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UChicago doctors see ‘remarkable’ success using ventilator alternatives

uchicagomedicine.org

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Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#101

Post by ineedasername »

achillesheels wrote: post #84
mmkhd wrote: post #77

Earlier quoted context omitted.

> they will let their patients and colleagues die first. No! They will definitively not let their patients and colleagues die firs! They will prevent you from killing them! You might believe in youRe therapy, but the vast amount if novel therapies will have (novel) adverse effects and you will haVe to supply the prove that your therapy will do less harm than doing the conventional thing. We have clinical trials to ad…

Please explain to me the risks of nebulized ethyl alcohol, which is what I am proposing? Ad hoc dismissals without the consideration of scientific literature reviews of alcohol inhalation - which there are several review papers published - demonstrates a serious lack of critical thought in medicine. Obviously to compare it to chloroquine is absurd. Your point about supplying the safety data is exactly where the roadb…

An ad hoc (fallacy) dismissal would be one that doesn't actually address the central question or finds an excuse that is not generalizable to similar circumstance without supporting evidence for the exception. Even if you think the GP's reasoning was wrong, the GP comment did provide specific reasons for their argument, which was itself an argument generalized to medical practice & research. Not ad hoc.

Further, if the GP had prior assumptions about these possible treatments being wrong, you commit the same error in the opposite direction with your casual assumption that your approach is right, that the FDA will not only approve the thing, but that the objections will also lose all validity. Even if approved, the objections may still have merit. The objection need not be completely wrong in order for the FDA to decide the balance of risk weighed in favor of approval.

Finally, the idea of using nebulized ethyl alcohol is interesting! I hope it works. It is, however, extremely easy to find information on the dangers of inhaling alcohol fumes. If it is a viable treatment path, patients are likely to be extremely sensitive to dosing levels. Recipients would also, by definition, be high-risk, making the safety issues more uncertain. It is not, on it's face, unduly obstructionist to be highly skeptical of such a treatment without a decent amount of evidence.

Edit: I even partly agree with your sentiment that this is a time when some (very careful) risks may need to be taken that ordinarily wouldn't be. But your comment conveys a strong sense of arrogance, of unassailable certitude. I hope I am wrong in that assessment: Someone looking to take these sorts of risk right now should be approaching them with the utmost humility. This makes your tone very disturbing.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#102

Post by loeg »

tomohawk wrote: post #94
loeg wrote: post #78

The article mentions 40% O2 sat to 80 or 90%; aren't the latter still really low? I'm certainly no doctor, but wikipedia[1] claims "Prolonged hypoxia induces neuronal cell death via apoptosis, resulting in a hypoxic brain injury" and suggests that 80-85% is considered severe and 86-90% moderate. Granted, both are a hell of a lot better than 40%! It adds, "Mild and moderate cerebral hypoxia generally has no impact bey…

Being on a ventilator is traumatic. So much so that they generally put you under. Can you imagine waking up with a tube through your mouth and down your throat forcing you to breathe? It happens and people panic and have to be restrained. People get PTSD. https://www.hopkinsmedicine.org/news/media/releases/ptsd_com... If you can get the O2 up to a livable level without a ventilator so that the patient is supported en…

I totally agree, but that isn't responsive to my comment.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#103

Post by Izkata »

loeg wrote: post #78

The article mentions 40% O2 sat to 80 or 90%; aren't the latter still really low? I'm certainly no doctor, but wikipedia[1] claims "Prolonged hypoxia induces neuronal cell death via apoptosis, resulting in a hypoxic brain injury" and suggests that 80-85% is considered severe and 86-90% moderate. Granted, both are a hell of a lot better than 40%! It adds, "Mild and moderate cerebral hypoxia generally has no impact bey…

> The article mentions 40% O2 sat to 80 or 90%; aren't the latter still really low? I'm certainly no doctor, but wikipedia[1] claims "Prolonged hypoxia induces neuronal cell death via apoptosis, resulting in a hypoxic brain injury" and suggests that 80-85% is considered severe and 86-90% moderate.

Yeah, unfortunately I can't find it now, but I remember reading a "what the fuck is going on, these patients should be dead!" statement from a doctor a week or two ago about exactly that.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#104

Post by Izkata »

ineedasername wrote: post #68

I wonder how they decide which patients would get the cannula instead of a ventilator? Otherwise, intubation w/ a ventilator generally requires some form of sedation-- I wonder if that sedation has an impact on the body's ability to fight back.

By seeing what type of damage is being done to the lungs through CT scan or X-Ray, according to this article on a similar topic from two weeks ago: https://www.webmd.com/lung/news/20200407/doctors-puzzle-over...

More and more it's starting to look to me like we have two different novel viruses going around.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#105

Post by ceejayoz »

1996 wrote: post #100
ceejayoz wrote: post #32

Earlier quoted context omitted.

It’s a far more complicated procedure, of course it pays more. A five year old can install a nasal cannula.

and it could be done at home, using an O2 cannister, that should be cheap even for those paying out of pocket without medical insurance. no wonder why the medical establishment would be opposed to a simple work around that would remove the need for hospitalization or ICU

These patients still need the care and monitoring you'd get in an ICU, and there's zero indication the "medical establishment" is opposed to it - high-flow oxygen is used regularly in hospitals in a variety of scenarios.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#106

Post by achillesheels »

arcticbull wrote: post #99
achillesheels wrote: post #84

Earlier quoted context omitted.

