Thursday, April 23, 2020

Ontology, Epistemology, and Life In A Dumpster Fire

Ontology is the study of What Is.
Epistemology is the study of How We Know What We Know.
Despite the fact that this has been pursued since at least the ancient Greeks, for some definite amount of people on the internet, this is news.

This is generally why any discussion on the internet quickly devolves to a pick-up game of four blind men describing an elephant.

I've shared before on this site James Burke's excellent synopsis of when medicine transmogrified from superstition and stupidity into science, from his 1986 book, The Day The Universe Changed.  

Briefly, for those unfamiliar, before about 1800, little was known and even less was understood, medically speaking. Any doctor that figured something out kept it a deep, dark trade secret, lest his colleagues learn them, and his livelihood be lost. This is a recipe for exactly the pre-literate practices that survived well into the 19th century. It's why George Washington was bled to death with what was probably a simple case of influenza.

But in post-Revolutionary France, courtesy of Napoleon, there were two drastic changes which took place, and one new idea, that revolutionized the art and science of healing. First, medicine, in the form of hospitals, became available to the common people, by design intent of TPTB. Second, Napoleon's constant campaigns and conquests provided the medical practitioners of the time with a near endless stream of subjects of all types.

But what drove things into civilizational hyperspeed was when these two things were combined with the nascent practice of medical statistical analysis, both formally and informally. The hospitals in Paris of the day, for example, were all specialized. One hospital only worked with broken bones. Another only did skin diseases. Another would treat gunshot wounds. And so on.

So when a patient came into the hospital that dealt with amputated limbs, for example, they could see what worked, and what didn't. Of 60 men with amputated legs, 20 might be treated with a poultice of horse manure and dog droppings on the stump. (No, really). 20 more might have the wound sealed with hot tar. And the last 20 might have the bloody stump washed daily, and clean bandages applied. Unsurprisingly, one of these methods surpassed the others. But unlike earlier eras, records were kept, statistics were compiled, and the results published for the medical community. Voila! medicine was no longer superstition, but now a scientific endeavor. In medieval and renaissance times, working class barber surgeons gradually surpassed degreed physicians for primacy (a trend which has continued to this day), because their hands-on practical experience in cutting people open and sewing them up worked better than the philosophical theories of balancing humors. But this trend really took off when it was combined with numbers, statistical analysis, then Germ Theory, and then anesthesia.

I bring this up because someone carped that what I bring to the discussion on the current Kung Flu pandemic is not the work of a statistician. My response to that (at least the part that's printable and mentionable in polite company) is "Au contraire!" and "Sweet Jesus!!"

I do statistical analysis my entire working day, for my entire career.
What works best, how each patient is doing, trend over time, temperature, pulse rate, respiration rate, blood pressure, systolic, diastolic, and mean, pulse oxygenation, over and over, lather, rinse and repeat. I work, on an average day, with more figures than anyone who isn't doing nuclear physics, astronomy, or high finance, with a pencil and paper. I gather statistical data all day long until my eyes hurt. The average nurse does more data collection and data analysis in one week than university student in statistics class does in a month.

When I'm running sedation for someone with a dislocated limb, the doctor or physician assistant is worried about getting it back in place, as that's what they're trained to do. But I'm the one doing the anesthesia. Monitoring the patient's vital signs and mentation, before, during and after, and checking the temperature, pulse, and sensation of the restored limb. Doctor's and P.A.s care about that, but they don't collect the data. I do.

So suffice it to say I know a wee bit about data collection and analysis.

Doing data collection and analysis is the entire heart of medical research.
How many patients have which symptoms, which side affects, how severe, how frequently. How much is enough, how much is too much, what to do if you give too much, how much is safe in a day. Body weight, dosages in milligrams or micrograms per kilogram, per hour, per day, overall. What's a therapeutic dose, versus a sub-therapeutic dose, versus a lethal dose.

Anybody that thinks I (or anyone else in similar circumstances) don't know statistics, frankly, has his head absolutely up his ass.

Actual hardcore number-crunching statisticians, however, are concerned with the applicability of numbers to problems. They can and have, for example, work out the formulas for how many people you need to extrapolate a valid result.

Which, by the way, is why most of what's being passed around on the internet as "data" goes by the statistical name "invalid" (which is an industry term translating to "total bullshit").
This includes the Stanford survey (because they didn't control for age, and almost certainly oversampled young tech-savvy yuppies with a youthful invincibility complex, and ignored or grossly undersampled seniors locked in their homes lest they die of the Kung Flu). The L.A. County test was less than half the size needed for statistical validity. Neither test has been shown to be specific for Kung Flu antibodies, rather than any other coronavirus, including strains that produce the common cold. Which is why neither one is peer-reviewed, because they'd be laughingstocks. But people who don't know any better are waving them around like magic talismans of "proof".

