As per the title - I'll try and give my personal and professional experience, without providing any specific medical advice (which is fraught with risk over the internet, without being familiar with your medical history).
I have been working as a specialist General Practitioner for the last 5 years, and am currently working in a COVID screening clinic in Melbourne seeing all the lovely coughs and colds.
I read it from the view of, do they actually have a mental illness or are they just looking for an easy way out of work for a few days.
Which is likely because they are stressed? Feeling down? Not sure why they aren't motivated? (they all sound like something that happens in one's head… you know, like…..)
Why say 'please educate yourself' when they are literally asking for an informed opinion? They didn't even insinuate that it wasn't worthy of a cert, just that it wasn't physical which obviously makes it harder for a GP to determine legitimacy.
'please educate yourself'… lol. what a tosser.
I'd assume DiLs' response is a subjective take on the motivation of FlopHunter's question.
To me it also does read as someone who is doubtful of the legitimacy of people's mental health day claims, but again that is my subjective take on the question.
Everything you read/hear/etc goes through your own filters and you interpret it how you interpret it. Likewise for anything you express - you express how you express, and then others interpret that how they interpret that.
Proper communication is hard y'all. Especially over a medium like forums on the internet.
Great question! I would happily provide certificates for this reason. Of course, you occasionally (rarely) get those from time to time who are blatantly trying to rort the system (e.g. who come in for these on clockwork, or ask for these just before resigning their job) who I will be honest with and explain why I can't provide these. But on the whole I find most people to be honest and genuine.
Try to use the Reply button otherwise it will become less and less clear who you are talking to
ok
no k
He was talking to himself, might need a certificate.
My GP always assumes that I am being dishonest as she gets a fair share of people who are dishonest as she runs a methadone clinic. I also look relatively fit even when I am sick and sometimes I am better only during the GP visit but crash when I come back home (my body is weird). I cannot explain this. She's a great GP to be honest but so harsh on me for sick days haha
Why would she care if you aren’t? It’s odd, it’s not her job to second guess your symptoms.
Uh, they are literally certifying you are unable to work.
It is the doctors job to determine if you have symptoms, and what the cause is
@greatlamp: Yes and no. If the patient states symptoms, then that is that. There's no need to check the truth unless you are going to prescribe or manage it in some way that necessitates it. You are not the med cert police.
Cause, yes. But symptoms are something that is stated. Many disease have few to no exam findings.
And it's $ to doughnuts that I have significant experience in this area, and more than the OP ;) (have a look at my other replies…)
So where do you draw the line between mental health issues (genuine) and mental "softness" / lack of fortitude ( if there can be such a thing)
As I've personally experienced a situation about 10 years ago at a work place with unlimited sick leave policy. (American).
A member of my team of 12 took "sick" leave for stress, initially for a few days. Then another certificate came in and it was for 2 weeks.
When I enquired about it (Not legal apparently), found out it was stress from "breaking up with his GF.." Okay.. so I let it go.
But it became problem as it really impacted my team. (He was FTE and we couldn't budget for contractor to cover shift). This went on and off for another 2 months and even HR agreed with the medical certs and policy.
Finally he came back on roster, and our entire team got the $hits as he let us shoulder the work while we saw him going to badminton / jogging sessions as "therapy" for stress. And bam! Out came the stress medical certs (different doc) again for "bullying". This went on for another 2 months and for a total of 6 months before the company lawyers got involved and let him go (he got a deal!).
Are you asking if your inability to cope with such a menial situation is a mental health issue or just mental softness?
Do you ever get asked to appear in court to testify about your patient's health due to workplace incidents like physical accidents, discrimination, bullying etc.?
Fortunately, most of the time this can be provided to court in the form of a written statutory declaration, and attending court, tribunals and inquests are only required if there are significant uncertainties around the case. I've had requests for things such as police statements, Workcover reports and coroner's statements in the past, but fortunately have never been required to present to court. However, that's not to say it couldn't happen one day!
I totally get that some patients take more time than expected, but why do doctors/their receptionists never call other patients when you’re running behind by 20+ mins?
