Probably because I don't know your position on the matter at hand. — Cheshire

Increasingly cryptic, I like it. The 'matter at hand' being? The thread? My argument? Your response? My job? Your most recent aphorism?...

keep running into seemingly undiagnosed cases of DID on Facebook. When I ask if they told a professional the answer is always that the executive control prevents verbalizing the condition. Anyway, I'm sure you are good at it. — Cheshire

I'm sure that's fascinating but I (as with about 50% of what you write) have not the faintest idea what you're talking about.

Guessing at the professional most suited to produce your argumentation. — Cheshire

I'm a consultant in psychology, I advise (among other clients) long-term risk analysts. They usually have a team of academics from all sorts of fields so there's considerable debate. None of it goes like this!

That's so weird to me. Your job orbits around abstraction, mine around concretion, usually shattered in some way. — frank

Yes. It's true we're at different poles of sociey's mortal injury, you trying to stem the bleeding, me trying to decide how the blood loss is going to affect people's decisions over the next five years. Do you think either has primacy on strategic decision-making?

Insurance adjuster? — Cheshire

Just had one thanks.

I have no idea what you're asking here.

I think you do engage in a little bad faith argumentation becuse you just like arguing. — frank

being able to produce complex arguments for bad ideas is dangerous. Too many people looking for confirmation bias for their fears and this seems like the El Dorado of misplaced intellectual weight. — Cheshire

It's interesting how you both have to create this alternative narrative for what's going on here. I've presented perfectly coherent arguments backed up whenever necessary by cited evidence, I've even referred to a few other experts in the field who share my views.

This all seems quite normal to me. In fact it's my job, a normal occurrence in my day-to-day life. I also listen a lot to other people doing the same and we clash occasionally.

But only here do I experience this odd narrative, that denies I could simply be a normal, educated professional with an adequately supported opinion. Somehow that option is ruled out. If either could explain why I'd be fascinated to hear the thought process behind it.

citing the conditions in England as evidence for conditions elsewhere is in principle a dubious approach to a data supported argument. — Cheshire

More dubious than rejecting it without citing any evidence from anywhere?

the increased marginal rate of patients is novel to a hyper transmittable virus making the argument that other conditions are equally as responsible for over loading a medical system misleading at best. — Cheshire

How? This argument seems to be lacking any structure. How does the fact that it's transmissible alter the proportion by which it is responsible for occupying healthcare resources?

The area under the curve for a single event is zero by nature of the variable. — Cheshire

?

The inability to predict idiosyncratic outcomes doesn't inform the decision, but does make for plenty of illusionary doubt. — Cheshire

??

would you suggest that recommending others avoid a vaccine during a pandemic, because that is the decision made for oneself is morally responsible? — Cheshire

No. I don't think that would be morally responsible. Not sure what that has to do with the discussion.

I agree that preventative medicine, a diet of whole grains and veggies for everyone, replacing cars with bikes, gun control, etc. would reduce the load on the healthcare system. Also if a frog had wings... — frank

What has the likelihood to do with the moral argument? It's unlikely the we'll ever get football hooligans to be less violent, but it doesn't affect the immortality of their actions. The argument here is that poor investment in preventative healthcare is responsible for more hospitalisations than covid vaccine hesitancy. That remains true regardless of the likelihood of either changing.

It's mostly genetic. — frank

Evidence?

Asthma is mostly genetic. — frank

Evidence?

We don't know what causes MS, but you'd need to show a proven preventative strategy to stay consistent with your earlier claim — frank

I've not made any claims about MS, it's a very minor comorbidity.

know you well enough to see when the conversation is going nowhere. — frank

Yes, it's the usual point that seems pretty much universal around here. I make an argument supported by citation, interlocutor claims it's false without any citation at all but rather because they just 'reckon' it is, then implies I'm the one arguing in bad faith.

I have a meeting to get to anyway so glad of the break...A meeting in which people will be discussing matters by presenting and interrogating evidence. Crazy, huh?

Hypertension — frank

These can all increase your risk of getting high blood pressure:

Drinking too much alcohol
Smoking
Being overweight
Not doing enough exercise
Eating too much salt — https://www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure#Heading3

asthma — frank

Environmental pollution, including traffic fumes and chemicals from power plants, can make asthma symptoms worse and may play a part in causing asthma.

Studies suggest that children living near very busy roads are more likely to develop asthma. — https://www.asthma.org.uk/advice/understanding-asthma/causes/

MS — frank

There's more and more evidence that low levels of vitamin D, especially before you become an adult, could be a factor in why people get MS.

