[pilowsky]

 Winstonm, on 2021-January-21, 08:51, said:

Ok, thanks

I think there is a slight misunderstanding of what is meant by the 'Placebo effect' and the opposite the 'Nocebo effect'.
Just to begin, the terms are derived from Latin.
Doctors use foreign language words so that they can speak freely in front of patients - believing that the patient will not be able to understand them.

The idea of using foreign words is sometimes credited to Rene Laennec (inventor of the stethoscope).
Laennec coined the terms Craptitations and Rhonchi to describe the breath sounds that are known in English as crackles and wheeze.

Placebo comes from the Latin and simply means to make acceptable - it's also the root for placate.
Nocebo comes from the same Latin root as noxious.

The 'effects' associated with these words have absolutely nothing to do with causation.

So looking for a physiological reason for them is not sensible. They are not really 'effects' they are phenomena.

Both placebo and nocebo effects are a problem in clinical research because they contaminate the data. In any trial (even 'n of 1' trials - similar to when you see a Doctor) a person my coincidentally get better or worse.
The change in state can be due to many things.

I have high blood pressure (ironically). I get it checked by my GP so that adjustments to my medication can be made if needed.
Yesterday I had it checked - it was a bit high - 5 minutes later normal.
This could be 'white coat hypertension' (unlikely) or just because when I arrived I was in a hurry. The placebo effect can be better characterised as a falling away of some previously active process. Maybe a better term is 'Apobo', but that sounds a bit silly.

The nocebo effect is the opposite. A person taking a compound becomes unwell in some way while taking an active ingredient. The unwellness has nothing to do with the treatment.

In both cases, there can be false positives and negatives. A person may get better because of a previously unidentified effect of the treatment and so on.

non deus ex machina - neither placebo nor nocebo has a physiological basis.

They are a bothersome statistical artefact, not a basis for management.

[shyams]

There is an interesting article on the NFL website on Covid transmission. (Link)

Some points from this report that I found interesting (only selective text shown below - the entire article can be accessed using the link):

NFL website said:

... the NFL found that transmission of the virus that causes COVID-19 occurred in less than 15 minutes of cumulative contact between individuals -- the timeframe the CDC initially used in its definition of close contact.

What was gleaned from the season suggest recommendations that could be useful in other settings.

• "It's important to recognize that the most impactful intervention was not testing or tracking devices," said Dr. Allen Sills, the NFL's chief medical officer. "The most impactful interventions were universal use of facemasks, holding meetings outside and minimizing in-person meetings, closing dining rooms -- those all have broad applicability outside of football."
  
  
• Also important were the quality of the masks being used, and air flow and ventilation. That is why in-person meetings were eventually forbidden in the NFL, even if people were able to be 6 feet away in a room, and why all meals at team facilities had to be grab and go -- eating together was an area of vulnerability.
  
  
• And the paper showed the importance of isolating and quarantining people who were deemed high-risk close contacts of an infected person. That mid-season adjustment in the NFL protocol was designed to limit the spread of the virus. To date, 37 individuals who were isolated after being a high-risk close contact later tested positive.
  
  
• The intensive protocol -- which included virtual meetings, mask-wearing at all times, including during practice, and elimination of group meals -- was put in place at the start of October for any team that had a positive case.

Edit: The CDC "Early Release" article on the above subject can be found here

[barmar]

 pilowsky, on 2021-January-21, 12:08, said:

So looking for a physiological reason for them is not sensible. They are not really 'effects' they are phenomena.

Electromagnetism is also a phenomenon. But it occurs reliably and we can quantify it, which allows us to make use of it in technology.

So it's not unreasonable to research whether the placebo effect is also reliable enough to be used clinically. And also to try to determine how much the effectiveness of "real" treatments is due to physiological processes versus psychological ones.

And on the other side, we can reasonably wonder how much of the fatality rate of COVID-19 is due to the psychological effects of being isolated in ICU wards.

It's very difficult to measure this, so what we mainly get are anecdotes, and they'll almost certainly be biased.

[pilowsky]

 barmar, on 2021-January-28, 12:05, said:

Electromagnetism is also a phenomenon. But it occurs reliably, and we can quantify it, which allows us to make use of it in technology.

So it's not unreasonable to research whether the placebo effect is also reliable enough to be used clinically. And also to try to determine how much the effectiveness of "real" treatments is due to physiological processes versus psychological ones.

And on the other side, we can reasonably wonder how much of the fatality rate of COVID-19 is due to the psychological effects of being isolated in ICU wards.

It's very difficult to measure this, so what we mainly get are anecdotes, and they'll almost certainly be biased.