Which gets me back to the main point.

The position I've taken isn't right because I say it is. It's simply where the current evidence available to me points. So it doesn't matter, strictly speaking, that I'm a nurse. I could be a pipefitter or a chauffeur; if I'm right I'm right, and if I'm wrong, I'm wrong.

People that don't get that are ascientific asshats, because they don't get how science works, and cannot grok that science isn't about scientific consensus, nor does it give a flying fuck about what degrees you possess. Einstein was a patent clerk when he wrote his Theory of Relativity. It isn't any less true because of that, nor did it become more true when he lectured at Princeton or Caltech, nor because the other physicists believed him. Every scientist was once sure the earth was the center of the universe. That was "scientific consensus". Galileo was the guy who stood up and said "You're all full of stercore. Eppur si muove." (because educated Italian men spoke Latin, as well as Italian, back then). He was right, they were all wrong. Period.

Barry Marshall was a humble ordinary doctor in West Australia (think North Dakota, except farther from civilization) who thought all the hacking people open for ulcers was wrong and stupid, and theorized that a bacteria was behind the problem. The entire medical establishment told him he was crazy. So he swallowed the bacterium he thought was responsible, got ulcers as a result, took antibiotics, and cured them. Now he has a Nobel Prize in Medicine, the Lasker prize, and is a Fellow of the Royal Society, while a million lesser doctors with far more on their C.V. and pedigree possess none of those honors, not leastly all the ones who assured him most learnedly and earnestly that he was completely wrong.

That's how science works.

And if you disagree with what I've said, that's meaningless.
Unless you have evidence that proves your point.
The reason comments are gone here, probably forever, is partly the jackwagons who think with their diaper, but just as much because of people who think they can just throw darts at the board, and that their responsibility stops with "You're wrong! I disagree!"
Like I'm doing a magic trick or something.

"Albuquerque! Snorkel! See, I can do it too."

As if I came to my conclusions with a oiuja board, instead of using the same mouse and keyboard you have, but also using my head for more than a hat rack.

For the Fucktard Army's benefit: that's not how it works.

Your work isn't ended when you scrape your diaper and fling it at the wall, and shout, like Madame DeFarge, "J'accuse!"
That's when your work starts.

Just as in any other court not presided over by kangaroos, if you have no evidence, you don't get to prosecute your case, and the gallery laughs you out the door. And to date, that was damned near every whiny jabberjaw popinjay lately who popped in here full of piss and vinegar.

You've got contrary evidence? Trot it out, and let's cut it open and see how, and if, it works.
If it doesn't pan out, no harm, no foul. And nothing personal, either way. We both look at what is, and adjust what we think in light of what we find. That's how a rational argument works.

But if you don't have anything like that, in fact couldn't be bothered to even address the concept that you have to have evidence for what you're shilling for, or to undo my argument that you're shilling against, and you can't be bothered to read up on the last 42 ideas that have already been examined and discarded, because you're a Baby Duck, and you get exactly the scorn and contempt you deserve. If that hurts your butt, maybe pull your head out of it. Better yet, stop doing that.

Which brings me to my theory of why this has been so hard on some people, and the vitriol it's engendered.

I deal with uncertainty every day. What's going on? Is it this? Is it that? What if that happens? Or the other thing? Or ALL the other things?

Not knowing the whole story is every patient, every day. There are hunches, and correlations, and diagnoses, and sometimes even certainty. But rarely a slam dunk, for me, for the doctors, for the patient, except when a Stevie Wonder diagnosis* is involved.

Most of you don't live or work like that. Some of you, almost never. Life is as comfortable as an old shoe.

So now, bring a virus that no one knows anything about. (At least, not anyone who's telling, without risking a Chinese firing squad, or 40 years in U.S federal SuperMax). Then it starts killing people. We're only just figuring out now, months later, how that may be happening. Then panic over it crashes the stock market, to the tune of $11.5T, overnight. Then you're laid off. Locked down. Your job may be gone forever. You might lose your house, your livelihood, your ability to do for yourself without charity handouts. You might become a refugee in your own country, like the Joads in The Grapes Of Wrath , which for most of you is pre-history from your parents or grandparents, in the misty past, like moon landings, trench warfare, and T. rex.

And after being stunned into inaction for a month or so, you're now just starting to go through grief stages.
All at once, in random order, cycling every hour, or day, back and forth, through all of them. Like people do.
Which is why people still won't accept what they see with their lying eyes.
We're headed for 50,000 people dead by the weekend, kids. Stop clutching at straws. Those people are really dead, and they're not coming back, and this could just be the beginning.