Our skin makes most of our vitamin D when we're out in the summer sun. We also get some from food like oily fish, eggs, spreads and breakfast cereals with added vitamin D in them. You can also get extra vitamin D from supplements (but too much can be harmful).

A blood test can show if your levels of vitamin D are low.

Smoking

Studies show you're more likely to get MS if you smoke. It might be because the chemicals in cigarette smoke affect your immune system. If you have MS in your family, your risk of getting it too could go up if you're exposed to passive smoking (breathing in other people's smoke).

If you have relapsing MS and you stop smoking it can slow down how fast your MS might change to secondary progressive MS.
Obesity

Studies show that getting MS could be linked to being very overweight (obese), especially when you were a child or young adult. This might be because obese people are often low in vitamin D. Obesity can also make your immune system overactive and cause inflammation in your body. There may be other reasons we don't understand yet.

Of course, not all people who are very overweight get MS, and having MS doesn't mean you are or were obese. But if your risk of getting MS is on your mind, perhaps because a close relative has it, then your weight is a risk factor you can change. — https://www.mssociety.org.uk/about-ms/what-is-ms/causes-of-ms

You were guessing, then. — frank

The CDC are guessing? If anything I underestimated. 80% preventable heart disease, obviously almost 100% preventable obesity. Those two alone make up more than half the comorbidities associated with less favourable outcomes from covid-19.

You don't even know what the comorbidities were. Some of it was diabetes, some hypertension. What about cancer, asthma, MS. etc? — frank

All of which have high levels of preventable causal factors.

Plus you said that with preventative medicine, 50% of ICU beds in use would be empty, didn't you? How did you get that figure? — frank

It was a rough estimate based on figures I've read. Here's a good example...

The U.S. Centers for Disease Control and Prevention (CDC) estimates that eliminating three risk factors
– poor diet, inactivity, and smoking – would prevent:
80% of heart disease and stroke;
80% of type 2 diabetes; and,
40% of cancer — Mensah G. Global and Domestic Health Priorities: Spotlight on Chronic Disease. National Business Group on Health

using that data, how do you determine the percentage of patients who would be free of comorbidities with better preventative care? — frank

You don't (not using that data) The data linking preventative care with lower rates of comorbidity is huge. I can present a sample, but I'm assuming that's not the point - or are you really questioning whether preventative medicine even works?

Are you suggesting there's a factor which might bias the selection of patient to transfer to ICU that favours those without underlying comorbidity? — Isaac


No. It's the reverse. — frank

Right. So if 90% of a population are red-heads, and you have a selection procedure that biases in favour of red-heads, your selected sample is going to be at more than 90% red-head. Imagine a jar full of mostly red beads and a few yellows, you prefer red and are picking a sample, it's going to be at least as much red as the jar, if not more.

72.2 percent... of what? The first article was about identifying risk factors for ICU admission if COVID19+ with underlying CVD. — frank

Patients treated in the ICU ... were more likely to have underlying comorbidities (26 [72.2%] — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042881/?report=reader

You've lost me. Are you thinking that all COVID19 patients are admitted to ICU? — frank

No. If the population of hospital admissions are made up of 90% red-heads, then taking an unbiased sample out of the group (to ICU, for example) you'd expect that sample to also be 90% red-heads. Unless there's some factor biasing the selection of that sample against/for red-heads.

Are you suggesting there's a factor which might bias the selection of patient to transfer to ICU that favours those without underlying comorbidity? If anything it'd intuitively be the opposite, no?

So England has almost 10 times as many hospital beds as the US with about one sixth the population? This would mean there is (roughly) 1 bed for every 556 people in England and 1 bed for every 25,460 people in the US. Surely this cannot be right? — Janus

The figure I quoted was for one state in the US. I couldn't find any figures for the US as a whole - Cheshire was trying to claim (without any evidence) that the situation in the UK was not comparable in terms of the risk one took of putting pressure on hospital services compared to other lifestyle choices. I was just trying to show it's not that dissimilar. Why I'm running around gathering the evidence for his claim I don't know, but that's the best I could find at the time. There's probably whole US figures out there, but they didn't stand out on the first search I did, and since it's not even my claim (that the US is radically different to the UK), I'm not much inclined to do the legwork to support/falsify it.