Great point! I totally understand the frustration as I also hate being made to wait for a pre-booked appointment, and I think there's something fundamentally wrong if your regular GP is consistently late to appointments. Generally most experienced receptionists/practices will do exactly what you suggest and offer to rebook with another doctor or reschedule an appointment.
I think there's something fundamentally wrong if your regular GP is consistently late to appointments.
I find that good doctors often spend more time with patients. They tend to be more popular and harder to book in to see. Thus in turn they run over-time.
Thats’s not the intention of the question. There is nothing wrong with running bit behind if you have to spend bit more time with previous patients. The question at hand is why the reception is not very clear on that. i’ve had this happened to me many times. I live 5 mins away from clinic but I’ve had times that I waited close to an hour for pre booked appointments as the doc was running late and the reception refused to pass this information to me.
@kaleidoscope: Why not call beforehand? When I lived 5 minutes from my clinic I would call the receptionist and ask if my GP is running on time.
@unelectric: I do… They don’t give answer to that. Simply replying with something like “can’t really say about timing but we expect you to be at the clinic at the time of your appointment”
What bs 😕
@unelectric: I believe some clinics have an issue with contacting patients over phone for this because they cannot easily verify who they are talking to. It's a breach of privacy to tell a non patient (or authorised party) about an appointment.
@wyrmy: Its not hard to verify a patients ID, you just need to ask for 3 contact points (eg Full name, DOB and address)
@kaleidoscope: Yes I find it odd that the receptionist wouldn't pass on that sort of information to you. I can understand if they were hesitant to give a time frame because the doctor wants to take that unannounced toilet/tea break, or the few patients in front of you end up taking longer then their allotted time, but it's not difficult to give you an estimated wait time or the number of patients ahead of you.
At the same time, the receptionists are incredibly busy with tasks like faxing referrals, scanning results, rescheduling appointments, cleaning vomit etc. so please understand if they're not able to get to you straight away.
Here's a bit of humour that I thought people might appreciate :) (warning: NSFW language)
Are you discouraged from sending people for blood tests?
Do you have quotas for specialist referrals?
Are you rewarded financially for prescribing certain medications over others?
Do you record down to the minute how long you spend with a patient?
Are you discouraged from sending people for blood tests?
- No. I'll send patients in for tests if they are appropriate. However some tests don't have any basis for referral and we are audited on these on a regular basis by Medicare (who fund these tests) so in a sense there is a disincentive to indiscriminately ordering tests (and rightly so)
Do you have quotas for specialist referrals?
- Generally we will refer if we feel it is more appropriately managed under a different specialty but we are not required to reach a certain quota/target per se
Are you rewarded financially for prescribing certain medications over others?
- I think in the past there were certain non-monetary incentives (e.g. paid overseas holidays in the guise of "conferences" and wining and dining) for what you mention, however the rules around these have become very tight nowadays and doctors and pharmaceutical companies are required to publically disclose their gifts over a certain amount, which I believe is a good thing in the interests of transparency
Do you record down to the minute how long you spend with a patient?
- The medical software used in practices usually automatically records how long is spent with each patient, for record keeping and Medicare audit purposes (patient billings and their Medicare rebates are generally calculated according to the length of time and/or the complexity of the consultation)
The transparency bit sounds genuinely like a good change. :)
So before a Doctor couldn't accept a gratuity of say, one million dollars, or maybe even a case of Grange. What happens now, must the Doctor refuse it, or would it need to be declared to their patients in any way other than say, fine print on a form? And is the rule the same for a commercial practice, as well as the individual Doctors working in it?
But what about $100?
Or say, one bottle of Grange for each referral (be it from a partner, or a supplier?)
What about a big pharma loosely associated with one of these, could it provide small, granular gratuities, instead of tallied commission payments? If they can split big payments into lots of small payments…
@resisting the urge: Not OP but knowing a GP closely it’s at the point that even seeing a pharmaceutical rep costs a GP money (where they could see a patient), so not worth the few pens and notepads they’re able to get.
