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Comment author: DanArmak 02 February 2015 01:40:58PM 7 points [-]

I'm 30 years old and almost entirely unvaccinated.

I've always had poor health, I had lymphoma at age 27, type 1 Diabetes since age 13, all of which suggests poor immune system performance. And anecdotally, when I get sick with common cold etc, I seem to stay sick longer than other people. So I don't expect my body to be good at fighting off really dangerous disease.

Which vaccines should I get? Most resources either target or assume vaccination of children on a regular schedule.

Comment author: VincentYu 03 February 2015 03:53:09AM *  5 points [-]

I second gjm's suggestion to talk to a healthcare professional.

Every year, the CDC updates and publishes their recommended immunization schedule for adults (patient version), which doesn't assume childhood vaccination. Below, I've summarized the parts that are most relevant to you.

Vaccines recommended for adults aged 30 years:

Additional vaccines recommended for adults aged 30 years with diabetes:

Note that if you have a concurrent immunocompromising condition (e.g., lymphoma), then live vaccines should generally be avoided. This includes the varicella, MMR, and zoster vaccines. Again, your healthcare provider can tell you more.

Comment author: Username 25 January 2015 06:04:00PM 5 points [-]

I have (what I presume to be) massive social anxiety. I live near lots of communities of interest that probably contain lots of people I would like to meet and spend time with, but the psychological "activation energy" required to go to social events and not leave halfway though is huge, and so I usually end up just staying at home. I would prefer to be out meeting people and doing things, but when I actually try to do this, I get overcome by anxiety (or something resembling it), and I need to leave. Has anyone else had this problem, and if so, what techniques helped you overcome it? "Just practice" doesn't seem to be working--when I am able to muster up the willpower to go to social events (even very structured ones, which are much easier to deal with), it takes more and more willpower to stay there as the event goes on, and this doesn't seem to be changing.

Comment author: VincentYu 26 January 2015 01:22:36AM 0 points [-]

I recommend reading section 19 (on the management of social anxiety disorder) in the recent treatment guidelines from the British Association for Psychopharmacology (pp. 17–19). A sample:

19.1. Recognition and diagnosis

Social anxiety disorder is often not recognised in primary medical care (Weiller et al., 1996) but detection can be enhanced through the use of screening questionnaires in psychologically distressed primary care patients (Donker et al., 2010; Terluin et al., 2009). Social anxiety disorder is often misconstrued as mere ‘shyness’ but can be distinguished from shyness by the higher levels of personal distress, more severe symptoms and greater impairment (Burstein et al., 2011; Heiser et al., 2009). The generalised sub-type (where anxiety is associated with many situations) is associated with greater disability and higher comorbidity, but patients with the non-generalised subtype (where anxiety is focused on a limited number of situations) can be substantially impaired (Aderka et al., 2012; Wong et al., 2012). Social anxiety disorder is hard to distinguish from avoidant personality disorder, which may represent a more severe form of the same condition (Reich, 2009). Patients with social anxiety disorder often present with symptoms arising from comorbid conditions (especially depression), rather than with anxiety symptoms and avoidance of social and performance situations (Stein et al., 1999). There are strong, and possibly two-way, associations between social anxiety disorder and dependence on alcohol and cannabis (Buckner et al., 2008; Robinson et al., 2011).

19.2. Acute treatment

The findings of meta-analyses and randomised placebocontrolled treatment studies indicate that a range of approaches are efficacious in acute treatment (Blanco et al., 2013). CBT [cognitive behavioral therapy] is efficacious in adults (Hofmann and Smits, 2008) and children (James et al., 2005): cognitive therapy appears superior to exposure therapy (Ougrin, 2011), but the evidence for the efficacy of social skills training is less strong (Ponniah and Hollon, 2008). Antidepressant drugs with proven efficacy include most SSRIs (escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline), the SNRI venlafaxine, the MAOI phenelzine, and the RIMA moclobemide.

[...]

19.4. Comparative efficacy of pharmacological, psychological and combination treatments

Pharmacological and psychological treatments, when delivered singly, have broadly similar efficacy in acute treatment (Canton et al., 2012). However, acute treatment with cognitive therapy (group or individual) is associated with a reduced risk of symptomatic relapse at follow-up (Canton et al., 2012). It is unlikely that the combination of pharmacological with psychological treatments is associated with greater overall efficacy than with either treatment, when given alone, as only one in four studies of the relative efficacy of combination treatment found evidence for superior efficacy (Blanco et al., 2010). The findings of small randomised placebo-controlled studies suggest that the efficacy of psychological treatment may be enhanced through prior administration of d-cycloserine (Guastella et al., 2008; Hofmann et al., 2006) or cannabidiol (Bergamaschi et al., 2011).

