BBO Discussion Forums: Coronavirus - BBO Discussion Forums

 shyams, on 2021-January-12, 08:30, said:

Only because it takes us ages to publish the figures, we only published the 2019 suicide figures in Sept 2020. Predictions are the figures will be way up (although the total number is actually relatively small (around 6K), so even a 100% increase would only make a small dent in the excess).

The Covid epidemic caused the deaths almost certainly, but there's lots of anecdotal evidence of old people unable to see their families basically losing the will to live and deteriorating rapidly. This is a stat you can't measure.

 Cyberyeti, on 2021-January-12, 09:08, said:

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I'm not here to chastise you, Cyberyeti, only to comment about the anecdotal misinformation

I worked for 7 years as a hospice nurse and I saw lots of death so every time I see this kind of anecdotal misinformation I cringe. Death is a biological event - period. How you feel about your life is not a contributing factor - if it were, you should be able to will yourself not to die. Doesn't work. We also hear of older couples dying close to each other. Happens. But many do not die close together. Cherry picking the close deaths to falsely prove an emotional cause isn't valuable. Seems as though cherry picking is the only job available during the pandemic.

How was I not surprised that the article described by shyams is due to Nick Triggle? See his collected works, for example Covid: Is it time we learned to live with the virus?.

 Cyberyeti, on 2021-January-12, 09:08, said:

I did not even consider extrapolating the trend observed in the first 8-12 weeks of 2020. If things had gone according to trend, the number this year should have been some 10k below the previous 5-year average. After all, the flu season of Jan-Feb was probably less lethal this year (random occurrence, but nevertheless).

So perhaps the UK Govt, BoJo, his greatest Health Secy ever Matt Hancock and the administration helped contribute to a provisional excess death number of 120k-130k in the period Apr-Dec. Reduce it by Cyberyeti's anecdotal evidentiary number of 6k (100% increase) and you now have 114k-124k excess deaths; a 33% rise compared to the 5-year average.

 cherdano, on 2021-January-12, 10:20, said:

Thank you. I wasn't aware of Nick or his record until now.

I just read one of his articles --- probably due to its catchy title. "Coronavirus: Does the UK have the pandemic under control?".

The entire write-up is full of meaningless words. I thought the author made no effort to actually answer his own question. He instead quoted some random stats to show his erudition or his ability to research or both.

I will henceforth track his new posts --- to see what new pearls of wisdom he bestows upon us BBC readers.

 Winstonm, on 2021-January-12, 09:56, said:

This is being reported regularly by relatives of these people and care home staff. The staff are noticing a marked change in attitude, and people going downhill rapidly. Positive attitude and keeping the brain active is known to be good for older people (it's one of the reasons bridge is promoted), and relatives have more time than staff to do this when they visit.

I think the default is that you are willing yourself not to die most of the time, but medical causes catch up with you eventually.

 Cyberyeti, on 2021-January-12, 11:02, said:

Let me explain some realities about the medical profession (from a U.S. point of view only): first, in long-tern care facilities the care is primarily handled by the lowest paid employees who do not have to be licensed but only have to pass a two-week course. They are often biased toward non-scientific methods and beliefs. Second, subjective data such as "marked change" and "positive attitude" are automatically invalid as a basis for a genuine study.

It is similar to the oft-quoted "reality" of a placebo effect.

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wikipedia

The placebo effect is a well-characterised phenomenon.
If you do a search in Pubmed - anyone can - rather than Wikipedia or google - you will discover that interest in this phenomenon (searching only by placebo+effect+[title]) is considerable.
There are roughly 30 scholarly articles published every year on the topic since 2010.
Clearly, this is an area of importance in interpreting Clinical trials.
Restricting the search to last 10 years+English only gives 271. This does not include any papers where the placebo effect was considered but the words were not in the title.
Here are some of the articles - 97 are open access and are in peer-reviewed Journals.
Here are a few so that you can understand the issue better:
https://docs.google....dit?usp=sharing

Google and Wikipedia are quite good to obtain very basic information. Pubmed is freely available and nowadays much of the information can be seen by anyone.
It's also possible to obtain theses - Here's one by Jill Biden.

 pilowsky, on 2021-January-12, 19:13, said:

Thanks for the link.

