UChicago doctors see ‘remarkable’ success using ventilator alternatives • Hacker News Board

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

#71

Post by ineedasername » Sat, Apr 25, 2020, 7:09 PM UTC

gus_massa wrote: post #40

DanielBMarkham wrote: post #15

Earlier quoted context omitted.

It's an excellent point. Learning is not the same as science, and we need randomized trials to actually be sure of anything. Unfortunately, in the middle of a pandemic, that's not going to happen with enough speed to prevent a lot of people dying. The perfect can be the enemy of the good enough. We don't have to guess or learn about the mass of an electron; that's been well-established through great lab work. But not…

> Unfortunately, in the middle of a pandemic, that's not going to happen with enough speed to prevent a lot of people dying. How are you sure that this method is not worse than the ventilator method and will kill even more people during the pandemic? How many death did they get with this method? How many death would they had got with the ventilator method?

This is "decision making under conditions of uncertainty." [0]

It's not that your questions are bad, it's that in practice medical professionals have to operate without answers to them. Doing so involves communication with peers about their own observations of what may work better/worse, such as in this article. Double-blind randomized trials are not the only source of actionable information: Case studies also form a significant pillar of knowledge, especially pending results from more systematic studies.

[0] https://link.springer.com/chapter/10.1007/978-1-4757-2068-6_...

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

#72

Post by _startingover » Sat, Apr 25, 2020, 7:12 PM UTC

christkv wrote: post #42

mistermann wrote: post #37

Earlier quoted context omitted.

Is this well known in media reports for a while? I stopped following closely quite a while ago so mostly just pick things up from forum, but this seems newish to me? Last I heard was that some doubts were arising here and there about the usage/safety for covid patients.

The on the ground reports from NYC in This week in virology has been talking about moving away from respirators for at least 3 weeks. Now the ability of reporters looking for sensational news to actually listen to the professionals or read studies is a completely different issue. I wish they could just ask some of them to write opinion pieces to lay out the facts as they exist.

Do you have data? I’m wondering if you may be overestimating how quickly ideas are adopted en masse.

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

#73

Post by ineedasername » Sat, Apr 25, 2020, 7:15 PM UTC

BurningFrog wrote: post #44

joshgel wrote: post #12

Earlier quoted context omitted.

Even better would be randomized experimental data that this was better than an alternative... 'It works' can mean lots of different things...

Randomized controlled trials are optimal for gathering science. They're not optimal for saving lives.

Well, in the long term they're probably better at saving lives than case studies such as this one. But until such time as they're available, collaboration, discussion, and cases studies are what we have to work with. Becoming paralyzed by uncertainty pending systematic studies will kill more people.

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

#74

Post by ineedasername » Sat, Apr 25, 2020, 7:18 PM UTC

newacct583 wrote: post #54

joshgel wrote: post #12

Earlier quoted context omitted.

Even better would be randomized experimental data that this was better than an alternative... 'It works' can mean lots of different things...

If that study takes a few months to finish, be reviewed and published, it's very clearly not "better". Science is important, but there are times like this where brute intuitive engineering is the only tool available.

>Science is important, but..."

This article isn't not science. It encompasses a key pillar of medical knowledge and advancements: case studies.

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

#75

Post by ineedasername » Sat, Apr 25, 2020, 7:39 PM UTC

fragmede wrote: post #43

not_a_moth wrote: post #24

Earlier quoted context omitted.

Yes, rather absurdly, I learned about him like a month ago on ZeroHedge when they started following him; he was brushed off for weeks, his message being, "Look at patient behavior, this is not actually ARDS, our ventilator strategy is probably wrong." Crazy to think that so many doctors around the world, experts, and policy makers didn't really question the fundamental nature of the disease, and perhaps telling that…

Dr Ignaz Semmelweis had this ludicrous theory, back in 1846, of “cadaverous particles” causing high deaths in women who had just given birth. Despite evidence that it worked , he spent the rest of his life trying to get people to listen. The doctors of the day were so threatened by the possibility that they were the ones killing their patients that they rejected the practice. We haven’t culturally evolved much furthe…

You attribute this to a lack of cultural evolution, but the problem is that wacky ideas that might be right are frequently difficult to discern from outright pseudo-science.

The idea of "cadaverous particles" in fact appears to be at least partly a bit of pseudo-science: There are no such things. Semmelweis had accidentally stumbled onto germs, but he didn't know it, and therefore his reasoning was flawed even if it gave a correct result; If the doctors stopped dissecting corpses, that would have reduced things just as much as the mid-wife ward. If he'd understood why washing hands actually worked, he could have had the mid-wives do so as well and save many more lives.

I also don't think it's correct, at least using the Semmelweis example, to say that "we haven't culturally evolved". Semmelweis's failure to spread what he learned was at least as much victim of his own personality as anything else: "Semmelweis was not very tactful. He publicly berated people who disagreed with him and made some influential enemies".

