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Munky-Necan | 5 years ago

I'm going to throw in my two cents as a medical student. There's no way that I could give you a lucid digestion of whether or not this paper has any significance after studying medicine for thousands to tens of thousands of hours. These topics are highly nuanced and incredibly specific to a certain domain of medicine/virology.

Your point on disinformation is also salient. I've noticed that many followers on here are intelligent, but being able to synthesize the Wikipedia article gives one the basics on a topic. There are medical theories and philosophy that contradict normal thinking, but are the fundamentals of practice. I've engaged multiple users on another account about medical principles but was shocked at how resilient people are in their claims when they seriously understand math/statistics but don't understand the medical application of those statistics; the example I can think of is I know what ARDS is, the treatment guidelines for it, how intense the nursing care is, but how many people here have ever watched someone be intubated, let alone do it themselves? There are a lot of intangibles that aren't directly written in a Wikipedia article or cannot be fully realized without actually experiencing them.

I remember learning about the 10,000 hour rule, in that spending 10,000 hours doing something one becomes a master of that domain. After my experience I can say that is not the case with medicine, which has shown me serious humility.

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StandardFuture|5 years ago

> but was shocked at how resilient people are in their claims when they seriously understand math/statistics but don't understand the medical application of those statistics;

> but how many people here have ever watched someone be intubated, let alone do it themselves?

I am not sure I understand the connection you are trying to make here. Are you saying that just because someone understands statistics they cannot understand medical application of statistics b/c they have no experience physically working in the field? Just looking for a little more clarification on the point you are making.

I am genuinely interested in learning about multi-disciplinary disconnects in real life, because these seem to be the some of the biggest problems we face in progress today.

Munky-Necan|5 years ago

I want to start by saying, I appreciate your curiosity :)

I think my point above was talking about COVID. The specific example was where I was describing how at scale COVID was going to be a massive problem and have an increasing case fatality ratio as the virus spread. The reason for that is because ~19% of people, I'm probably out of date here and frankly don't feel like looking at Uptodate, go into ARDS. ARDS usually requires high flow oxygen therapy or mechanical ventilation. High flow oxygen essentially means you're hospitalized on a standard medicine floor costing ~$5k per night whereas mechanical ventilation is $10k with crucial nurses managing. A tertiary care hospital in your local probably has between 50-200 ICU beds. Rural hospitals will have 10-30.

Now the the disconnect here is with the statistics. Early estimates were putting COVID at 2-4% CFR because when you have practically unlimited resources you can save the overwhelming majority of patients. But as incident rate increases those supplies become saturated. ARDS is an intense symptomology to treat, this isn't just a cold and it is a tonne of resources. Also, the recovery times from pneumonia that leads to ARDS is usually measured in the months from initial hospitalization. Then on top of all of this COVID has a reproducibility number of 2.5-2.7, but now we're thinking it's actually around 3. Influenza is ~1.3 for reference.

So the key points of why I was afraid: 1) ARDS is life threatening 2) ARDS requires intense nursing/intensivist (ICU doc) care 3) ARDS takes months to recover from 4) COVID has a crazy reproducibility number

Here on Hacker News there are many mathematicians and statisticians who have done centuries of work, so I was told that making an assumption this early was a fools errand because the numbers were not painting the picture that I was describing: a very bad pandemic. I think I was told that because the consequences of a viral pneumonia are not common knowledge and there is a lack understanding of what entails a viral pneumonia. But the main crux of my argument was that the CFR was going to rise from the reported 2-4% all the way up to 5-10% based on the percentage of complications that were occurring. In Wuhan the CFR is 5.9% and there's still 2-3k people on ventilators months later (on top of the fact that in the American medical community there's accusations of a manipulation of those numbers....). The CFR in Italy and France at ~10% at the moment, if not higher.

I hope this explains the entire crux of what my point was earlier. I didn't want to get into too many specifics so as not to offend anyone.

withinboredom|5 years ago

It’s like if someone came to you and asked you to deploy some software so that if someone calls 911 from a cellphone their location shows up on the dispatcher’s terminal. In 2006.

“It’s just software” they say, “I’ve already written it, how hard can it be to deploy it? It’s only a few thousand lines of code!”

nradov|5 years ago

There has never been any "10,000 hour rule". In his book Outliers, Malcolm Gladwell misinterpreted and oversimplified the research into learning and training.

Munky-Necan|5 years ago

Honestly, I never really thought that the 10,000 hour thing was that lucid to begin with. Certain things are mastered in hundreds of hours while others are "never truly mastered". When I say I learned of it, it was reading the New Yorker article and then hearing it from my favorite kind of philosopher: stoned ones.