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“You're not allowed science any more”

nature.com

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Re: “You're not allowed science any more”

#141

Post by falcolas »

kstenerud wrote: post #91
falcolas wrote: post #75

Earlier quoted context omitted.

“As I said, there is always a small risk, but if you look, you will see that this is less than the probability of...” Sacha held up her hand. “Please, Doctor. Don't try and confuse the issue.” --- Education attempt, and rejection of such education, in three sentences. After previous education attempt (plus a pamphlet) and rejection of such education. What more should the doctor have done?

Doctor attempts to educate in a format of his own choosing. Patient rejects. Doctor then rejects patient. Normally when something doesn't work, you look for reasons why it doesn't work. You then take some educated guesses at what might be blocking success, and try altering your approach. After some trial and error, you eventually discover how to make it work. This doctor-patient situation is the same kind of thing, e…

You still haven't answered the basic question: What else could he have actually done, given that the woman wasn't interested in having a conversation - just the answer to a yes or no question.

If the other party is unwilling to have a conversation (to the point where she attempts to leave when he won't give the binary answer), there simply is no way to "look for reasons why it doesn't work". The doctor shows his willingness and interest in having a discussion at the end, where he supports her asking of a non-binary question. What's most unfortunate in this tale of what it took to get to the patient to that place.

Re: “You're not allowed science any more”

#142

Post by mpweiher »

danielweber wrote: post #113
mpweiher wrote: post #83

Earlier quoted context omitted.

You didn't get the point at all. "You can't explain something," That's exactly not it. The doctor wanted to explain the facts, with the leaflet. Sacha wanted a simplistic assurance that wasn't possible, and refused point blank to have it explained to her.

Those were the words she used, which could be entirely different from her actual reasoning that she didn't feel like talking about. And if this were any kind of world where doctors overrule you because "your argument is invalid" then she will of course not be forthcoming with her doctor ever. She will instead learn the magic words "oh, Johnny had a bad reaction to a vaccine at his previous doctor in Canada." The doct…

"Those were the words she used, which could be entirely different from her actual reasoning that she didn't feel like talking about."

Er, no.

She is a fictional character in a parable, entirely the author's creation. I think it's safe to assume that the words "she" used were the ones "she" intended to use.

Re: “You're not allowed science any more”

#143

Post by gretful »

untothebreach wrote: post #48
sbhere wrote: post #21

Earlier quoted context omitted.

The mother in the narrative is requesting to be informed. A pamphlet does not inform, although it may. Face-to-face conversation has the opportunity for an asker to ask questions for an authority on the matter to answer. However, more to the point: is this pamphlet science or marketing? Many such pamphlets about medicine blur that line quite well...

The mother in the narrative is not asking to be informed, she is asking for a specific guarantee that the doctor cannot give. It would be like a client saying, "give me a guarantee of 100% uptime or I'm going with someone else," and refusing to read your literature about how many "9s" you can provide.

nah, the doc is equivocating because he CAN'T give the woman a 100% guarantee (would make a nice malpractice suit if something did happen to the child).

Re: “You're not allowed science any more”

#144

Post by gretful »

So here you have a Doctor trying to be Lawyer. There is a chance, however small, of a bad reaction to the vaccine. The Doctor knows this, therefore he cannot give this woman her 100% guarantee that nothing will go wrong because of the vaccination. He knows that if he tells this woman it will be OK and nothing will happen, that if something DOES happen he will be sued for medical malpractice.

Re: “You're not allowed science any more”

#145

Post by tzs »

JumpCrisscross wrote: post #44
suprgeek wrote: post #36

I think we should be making a financial/societal incentive to do the right thing if the science is settled enough. The trouble with the view presented here is that sure the children get the vaccine due to this hypothetical rule. what happens when later the children get a severe cold (say) and the mom who remembers the previous visit thinks - bloody doctors I will just keep my kid home and pray for him to get better?…

> At school: "Sacha your kids are not vaccinated and we do not admit any students not vaccinated." I thought this would perpetuate social stratification. But my hypothesis, that poor families are less likely to vaccinate their children than rich families, was incorrect. The National Network for Immunisation Information finds that "compared to fully immunized children, unvaccinated children were more likely to be non-…

> But my hypothesis, that poor families are less likely to vaccinate their children than rich families, was incorrect

Indeed. The Waldorf School of the Peninsula, an expensive private school ($20k/year tuition for kindergarten and elementary school, $21k/year for middle school, and $28k/year for high school), full of the children of very well off people from top Silicon Valley companies, had a 23% immunization rate a few years ago (I haven't seen what the current rate is). Compare to 90% for the public schools in the same city, and 94% for the public schools in the county.

Re: “You're not allowed science any more”

#146

Post by kstenerud »

falcolas wrote: post #141
kstenerud wrote: post #91

Earlier quoted context omitted.

