The KHIT Blog: Losing focus during the Covid19 pandemic?

Saturday, August 8, 2020

Losing focus during the Covid19 pandemic?

As the calendar turned to 2020, I, like most of us outside the epidemiologic and virology disciplines, had no idea that the rapidly spreading global Covid19 illness would escalate to consume just about all of our aggregate attention and increasingly debilitate the world's economies.

I first made a passing allusion to it in my January 18th post, subsequently initially posting the Johns Hopkins tracking site info on February 11th. On March 12th, I played my last game of hoops at the Towson BYKOTA center I'd joined back in the fall of 2019. They closed that evening until further notice (and remain thus).

Beginning Monday March 16th I began posting pretty much all Covid-related lead-in topics all the time. The coronavirus screening issues continue to bedevil us.

I mostly observed the "stay-at-home" public health advice, venturing out infrequently, only as necessary. Newly diagnosed with Parkinson's in December (w/ annoying symptoms elevating), and a year and a half out of open heart aortic valve replacement, I didn't (and still don't) like my ICU intubation/ventilator odds in the event of my encountering a case of Covid19.

Been getting caught up on a ton of reading, dozens of compelling books, in addition to my routine long list of periodicals and daily blog stops. Annie Duke's and Maria Konnivoka's books were awesome, and they sent me back to closer study of the original von Neumann "Theory of Games."

Grateful to not be in the dire economic circumstances now afflicting so many people. Grateful that my son and Eileen have not lost their jobs, and that new grandson Calvin is thriving, as is my preemie great-grandson Kai (born 7 weeks early).

Still, nearly five months of being so circumscribed (with dubious end in sight) is starting wear on my motivation, my focus apropos of topical direction going forward. I'll get back on track.

I'm sure I'm by no means alone in that regard. We slog on, I guess, amid our enervating "Concurrent Pandemics."

4.3% of world population, 25.4% of confirmed cases, 22.3% of case fatalities.

ERRATUM

ON "NORMS"

apropos of my recent prior post.

As I noted,

“Given the practical logistical impossibility of legislating, litigating, or prosecuting every last bit of contentious human interaction, consensus "norms" provide both the mediating lubricants and constraints of civil self-governance.”

Minimally, "norms" are those policies and behaviors we tolerate, often by mere passive acquiescence. They are by no means all rational or beneficent. Case in point; our recently ascendant presidential "leadership" norms of reflexive hostility toward expertise and science.

SCIENCE MAGAZINE EDITORIAL

The first half of 2020 has seen extraordinary accomplishments in science. The international scientific community has described the genomic sequence of the virus that causes coronavirus disease 2019 (COVID-19) and structures of its important proteins, elucidated principal aspects of the immune response, identified neutralizing antibodies that can serve as therapeutics, and developed promising vaccines. There is much more to learn about COVID-19 and its cause, but the achievements so far are remarkable. So why doesn't this progress feel like the triumph that it is?

Public health guidance is ignored, reopening businesses happens too fast, people fight over wearing masks, and the forces that undermine confidence in vaccines proceed unimpeded. Scientists who burn the midnight oil in academia, government, and industry to decipher COVID-19 are confronted with political leaders who downplay and criticize their tireless efforts. Many are immigrants who hear that they aren't welcome in the United States. President Trump and his allies are sticking their fingers in the eyes of the very people who can lead the world out of this calamity…

Having botched the distribution of diagnostic tests to get ahead of the pandemic, disemboweled the CDC, trampled on its own experts, stoked conspiracy theories about wearing masks and the origins of the virus, pushed an unproven treatment that proved worthless, stepped on the independence of the NIH, and audaciously attacked Fauci, the Trump administration does not inspire confidence in its ability to make sound public health decisions. With no strategy, a vaccine is the government's best way out of the pandemic crisis.

It's not too late to get it right. We need clear decision-making by experts, articulated crisply and without interference. This is not a time for leading with the gut, building up false hope, or making speculative bets. It's time to let the data do the talking.

Science is doing its part. Over to you, Mr. President.

ANOTHER READING RECOMMENDATION

In the wake of the George Floyd murder.

_____________

More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Saturday, August 8, 2020

Losing focus during the Covid19 pandemic?

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