You are splitting hairs, Barry. I don't want to get into a tedious debate about the difference between effects and phenomena.
Perhaps I made the wrong choice of word, but my intent was clear.

The placebo effect is not a 'positive' state. It is something that is attributed to an outcome when all real-world explanations are ruled out.

Doctors do not chat amongst themselves and say "hmm I wish we had some placebo to offer this person". Although there was a Band at the med school I went to that was called 'Placebo' - their music would not have effectively treated anyone.

No physicist will say "I can't work out why that happened, it must be electromagnetism!".

You are absolutely correct about the psychological effects of confinement in ICU. My daughter is doing her PhD on this topic. She has just published her first paper about it. I'm a little bit proud.

[shyams]

I have noticed over the past week or two that every article on Covid vaccine effectiveness seems to top the "most read article" list on the BBC website. I would have thought the a single-number for effectiveness (e.g. today's headline --- "Janssen single dose Covid vaccine 66% effective") provides no informational value to the average (i.e. non expert) citizen.

The Covid vaccination centres are unlikely to offer people a choice, right? And even if they did, would the recipient be in able to make an informed choice? In other words, is the fixation on the percentages a needless distraction?

Would love to hear opinions.

[Cyberyeti]

 shyams, on 2021-January-29, 09:00, said:

I have noticed over the past week or two that every article on Covid vaccine effectiveness seems to top the "most read article" list on the BBC website. I would have thought the a single-number for effectiveness (e.g. today's headline --- "Janssen single dose Covid vaccine 66% effective") provides no informational value to the average (i.e. non expert) citizen.

The Covid vaccination centres are unlikely to offer people a choice, right? And even if they did, would the recipient be in able to make an informed choice? In other words, is the fixation on the percentages a needless distraction?

Would love to hear opinions.

I think all it means is that's another 30M doses coming in to the UK of a decent vaccine, the effectiveness number means little as long as it's decent. Also the ones that work in different ways may give options to some patients for those that can't take some of the others.

[cherdano]

 shyams, on 2021-January-29, 09:00, said:

I have noticed over the past week or two that every article on Covid vaccine effectiveness seems to top the "most read article" list on the BBC website. I would have thought the a single-number for effectiveness (e.g. today's headline --- "Janssen single dose Covid vaccine 66% effective") provides no informational value to the average (i.e. non expert) citizen.

The Covid vaccination centres are unlikely to offer people a choice, right? And even if they did, would the recipient be in able to make an informed choice? In other words, is the fixation on the percentages a needless distraction?

Would love to hear opinions.

One number??
We need efficacy against symptomatic disease, against asymptomatic infection, against transmission, against severe disease, against hospitalisation, against death. For old-fashioned covid-19, for B1.1.7, for B1.351. By age, risk group, gender.

Also, frequentist confidence intervals, CIs based on a Bayesian model with minimally informative prior, or CIs based on cherdano's model (Bayesian model with a "best guess" prior based on clinical Phase 1/2 results - antibody titers etc. compared to other vaccines). Now we are talking.

More seriously? Let BBC readers enjoy some good news, we had enough bad news to digest!

[pilowsky]

 cherdano, on 2021-January-29, 17:18, said:

One number??
We need efficacy against symptomatic disease, against asymptomatic infection, against transmission, against severe disease, against hospitalisation, against death. For old-fashioned covid-19, for B1.1.7, for B1.351. By age, risk group, gender.

Also, frequentist confidence intervals, CIs based on a Bayesian model with minimally informative prior, or CIs based on cherdano's model (Bayesian model with a "best guess" prior based on clinical Phase 1/2 results - antibody titers etc. compared to other vaccines). Now we are talking.

More seriously? Let BBC readers enjoy some good news, we had enough bad news to digest!

Confidence interval - the gap between reality and fantasy.

This definition would certainly explain a lot about how politicians manage disasters.

[y66]

Matt Yglesias said:

https://www.slowbori...p/good-vaccines

When you read in the press that a vaccine is 90 percent effective vs another one that’s only 70 percent effective, do you know what that means? It turns out that what everyone is measuring in their Covid trials is the share of people in the control group who develop symptoms vs the share of people in the treatment group. That focus on symptoms has a bad news aspect that’s been widely publicized — they measured symptoms rather than doing constant PCR tests so some of the vaccinated people may have had asymptotic infections, and it’s possible that vaccinated people can still spread the virus.

Less widely publicized is the good news: None of the people in the Pfizer/Moderna treatment groups died or even fell seriously ill and had to be hospitalized.

