COVID vaccine works - we're saved!

Kleinman:

---

Do you understand that a general mask mandate for the prevention of the spread of an infectious disease requires a lot of preparation of the population, (education, training,...etc.)? And what do you do with children that are too young to understand that training? Do you think that writing a law solves the problem? Yours and the "good intentions" of others that think like you have harmed a lot of people with your shallow thinking.

Percy:

---

You don't provide examples of the kind of harm you're thinking of, but how do you balance the risk of death to a family's breadwinner against the loss of income from not working?

---

---

The first step in trying to do a risk/benefit analysis is to correctly formulate the probability problem correctly. You haven't formulated the problem correctly and people like you won't correct your formulation when your errors are pointed out, such as the difficulty of implementing a general mask mandate.

Kleinman:

---

I'm not arguing whether a properly worn, effective mask will reduce the risk of transmission of an infectious disease. Why do you continue to argue this way? The question is whether a generalized mask mandate will reduce the spread of Covid (or for that matter any other infectious disease). Where is your evidence that any generalized mask mandate reduced the spread of Covid?

Percy:

---

The mentions of mask mandates are all coming from you. I haven't mentioned them or commented on them. Why are you demanding evidence related to your assertions from me?
​
I do believe that the more that people wear high-quality masks in a public settings and the more properly they wear them, the more the spread of respiratory disease will be reduced.

---

---

This is the way you try to address your errors in the risk/benefit analysis for the implementation of a general mask mandate.

Kleinman:

---

Do you think that looking at a spreadsheet is the same as seeing and caring for patients?

Percy:

---

No, I don't think that, nor did I make any comment related to that. What I did was show that your claim that Fauci had little to no clinical experience was false.

---

---

Clinical Definition & Meaning - Merriam-Webster

Kleinman:

---

Do you think you know enough to force people to behave in ways in their own best interests?

Percy:

---

I don't know how to make anyone do anything they don't want to do.

---

---

Try writing a law and then get the person arrested or fired.

Kleinman:

---

Try doing 150,000 documented patient encounters (encounters I got paid for) and see if you get some idea of how patients behave and respond.

Percy:

---

Please tell us about it.

---

---

Do you want me to tell you the instructions I give to patients that have an infection and being treated with antibiotics? Won't Theodoric's wife tell you? Or has Google failed to give you the expert advice.I'll give you a hint, start with the four classical signs of infection. You can give me your answer in Latin. That is where you begin addressing the problem.

Kleinman:

---

The first step in trying to do a risk/benefit analysis is to correctly formulate the probability problem correctly. You haven't formulated the problem correctly and people like you won't correct your formulation when your errors are pointed out, such as the difficulty of implementing a general mask mandate.

Percy:

---

Again, I've never mentioned a general mask mandate, and I leave the epidemiological analyses to the epidemiologists. If you have epidemiological information that would be helpful to the discussion then please provide it.

---

---

Do you understand the difference between claiming masks work and imposing a mask mandate on the general population?

Kleinman:

---

This is the way you try to address your errors in the risk/benefit analysis for the implementation of a general mask mandate.

Percy:

---

I haven't conducted any risk/benefit analysis for the implementation of a general mask mandate that I've never mentioned, other than to tell you that I've never mentioned it.

---

---

Are you aware that general mask mandates have been imposed in some localities? Do they show that they have decreased the spread of Covid? And if not, why?

Percy:

---

I don't know how to make anyone do anything they don't want to do.

Kleinman:

---

Try writing a law and then get the person arrested or fired.

Percy:

---

Are you suggesting that to deal with pandemics government should pass and enforce laws with severe penalties for non-compliance?

---

---

---

That's the strategy that you and people like you try. Where is the data that shows that mask mandates decrease the spread of Covid?

Kleinman:

---

Do you want me to tell you the instructions I give to patients that have an infection and being treated with antibiotics?

Percy:

---

Sure, tell us, but specific to respiratory infections contagious enough to cause pandemics.

---

---

So you don't want the instructions that should be given to a patient when being put on antibiotics but the instructions for reducing the spread of their infection?

Kleinman:

---

I'll give you a hint, start with the four classical signs of infection. You can give me your answer in Latin. That is where you begin addressing the problem.

Percy:

---

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---

---

If you are going to cut and past from Wikipedia, at least cut and past the correct answer.
Inflammation - Wikipedia Before you start claiming that there are five signs, loss of function is not one of the classical signs of infection. There is actually much more to identifying someone with an infection. Infections can be imposters of other diseases.

Kleinman:

---

Do you understand the difference between claiming masks work and imposing a mask mandate on the general population?

Percy:

---

Yes.

---

---

Based on that understanding, why can't you show the data that mask mandates work for reducing the spread of Covid?