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

#76

Post by ineedasername » Sat, Apr 25, 2020, 7:49 PM UTC

beagle3 wrote: post #59

fragmede wrote: post #43

Earlier quoted context omitted.

Dr Ignaz Semmelweis had this ludicrous theory, back in 1846, of “cadaverous particles” causing high deaths in women who had just given birth. Despite evidence that it worked , he spent the rest of his life trying to get people to listen. The doctors of the day were so threatened by the possibility that they were the ones killing their patients that they rejected the practice. We haven’t culturally evolved much furthe…

There’s a saying, “progress is made one funeral at a time”, especially in science but also in other areas; smbc had a good comic about it too a whole back (am in mobile and can’t find it now). Linus Pauling famously and successfully used all his night to reject the idea of quasicrystals. The Updated concept of crystals was adopted shortly after his death; i can’t say I was able to track the history - there is an enor…

When I studied computational linguistics, my professors told me that a great deal of promising research on linguistics in the US had been similarly stifled by Noam Chomsky and his adherents, the result being a relative stagnation in "continental" linguistics compared to that seen in Europe.

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

#77

Post by mmkhd » Sat, Apr 25, 2020, 7:58 PM UTC

achillesheels wrote: post #57

DanielBMarkham wrote: post #15

Earlier quoted context omitted.

It's an excellent point. Learning is not the same as science, and we need randomized trials to actually be sure of anything. Unfortunately, in the middle of a pandemic, that's not going to happen with enough speed to prevent a lot of people dying. The perfect can be the enemy of the good enough. We don't have to guess or learn about the mass of an electron; that's been well-established through great lab work. But not…

And unfortunately, there are doctors that will not make a move on an experimental therapy without it going through IRB approval, as I am learning with my own efforts at introducing a portable nebulizer biocidal therapy. Some will not take chances unless they see safety data first - they will let their patients and colleagues die first. As a former biomedical engineering researcher, this pandemic has been profoundly e…

> 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 administer new therapies in a controlled and ethical way to cause the least harm. Just trying things will kill more people than it helps. The vast amount of new ideas do more harm than they help. Look at chloroquine and what a shit show it is, because everybody just tried it willy nilly. The side effect of harming Lupus patients who could not get their medicine alone caused tremendous unintended harm. And that wasn’t even harming because if administering a useless therapy with serious side effects. Move fast, fail fast and fail often aren great principles for developing software but they have no place in developing therapies. (I actually wanted to hurl swear words at you. But that helps nobody. It is true that medical research is overregulated and could be improved Bit there are reasons for that. Throwing all regulations away is just Trumpish behavior.)

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

#78

Post by loeg » Sat, Apr 25, 2020, 7:59 PM UTC

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 beyond the episode of hypoxia; on the other hand, the outcome of severe cerebral hypoxia will depend on the success of damage control, amount of brain tissue deprived of oxygen, and the speed with which oxygen was restored."

So I guess my questions are:

* How does this stack up against an intubated ventilator, assuming one is available?

* My understanding is the patients needing respiratory support are often on ventilation for 1-2 weeks; how much damage would one expect from having severe hypoxia for that duration?

[1]: https://en.wikipedia.org/wiki/Cerebral_hypoxia

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

#79

Post by humaniania » Sat, Apr 25, 2020, 8:05 PM UTC

not_a_moth wrote: post #24

theobeers wrote: post #5

One of the most active figures in this debate has been a New York doctor named Cameron Kyle-Sidell. He frequently posts interesting sources on Twitter: https://twitter.com/cameronks

Yes, rather absurdly, I learned about him like a month ago on ZeroHedge when they started following him; he was brushed off for weeks, his message being, "Look at patient behavior, this is not actually ARDS, our ventilator strategy is probably wrong." Crazy to think that so many doctors around the world, experts, and policy makers didn't really question the fundamental nature of the disease, and perhaps telling that…

You should be very careful about reading ZH. There is so much toxic paranoia on there it can be bad for your mental health.

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

#80

Post by abakker » Sat, Apr 25, 2020, 8:07 PM UTC

joshgel wrote: post #12

DanielBMarkham wrote: post #7

One of the most interesting parts of this press release, following it on other boards, is the immediate "We already do that. Nothing new here." That kind of reply would immediately lead me to think it was just a useless release, but then I see people posting comments along the lines of "No, we don't do that. In fact, we have a policy against doing that because of the danger of aerosolization" For my hacker/systems wo…

Even better would be randomized experimental data that this was better than an alternative... 'It works' can mean lots of different things...

If the effect size is large, the benefits of randomization go down. A very effective treatment would be evidently very effective without the burden of statistical proof. The randomization is critical when you are looking to differentiate small effects from random noise.

That said, large effect sizes in one hospital don’t control for confounding variables.