This is typical of vaccines. For virology reasons that I don’t really understand, flu vaccines have very low efficacy as measured in this way. One of the main reasons doctors recommended them anyway is that the immune system head start they provide greatly reduces the severity of flu infections even when it doesn’t stop them. These days they vaccinate kids against chickenpox, so kids mostly don’t get chicken pox. But even more remarkable, when they do get chickenpox these days it’s a “sick for a few days” kind of thing not “miss weeks of school while suffering in agony.”

This is a really big deal with regard to the lower efficacy we are expecting from the AstraZeneca and Johnson & Johnson vaccines. A vaccine that’s only 70 percent effective at blocking infection would be expected to generate a larger than that reduction in hospitalizations and an even larger reduction in death. Which is to say that especially as a solution for the non-elderly, a vaccine like that is actually really good. Giving everyone under 65 a 70% effective vaccine sounds a little lame, but would eliminate almost all the loss of life among the non-elderly and also take a huge burden off America’s hospital system. These vaccines are really good.

[y66]

Cat Ferguson at MIT Technology Review said:

The CDC ordered software that was meant to manage the vaccine rollout. Instead, it has been plagued by problems and abandoned by most states.

https://www.technolo...-vams-problems/

[hrothgar]

Writing software is hard

Writing software that needs to be ready immediately and works perfect is especially hard.

The Obama administration got burned during the early phases of the Obamacare rollout.
I'm not surprised that we're seeing similar problems here.

Don't get me wrong. I'd like to be able to blame this all on Trump /Jared / whomever. However, I'm not sure that that's quite fair this time around.

[y66]

 hrothgar, on 2021-January-30, 14:02, said:

Writing software is hard

Writing software that needs to be ready immediately and works perfect is especially hard.

The Obama administration got burned during the early phases of the Obamacare rollout.
I'm not surprised that we're seeing similar problems here.

Don't get me wrong. I'd like to be able to blame this all on Trump /Jared / whomever. However, I'm not sure that that's quite fair this time around.

It may be premature to assign blame. You can't build decent software if the requirements suck or if the requirements are still changing or the runtime environment is unpredictable. But I don't think it's premature to say that Deloitte's software sucks or, given their history, that this is not surprising.

[pilowsky]

If you aren't blaming Trump and his band of alternate 'geniuses' then you are mistaken.

Everything is 'hard' when you don't know how to do it.
Countries - with actual functioning health care systems - have been giving vaccinations for more than 100 years. Even before software was invented.
Computers with hard drives that people could operate easily did not arrive until after 1990. Access to computers is still limited.

Neil Armstrong landed on the moon in 1969. The computing power available to him was equivalent to an HP-125
The Federal system for managing healthcare in the USA looks like it was designed by Kafka and implemented by Mervyn Peake.
Read Catch-22, The House of God etc to understand why the American system (I use the word advisedly) is a failure.

To distribute a vaccine you need is a little book with a few columns and a pen.
A steady supply chain would also be helpful.

What you don't need is software. Using software impairs access to poor people. In the USA the 'average Joe' is finding it damn near impossible to get a vaccine because of the 'software'.

In any event, I'm sure that when they get the injection the software that bills them will work just fine.

Except with Trump of course. He can't pay his bills because he's under audit, and someone called Eric is running his company for him. But Eric has been cancelled so don't hold your breath for anything useful to happen.

In any event, you seem to be suggesting that while they were spending time making the vaccine nobody in government thought that it would be a good idea to think of a way of distributing it.

The US Federal government is now so lacking in expertise that when Trump was rambling to Johnathon Swan the graphs he was misinterpreting were obviously downloaded from ourworldindata.org - everyone's go-to source on this Forum.

This means that Trump was relying for his advice on some staffer googling the internet to get help from a University in the United Kingdom instead of taking advice from the vast intelligence infrastructure specifically designed to help any administration cope with disasters.

The fact that Trump failed to appoint a Minister of Science (different name in the USA) for more than a year is emblematic of the catastrophe.

Not everything needs good software: interest, empathy, determination and perseverance are also useful.

Was Polio eradicated with software? How about Cholera in London.

[hrothgar]

 pilowsky, on 2021-January-30, 16:12, said:

In any event, you seem to be suggesting that while they were spending time making the vaccine nobody in government thought that it would be a good idea to think of a way of distributing it.

Actually, that is precisely what happened here in the US.

The Federal government almost completely ignored issues surrounding distribution (particularly what would happen once supplies were handed off to individual states)

This is what REPUBLICANS are saying

“That comprehensive vaccination plans have not been developed at the federal level and sent to the states as models is as incomprehensible as it is inexcusable.”