A few decades ago they were able to get indirect things such as an educational conference ‘sponsored’ by the company, as long as they paid extra to bring their partners and families but even that seems long gone.
Australia really is at the point where there’s more disincentive to prescribe (via audits) rather than any incentive to prescribe. The real money is in the alternative medicines, things that aren’t regulated, oddly pushed by people who like to talk about big Pharma.
@[Deactivated]: Some work the system and some don't. A lot of GPs just do the hard yards and avoid the get rich schemes. However one look at historical Medicare audit results shows how many do.
Whilst you are right about incentives/disincentives, my question is around the regulation, and what is effectively allowed/disallowed. I see a lot of GPs referring to preferred pathology providers, fancy specialists and private specialist firms, as well as private clinics for one-off procedures.
Not sure how this is so procedural, esp. when patients rely on their Docs for recommendation. However like you I know a lot of these referrals are from what the Doctor knows of the provider, and the patient's need/ability to pay, etc. May still be sizeable space for commercial exploitation as some firms get very creative.
@resisting the urge: Most pharma reps in AU are terrified of breaching the Medicines Australia code of conduct, which only gets stricter over time. Massive compliance departments within pharma to make sure they don’t colour outside the lines, it’s not worth it.
Pharma can influence doctors in much smarter ways - see the book Bad Pharma.
Common misconception with specialist referrals is that you have to see the specialist named on the referral. This is only true for public hospital clinics. For private specialists, you can take the referral to whomever you like. Not all medical receptionists or even doctors are aware of this, partly because it’s not easy to get straight answers to these things
GPs tend to refer to specialists who communicate well, see patients promptly, and make their patients happy. Once you’re happy with one, you tend to refer to them repeatedly.
@BigPalooka: @BigPalooka, Very good contribution, thank you.
I think you are right for many specialists, but not all will comply as you suggest. Docs are trained in the legal aspects of their profession, PL, PI and quite a few are well serviced by lawyers anyway. thye do not all play nicely.
However pathology kick-backs are more likely due to its industrial scale and the size of the corporations running them.
@resisting the urge: The main reason they can’t really incentivise GP-
Private specialist referrals aren’t worth much too. Specialist. Grange? How much do you think patients and Medicare pay?
Also there’s either no competition and they don’t need to bribe anyone, or lots of competition and they can’t afford to bribe anyone.
With pathology there is a form of incentive to just be allowed nearby-
They often pay rent if co-located. Each doctor in a clinic is worth some ridiculous amount to a pathology provider, so they compete by paying rent. But they can’t incentive the gps to order more path, and they compete with each other so they can’t threaten or penalise the gps as they have no leverage.
With pharma, you can look up the register of what your gp and others have received. Dinners are capped at a value (?$80?) now and many clinics are refusing pharma reps.
@cynicor: @cynicor, All valid points too, thank you.
Thing is, if I refer you 50 clients a week, and you charge them specialists fees, why would you not afford me a bottle or two or Grange once in a while? Or a lunch account for my staff, or a dinner with our mates every now and then?
Can buy you a dinner at $79 today, can I buy you one every day of the year and some? Invoices follow the trail, they don't define it. Maybe dinner was $631.00, and we just had the restaurant produce 8 invoices with 8 different dates.
Gratuities can always be split to meet the requirements, more easily than following some rules.
What do you believe is the cause of an increase in people diagnosed with anxiety and depression in this day and age and how do you go about treating your patients. I.e medication lifestyle changes?
That’s got more to do with the Social Media than anything else.
I’m pretty sure it’s been researched.
But it’s pretty obvious the effects it has over people, you are exposed to hyper successful 0.1% of the society fake or real it makes you inadequate.
If an effective COVID vaccine became available tomorrow, such as the one reported yesterday, would you be comfortable in having that immunisation done yourself or on your family?
I'm not anti-vax but I'm asking due to the general feeling of "I'll get it done when it's proven to be safe" that I've heard in conversation.
Personally, I'd probably want to wait for a good period of time before seeing what kind of side effects manifest. Usually vaccine development is a highly regulated process and takes years if not decades of research and development, which has simply not been available due to the urgency of the current pandemic.