I don't see how that article supported your claim. Could you point it out specifically? — frank

Sure. Take the 72.2% figure from the first study (which didn't include obesity) and add to it the OR (as a factor of case admissions) in the Lancet study. I get 91.4%

Other studies I've read since have shown obesity to be a much higher factor in ICU admission - this one https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262326/ for example has it at 76%, but since it didn't use separate ORs I couldn't add that one (as I'd have no way of knowing how much overlap in comorbidity there was - obese and CVD for example)

Either way, if you're happy with the data from the CDC showing over 90% of hospital admissions have underlying comorbidity, and the data (again CDC) showing over 90% of mortality with underlying comorbidity, then why would you be suspicious of ICU admission rates which match. It'd be odd if the didn't match wouldn't it? A lower ICU rate than admission rate would mean that hospitals were actually increasing the general risk for healthy patients. Possible, I suppose, but seems unlikely.

If you're interested (I can never tell whether you genuinely are interested or whether you're just playing 'catch Isaac out'), anyway - on the off chance you're actually interested from a medical point of view - this article breaks down the ICU requirements in term of ORs https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228874/?report=reader.

To make a lot of something fast requires many something makers. — Cheshire

Does it?

This is a different thread. — Cheshire

You brought it up.

To a pandemic?
— Cheshire

Yes. — Isaac


Fin — Cheshire

I wish.

Are you sure you weren't looking at hospital admissions vs ICU admissions? — frank

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390529/

...was where I got the figure from. Other studies have given lower figures, but still over half, it seems to depend on what comorbidities are measured (obviously)

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00074-0/fulltext

Obesity alone gives ten times the likelihood of ending up in ICU, miss that out, your figures are going to be a lot lower. Just a thought (not trying to be disparaging to Americans, but maybe you guys don't even see obesity as a comorbidity? It's so common in the US).

The point would still stand even at the lowest figure I've seen (~60% if I recall).

To a pandemic? — Cheshire

Yes.

But, that requires quick production of a vaccine. If there's not enough data about something that was produced just recently; people will pretend it's deficient. — Cheshire

Some will, others clearly won't.

And we'll have to use a business with access to vast resources. — Cheshire

Why?

All of them are evil for some reason. — Cheshire

Pretty evil, yes. I'd call restricting access to a life-saving vaccine and thereby leading to thousands of deaths evil. The head of the WHO seems to agree likening it to "apartheid". Why, do you think that's just OK behaviour?

It turns out people have to actually take the vaccines. — Cheshire

That might well be why, several pages back, I said...

I think vaccination is an excellent public policy response in general. — Isaac

Tell me why your quoting British figures and trying to tell me something. — Cheshire

They're American figures there. Read first, comment second

Your perspective is afflicted by a disconnection with the real world. — frank

Pathogen emergence used to be monitored to a greater degree than it is now, so it did actually happen in the real world. Countries did put swifter emergency measures in place and thereby reduced their case load, that actually happened in the real world too.

That sounds absurd — frank

Really? Why do you think that 'sounds absurd'? Do you think I'm likely to just quote figures I've got no support for, is that something my posting history suggests?

What you're suggesting is that my hospital could pay nurses, therapists, pharmacists, secretaries, central supply employees, intensivists, radiologists, cardiologists, neurologists, surgeons, orderlies, and me to stay at home until the next pandemic. — frank

How are your shifts? Busy? In England 18hrs is not uncommon for a junior. No-one would have to stay at home, just a normal fucking working day would do it.

Besides, as Cheshire was so delighted to pretend I didn't say, I'm not suggesting a need to double normal capacity (though we could), increasing capacity is one of a number of things which need going, including better community healthcare, hygiene, lockdowns and vaccines.

No one, literally no one, blames the crisis on hesitancy for a vaccine that didn't exist. — Cheshire

I'm not talking about pre-vaccine times, I'm talking about right now.

An increase of only half the entire capacity? So, just make it 150% of what's available. — Cheshire

Even without taking any other public health action...why we would assume that, I don't know — Isaac

Read first, comment second.

Oh, and England in the 80s had double the hospital capacity we have now. It's not hard.

You just extrapolated from the hospital conditions on your island to support an argument that spans the globe. Make that make sense. I'll wait.

My house is on fire! Can't be because mine isn't. — Cheshire

Really? You're still persisting? Did you even check the figures, or did you , again, just presume I must be wrong because the telly says so?

https://scdhec.gov/covid19/hospital-bed-capacity-covid-19

Covid occupancy in the US 1,800 out of 13,000 beds, obesity the most common comorbidity in covid https://www.nature.com/articles/s41366-020-0640-5, over 90% of covid cases in hospitals have comorbidities https://pubmed.ncbi.nlm.nih.gov/32578683/.