 Winstonm, on 2021-January-12, 20:09, said:

On this one I actually have to side with pilo. There are some very good and very scientific studies that have shown that the placebo effect is real, measurable and in certain areas quite powerful. What is more, you can track variations in the level of the effect according to the shape and colour of the placebo itself. The challenge facing the medical profession in this decade is not whether placebos work but rather to find ways of harnessing the effect ethically. Because it only works if the patient actually believes in it but it is unethical to tell a patient that they are receiving an active drug when this is not true. It is actually a really interesting area of research. If pilo has some genuine knowledge in this area, it might make for a good thread where he could both educate and entertain us. And perhaps one or more of the other posters has crossed paths with placebos as well...

 Zelandakh, on 2021-January-13, 09:35, said:

I certainly understand that and do not disagree; at the same time, I am (and probably always will be) still skeptical about measurements of pain, a really non-quantifiable expression. I am not in a position to challenge genuine experts in this field, I know. But I would like to question someone about things like this:

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In particular, blood pressure, heart rate, and various blood test results have been shown to change among subsets of research subjects who responded to a placebo.

Of course, not everyone has a therapeutic response to a placebo.

Could it not simply be that pre-testing stress and anxiety are the cause of the increased heart rates and blood pressures and simply relieving the stress is all that is required? As for the blood tests, I notice that no specific ones were mentioned so I can't say anything there.

The other problem is the finding that not everyone responds. It seems to me that if the placebo effect were genuine, then it could kill bacteria and viruses without discrimination. I have never seen that claim, though. Most of what I've seen falls into a more squishy area - a lot of it about pain.

Count me as listening openly but still with doubts.

I believe that you are right to be sceptical.

I don't believe anything until I check the sources where you will always find at least two different views - usually opposing - on the meaning of any particular result.

As you are no doubt aware - as Orwell would have put it - all Experts are equal, but some are more equal than others.

Regarding the placebo effect, my brief examination of the topic suggests that it is not the placebo effect per se that is the biggest concern in clinical trials.
Instead, it is differentiating any non-treatment effects from effects that are actually due to the therapy.

The placebo effect is a problem in hypertension management but is a bigger problem in psychology and pain management.
Psychology is a particularly problematic area because the effects of many of the treatments (mindfulness, CBT etc.) are tough to measure.

Even hypertension where you can measure the blood pressure has problems in humans where commonly the measurement is taken usually only an average of three discrete readings before treatment is instituted.
Nowadays, there will be 24-hour assessments done, but even then they are marred by the problems associated with the measuring device. About 90% of hypertension cases are 'essential' meaning that causes such as adrenal gland tumours and kidney disease are ruled out.
(There is much more to the assessment and management of hypertension, but here is not the place)

Arriving in the USA, I was once asked at security "why are you visiting?", "to attend a meeting on high blood pressure," I replied. The woman stared me down for about 15 seconds then said: "Do you know what causes high blood pressure?"
Instead of launching into an explanation, I took the bait and said: "no, what". She looked at me for another 15 seconds and told me: "Stress".

I learned a great deal from that woman. She was right and wrong and partly right all at the same time; a bit like me.

The idea that the placebo effect is useful as an actual treatment is a different question. If I have a disorder and some 'expert' decides to give me a placebo, I will certainly be questioning their competence.
The term placebo effect has come to mean amongst non-experts an effect that requires no active ingredient to induce a beneficial effect.
While it is true that sometimes not doing anything can be a good idea (same in Bridge; 'pass' is also a good bid), it is not true that doing nothing is in and of itself a positively beneficial management technique.

Prayer will not cure cancer, but diseases might remit for all sorts of reasons with no external treatment.