Being younger and without any comorbid medical conditions I feel I'd be more comfortable with the known risks (of contracting COVID-19) compared to the unknown risks of a new relatively untested vaccine
Screencapping?
@brendanm: Same. I’m going to use an interwebs AMA from an OzBargain user as good solid research and evidence to support my position.
@Vote for Pedro: I was waiting for you. I've set the table for tea, how do you like it? Have a scone?
Origin - Latin
Prosperous - doing well.
I plan to bring it out later on and revel in it, it will bring me great joy.
@Jackson: Some people might argue that posterity are a form of prosperity :P (guess it depends on whether you send them to private school and they want all the latest gadgets)
I suppose you have to weigh up risks of getting Covid19. If you immune suppressed or a cancer patient (or close family member is) etc maybe worth risking the vaccine rather than getting Covid19 or spreading it to family.
From their press release. Pfizer have conducted trials with 43,500+ participants to date. 38,900+ have received a second dose. No serious adverse reactions. 90% efficacy (reported). Phase 3 data due for peer review submission soon.
So what do you mean by "untested"? What counts as "tested" in your mind?
Sometimes with medications, potential side effects may take years or even decades to manifest, or they are sufficiently rare that they might not be attributed to the effects of the medication, which is usually why the process of vaccine development involves decades of trials and thousands of trial participants. With the expedited development of any proposed COVID vaccine there won't have been adequate time to get an idea of what these potential risks might be
@inasero: Fair point. But covid-19 poses long-term health effects. What are (some of) the ongoing difficulties (some of) your patients face after recovering from covid?
Do you have an example of a medication with potential side effects that has manifested after many years or decades? I know psychotropic drugs, with repeated and regular consumption, are in that pile. But these vaccines are different, are they not?
@[Deactivated]: Check out Dengvaxia - used to immunise against Dengue Fever. Killed about 600 kids (recently - 2017). It was discovered that risks from dengue were lower than the vaccine in people that had not been previously infected.
@[Deactivated]: Not sure - I just got very sick with dengue and looked into getting the vaccine. It’s so dangerous you are only eligible for it here if you are moving to a dengue endemic region permanently, have had dengue and are between 12 and 45. It is scary that it was such a big stuff up only a few years ago.
@[Deactivated]: There was that anti nausea medication in the 60's (name escapes me) which was commonly prescribed to pregnant women experiencing morning sickness, a few years later they found it was causing birth defects.
Granted that was 60 years ago and it wasn't a vaccine, but it is an example of something that was deemed safe at the time which had really bad side effects later on.
With Covid19 long term side effects, whilst they might not be fully known it is possible that close to a billion people have had it so we probably have a much better understanding than an unknown vaccine been tested in 40,000 people where the data hasn't been released or peer reviewed.
But covid-19 poses long-term health effects
The virus has barely existed for a year. Not sure this can be stated as fact yet. Research is still on going in this area. Even influenza in some cases can have health effects lasting the better half of a year.
@IdBuyThat4aDollar: You're right. In fact, influenza can cause lung-scarring which poses long-term negative health effects. So if the same phenomena is observed in covid-19 patients (e.g. lung-scarring), it is inferred that there will be long-term negative impacts on health as well. Covid-19 is a more severe illness than just the "common" cold and flu.
@inasero: I see this as a doctor applying the “precautionary principle” more so than someone who truly understands the science or pharmaceutical development regulatory environment.
We don’t typically wait years and years waiting and waiting for “long term effects.” We maybe do that for novel drugs. A vaccine with a few peptides isn’t a novel. We usually discount those possibilities based on common knowledge, for instance, the use of GRAS ingredients, and a general understanding of how the body reacts to those short, inactive peptides.
The vaccine adverse outcomes registers is used otherwise, and generally even that is only there to look at batch-specific issues. But we usually give it the seal of approval regardless. It’s not like it is a part of the approval process that’s ‘been skipped.’