Kleinman:

---

Are you aware that general mask mandates have been imposed in some localities?

Percy:

---

Yes.

---

---

Do you have any data that these general mask mandate work?

Kleinman:

---

Do they show that they have decreased the spread of Covid? And if not, why?

Percy:

---

The expectation would be that properly worn high-quality masks should reduce spread in public spaces.

---

---

On what do you base that expectation that the general public would wear masks properly and the masks be effective?

Kleinman:

---

That's the strategy that you and people like you try.

Percy:

---

The only one raising this strategy is you.

---

---

Where have I advocated for a mask mandate?

Kleinman:

---

Where is the data that shows that mask mandates decrease the spread of Covid?

Percy:

---

Please see Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates — 10 States, March–October 2020 | MMWR for one.

---

---

Do you understand the difference between the spread of Covid and the decline in hospitalization from Covid?

Kleinman:

---

So you don't want the instructions that should be given to a patient when being put on antibiotics but the instructions for reducing the spread of their infection?

Percy:

---

You referred generally to "an infection", so I requested that you focus on respiratory infections to keep discussion more relevant to the thread's topic, which is covid, a respiratory infection.

---

---

Do you understand the difference between the instructions in how to use antibiotics and the instructions that would guide a patient in reducing the spread of their infection, respiratory or otherwise?

Kleinman:

---

If you are going to cut and past from Wikipedia, at least cut and past the correct answer.

Percy:

---

That bit of Latin flotsam is used all over the Internet as filler. That was a joke. I put a smilie on it.

---

---

Oh, good joke.

Kleinman:

---

Inflammation - Wikipedia

Percy:

---

You asked about "the four classic signs of infection" but instead gave those for inflammation.

---

---

Aren't you aware that infections cause inflammation?
Diagnosis and management of cellulitis | RCP Journals

Percy:

---

You seem very interested in mask mandates, so I did a little more searching. Here's another study on mask mandates: State-Level Masking Mandates and COVID-19 Outcomes in the United States. From the Conclusions section:

​

quote:

---

Our study builds on growing evidence that, prior to widespread vaccination, public masking mandates are associated with population-level reductions in COVID-19 spread.

---

---

Why didn't you post this from your link:

Kleinman:

---

Based on that understanding, why can't you show the data that mask mandates work for reducing the spread of Covid?
...
Do you have any data that these general mask mandate work?

Percy:

---

See Message 890

---

---

I see your Message 890 and raise it to Message 892

Kleinman:

---

On what do you base that expectation that the general public would wear masks properly and the masks be effective?

Percy:

---

That wasn't the expectation I expressed. I said that the expectation would be that properly worn high-quality masks should reduce spread in public spaces.

---

---

Why would you expect that?

Kleinman:

---

Where have I advocated for a mask mandate?

Percy:

---

I didn't say that you were. I said you were the one who keeps mentioning it.

---

---

That's because you have false expectations about what the public would do.

Kleinman:

---

Do you understand the difference between the spread of Covid and the decline in hospitalization from Covid?

Percy:

---

Not sure what you're saying here. If you're just asking if I know the difference, then yes I do. If you're implying a correlation between covid spread and declining covid hospitalization, then that seems unlikely to me.

---

---

Who is more likely to be hospitalized for Covid, a child or an elderly person?

Kleinman:

---

Do you understand the difference between the instructions in how to use antibiotics and the instructions that would guide a patient in reducing the spread of their infection, respiratory or otherwise?

Percy:

---

You're asking if I know the difference between instructions for taking medication and the instructions for reducing contagion? If so then yes.

---

---

Do you think the general public understands that distinction? And if so, do they understand those instructions without the physician having to explain those instructions?

Percy:

---

You asked about "the four classic signs of infection" but instead gave those for inflammation.

Kleinman:

---

Aren't you aware that infections cause inflammation?

Percy:

---

Yes. Are you saying that the answer to your question about the four classic signs of infection is identical to the answer to the same question for inflammation? Because they're not. It isn't even an appropriate question for infection because the symptoms for infection can be incredibly varied due to the wide variety of diseases. It might be best to just stay focused on covid in this thread.

​

Addressing this generally to the thread, I don't know if anyone has already posted this, but I found this message at Panda's Thumb: Evaluating Alan Kleinman's arguments

---

---

---

The Covid infection triggers inflammation, as do many other causes of injury to the tissues. Don't you want to know what the patient should understand when they are treated for an infection with antibiotics? Theodoric won't tell what his wife tells her patients, and Google doesn't tell you what the expert advice is. Don't you want me to tell you so that you can say, "That's obvious", except you won't tell us now?And Tangle has already pointed out my discussion with Felsenstein on Panda's Thumb. Do you know that Felsenstein refuses to do the mathematics for the Lenski experiment?