From a patient perspective, the guidelines suggest that each of the following four approaches should be similarly effective for the treatment of social anxiety as long as the care provider is adequately trained and up-to-date with current best practice:

  • Pharmacotherapy
    • given by a psychiatrist.
    • given by a primary care physician.
  • Psychotherapy
    • with a therapist.
    • in a group setting.
Comment author: RowanE 19 January 2015 01:27:06PM 4 points [-]

How long do the effects of caffeine tolerance, where when you're not on caffeine you're below baseline and caffeine just brings you back to normal, last? If I took tolerance breaks inbetween stretches of caffeine use, could I be better off on average than if I simply avoided it entirely?

Comment author: VincentYu 20 January 2015 03:58:38AM *  6 points [-]

where when you're not on caffeine you're below baseline and caffeine just brings you back to normal

This is a hypothesized explanation for the acute performance-enhancing effects of caffeine that fits well with the Algernon argument, but it is not a conclusive result of the literature. For instance, the following recent review disputes that.

Einöther SJL, Giesbrecht T (2013). Caffeine as an attention enhancer: reviewing existing assumptions. Psychopharmacology, 225:251–74.

Abstract (emphasis mine):

Rationale: Despite the large number of studies on the behavioural effects of caffeine, an unequivocal conclusion had not been reached. In this review, we seek to disentangle a number of questions.

Objective: Whereas there is a general consensus that caffeine can improve performance on simple tasks, it is not clear whether complex tasks are also affected, or if caffeine affects performance of the three attention networks (alerting, orienting and executive control). Other questions being raised in this review are whether effects are more pronounced for higher levels of caffeine, are influenced by habitual caffeine use and whether there [sic] effects are due to withdrawal reversal.

Method: Literature review of double-blind placebo controlled studies that assessed acute effects of caffeine on attention tasks in healthy adult volunteers.

Results: Caffeine improves performance on simple and complex attention tasks, and affects the alerting, and executive control networks. Furthermore, there is inconclusive evidence on dose-related performance effects of caffeine, or the influence of habitual caffeine consumption on the performance effects of caffeine. Finally, caffeine’s effects cannot be attributed to withdrawal reversal.

Conclusions: Evidence shows that caffeine has clear beneficial effects on attention, and that the effects are even more widespread than previously assumed.

The authors' conclusions:

  • Caffeine improves performance on both simple and complex attention tasks.
  • Caffeine improves alerting, executive control and potentially also orienting.
  • There is inconclusive evidence on dose-related performance effects of caffeine.
  • There is inconclusive evidence on the influence of habitual caffeine consumption on the performance effects of caffeine.
  • Caffeine’s effects cannot be attributed to withdrawal reversal.

Note the following conflict of interest:

The authors are employees of Unilever, which markets tea and tea-based beverages.

Comment author: ilzolende 19 January 2015 08:04:32AM 13 points [-]

Assuming you just want people throwing ideas at you:

Make it illegal to communicate in cleartext? Add mandatory cryptography classes to schools? Requiring everyone to register a public key and having a government key server? Not compensating identity theft victims and the like if they didn't use good security?

Comment author: VincentYu 19 January 2015 12:11:24PM 7 points [-]

Requiring everyone to register a public key

This is already the case in Estonia, where every citizen over the age of 14 has a government-issued ID card containing two X.509 RSA key pairs. TLS client authentication is widely deployed for Estonian web services such as internet banking.

(Due to ideological differences regarding the centralization of trust, I think it's unlikely that governments will adopt OpenPGP over X.509.)

Comment author: Mark_Friedenbach 11 January 2015 06:46:42AM 3 points [-]

Is this what you're seeing?

http://imgur.com/94RsYDV

Comment author: VincentYu 14 January 2015 03:39:31AM 4 points [-]

The crappy resolution is due to the image host (postimage.org), which is downsizing some images served to some IPs (verified this through a few private VPNs).