The reason it takes years and years is a slightly different reason, which is because we strongly avoid parallel studies. We try to study participants sequentially, stopping the trial every time there’s an adverse event. This is because we expect vaccines to be safe not only after they’re tested and approved, but we demand that they’re safe for our participants as well, carefully checking every person who gets sick for whatever reason, and possibly not starting up the trial again for months. The speed of the trials isn’t because we are looking less distant into a participants after-dose response - it’s because we are trialling more participants in parallel and getting the process done simultaneously.
Yes, some adverse events are rare. But actually the phase 3 trials have hugely sufficient numbers already to pick up rare events. Tens of thousands of participants.
Whilst it’s a bit on the nose to debate someone who just wants to be precautionary, which sounds like a fair enough statement, the reason I must do so is it is basically fear mongering to highlight concerns which clearly aren’t terribly huge, in the face of a virus which is …actually killing people en masse. Like girl. You weighed the risks, but your scale wasn’t balanced.
90% efficacy on a sample size of 94….lol.
CEO dumps 60% of stock on the day of announcement.
Just shows the press release was purely for commercial interests not the greater good of science. No other company that are at similar stage with their vaccine have gone with a press release.
sample size of 94
What do you mean?
CEO dumps 60% of stock on the day of announcement
Yes, it does seem like he was doing some profit-taking. At the same time, the sale was part of a diversification schedule, which was pre-determined and planned months ahead of the results.
for commercial interests … No other company that are at similar stage
Yes, there is a commercial element. Other companies have had to pause trials due to adverse reactions. Let's wait and see what the peer review says.
What do you mean?
They can't ethically infect the 40k people in the trial with covid.
So they have to "hope" those in the trial get covid naturally.
94 people caught covid. Of those 94, 8 where in the group that were given the vaccine, the rest where given a placebo (the control group). This is how they come up with "90% efficacy"
The standard deviation on a sample of 94 is off the charts. It's laughable the widestream attention this 90% figure is getting
8 where in the group that were given the vaccine, the rest where given a placebo (the control group) … The standard deviation on a sample of 94 is off the charts
Where are you getting these "data" from?
@[Deactivated]: It's widely reported. Even the press release you linked mentions this:
Upon the conclusion of those discussions, the evaluable case count reached 94 and the DMC performed its first analysis on all cases. The case split between vaccinated individuals and those who received the placebo indicates a vaccine efficacy rate above 90%, at 7 days after the second dose.
While they don't break down the numbers, mathematically no more than eight people of the 94 could have been in the vaccine group vs placebo group to reach >90%
Here's another source if you don't trust what I'm saying https://www.biopharmadive.com/news/pfizer-biontech-coronavir…
Pfizer and BioNTech's announcement came after an interim analysis, in which the companies found that the vaccine was more than 90% effective at preventing COVID-19 compared to a placebo. The analysis included 94 cases, implying that some 86 infections were in the placebo group, compared to eight on the vaccine.
@IdBuyThat4aDollar: Pardon my stupidity, but I still can't figure how the mathematical conclusion that 8 received a vaccine and 86 received a placebo was arrived. Efficacy means success in preventing covid-19 new infection. How is 90% derived? Add to further confusion, all "94" were confirmed covid cases.
Pfizer's press release revealed not very much. Just the overall participant size upon trial completion, efficacy results (raw data withheld), current stage of testing.
Pfizer further added: "We look forward to sharing additional efficacy and safety data generated from thousands of participants in the coming weeks … The trial is continuing to enroll and is expected to continue through the final analysis when a total of 164 confirmed COVID-19 cases have accrued."
Any scientists here who can offer clarification?
@[Deactivated]: The >90% efficacy is because:
(94-8) / 94 = 91%
You’re sort of working in the wrong direction. We aren’t trying to calculate who got vaccine and who did not: we KNOW who got it and who did not by checking the vaccine administration records.
What we are calculating is the proportional relationship between those groups, actually getting covid-19 disease.
If >90% of the covid-19 disease cases are those that got the placebo, but only <10% in the vaccine group, it implies the vaccine is working.
If the vaccine did nothing, we would expect the ratio to be closer to 50:50.
Which would be to say we would expect 86 cases vaccinated, 86 cases placebo.