Percy:

---

Addressing this generally to the thread, I don't know if anyone has already posted this, but I found this message at Panda's Thumb: Evaluating Alan Kleinman's arguments

Tangle:

---

It's been posted at least twice Percy.
​
Several attempts have been made to reason with him but he is impervious - he's a religious nut job and troll with no hope of redemption.​

---

---

I just don't buy your pseudoscientific tripe. Do you know Felsenstein's reason for not doing the mathematics of the Lenski experiment?

Stile:

---

I found that if I read Kleinman's messages - I don't have any idea what's going on.
​
But, if I read Percy's messages - I get the gist of the conversation.
​
Not only that, even if I read only Percy's text (and ignore Kleinman's text that Percy quotes in his message...) - I can still follow the conversation just fine.
​
I dunno - I just think that says a lot.

---

Math really isn't that hard.

Stile:

---

I dunno - I just think that says a lot.

Tanypteryx:

---

It says everything!

---

---

On the other hand, math might be too hard for someone that is poorly trained in biology.

Kleinman:

---

On the other hand, math might be too hard for someone that is poorly trained in biology.

Tanypteryx:

---

Yes, you have demonstrated your difficulties and lack of training.

---

---

Tany will now show us his papers that explain the mathematics of descent with modification and adaptation for the Kishony and Lenski experiments, and why it takes a billion replications for each adaptive mutation in those experiments. Here are the papers I've presented.
For a single selection pressure:
The basic science and mathematics of random mutation and natural selection
And for multiple simultaneous selection pressures:
The mathematics of random mutation and natural selection for multiple simultaneous selection pressures and the evolution of antimicrobial drug resistance
Tany will now demonstrate his proficiency in mathematics by explaining how he is related to fecal bacteria.

Tanypteryx:

---

You first.

---

For a single selection pressure:
The basic science and mathematics of random mutation and natural selection
And for multiple simultaneous selection pressures:
The mathematics of random mutation and natural selection for multiple simultaneous selection pressures and the evolution of antimicrobial drug resistance
Since you have no papers to present, Tany will now demonstrate his proficiency in mathematics by explaining how he is related to fecal bacteria.

Kleinman:

---

I see your Message 890 and raise it to Message 892

Percy:

---

Yes, I saw that and thanked you for supplying the additional information.

---

---

Any time. You need additional information.

Percy:

---

I said that the expectation would be that properly worn high-quality masks should reduce spread in public spaces.

Kleinman:

---

Why would you expect that?

Percy:

---

Because for those infected it greatly reduces the number of infected droplets reaching the air, while for those uninfected it greatly reduces the number of infected droplets in the air being inhaled. The greater the concentration of people the more protection masks provide.

---

---

---

Do you think that children wear appropriate masks effectively? Some general mask mandates have an exception for masks for children. How does that affect the spread of Covid.

Percy:

---

I didn't say that you were. I said you were the one who keeps mentioning it.

Kleinman:

---

That's because you have false expectations about what the public would do.

Percy:

---

I haven't expressed any expectations about what the public would do. I said that it seems very hard to predict but that it does seem reasonable to expect that the greater and more obvious the threat the more likely the public would be to follow health advice.

---

---

---

Who explained the health advice to the public?

Kleinman:

---

Who is more likely to be hospitalized for Covid, a child or an elderly person?

Percy:

---

An elderly person.

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---

Why do you think that happens?

Kleinman:

---

Do you think the general public understands that distinction? And if so, do they understand those instructions without the physician having to explain those instructions?

Percy:

---

I think that as a group the public is not very discerning. I imagine physicians find it frustrating that their instructions and advice are so often misunderstood or ignored.

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---

Does your understanding come from your imagination? What makes you think that as a group the public is not very discerning. Most of my adult patients understand my instructions. Pediatric patients will have trouble understanding some of these instructions, but parents generally do understand medical instructions including those I give on how to use antibiotics and what to expect from treatment. Do you know what those instructions are? Theodoric's wife won't tell you and Google doesn't tell you what that expert advice is.

Kleinman:

---

The Covid infection triggers inflammation, as do many other causes of injury to the tissues.

Percy:

---

The signs of covid infection are by no means identical to the signs of inflammation.

---

---

And you say this from personal experience? Are you aware that one of the most common and most difficult diagnostic problems that pulmonologists face is the diagnosis of an inflammatory process in the lungs?

Kleinman:

---

Don't you want to know what the patient should understand when they are treated for an infection with antibiotics?

Percy:

---

It might be better to keep the focus on covid in this thread.