Even without taking any other public health action your 100 extra doors example is out by a thousand fold. In the US, it's half a door extra.

Even assuming no other strategies at all (why we would assume that, I don't know) your building example is a hundred times too extreme. Maximum occupancy with no vaccine was about a quarter of available beds, so a normal two door building would need an extra half a door. Your hyperbole is absurd.

There's no way to be constantly ready for a pandemic. — frank

I disagree. For a start, emerging pathogen monitoring was cut to the bone, it should never have been. Emergency measures were drafted but not acted on. Both would have dramatically reduced infection rates, as can be seen in the countries which acted more quickly than others.

That done, there should be no need for the crisis-level ICU occupation.

Secondly, still over 90% of ICU admissions have pre-existing comorbidities. We know from the preventable disease study I've already cited that better community healthcare can more than half ICU occupation. So half the existing occupation and nearly half the Covid occupation (half the comorbidities, halves the hospitalisations) and your ICU has bags of capacity.

Thirdly, I'm not, nor ever would be, advocating not using other forms if intervention - lockdowns, masks, sanitation, vaccines... I've never advocated just letting it rip. What I'm opposed to is the narrative which hides all of the massive societal failings which brought this crisis about under the blanket of vaccine hesitancy.

Vaccine hesitancy is a nothing issue, trivially unimportant compared to the practically genocidal strategies adopted by governments and corporations which are the root cause of this.

It would be like adding a 100 doors to every building on the off chance everyone wants to leave at once on any given day. — Cheshire

Again, this is why we look at actual numbers rather than guess what the numbers might be based on the strength of media interest.

Beds occupied by Covid-19 patients currently stand at about 2,500 out of 115,000 beds (source https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-hospital-activity/), about 2% of activity. About 20% of those 115,000 beds are occupied by those with avoidable illness (source https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/avoidablemortalityinenglandandwales/latest). — Isaac

A building normally has two doors, right? We'll call that the 115,000 beds normally occupied. Covid has required an extra 2,500. So your analogy is miles off - emotive hyperbole. It's not like adding a hundred extra doors (which obviously sounds ridiculous), it's adding an extra one twentieth of a door. Barely even a catflap.

So we take your absurd example derived from your hysterical guesswork, add some real figures from, you know, actually checking the fucking facts, and we find you're off by a factor of two thousand.

Your real example is the suggestion we add a catflap to every building to add a little extra escape capacity. Does that still sound so ridiculous now we've bothered to check?

It's always been that way, though, right? Too much fury, too little rational thought. — frank

Yeah, you're probably right. It didn't feel that way at the time, but I expect it was. That's probably why we didn't get anywhere then either. Remember Scargill and Solidarity?

Well this is troubling. I'll have to change my entire outlook on life now. — frank

Seems unlikely...

https://scholar.google.co.uk/scholar?hl=en&as_sdt=0%2C5&q=Frank+changes+his+entire+outlook+on+life&btnG=

https://vaers.hhs.gov/

Joking. Hope all goes well. For discussion see...well, literally anything I've posted for the last month!

Are you saying buying garden hoses has nothing to do with the weather? Citation? — frank

https://scholar.google.co.uk/scholar?hl=en&as_sdt=0%2C5&q=buying+garden+hoses+causes+rain&btnG=

Ah, fuck it. It's not worth it.

My real kvetch with StreetlightX is that he'll take preliminary shots at my nearest allies, the aforementioned "bleeding heart liberal" pacifists, before engaging within any debate — thewonder

The reason why left wing politics is failing in a nutshell.

For a movement which used to unite under the banner of Solidarity, most are more interested in the intellectual equivalent of trend-spotting in Vogue than actually gaining any more ground in the fight against class oppression... only the left wing version of being found wearing last years hem-line is to be the recipient of a wall of abuse. My enemy's enemy...

I don't need any science... — frank

Says it all. When science backs the corporate agenda it's all "follow the science", as soon as it opposes it, "We don't need science...". Pathetic.

Try to think rather than fall back on the narrative you've been fed. What doesn't make sense?

The health services have a number of incoming patients to deal with, that is their 'burden'. These patients have all sorts of conditions with all sorts of causes. Some of those causes are preventable, some of these preventable causes are deliberate choices made by the patient.

I'm asking you to justify why the deliberate choice, made by a patient to risk covid infection by not taking a vaccine counts as over burdening the health service, whereas the deliberate choice by the patient to eat a poor diet counts merely as an ordinary burden.