Not 8 and 86.
@IdBuyThat4aDollar: Whilst you are correct in your maths, 94 is not at all too tiny a sample size to make some good assumptions.
The st dev is not “off the charts” it’s actually pretty small.
We mainly worry about st dev when looking at associations that could be random. Meaning we are placing a lot of risk “on the dice.”
But immunisation isn’t random. We already suspected we would see some positive bias - and we do. It correlates well, and the study is looking promising.
I’d love to see more data before mass production, for sure. But so far, 94 is pretty good. I wouldn’t discount that as small sample.
@IdBuyThat4aDollar: sample size was not 94 from my understanding - that's how many recorded infections there have been, among the pool of 40k people in the sample. Now that sample is being run at varying points I assume, even within the same phase 3, given it's being run across geographies, but happy to be corrected where the idea of a sample size of 94 is coming from.
edit - can see you've replied whilst I was typing a response :)
Thalidomide was approved by medical authorities in Britain. We saw the damage that did.
Given the downside of not taking a vaccine is limited (for me, I survived COVID-19 quite easily), why take the remote but entirely possible risks of major side-effects?
Thank you for your honest reply. Finally a GP with common sense!!
You're in a position of authority here and your word can do a lot of good or harm, so I'm going to ask you if you'd feel the same way if Australia had experienced as many cases as the US (>10.8M cases) or any other the other top 10 countries in terms of infection, all of which have had more than 1M of Covid
https://www.worldometers.info/coronavirus/#countries
In contrast as of the stats above Australia has had just 27,702 cases. Yes I'm aware Australia has less than 8% of the population (25.5M) of the US (331M). but adjust for population the numbers would be ~13x27702= 360,000. 10.8M/360k, so very crudely adjusted for population the US have 30x as many cases per capita. That math matches the total cases/1M figure in the table above. US = 32,781, AUS = 1,082. So 30-30x as many cases. Deaths per million is US = 749, Aus = 35.
Point is if community transmission was more wide spread here, or mortality rate higher would you still be an advocate for waiting a prolonged period before vaccinating? You'd unfortunately be in a position where you would likely be hearing of your patients dying.
Personally I already gave the same response as you to a friend that asked long before this thread appeared. I'd take it but not be among the first - and that's despite comorbidities and health issues making me and my family at higher risk. But if I lived in one of the Covid hotspots or numbers were higher here i'd be less inclined to do so.
We've been very lucky in Australia though many don't seem to understand that. We also could have been much luckier if a couple of key failures had not occurred. For a long time we had around only 100 deaths.
Another doc here.
I'd want to see the studies that have been done. And if they were only drug company sponsored.
I am very pro-vaccines and to my knowledge there haven't been any vaccines pushed out that have had terrible side effects and pulled from the market. Most vaccines are all still "common mild side effects like pain at site, feeling fluey the next few days" with "super-rare horrible side effects like Guillian-Barre" and if it's the same with the new one, I'm happy to get it.
Medicine has become a lot more open and evidence focused and rejectful of the "this is the way it's always been" mentality.
Scepticism shouldn't been seen as "they're trying to poison us with their 5G and nanorobot injections!" but rather "lets not repeat the Tamiflu debarcle"
(for those not aware, Tamiflu is an antiviral that was pushed as an answer to… I can't remember which virus and the government stockpiled it. The only problem is, it's shit and doesn't work.)
So doctors will be wary to know that it actually IS effective and has a normal side effect profile. But a lot (myself included) would be happy to take it as part of a trial to prove it. ED docs and nurses are dying worldwide due to the high viral load they get from daily face-to-face contact and if there was an outbreak here, I'd happily be a guinea pig, knowing the risks of COVID.
Tamiflu was for swineflu I believe.
It didn't go to waste, swineflu never hit so noone realized it wouldn't have worked until years later.
Meanwhile pharmacies sold off their stockpile after a while. Roche also did very well from the deal.
I think we are in a much better position these days, there are multiple potential suppliers of a vaccine.
