dumbneurologist

This is such sad news.

> I did not accept this. I have young kids to watch grow up and a loving wife to grow old with. Life and time are the two most precious commodoties we will ever have.

As sorry as I am that his hopes were futile, time and again the universe shows us how little it cares for these sentiments.

Regardless of what resources one might have to protest, we are all slowly ground to dust.

Is anyone aware of a "false positive" retraction?

Meaning a retraction that was later found to be in error, resulting in re-publication (or whatever)?

I imagine the bar for retraction is so high it would never happen, but it would be really interesting if it ever did.

Go is a remake of what?

I think it's "Tavis" (no "r")

It seems inconsistent to punish technologists like Levandowski when we don't punish bankers, CEOs, and polluters with the the same enthusiasm.

This is an important point, and for some reason I haven't seen it discussed very widely: masks with valves protect you, but they don't fully protect anyone else.

Why are social and economic arguments against it invalid?

You nailed it.

This is a reported piece, so the description could be completely off the mark. But the quote from the neuroscientist is

> “What it tells me,” says Christof Koch, a neuroscientist at the Allen Institute who specializes in consciousness, “is that … you can get dissociation between cognition and consciousness.”

which is a wild overintepreretation.

Gerstmann syndrome is the same kind of deficit where you have preserved consciousness and severe impairments in one very specific cognitive domain. Aphasia is a more common version of a focal neurological deficit which is equally analogous.

This whole article is just pop science nonsense (although it's entirely possible the underlying research has merit; it's not easy to tell based on an article about it).

The post I'm responding to is a stanford researcher who is posting about lyme disease. Is she a lyme sufferer? If she is she doesn't say so, and I'm not making any assumptions.

You are attacking me for saying "lyme people" even as you use "lyme patients" in the same sentence. There is no difference: both use lyme as an adjective to define a subpopulation using a completely innocuous starting population ("people" v "patients"). I'm just starting with a bigger group, because unaffected family, friends, etc can have these opinions too.

> This shows a lack of empathy.

Well, now you are attacking my humanity. It's very difficult to have constructive dialog about these issues when individuals attack the speaker, and not what's being said. We are talking about public health policy, which necessarily glosses over individual patients who are suffering and aggregates them into cold, sterile statistics in order to make decisions that are best for society. It's not particularly compassionate, but it's unavoidable if you want resource allocation to be proportional to need.

> like you, deny the severity of the problem

This is a straw man argument, where you take a crummy version of my argument and knock it down. "Severity" is not the word I used. I said "level of need", which is different because it takes severity (magnitude) and frequency into account. Progeria is a devastating (severe) disease, but it's also exceptionally uncommon. From a public health standpoint, both are an important part of determining the level of need, and therefore the level of support that these problems receive.

> how would they hear about this trial

from the internet, where the conventional doctors you are assailing created clinicaltrials.gov in order to make such information accessible to everybody.

> But the main reason is that patients don't need the trial, Lyme communities are full of people taking disulfiram on their own and finally recovering.

Nothing makes us happier than when our patients are connected with effective treatments. Nevertheless, the publications you site appear to lack random assignment, placebo control, or a double blind. Therefore I find the data uncompelling, even as I am happy to see that there is a trial for it; I hope it includes these three elements which make the results most meaningful.

Absent that study it remains possible that disulfuram will be the miracle cure you claim that it is, but I'm not expecting that to happen, and I suspect that chronic lyme will be a topic on HN in another 9 months exactly because the needle hasn't moved far enough. Please prove me wrong! That's how big breakthroughs are made! (witness h pylori infection and gastric ulcers). But please excuse me if I don't hold my breath for the announcement, and advocate more more conventional research during that time.

On a tangent: how do you know if the outcome is directly meaningful? that part is easy: ask yourself if you, personally, care. If I told you "an hour of Yoga will make your hippocampus more dense on an MRI" you should

1) ignore me, because that isn't even internally consistent

2) ask yourself why that's a good thing.

Compare that to

"your brain scan in 10 years will show less atrophy", or

"your brain scan in 5 years will show less chronic microvascular injury", or

"your scores in attention and daytime sleepiness will improve", or

"your life expectancy will increase by 4 years"

Those are directly meaningful, because you don't need a doctor to tell you why they are good things (or you do because it's jargony, but a doctor could explain it in one sentence)

this is not meaningful work, because there is no "brain health" outcome in the papers they reviewed that is clinically relevant.

For example: "Increase in right hippocampal GM density among yoga group." Why is this a good thing? Let's not even talk about the physical inappropriateness of using "density" to discuss MRI results.

Using meaningless-but-easy measurements as a surrogate / proxy for meaningful-but-hard measurements is an entire field called "biomarkers". It's incredibly challenging in neurology, and we don't have many good, validated biomarkers. If you want to use "MRI density" (sic), or "fMRI activation", then first you need an entire study to prove that the biomarker is valid. This a subtle point, but it's as if you're counting lines of code to determine the best programming language: yes, it's a measure, but how does it relate, and what does it mean?

We all (including doctors) want things that are natural, wholistic, and give us a subjective sense of well-being (like exercise and mindfulness) to be magically effective. But that doesn't change the need for rigorous science in order to know that it's the case.

And the formula is always the same: a double-blind, placebo-controlled trial within a representative population using a directly meaningful outcome.

This review failed the "meaningful outcome" part, even if (and I personally don't care to look further) they got the rest of pieces right.

> the treatments tested were from 30 days to 12 weeks - hardly what I would consider 'long term therapy' that's currently advocated/practiced by LLMDs

ahh! there is something here. I't subtle but I think it's a really important process you've described:

Conventional medical experts took the anecdotes and lyme theories, and decided to test "long term" therapy that was being advocated by less-conventional but still well-meaning providers at the time. These were the results: they showed there was no benefit.

So conventional thinking moved on, and the now-fringe thinkers simply moved the goalposts. Any scientist is going to be open-minded about the possibility of something being effective, even if they don't understand it. But at this point there are far better places (meaning "likely to show efficacy") to invest research resources.

And the question we're all asking ourselves is: if the alt-medicine community is so convinced that there is a benefit, why on earth won't they perform a randomized, placebo-controlled, clinical trial. We already did several, and published them. If the alt-lyme community still wants to continue making claims and expect to be listened to, they are going to need evidence.

That seems like it should be uncontroversial to me, but here we are.