---

---

What should the patient be advised that has Covid but is not ill enough to be hospitalised and is put on an anti-covid medication as an out-patient?

Kleinman:

---

Theodoric won't tell what his wife tells her patients, and Google doesn't tell you what the expert advice is.

Percy:

---

Google finds a great deal of expert advice online.

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---

What does Google tell you that the patient be advised that has Covid but is not ill enough to be hospitalised and is put on anti-covid medication as an out-patient

Kleinman:

---

Don't you want me to tell you so that you can say, "That's obvious", except you won't tell us now?

Percy:

---

If you have useful information you'd like to present then please proceed.

---

---

Don't you know the obvious?

Kleinman:

---

And Tangle has already pointed out my discussion with Felsenstein on Panda's Thumb. Do you know that Felsenstein refuses to do the mathematics for the Lenski experiment?

Percy:

---

You don't say!

---

---

Sure enough, Felsenstein said this.
Sandwalk: Contingency, selection, and the long-term evolution experiment

Felsenstein:

---

I am not going to do some long study of the LTEE, but I thought I should document my assertion that Alan Kleinman's work ignores natural selection. Let me concentrate on his 2014 paper in the journal Statistics in Medicine, which is his first on mutation and natural selection, and is grandly entitled "The basic science and mathematics of random mutation and natural selection". It turns out to be a lot narrower than that, analysing a model where 5 favorable mutations can occur at a locus, but only if they occur in a particular order, first A, then B, then C, then D, then E.

​

Kleinman starts out correctly, computing in his equations (4) through (9) the probability that mutation A will not occur in the first nGA generations in a population of size n. Then he goes on in equation (10) to mutation B, trying to compute the probability of it not occurring in a subsequent GB generations. There is where things go wrong. He assumes that the 'subpopulation size" of A-containing members of the population is nA. Although he later acknowledges that the numbers of those in the population will change, he does not allow that in his math, keeping nA constant in each of the subsequent nGB generations. There is the point where I first find an error. Perhaps Alan Kleinman can explain that one specific point, rather than demanding that we all discuss the LTEE in detail.

---

Felsenstein makes a blunder here. He assumes natural selection only depends on the relative fitness of different variants as seen with biological competition. Natural selection in descent with modification and adaptation depends on the absolute fitness of a variant, that is the number of replications that variant is able to do. The mathematics of the Lenski experiment is not that difficult to do. I show how to do it in the following publication.
Fixation and Adaptation in the Lenski E. coli Long Term Evolution Experiment
And here is a short video presentation that shows how to do the calculation in detail.
The Lenski Long Term Evolution Experiment

Kleinman:

---

Do you think that children wear appropriate masks effectively?

Percy:

---

About appropriate masks, I think children most likely wear the masks provided to them by adults.
​
As to how effectively children wear masks, I expect that how well any group wears masks is dependent upon their average competency, and the greater the competency of a group the more likely its members are to wear masks effectively. I'd guess that the very young and the very old are least likely to wear masks properly.​

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---

Do you think that if someone wears a mask improperly or wears an ineffective mask that it will increase the spread of Covid?

Kleinman:

---

Some general mask mandates have an exception for masks for children. How does that affect the spread of Covid.

Percy:

---

I don't have an answer for you.

---

---

Do you think if a child has Covid but is asymptomatic and the child is out in public that the child is more likely to spread the infection?

Kleinman:

---

Who explained the health advice to the public?

Percy:

---

Public health officials at all levels of government and medical professionals.

---

---

Did someone explain to you what mask was appropriate and what was the effective way of using the mask?

Kleinman:

---

Who is more likely to be hospitalized for Covid, a child or an elderly person?

Percy:

---

An elderly person.

Kleinman:

---

Why do you think that happens?

Percy:

---

You're asking the wrong person, but one possibility might be that the immune system of children is more robust than in the elderly.

---

---

---

---

That is partially correct. Very young children and infants don't have a fully developed immune system and as we get older, our immune system tends to become less effective in later years as do our other organ systems. There are other factors that affect our immune system such as our state of nutrition and comorbid conditions. Someone with cancer, heart disease, or diabetes,... tend to be more vulnerable to Covid, Influenza, and other infections because of their weakened state from other diseases. The extra stress that Covid puts on a person can push them over the edge.

Kleinman:

---

Does your understanding come from your imagination?

Percy:

---

No.

---

---

Where does your understanding come from of how physicians feel when communicating with their patients?

Kleinman:

---

What makes you think that as a group the public is not very discerning.

Percy:

---

General observations over time.

---

---

Give us an example of your observations that make you draw this conclusion. I come to a very different conclusion than you. Perhaps it is because I live in a community where many people make their living by agriculture. I think these people are very smart and would never be so disrespectful as you are and say they are not very discerning.