Comment author: NatPhilosopher 13 January 2015 10:23:37AM *  -2 points [-]

The actual conclusions are crowd think. The fact of the matter, as they discussed, is they had no empirical basis to assess the toxicity of injected aluminum in neo-nates, or even adults for that matter, in spite of having done it for 70 years. They had never bothered looking. They still have no empirical basis for claiming its safe, in fact, just the opposite. In fact, they are injecting 100's of times as much aluminum into neo-nates as they get from diet in the first six months, bypassing numerous evolved filters that served to keep it out. When people actually did animal experiments on neo-nates, they reported this was very toxic to development. When people actually look at any epidemiology that's sensitive to it, they find its very toxic to development. Its highly correlated to autism, for example, as well as infant mortality.

Incidentally, when they talk about "low incidence of adverse events", they are talking about adverse events within 72 hours. I am talking about the impact of aluminum on development and the immune system and the development of the brain. Much of the aluminum gets stuck in the muscle and only leaks out over periods longer than 72 hours. The total load infants get from vaccines over the first six months is hundreds of times the total load they get from diet, taking into account that the dietary system filters 99.75% of ingested aluminum but virtually all parenterally injected aluminum eventually makes its way into systemic flow.

The results of the various medical surveys are crowd think. The summaries as a general rule present blather that soothes the soul. If you look at the actual empirical results published in the scientific literature, the situation is clear, even though it is the opposite of what all the surveys tell you in their summaries. If you ignore this, you are destined to fail to realize that committees of doctors or government officials are incapable of understanding a scientific literature or making medical decisions that are better for health than random, and more generally that crowd think is an important phenomenon in the world.

Comment author: VincentYu 13 January 2015 10:44:55AM 11 points [-]

Regardless of the conflicts between your beliefs and that of others, it is dishonest to misrepresent the writings of other people to bolster your arguments. Do not manipulate quotes from a report to make it say what you want it to say, even if you believe that the original report is incorrect.

Comment author: FrameBenignly 13 January 2015 05:14:08AM 5 points [-]

I just looked at those posts from that discussion, and your description of the literature is clearly cherry-picked. You're only concentrating on the studies which favor your argument and not contrasting them with the studies which oppose your argument. You only acknowledge that those other studies exist in passing. By going into great detail on your preferred studies instead of presenting a comprehensive overview you're exposing yourself to sampling bias.

Comment author: VincentYu 13 January 2015 08:52:58AM *  9 points [-]

NatPhilosopher is also underhandedly manipulating quotations by lifting words out of context.

Take a look at NatPhilosopher's first quotation and citation in their pièce de résistance arguing against the safety of pediatric vaccination:

In 2002 the National Vaccine Program Office (NVPO) convened an expert group to study safety issues with adjuvants in vaccines. Among their conclusions:

“pervasive uncertainty [from] missing data on pharmocokinetics and toxicities of aluminum injected into humans… There seems to be abundant data concerning risk levels for ingested aluminum, but scant data about risk levels for injected aluminum. The oral minimum risk level, for example, appears to be in the range of 2–60 mg/kg of aluminum per day but there are no comparable data for injected aluminum.”[1]

This does sound worrying. But let's take a look at the actual report. Here are the quotations in context (emphases mine, italics are NatPhilosopher's lifted words):

From the Metal Ions in Biology and Medicine International Symposium held immediately prior to the aluminum workshop, we learned about “pervasive uncertainty”, a phrase used in this workshop to denote missing data on pharmocokinetics and toxicities of aluminum injected into humans. Even with identification of areas needing further study, it was apparent that aluminum which has been used as a vaccine adjuvant for more than 70 years, has an established safety record with low incidence of reported adverse events.

[...]

There seems to be abundant data concerning risk levels for ingested aluminum, but scant data about risk levels for injected aluminum. The oral minimum risk level, for example, appears to be in the range of 2–60 mg/kg of aluminum per day but there are no comparable data for injected aluminum. The uncertainties notwithstanding, there appeared to be a large margin of safety for aluminum adjuvants.

Not so worrying with context, is it?