Please explain to me the risks of nebulized ethyl alcohol, which is what I am proposing? Ad hoc dismissals without the consideration of scientific literature reviews of alcohol inhalation - which there are several review papers published - demonstrates a serious lack of critical thought in medicine. Obviously to compare it to chloroquine is absurd. Your point about supplying the safety data is exactly where the roadb…

> I’ll update you when the device is approved by the FDA and voila these objections mysteriously disappear ;) You know a proper FDA approval takes years, right? Not the emergency do-whatever-you-want approval, a proper approval. By all means, please do post.

That’s for pharma trials. Medical devices flow through the CDRH.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#107

Post by achillesheels »

ineedasername wrote: post #101
achillesheels wrote: post #84

Earlier quoted context omitted.

Please explain to me the risks of nebulized ethyl alcohol, which is what I am proposing? Ad hoc dismissals without the consideration of scientific literature reviews of alcohol inhalation - which there are several review papers published - demonstrates a serious lack of critical thought in medicine. Obviously to compare it to chloroquine is absurd. Your point about supplying the safety data is exactly where the roadb…

An ad hoc (fallacy) dismissal would be one that doesn't actually address the central question or finds an excuse that is not generalizable to similar circumstance without supporting evidence for the exception. Even if you think the GP's reasoning was wrong, the GP comment did provide specific reasons for their argument, which was itself an argument generalized to medical practice & research. Not ad hoc . Further, if…

Thank you for your reply, but I never claimed an ad hoc fallacy? Nor did I claim infallibility? I am insinuating the disregard for novel therapies in a pandemic because there is no data conceived (ad hoc dismissal or excuse), and not because of an intuitively perceived judgment on its harm, which is readily discernible from the collection of scientific literature on alcohol inhalation I have found and can share, is a testimony to healthcare bureaucratization.

For instance, the banning of nebulization in hospitals for fear of viral aerosolization published in a faulty NEJM letter[1] is preposterously cautious. By this logic, Lysol disinfectant sprays ought to be banned too, even though it’s recommended by the CDC. So this “arrogance” you sense is probably because it is apparent to me I am hungrier to save lives than (many) doctors and hospital administrators who won’t take a chance to even measure the risk to accumulate much needed experimental evidence; even if their patients are willing! Hippocratic Oath is the retort.

Frankly, “no data no dice” does not cut it when confronting such a global humanitarian challenge. The medical profession appears to be just that - licensed occupational employees motivated about retaining their jobs. Hence my snarky expectation that this will be an easier, ie quicker, sale if/when the nebulizer has been rubber stamped by the FDA. No one was ever fired for buying IBM

[1] https://www.nejm.org/doi/full/10.1056/NEJMc2007942

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#108

Post by jonkho »

james-mcelwain wrote: post #92
jonkho wrote: post #87

Earlier quoted context omitted.

Sources? I would disagree, reports show that by not intubating, outcomes are dramatically improved. [1][2] [1] https://www.bloomberg.com/news/articles/2020-04-22/almost-9-... [2] https://www.reuters.com/article/us-health-coronavirus-ventil...

I'm taking issue with the use of the word "dramatically" not the claim that it could improve patient outcomes.

Sounds like mincing words. Still you have not provided sources to support your assumptions whatsoever.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#109

Post by ineedasername »

achillesheels wrote: post #107
ineedasername wrote: post #101

Earlier quoted context omitted.

An ad hoc (fallacy) dismissal would be one that doesn't actually address the central question or finds an excuse that is not generalizable to similar circumstance without supporting evidence for the exception. Even if you think the GP's reasoning was wrong, the GP comment did provide specific reasons for their argument, which was itself an argument generalized to medical practice & research. Not ad hoc . Further, if…

Thank you for your reply, but I never claimed an ad hoc fallacy? Nor did I claim infallibility? I am insinuating the disregard for novel therapies in a pandemic because there is no data conceived (ad hoc dismissal or excuse), and not because of an intuitively perceived judgment on its harm, which is readily discernible from the collection of scientific literature on alcohol inhalation I have found and can share, is a…

My apologies, when you said "ad hoc dismissal", I assumed you meant the fallacy. Your phrasing was an appropriate way to state that someone had committed that fallacy.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#110

Post by raverbashing »

StavrosK wrote: post #91
raverbashing wrote: post #48

Earlier quoted context omitted.

This, exactly. The fixation on RCTs has kinda become "a meme" at this point. However it's lives on the line in some situations. Not everything can be double-blind. Not every experiment can be ethically done with a placebo (or done at all). Also the placebo effect is real but it is more pronounced in things like back pain or headaches, not so much in broken bones or aggressive viruses.

You don't need to have a placebo to do a controlled trial, you can just have a control arm of people you administer nothing to. How are you going to know if you have an improvement if you don't have something to compare your treatment to, though?

> How are you going to know if you have an improvement if you don't have something to compare your treatment to, though?

Historical data? Past experiments? Sure, they might have biases, but the higher sample size of historical data can help with that.

I think (specific) control groups make sense when you're talking about small effects or very specific cases (for example, the control group will undergo the standard treatment instead of the new treatment)

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