Just today, it was announced that the Federal Government "lost" 30 millions doses...

https://pbs.twimg.co...pg&name=900x900

[hrothgar]

 pilowsky, on 2021-January-30, 16:12, said:

To distribute a vaccine you need is a little book with a few columns and a pen.
A steady supply chain would also be helpful.

How do you think that supply chain management is done?

Hint: It involves software....

[pilowsky]

 hrothgar, on 2021-January-30, 16:48, said:

How do you think that supply chain management is done?

Hint: It involves software....

How do you think it was done prior to 1990?

Hint: it doesn't involve software...

[pilowsky]

 hrothgar, on 2021-January-30, 16:34, said:

Actually, that is precisely what happened here in the US.

The Federal government almost completely ignored issues surrounding distribution (particularly what would happen once supplies were handed off to individual states)

This is what REPUBLICANS are saying

“That comprehensive vaccination plans have not been developed at the federal level and sent to the states as models is as incomprehensible as it is inexcusable.”

Just today, it was announced that the Federal Government "lost" 30 millions doses...

https://pbs.twimg.co...pg&name=900x900

Actually, That is exactly what I said. You seem to have that singularly American skill of being an 'irony-free zone'.

See those spaces

in between the lines

try to read them.

It will hurt a bit at first.

But then you will get better at it.

[shyams]

 pilowsky, on 2021-January-30, 17:45, said:

Actually, That is exactly what I said. You seem to have that singularly American skill of being an 'irony-free zone'.

See those spaces

in between the lines

try to read them.

It will hurt a bit at first.

But then you will get better at it.

This is utter bullshit used to backtrack from previous misstatements or poorly constructed points.

[pilowsky]

 shyams, on 2021-January-30, 17:59, said:

This is utter bullshit used to backtrack from previous misstatements or poorly constructed points.

I would not be the first to utter bullshit around here.

[kenberg]

The vaccine roll-out.
I'll say a bit from personal experience. I suspect my experience is common.


Background: I'm 82, Becky, my wife, is 73, we are both in reasonable health I am often told I am in great share for an 82 year old which is sort of giving with now hand and taking back with the other. I have spent more time tin doctor's offices in the last ten years than in the seventy years before that. A different order of magnitude really. I live in Carroll County Maryland. It's a short walk to get to see cows, it's a short drive to get into Baltimore. OK, enough background.


I filled out a form expressing interest in the vaccine for the county, and one for the county hospital. At first they were overwhelmed but within a few days they got it together and I have been acknowledged as in their list of people to get it. I am 1B (being over 75), Becky is 1C(between 65 and 75). The original statement, maybe 3+ weeks back, was that 1A people would be seen within a week and then they would start on the 1C. Oops. Not so.
But now it gets complicated.

Among my various medical interactions, I was involved with the University of Maryland Medical System, and that puts me in their database. I also expressed interest in the vaccine to UMMS and, last Monday evening, I got an email saying I could come in on Tuesday or Thursday. I got my first vaccine (Pfizer) on Tuesday. A very impressive operation, many people in a large area, including a large area where we were to stay for fifteen minutes after the shot to see if there was any adverse reaction. There wasn't. I will get the second dose Feb 17.
Ok, now I should get off of the other lists that I am on. I should, but as near as I can tell, I can't. Perhaps they have access to the UMMS database and can see that I am already with them? Maybe, but I doubt it.

And, as I say, I expect this to apply to quite a few others. We octos, most of us, get to know more than one or two docs. A bridge playing friend has been to Johns Hopkins for knee issues, he has now received the vaccine from Johns Hopkins. You get the idea.

A recent article in the Carroll County times spoke of how few people over 75 in the county have received the vaccine. They were relying on data from the county health person. But am I in his data set as someone who got it, from UMMS, or am I in his data set as someone who has expressed interest to the county health office but has not yet received the vaccine? I sus[pect it is the latter but do I know? No, it beats me. And the County Commissioners were concerned with the number of 0ver 75s that have not been vaccinated. No doubt there are some over 75s, perhaps quite a few, who have not received the vaccine, but I seriously doubt that the data that they have is (ok, are) accurate. Perhaps a long way from accurate. But I don't know.

As for Becky, she is 1C rather than 1B, and now the county is being somewhere between vague and pessimistic about when they will get to 1C. And she has not been involved with UMMS or any other such good luck.
Ok, as of yesterday, I do the grocery shopping, not Becky. We can cope.

I appreciate the vaccine, I really do, and I can appreciate that there are problems with a roll-out of this magnitude. Still, it's a little troubling. It's as if the vaccine Santa decided I have been a good boy but Becky has been a naughty girl.

This is not really a letter of complaint, just a statement of how things are from what I have seen up close.