID was actually very bad and I'm not going to be able to convince you because you were locked inside along with everyone else when it was bad. No, no, I'm not going to be able to convince anyone still complaining about COVID at this point so let's move on.
-
Medicine is obviously politically compromised when it comes to culture war topics.
-
The correct response to 2 is to have a high degree of suspicion when you see recommendations about trans people or whatever not ignore general and uncontroversial medical advice.
A reasonable middle ground is to do things like actual independent high quality research (like a lit review on pubmed) or ask someone who is not politically compromised (me! me!).
Just because someone was wrong one time or on one category of things doesn't mean you stop listening to them for everything. That's woke thinking and I expect better of us.
One of the other posters hit on this but basically in most states people have a right to be not forced into treatment (of any kind, not just psychiatric) as long as they are not actively suicidal or homicidal (gross oversimplification the laws around this are very state specific and complicated).
Drugs don't count for this. We can't force someone to take their diabetes medication. We can't force someone to go to a psychiatrist (again with above caveats).
This is generally good despite the edge cases.
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