Sometimes miracles do happen; Mark my words. Sometimes people agree with me. How about that!

While it may be true that some patients die sooner because they've "lost the will to live", I think it's probably not as significant as the anecdotes make it out to be. These occurrences seem especially tragic to the families and caretakers, which causes them to remember them more strongly, and it's a known psychological effect that we overestimate occurrences that trigger strong emotions.

To give an analogy that most of us should appreciate, it's the "Why do my finesses always lose?" effect.

The 'will to live' is not a medical cause of death.
People don't say "oh well, nothing to live for - I'll just stop breathing".
Being depressed is a serious mental health condition; statements such as 'he lost the will to live' are lay constructs to explain events when people lack the knowledge to understand the problem.

The plane crashed because the pilot lost the will to fly.
It sounds a bit silly, doesn't it?

How about "I lost at Bridge because the King was on the wrong side" Well, how did the others with the same hand win?

Hence the metaphor, "you play the hand you're dealt", but some play it better than others.

Try instead, "The doctor, family, friends and society lost interest in caring for them, and then they died of whatever illness overtook them" - you'll be closer to the mark.

When a country's leader has no interest in caring for its citizens, look at what happens.

Here in the U.S., Operation Warp Speed has been swallowed by the black hole named Trump.

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When Health and Human Services Secretary Alex Azar announced this week that the federal government would begin releasing coronavirus vaccine doses held in reserve for second shots, no such reserve existed, according to state and federal officials briefed on distribution plans. The Trump administration had already begun shipping out what was available beginning at the end of December, taking second doses directly off the manufacturing line.

 pilowsky, on 2021-January-14, 17:39, said:

Not wishing to stray too far into your area of expertise and with apologies if I do, I feel the links and feedbacks between the false (largely) dichotomy of mental/psychological illness or disorders and the physical still does not get the attention it deserves. At the personal level I have experienced many aspects of the psychological stressors, depressors, physical consequences and/or causes, impacts of medications. However the link between what happens in someone's life ad the speed with which it can affect you physically in my view goes beyond a nice simple physical explanation to allowing the concept of "losing the will to live" or "dying from stress/misery/lack of hope", "lack of company, loneliness, lack of society" etc

In fact regarding links between the physical and the psychological 2020 and 2021 so far has had devastating impacts on me physically and psychologically and despite some ignoramuses in this world saying that we dont need gyms I'm heading to my gym with my mask for some much needed exercise and peace and time to think

On an area I feel safer talking about there are very interesting studies in the different components of therapies and how they are regarded as contributing to or explaining improvements in pscyhological well-being. What is fascinating with all the interest in and importance on evidence based approaches is how little unique variance can be explained by any single therapy most of the time, and how much relates to common factors of nearly all therapies and the psychological equivalent of the placebo effect, simply acting or seeking some sort of assistance and the expectation of improvement. Apologies for garbling my memory of various studies; I'm too tired to look for them. Also without wanting to sound too unprofessional the reason there is considerable evidence for some particular types of therapies is that they are easily manualised and studied, when most arent

 thepossum, on 2021-January-15, 21:46, said:

I agree. The idea that the body and the mind are separate always struck me as a bit strange.
Because of various physical problems, the gym is a non-starter for me, but I am training my two small poodles to be guide dogs. It's really working out for me; they take me wherever they want to go.

Good news! Trump is now discussing martial law with a pillow salesperson; the mind boggles.

 pilowsky, on 2021-January-15, 22:17, said:

I'm a bit over the way Trump and all associated debate one way or the other has sucked so much oxygen out of the whole world for 5 years and counting
I cant even go to a social even or have a conversation with many important people in my life without a tedious obsession with Trump which misses the bigger picture on everything

PS I hope you are happy to hear that after an hour's reasonably hard weights session (first time in a few weeks) I have gone from a state of high anxiety, relative lack of breath and feeling like **** to actually feeling good and being able to breathe properly

 thepossum, on 2021-January-15, 23:22, said:

That is a weight off my mind .