And then the Uncertainty magnifies it all: You don't know how long this will last, because no one does. You don't know how bad it's going to get, because no one does.
No One Does?!? HOLY SHIT!!!

And you'll clutch at anything, like a man drowning, including any slight glimmer, no matter how recockulous, that has the merest twinkling shot at making things Go Back To The Way It Was Before.

And any possibility that's not going to happen really scares the living shit right out your britches, and turns your brain full goose bozo. So you lash out, trying to fight what you can, instead of dealing with how it is, and what you don't know, and what nobody knows.

You're feeling helpless, hopeless, alone, and afraid of the dark.
And it's all dark, everywhere you look.

If you were expecting this is the part where I give you a big rhetorical hug, this is where I completely disappoint you.

In fact, let me offer you some amplification.

Because even if you had Ruby Slippers, clicked your heels together three times, and repeated "There's no place like home.", things are NEVER going back to How They Used To Be. That's been true your whole life, but it's been a more subtle kind of thing.

Now, it's going to be subtle like this:

Suck it up, buttercup. It's a big shit sandwich, and we're all gonna hafta take a bite.
Pining for better days is a sucker play. You had your heydays, and they're over.
This may suck for weeks, months, maybe even years.

Everybody's got a plan until they get hit in the mouth.
We all got tagged, but good.
Navy BUDS candidates get beaten into a zombie-like state, and the ones who don't crack, don't crumble, and don't quit, get a shot at being SEALs. Because their brains have learned that pain is in your head, you don't control anything but you, and you don't have to like it, you just have to do it. So just FIDO: Fuck It, Drive On. The ones who learn that lesson are turned into world-beaters, but their secret is no secret. It's just that they believe it enough to get through it.

The sooner all y'all start dealing with your shit, the sooner you can begin to process what you should be doing, instead of convincing yourself this is all not happening.

It's happening, it's real, it may go on (and on, and on) or it may fizzle out, but you don't know, and no one you trust does either. So deal with what you can, take stock of what you've got, and start thinking about how you're going to deal with whatever comes next.
You're cold, wet, and sandy, and you don't know when this will ever end. Except you can't puss out and ring out on this version of Hell Week. Bummer. None of us can.

A good first start would be to recognize you're in freefall, and stop flailing like a spaz, even mentally. Stop trying to fight the current.
Get your shit together, handle it, and deal with it.

I didn't put you in it, and I'm not going to get you out.
YOU are.

The sooner you start tracking with that reality, the better off you're going to be, and the less this problem is going to affect you.
Even if the pandemic is over next week, or next month, you won't be gliding on Easy Street when it's done and gone. Things are going to be different, in ways you haven't even thought about.

Beat your head, or your gums, about that topic, in the inner monologue inside your head.
Start by reminding yourselves that you're going to get through this.
Stop wasting time and energy on shit you can't control.
(And hey, back the fuck offa me, too.)
Regroup, and expect chaos and disorder to keep counter-attacking, until you get your head dug in to being in charge of you, at most. And sometimes, not even that.

And be okay with the chaos.
Just not blown around by it.
If the current situation has you at the end of your rope, tie a knot and hang on.
IF you can pull that off.
If you can keep your head when all about you   
    Are losing theirs and blaming it on you,   
If you can trust yourself when all men doubt you,
    But make allowance for their doubting too;   
If you can wait and not be tired by waiting,
    Or being lied about, don’t deal in lies,
Or being hated, don’t give way to hating,
    And yet don’t look too good, nor talk too wise:

If you can dream—and not make dreams your master;   
    If you can think—and not make thoughts your aim;   
If you can meet with Triumph and Disaster
    And treat those two impostors just the same;   
If you can bear to hear the truth you’ve spoken
    Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to, broken,
    And stoop and build ’em up with worn-out tools:

If you can make one heap of all your winnings
    And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings
    And never breathe a word about your loss;
If you can force your heart and nerve and sinew
    To serve your turn long after they are gone,   
And so hold on when there is nothing in you
    Except the Will which says to them: ‘Hold on!’

If you can talk with crowds and keep your virtue,   
    Or walk with Kings—nor lose the common touch,
If neither foes nor loving friends can hurt you,
    If all men count with you, but none too much;
If you can fill the unforgiving minute
    With sixty seconds’ worth of distance run,   
Yours is the Earth and everything that’s in it,   
    And—which is more—you’ll be a Man, my son!

*{i.e.: Any vein I can see from across the room is a Stevie Wonder vein, because even Stevie could get an IV in it; a broken arm in a Z formation is a Stevie Wonder fracture, because even Dr. Stevie Wonder could diagnose that.}

1 comment:

Gruelie said...

i've intubated 30 or so covids. i've read their charts.