Kleinman:

---

Most of my adult patients understand my instructions. Pediatric patients will have trouble understanding some of these instructions, but parents generally do understand medical instructions including those I give on how to use antibiotics and what to expect from treatment.

Percy:

---

That's wonderful.

---

---

What kind of community do you live in where the people cannot understand reasonable and logical instruction when given to them in a coherent manner?

Kleinman:

---

Do you know what those instructions are?

Percy:

---

Unless you tell me then no, I don't know what instructions you give your patients.

---

---

It's not that complicated. The history and physical exam give clues to what the infection most likely is. I have a reasonable idea what are the possible causes of infection but still will do bacterial culture and drug sensitivity testing but that will take several days to get the results. For most infections, antibiotics work quickly. I tell the patient that if he/she doesn't feel at least some improvement in the first 24 hours, to contact me. By about the 3rd day, I'll get the results of the lab tests. If they don't agree with what I have prescribed and the patient hasn't called me, I'll call the patient and find out how he/she is doing. It is not that uncommon for lab results to show that an antibiotic won't work but they do anyway. Do you know why? If necessary, I'll change antibiotics at that time. I also tell the patient to take the drugs for 3 days after their symptoms have resolved in case there is any residual occult infection. If symptoms return, restart the antibiotics and call me. It is just a matter of maintaining open lines of communication. The vast majority of my patients get it.

Kleinman:

---

The Covid infection triggers inflammation, as do many other causes of injury to the tissues.

Percy:

---

The signs of covid infection are by no means identical to the signs of inflammation.

Kleinman:

---

And you say this from personal experience?

Percy:

---

No. Does this mean you're going to continue to claim that the signs of covid infection are identical to the signs of inflammation?

---

---

---

---

The difference in the inflammatory response caused by Covid is often very similar to the inflammatory response caused by other diseases.

Kleinman:

---

Are you aware that one of the most common and most difficult diagnostic problems that pulmonologists face is the diagnosis of an inflammatory process in the lungs?

Percy:

---

If you say so, but how is that relevant to your erroneously equating signs of inflammation to those of covid infection?

---

---

I don't know, it might be the last 15 years of continuing medical education in pulmonary and intensive care medicine. It's only an hour per week but I do it for about 40 weeks per year. They have presented quite a few Covid cases. I realize your experience as a website administrator makes you much more knowledgeable in this topic.

Kleinman:

---

What should the patient be advised that has Covid but is not ill enough to be hospitalised and is put on an anti-covid medication as an out-patient?

Percy:

---

I don't know. What?

---

---

The same kind of advice as given above except viruses such as Covid and influenza are associated with bacterial superinfection. These people should be watched for superimposed bacterial pneumonia and treated appropriately and rapidly.

Kleinman:

---

What does Google tell you that the patient be advised that has Covid but is not ill enough to be hospitalised and is put on anti-covid medication as an out-patient?

Percy:

---

This particular link (among many returned by a Google search) is about how to treat covid patients with Paxlovid: Fact Sheet for Healthcare Providers: Emergency Use Authorization for Paxlovid™

---

---

So, you think that pushing a pill is all you have to do to treat an infection?

Kleinman:

---

Don't you want me to tell you so that you can say, "That's obvious", except you won't tell us now?

Percy:

---

If you have useful information you'd like to present then please proceed.

Kleinman:

---

Don't you know the obvious?

Percy:

---

Apparently not. Please tell us your useful information.

---

---

---

---

I have, and you don't know the obvious.

Kleinman:

---

Felsenstein makes a blunder here. He assumes natural selection only depends on the relative fitness of different variants as seen with biological competition. Natural selection in descent with modification and adaptation depends on the absolute fitness of a variant, that is the number of replications that the variant is able to do.

Percy:

---

Felsenstein used the term generations, and I'll just assume that your "replications" and his "generations" mean the same thing. Anyway, Felsenstein doesn't address fitness at all in what you quoted, so I don't really know what his position on it is. You do quote him saying that you erroneously keep the succeeding subpopulations the same at nA, and you don't address that. I'm not myself qualified to discuss this, and it's not relevant to covid anyway.

---

---

Replications do not equal generations. A replication is the random trial. The possible outcomes for that trial is a mutation occurs or a mutation does not occur. You can have more than one replication of a variant in any given generation. Kishony's experiment doubles the number of replications for each generation. Lenski's experiment has competition and bottlenecking so the most fit variant increases in population size very slowly initially at the beginning of a fixation/adaptation cycle. In my paper, I happened to use a constant population size for each generation but it is the total number of replications of a given variant and the mutation rate that determines the probability of an adaptive mutation occurring. That math works.