Industry funding isn’t necessarily “tainted.” We have regulatory bodies, third-party auditing, peer review, health legislation, etc for a reason.
We don’t have to rely on funding to fall from the sky be sure of research integrity.
If “big pharma” says the vaccine works… honestly… the vaccine probably works.
Would agree in the case of a major vaccine in terms of efficacy and short term safety. As a new format of vaccine for humans I will rely on experts in the area, even as a doctor I wouldn't suggest it is unsafe or even potentially unsafe.
Pharma funding for studies, though, is pretty fraught. There are a lot of half truths and unpublished studies out there.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC156458/
Meta-analysis shows that drug company sponsored research is more likely to state a positive outcome, encourage more research into an area and advocate FOR an expensive intervention than non-drug company sponsored.
"This cannot be explained by the reported quality of the methods in research sponsored by industry" - I agree, the research methods themselves are robust… it's likely publishing bias.
Definitely drug company research has a place. For the majority of new therapies though (say a new statin/ACE-i), I don't think drug company research should be the only proof that an existing treatment should be replaced.
COVID is a special case because there is no existing treatment and as long as a vaccination has been proven safe, then it's likely that we'll bring it out on that alone and discover the true efficacy while in the market.
@EtherealArchelon: Look, I fully get financial biases. But exactly as you said: this is a special case.
As such, your paper is irrelevant white noise. It’s academically interesting but it’s comparing apples to oranges.
For instance, a large factor in bias (mentioned regularly in your linked paper) is publication bias. That is; unfavourable results don’t make it to publication and are hidden.
But this is a widely watched registered clinical trial of massive participation and global significance. The results WILL be published, negative or positive. The fear isn’t grounded.
That’s just one example. But comparing massive stage 3 vaccine trials under emergency use authorisation and relevant regulation… to all these other therapeutics used in complex (some of them rare) diseases with complex treatments, regimens and combined therapies, and varied participant numbers is…
Well, to be blunt, the comparison is just not there.
The true efficacy is very likely to be solidly determined by industry. With no exaggeration, we should trust the results with our lives. Because lives ARE being cut short.
The true efficacy is very likely to be solidly determined by industry.
I think the actual data will be pretty spot on, but some of the claims they're making at the moment about efficacy are on really comparatively small trials where the results are significant enough to say 'it works', but throwing out claims like 95% effective doesn't seem to be very definite based on the data (eg, there are a large number of people in the trial, but even on the placebo only a small number got the virus, so in effect the sample size is actually pretty small). The difference is enough that it's incredibly unlikely to be 'chance' but converting it to a very specific % effectiveness could be off by quite a bit. The sample size is probably enough to say if side effects are rare though.
@[Deactivated]: Look, I wont disagree with anything you've said there at all. The number will probably round out to something other than 95… my bet, something lower. But it isn't going to go from "effective" to "dud" I don't think..
The more interesting question for the future is: works for how long? I suspect we will need annual boosters. But I digress.
With most work places saying that a "sickie" has to be accompanied by a Dr. certificate, what percentage of people do you see, in say, a week, who are just there for their "Dr. Cert."? Are there days that are higher percentage, like, say Mondays, 70% of patients just want the cert?
I think certain days (either side of a weekend or a public holiday) have slightly higher numbers of patients requesting a med cert, but certainly nowhere near 70%.
It's difficult to say whether they're telling the truth or pulling your leg so I just tend to take their word for it (unless there's any strong evidence to the contrary - see my earlier response).
Interestingly, lethal myocardial infarcts (or heart attacks in laymans terms) are statistically more likely on Monday, so there might be some physiological basis to the "Monday-itis" that we hear about, and might bear for some interesting research.
Also, my work actually requires a medical cert if its a long wknd, so long weekends ≠ sickies, just more need for a med cert.
Also, if you're sick with something which will require you to be off for three days then it's much more likely that you'll go to the doctor on a Monday - because if you started getting sick on Saturday or Sunday then you didn't need a cert, but by Monday you'll still be sick.
What do you do that can't be replaced with AI?
What’s your opinion on people coming in asking for medical certificates for mental health days, without any physical ailment?