It isn't proportion - the obese make up a higher proportion of patients than the unvaccinated covid cases.
It isn't risk - the chances of a healthy young adult needing hospitalisation with covid are much smaller then their chances of needing hospitalisation from obesity.
It isn't harm to others - there's no evidence that being unvaccinated increases transmission to any greater extent than non-pharmaceutical measures, and taking a vaccine if you're healthy reduces the number available for other countries who need them to protect their vulnerable.

The overwhelming pressure on hospitals always was, and still is, poor health, resulting from poverty, reduction in community healthcare and lobbying by fast food manufacturers and pharmaceutical companies. That they can't cope with extra covid cases is not anyone's fault but the criminal lack of investment in health.

If you want to help prop up the corporate feeding trough by joining in this global exercise in distraction then be my guest, it only reflects poorly on your critical capacity, but don't expect to do it uncontested.

A series of massive, completely predictable failures of governments and institutions have lead to millions of deaths and an almost unprecedented transfer of wealth to the rich. And all you guys can find to direct your vitriol toward are an unlikely minority hodgepodge of nutcases and cynics. It's one of the most pathetic displays of corporate bootlicking I've had the misfortune to witness.

Americans should definitely receive boosters. — frank

So if you're no longer following the scientific advice, what are you following?

As some health official said, we were seeing women burying their parents, husbands, and brothers. Now they're burying their children.

Those are just the facts. — frank

2,000 children die every day just from diarrhea. No one gave a shit. No media storm, no hysteria, no moralising those who fail to act...nothing. A thousandth of that and suddenly billions are spent, anyone who doesn't help has "blood on their hand" and you're trying to tell me this isn't a narrative, just the facts?

Yea, mine. I'm suspicious of the pharmaceutical industry. I understand concerns about taking the vaccine. — frank

Oh. Then I've misjudged you and I apologise.

So in your response to @Janus's concern about vaccine distribution, you seemed to be saying that there wasn't a problem because the US needs all those vaccines to tackle its own outbreak (for the good of everyone). Did I misjudge that too? Because if not, it does come across a little like post hoc rationalisation to support the narrative you've just said you're suspicious of... the vaccines just so happen to be needed most in the one country that can most afford to pay for them. Does that not strike you as even a little suspicious?

I couldn't slam my head against the wall at the correct angle in order to interpret how you found it compelling. I see the above explains the logic-sink I was originally faced with interpreting. — Cheshire

Yes, it's exasperating when educated and intelligent people won't simply agree with your totally unsubstantiated assertions... and you even used your most condescending tone as well...

You poor thing. If only there wasn't that legal contract forcing you to reply...

Well let's not do that then. It's not a Disney movie. — frank

Do you see much awareness of that here? Is there a narrative you can point to here that extends beyond our flawless pharmaceutical saviours delivering us from the twin evils of nature (the virus) and the immoral unenlightened (the anti-vaxxers)? Anything at all?

Yeah, but so goes inflation and salaries. — ssu

It's not about inflation, spending has gone up even in real terms because GDP has gone up in real terms. It's no good trying to make it about the poor squaddie's wage packet, it's not. It's about the massively lucrative deals the arms manufacturers have.

https://www.defense.gov/Newsroom/Releases/Release/Article/2079489/dod-releases-fiscal-year-2021-budget-proposal/

Your graph doesn't show what it purports to show. That defence spending is a lower proportion of GDP is not the same a defence spending being 'low'. If GDP goes up, then defence spending goes up even when it remains the same proportion.

Arms manufacturers aren't interested in the proportion of GDP they get, they're interested in the actual cold hard cash.

US defence spending has never been higher https://www.macrotrends.net/countries/USA/united-states/military-spending-defense-budget . I don't see what difference it makes that other industries have also benefitted from American expansionism.

The point is actually well made by your response. The problem is the polemicisation of the issue. Vaccines are neither useless nor panaceas. They're neither good for everyone, nor good for no-one. They're neither brilliant solution to all our problems, nor propagators of the next armageddon.

It baffles me why complexity must be purged from discourse all the time.

Wait. Aren't you skeptical about the value of vaccines? If not, when did you change your mind? You sure as hell were a few months ago. — frank

Where did I say that? My last comment on the matter...

The Covid vaccination programme is unquestionably an excellent public health initiative, as most vaccination programmes are — Isaac

I don't see them as manna from heaven to be lapped up enthusiastically at every opportunity. That's hardly the same thing as the sort of skepticism we're talking about here. Vaccines undoubtedly save millions of lives and for the vulnerable, the risk/benefit analysis, in the case of this particular vaccine, seems indubitable.