Kleinman:

---

Do you think that if someone wears a mask improperly or wears an ineffective mask that it will increase the spread of Covid?

Percy:

---

Every little bit hurts.

---

---

Do you think that a single infected person wearing a mask improperly or wearing an ineffective mask that they can spread infectious disease to more than one other person?

Kleinman:

---

Do you think if a child has Covid but is asymptomatic and the child is out in public that the child is more likely to spread the infection?

Percy:

---

Current understanding is that covid infected children as a group tend to be much less contagious than adults, but an infected child in public is more likely to spread infection than one at home.

---

---

Where did you get that idea? This is anecdotal, but I have treated a large number of elementary school teachers for respriratory infections. Can you imagine where these teachers contracted their infections?

Kleinman:

---

Did someone explain to you what mask was appropriate and what was the effective way of using the mask?

Percy:

---

Most of my understanding was gained from written material.

---

---

Can we assume that you have some interest in the subject? Do you think that the general public has the same interest?

Kleinman:

---

That is partially correct. Very young children and infants don't have a fully developed immune system and as we get older, our immune system tends to become less effective in later years as do our other organ systems. There are other factors that affect our immune system such as our state of nutrition and comorbid conditions. Someone with cancer, heart disease, or diabetes,... tend to be more vulnerable to Covid, Influenza, and other infections because of their weakened state from other diseases. The extra stress that Covid puts on a person can push them over the edge.

Percy:

---

Thank you for this useful information.

---

---

It is particularly difficult to tell if a new born is sick.

Kleinman:

---

Where does your understanding come from of how physicians feel when communicating with their patients?

Percy:

---

I wouldn't call it an understanding. But my sense in talking to physicians (both friends and ones I see professionally) and reading articles by them is that treating patients can be like pushing on a string.

---

---

That's interesting because that's not how I feel and I don't know any physicians that feel like that. Perhaps it is due to the physicians that you listen to are trying to force their patients to do what they say and the patients are not compliant.

Kleinman:

---

What makes you think that as a group the public is not very discerning.

Percy:

---

General observations over time.

Kleinman:

---

Give us an example of your observations that make you draw this conclusion.

Percy:

---

The way that many responded to the pandemic is a good example. Many fit in the same category as two tennis buddies of mine, so I'll briefly describe their situations since they serve as good examples.
​
One caught covid back in 2020 which turned into long covid. Within about a year he had begun to improve but refused to be vaccinated, caught covid again which worsened his long covid, and now he can't stay on a tennis court for more than about 5 minutes at a time. He's had to give up the game.
​
Another tennis buddy declared that his immune system was so robust that he didn't need vaccination. He caught covid several months ago from which he still hasn't fully recovered, and he, too, cannot stay on a tennis court for more than 5 minutes at a time. Hopefully he'll continue to improve and it won't turn into long covid, but we'll see.
​
Had either friend been more discerning about hail of conflicting covid information and gotten the vaccine and worn masks they could have reduced the likelihood of catching covid and of being hospitalized (both were).

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So, if someone doesn't believe as you do they are not discerning? Do you know that in the CME course that I attend, they have presented quite a few cases of patients that were vaccinated for Covid but still ended up in the ICU with Covid?

Kleinman:

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I come to a very different conclusion than you. Perhaps it is because I live in a community where many people make their living by agriculture. I think these people are very smart and would never be so disrespectful as you are and say they are not very discerning.

Percy:

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My mother's side has been farmers and ranchers for generations. Good people, smart about livestock and agriculture and other areas where they have familiarity, but not so smart in other areas with which they're unfamiliar, which is true in a general sense of all of us.
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The best thing one can know about oneself is awareness of those areas where one's knowledge is lacking. There are many people who have ready answers for things where their answers should be, "I don't now." That's what I mean by not very discerning.​

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That is reasonable.

Kleinman:

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What kind of community do you live in where the people cannot understand reasonable and logical instruction when given to them in a coherent manner?

Percy:

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I think people on average are about the same in terms of comprehension ability all over the country.

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I think so as well. The biggest difference is in their biases. People with different biases will understand things differently.

Kleinman:

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It's not that complicated. The history and physical exam give clues to what the infection most likely is. I have a reasonable idea what are the possible causes of infection but still will do bacterial culture and drug sensitivity testing but that will take several days to get the results. For most infections, antibiotics work quickly. I tell the patient that if he/she doesn't feel at least some improvement in the first 24 hours, to contact me. By about the 3rd day, I'll get the results of the lab tests. If they don't agree with what I have prescribed and the patient hasn't called me, I'll call the patient and find out how he/she is doing. It is not that uncommon for lab results to show that an antibiotic won't work but they do anyway. Do you know why? If necessary, I'll change antibiotics at that time. I also tell the patient to take the drugs for 3 days after their symptoms have resolved in case there is any residual occult infection. If symptoms return, restart the antibiotics and call me. It is just a matter of maintaining open lines of communication. The vast majority of my patients get it.