Doctor attempts to educate in a format of his own choosing. Patient rejects. Doctor then rejects patient. Normally when something doesn't work, you look for reasons why it doesn't work. You then take some educated guesses at what might be blocking success, and try altering your approach. After some trial and error, you eventually discover how to make it work. This doctor-patient situation is the same kind of thing, e…

You still haven't answered the basic question: What else could he have actually done, given that the woman wasn't interested in having a conversation - just the answer to a yes or no question. If the other party is unwilling to have a conversation (to the point where she attempts to leave when he won't give the binary answer), there simply is no way to "look for reasons why it doesn't work". The doctor shows his will…

By the time she's in the doctor's office, there's not enough time to undo all the damage. The doctor cannot change her mind in a 15 minute visit, let alone build up her trust.

This is a false dilemma. It takes time to fix this sort of thing. Unilaterally shutting her out is probably the worst thing the doctor could do.

Re: “You're not allowed science any more”

#147

Post by mynewwork »

CanSpice wrote: post #139
mynewwork wrote: post #118

I'm confused by the awkward grammar in the title. Is it intentional for humor (like xkcd's 'going to try science') or is that wording acceptable use in British dialects? I'm parsing it as "You're not allowed science" or "You're not allowed science", but it's right on the line of believable that I could see that sentence being used genuinely in another dialect.

They're using science as a noun. Think of it like "You're not allowed oxygen any more."

Which still sounds wrong to me. I'd expect "You're not allowed to breathe oxygen" or "You're not allowed to have oxygen".

So I guess it's "allowed" which is being used in a way I'm unfamiliar with.

Re: “You're not allowed science any more”

#148

Post by tanglisha »

api wrote: post #63
micro_cam wrote: post #50

Things like this makes me ashamed to have my name on papers in Nature. First, lets set aside the hypocrisy of a non open access journal publishing this[1]. (What happens if Sacha wants to inform her self by reading a few old nature papers?) I am pro vaccine but far too many doctors have this fantasy that they should have unlimited control and articles like this just serve to validate that view point. Medicine is an i…

https://en.wikipedia.org/wiki/Polio_vaccine#Contamination_co... I'm not at all anti-vaccination, but I am anti-authoritarian and anti-closed-science. People have a right to know what they're putting in their bodies. The SV40 contamination turned out to not be that serious, but it was a close call. Had SV40 been potently carcinogenic, we would have had a medieval plague of cancer. In the end it reduces to the problem…

Public health issues like vaccination aren't like other issues. Vaccination decisions aren't made in a bubble where only you suffer if you get sick or become a carrier.

There will always be a certain portion of the populace that cannot receive a specific vaccination because of allergies or a weakened immune system that cannot handle it.

The whooping cough epidemics that have been sweeping through anti-vaccination areas in recent years are an example of how a decision that you make for your kids can result in other people dying.

Re: “You're not allowed science any more”

#149

Post by falcolas »

kstenerud wrote: post #146
falcolas wrote: post #141

Earlier quoted context omitted.

You still haven't answered the basic question: What else could he have actually done, given that the woman wasn't interested in having a conversation - just the answer to a yes or no question. If the other party is unwilling to have a conversation (to the point where she attempts to leave when he won't give the binary answer), there simply is no way to "look for reasons why it doesn't work". The doctor shows his will…

By the time she's in the doctor's office, there's not enough time to undo all the damage. The doctor cannot change her mind in a 15 minute visit, let alone build up her trust. This is a false dilemma. It takes time to fix this sort of thing. Unilaterally shutting her out is probably the worst thing the doctor could do.

> Unilaterally shutting her out is probably the worst thing the doctor could do.

Really? That's what she has done to her doctor. She's chosen a life of potential suffering and death for her children because she wasn't paying attention. If someone has ignored the internet ads, billboards, magazine reports, news articles, and their own doctor, they're not going to change their tune just because someone prettied up the message bit (even though that's exactly what people have been doing for years now, plenty of examples if you look for them).

In the end, I think shutting her out is the best course of action in this story, if only for the children. And for her - it's shaken up her life enough to make her start asking interesting questions.

Re: “You're not allowed science any more”

#150

Post by robotresearcher »

micro_cam wrote: post #50

Things like this makes me ashamed to have my name on papers in Nature. First, lets set aside the hypocrisy of a non open access journal publishing this[1]. (What happens if Sacha wants to inform her self by reading a few old nature papers?) I am pro vaccine but far too many doctors have this fantasy that they should have unlimited control and articles like this just serve to validate that view point. Medicine is an i…

> What happens if Sacha wants to inform her self by reading a few old nature papers?

She can go to pretty much any reference library in the world. I'm all for open access but let's not over-do it.

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