The actual conclusion of the report (emphases mine):

In summary, a variety of aluminum salts have useful physicochemical and immunogenic properties that lend these minerals to use in vaccines. Based on 70 years of experience, the use of salts of aluminum as adjuvants in vaccines has proven to be safe and effective. Aluminum as an adjuvant enhances antigen presentation and stimulates a type II immune response. It has been possible, using aluminum adjuvants, to reduce the number of injections and the amount of antigen per dose, and thereby decrease the toxicity of some antigens. Without extensive research, it is impossible to know how removal of aluminum from vaccines would affect the known benefits of vaccines in which it is contained. More pharmacokinetic data are needed but there is an apparent wide margin of safety with the use of aluminum adjuvants and reported adverse events have been mostly minor and of low incidence. MMF histologic lesions may be a consequence of the normal immune response and may, in fact, be a wholly serendipitous finding in patients with ascending myalgias and fatigue. Some identified areas of research include: expanding the aluminum pharmacokinetic database, especially following IM injection in young children, conducting bimetal (mercury and aluminum) toxicological studies in animals, identifying biomarkers of toxicity, defining the frequency and duration of MMF in normal controls, determining the role of aluminum in the pathophysiology of the MMF lesion, developing new adjuvants, and establishing new methods for administering immunizations.

Comment author: B_For_Bandana 17 December 2014 09:03:17PM *  4 points [-]

When you go to GiveWell's Donate page, one of the questions is,

How should we use your gift? We may use unrestricted gifts to support our operations or to make grants, at our discretion:

And you can choose the options:

  • Grants to recommended charities

  • Unrestricted donation

I notice I'm reluctant to pick "Unrestricted," fearing my donation might be "wasted" on GiveWell's operations, instead of going right to the charity. But that seems kind of strange. Choosing "Unrestricted" gives GiveWell strictly more options than choosing "Grants to recommended charities" because "Unrestricted" allows them to use the money either for their own operations, or just send it to the charities anyway. So as long as I trust GiveWell's decision-making process, "Unrestricted" is the best choice. And I presumably do trust GiveWell's decision-making, since I'm giving away some money based on their say-so. But I'm nevertheless inclined to hit "Grants to recommended charities," despite, like, mathematical proof that that's not the best option.

Can we talk about this a little? How can I get less confused?

Comment author: VincentYu 20 December 2014 02:58:23PM *  1 point [-]

Holden has written about donation restrictions on the GiveWell blog back in 2009 (bold and italics in original):

  • We would guess that cases fitting the conditions for “meaningful restricted funding” are rare – i.e., when you give to a multiprogram organization, your donation usually will expand what they want to expand, regardless of how you restrict it.
  • We have a general aversion to restricting donations. It seems like “micromanaging” an organization in this way is asking for trouble: the charity may avoid your intentions using technicalities or spend the “extra money” allocated to a program badly, and in any case, you are creating an extra headache for the charity.

Thus, our current rule of thumb is to find an organization whose existing priorities you are comfortable with – and give unrestricted.

See also the following on the GiveWell blog:

Comment author: gwern 30 October 2014 03:23:54AM *  0 points [-]
  • Trowbridge, F.L. "Intellectual assessment in primitive societies, with a preliminary report of a study of the effects of early iodine supplementation on intelligence". In Stanbury, J.B .; Kroc, R.L., Eds. Human development and the thyroid gland. Relation to endemic cretinism, Plenum Press, New York; 137-150; 1972.

I think it might be available elsewhere: http://europepmc.org/abstract/MED/4662265 identifies it as being in "Advances in Experimental Medicine and Biology [1972, 30:137-149]", which doesn't seem to be this book.

EDIT: no response here, so trying https://www.reddit.com/r/Scholar/comments/2o4e7n/article_intellectual_assessment_in_primitive/

Comment author: VincentYu 20 December 2014 02:29:45AM 1 point [-]
Comment author: gwern 30 October 2014 03:23:54AM *  0 points [-]
  • Trowbridge, F.L. "Intellectual assessment in primitive societies, with a preliminary report of a study of the effects of early iodine supplementation on intelligence". In Stanbury, J.B .; Kroc, R.L., Eds. Human development and the thyroid gland. Relation to endemic cretinism, Plenum Press, New York; 137-150; 1972.

I think it might be available elsewhere: http://europepmc.org/abstract/MED/4662265 identifies it as being in "Advances in Experimental Medicine and Biology [1972, 30:137-149]", which doesn't seem to be this book.

EDIT: no response here, so trying https://www.reddit.com/r/Scholar/comments/2o4e7n/article_intellectual_assessment_in_primitive/

Comment author: VincentYu 19 December 2014 07:47:24AM 0 points [-]

Requested.

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