Percy:

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Thank you for this information.

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I learned these fundamentals when I did my hospital-based training over 30 years ago. In the hospital, you saw your patient at least twice a day and had 24-hour nursing care for the patient so it was easy to monitor the patient. In the outpatient environment, you don't have this kind of monitoring, you must depend on the patient's communicating back to you on their response to treatment.

Kleinman:

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The difference in the inflammatory response caused by Covid is often very similar to the inflammatory response caused by other diseases.

Percy:

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Your evolving answers are getting better.

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Do you think you can identify what caused an inflammatory response just by looking at it?

Kleinman:

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I don't know, it might be the last 15 years of continuing medical education in pulmonary and intensive care medicine. It's only an hour per week but I do it for about 40 weeks per year. They have presented quite a few Covid cases. I realize your experience as a website administrator makes you much more knowledgeable in this topic.

Percy:

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Aw, shucks, you're embarrassing me.

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You are mistaken, I'm showing you that you are not discerning. You think you understand inflammation, a subject that you have little familiarity with.

Kleinman:

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What should the patient be advised that has Covid but is not ill enough to be hospitalised and is put on an anti-covid medication as an out-patient?

Percy:

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I don't know. What?

Kleinman:

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The same kind of advice as given above except viruses such as Covid and influenza are associated with bacterial superinfection. These people should be watched for superimposed bacterial pneumonia and treated appropriately and rapidly.

Percy:

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Good to know.

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What do you think of the advice, "You can't treat a viral infection with antibacterial medication".

Kleinman:

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So, you think that pushing a pill is all you have to do to treat an infection?

Percy:

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What I think is that I provided what you requested, expert advice found with a Google search on how to treat covid with medication. That material covers dosage and administration, contraindications, warnings, adverse reactions, drug interactions, population specific concerns, overdosage, clinical pharmacology, nonclinical toxicology and references to clinical studies.

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Do you think that is all that is required to treat Covid or any other infection?

Kleinman:

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I have, and you don't know the obvious.

Percy:

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Alas.

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What, no smilie?

Kleinman:

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Replications do not equal generations.

Percy:

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If you're going to comment in terms of "replications" while Felsenstein's comments in terms of "generations", then I can't tell how your comments relate to his.

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Is the meaning of "replications" and "generations" that complicated?

Kleinman:

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That math works.

Percy:

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How nice.

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Ask AZPaul3 or Tanypteryx how nice that math is.

Kleinman:

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Do you think that a single infected person wearing a mask improperly or wearing an ineffective mask that they can spread infectious disease to more than one other person?

Percy:

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Yes.

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How many people could a single infected person transmit that infection?

Kleinman:

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Do you think if a child has Covid but is asymptomatic and the child is out in public that the child is more likely to spread the infection?

Percy:

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Current understanding is that covid infected children as a group tend to be much less contagious than adults, but an infected child in public is more likely to spread infection than one at home.

Kleinman:

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Where did you get that idea? This is anecdotal, but I have treated a large number of elementary school teachers for respriratory infections. Can you imagine where these teachers contracted their infections?

Percy:

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Covid infections are most commonly contracted by inhaling covid-laden droplets in the air from the exhalations of nearby infected persons.

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Can Covid be transmitted by any other means other than inhaling covid-laden droplets?

Kleinman:

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Did someone explain to you what mask was appropriate and what was the effective way of using the mask?

Percy:

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Most of my understanding was gained from written material.

Kleinman:

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Can we assume that you have some interest in the subject?

Percy:

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Sure.

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And

Kleinman:

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Do you think that the general public has the same interest?

Percy:

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No.

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Does that make the general public nondiscerning? Are you aware that there is a very high probability that you harbor infectious agents that under the right conditions can cause you serious and even life-threatening diseases?

Kleinman:

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It is particularly difficult to tell if a new born is sick.

Percy:

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Good to know.

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This should be obvious to you.

Kleinman:

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Where does your understanding come from of how physicians feel when communicating with their patients?

Percy:

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I wouldn't call it an understanding. But my sense in talking to physicians (both friends and ones I see professionally) and reading articles by them is that treating patients can be like pushing on a string.

Kleinman:

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That's interesting because that's not how I feel and I don't know any physicians that feel like that.

Percy:

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Even greater frustration comes from the requirements and constraints imposed upon them by insurance companies.

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Do you think that the cost of medical care is of no consequence?

Kleinman:

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Perhaps it is due to the physicians that you listen to are trying to force their patients to do what they say and the patients are not compliant.

Percy:

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I think it is more the lack of control. It is frustrating when people become sick or more sick due to ignoring or in some way failing to follow sound medical advice.

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Do you understand the difference between a medical opinion and sound medical advice?

Kleinman:

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So, if someone doesn't believe as you do they are not discerning?

Percy:

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No, I wouldn't say that. Discernment is usually associated with the ability to assess evidence according to its relevance and reliability.

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How do you determine that evidence is relevant and reliable?

Kleinman:

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Do you know that in the CME course that I attend, they have presented quite a few cases of patients that were vaccinated for Covid but still ended up in the ICU with Covid?

Percy:

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Statistics show that vaccination reduces the odds of visiting an ICU.

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Do you think that someone that refuses to get vaccination should be punished?

Kleinman:

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Do you think you can identify what caused an inflammatory response just by looking at it?

Percy:

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No.

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There can be a pattern of inflammation that can be attributed to certain diseases but it is not absolute.

Kleinman:

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You are mistaken, I'm showing you that you are not discerning.

Percy:

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You mean I missed the sarcasm? Darn!

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What makes you think I'm being sarcastic?

Kleinman:

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You think you understand inflammation,...

Percy:

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I never made any claims regarding my understanding of inflammation.
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What I did was notice when you asked about the four signs of infection, then answered your own question by telling us about the four signs of not infection but inflammation.

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The Journal of Inflammation - PMC

Kleinman:

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What do you think of the advice, "You can't treat a viral infection with antibacterial medication".

Percy:

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It's good advice.

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Do you think that someone with Covid that gets a secondary bacterial pneumonia should not be treated with antibiotics?

Kleinman:

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So, you think that pushing a pill is all you have to do to treat an infection?

Percy:

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What I think is that I provided what you requested, expert advice found with a Google search on how to treat covid with medication. That material covers dosage and administration, contraindications, warnings, adverse reactions, drug interactions, population specific concerns, overdosage, clinical pharmacology, nonclinical toxicology and references to clinical studies.

Kleinman:

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Do you think that is all that is required to treat Covid or any other infection?

Percy:

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No.

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What do you think of the advice, "Take all your antibiotics until they are finished"?

Kleinman:

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Replications do not equal generations.

Percy:

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If you're going to comment in terms of "replications" while Felsenstein's comments in terms of "generations", then I can't tell how your comments relate to his.

Kleinman:

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Is the meaning of "replications" and "generations" that complicated?

Percy:

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I only noted that the different terminology means it isn't possible to know how your comments relate to Felsenstein's.

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Do you think that Felsenstein uses a different definition for replication and generations than others?

Kleinman:

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Are you aware that there is a very high probability that you harbor infectious agents that under the right conditions can cause you serious and even life-threatening diseases?

Percy:

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Yes.

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Should you be required to get medical care?

Kleinman:

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Do you think that the cost of medical care is of no consequence?

Percy:

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No.

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Why should doctors be frustrated that insurance companies be involved in medical decisions?

Kleinman:

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Do you understand the difference between a medical opinion and sound medical advice?

Percy:

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The difference is context dependent.

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What is that context for Covid?

Kleinman:

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How do you determine that evidence is relevant and reliable?

Percy:

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Good question. I expect that one becomes better at it through validating one's reasoning from evidence with feedback from the real world.

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Is that the same real world that doesn't discern your view?

Kleinman:

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Do you think that someone that refuses to get vaccination should be punished?

Percy:

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If by punishment you mean isolation to prevent the risk of infecting others with a dangerous contagion because they're unwilling to self-isolate, then sure. If by punishment you mean incarceration, then that would depend upon other factors such as intentionality.

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You have already admitted that you may be harboring microbes that can cause serious or fatal diseases. Should you be self-isolating? If not, why not?

Kleinman:

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What makes you think I'm being sarcastic?

Percy:

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Because "I realize your experience as a website administrator makes you much more knowledgeable in this topic" is sarcastic.

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Did I say I was experienced as a website administrator?

Kleinman:

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Do you think that someone with Covid that gets a secondary bacterial pneumonia should not be treated with antibiotics?

Percy:

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Yes.

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When should that treatment start?

Kleinman:

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What do you think of the advice, "Take all your antibiotics until they are finished"?

Percy:

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I think the same thing as last time you asked.

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Do you think that a patient should take their antibiotics even if they are not showing any clinical benefit?

Kleinman:

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Do you think that Felsenstein uses a different definition for replication and generations than others?

Percy:

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I think only you know what you mean.

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DNA Replication Generation Definition & Meaning | Dictionary.com What do you mean by "replication" and "generation"?