Antivaccine nonsense Complementary and alternative medicine Medicine Pseudoscience Quackery Skepticism/critical thinking

The fixed mindset of medical pseudoscience

One of the key principles of skepticism, particularly in medicine, is that correlation does not necessarily equal causation. I emphasize the word “necessarily” because sometimes skeptics go a bit too far and say that correlation does not equal causation. I myself used to phrase it that way for a long time. However, sometimes correlation does equal causation. However, much, if not most, of the time it does not. So how do we tell the difference between when correlation might well equal causation and when it does not? Science, of course, and critical thinking. Science is the main reason that we know that all those stories of autistic regression after vaccination are virtually certainly coincidence. Whenever you have millions of children receiving vaccinations around the same age that the first symptoms of autism manifest themselves, by random chance alone there will be a lot of children whose symptoms first manifest themselves within a few days of receiving a round of vaccinations.

Of course, one of the major characteristics of the antivaccine movement (of course) and many other advocates of pseudoscience is to confuse correlation with causation. It’s not because they’re stupid. It’s because that’s the way our brains are wired, to attribute causation to a thing that happens right before another thing. Add fear of big pharma and the normal human revulsion at seeing needles stuck into the most precious thing in the world to them (their babies), and it’s not hard to see how some parents would blame vaccines for their children’s autism if their child happens to be one of those children who exhibit autistic symptoms by coincidence not long after a round of vaccinations. This attribution of causation to a correlation is remarkably resistant to science and reason, as the continued existence of the antivaccine movement and the resistance of individual antivaccine activists demonstrate.

So when I came across a post on that wretched hive of scum and quackery (other than Age of Autism), The Drinking Thinking Moms’ Revolution entitled Reporting Adverse Reactions: VAERS and FAERS, I saw it immediately as a “teachable moment” that demonstrates the general principle of how people prone to accept pseudoscience (like antivaccine misinformation and “autism biomed”) see the world. The post is by one of the Drinking Thinking Moms whom I don’t recall having encountered before, someone who goes by the ‘nym Rogue Zebra. A perusal of her archives shows not very many contributions to the blog dating back only six months. A quick search reveals that she must have been a guest blogger who was made a regular.

Whoever she is, she cheerfully describes to us the world view of an antivaccinationist as she describes how she filed a FAERS report. To be honest, I didn’t know (or had forgotten) that FAERS exists. Those of us who follow the antivaccine movement know what the VAERS system is, namely the Vaccine Adverse Event Reporting System. Its function is basically as its name indicates: It’s a system to report suspected adverse reactions to vaccines. Of course, the main problem with VAERS (and one of the reasons antivaccinationists love it so much) is that anyone can report any adverse event, whether there’s a reason to suspect that it’s due to a vaccine or not—and antivaccinationists have done just that. Indeed, it’s pretty clear that litigation has distorted the VAERS database as lawyers trying to claim damages for “vaccine-induced autism” have urged parents to report cases of autism to VAERS. Indeed, it’s not for nothing that I’ve referred to antivaccine activists mining the VAERS database as “dumpster diving.” That’s not to say that the VAERS database is useless. It still serves as a useful “canary in the coalmine” to alert the CDC of possible new adverse reactions to vaccines. It’s just basically useless for any sort of prevalence or incidence study. After all, if you can submit an adverse reaction in which you claim a vaccine turned you into the Incredible Hulk, there’s an issue.

Well, it turns out that there’s a similar database for reporting adverse reactions to drugs, biologicals, supplements, and medical devices, basically anything other than vaccines, called FAERS (FDA Adverse Event Reporting System). This is the story of how Rogue Zebra entered a FAERS report. Here’s what provoked it:

So what happened to make me file a FAERS report? We had a follow-up appointment with our pulmonologist where I filled out paperwork citing recent health changes. We were escorted to a room by a nurse who wheeled in a cart for a pulmonary function test (PFT). Crash has difficulty clearing mucous and secretions due to muscle weakness, necessitating daily maintenance nebulized medication and HFCWO (high-frequency chest wall oscillation) treatment. Crash did her first two PFTs to get an average without issue. Normally, she would be given a rescue medication in inhaler form before doing a third PFT to open airways to their maximum capacity. This time the nurse wanted her to use a “spacer” (chamber that holds aerosolized medicine) with the medication. She doesn’t use one at home, so when given a choice she chose the nebulized medicine instead. She has used the rescue medication in nebulizer form before, but hasn’t needed it at home in over a year. Her PFTs were all in the normal range of 70%+, and sleep is great with a new BiPAP (bilevel positive airway pressure) mask after our last visit, so no changes to home protocol or her nighttime BiPAP. Easy appointment with no changes is good news!

So far, so good. Nothing out of the ordinary here. Then:

My daughter waking me at 5 a.m. the next morning was not so good. I was late going to bed, working on a more in-depth blog that requires scientific research. After four hours of sleep, I drowsily heard her making noise — I was awake! Crash and I went downstairs, settling in while I tried to elicit what caused the early rise. Not two minutes later, we were in the bathroom talking 3 Ps (poop, puberty, pain/UTI) with her looking white as a ghost. The path from bathroom to living room would be traversed seven more times in the next two hours. Finally, evidence of the adverse reaction presented (specifics reserved to preserve her dignity). She has never experienced this symptom before in 11 years, so deciphering clues was challenging. We recalled that, usually, at the pulmonologist’s she has the inhaler version of medication rather than the nebulized version for PFTs. I am 100% confident that the nebulized medication was the cause as it was the only new thing introduced. The cascade of consequences for the next 24 hours included cycles of nausea, lack of appetite, fatigue, false bursts of energy after five bites of carbohydrates, roller-coaster of sugar highs and lows, and arguments about the protein-to-carbohydrate ratio in her food. Five days later, she is stable without having needed IV fluids to restore what was lost. *Shout out to IonCleanse by AMD footbath for nausea elimination.

Of course, IonCleanse is just another brand of “detox footbaths,” a modality that is about as pure a form of quackery as I can imagine, so much so that I featured it as one of my Friday Doses of Woo eight years ago.

So how likely is it that this was an adverse event related to the nebulizer medication? Consider first that, most likely, the drug involved was albuterol. We don’t know for sure, because she never identifies the drug by name, but I’m playing percentages here based on how commonly albuterol is used for the purpose described in this anecdote. Known adverse events due to albuterol inhalation don’t really include explosive diarrhea or much of the rest of the symptoms described above. Note what Rogue Zebra fixated on: The fact that her daughter used the nebulized version of the drug rather than the inhaled version of the drug, which she had used many times before, is incredibly unlikely to have anything to do with her daughter’s illness. After all, an inhaler provides a single metered dose that needs to be inhaled right away, while the nebulizer is a more gentle way of administering an inhaled medication that provides it in the form of a fine mist. Also, inhalers usually contain more than just the drug, such as the propellant and surfactant, while the nebulizer version is just an aqueous solution of albuterol, usually 0.5%. Of course, if the drug was not albuterol, the same considerations still likely apply.

Not surprisingly, the doctor didn’t think her daughter’s problems were due to the nebulized drug, because, of course, it’s incredibly unlikely that it was. There was also no notice of these sorts of symptoms as an adverse event to the drug on the manufacturer’s website. A nurse, quite reasonably, suggested that it might be a GI viral illness, which is really the most likely culprit for symptoms like this in a child (or even an adult, for that matter). So is it possible that this reaction was due to the nebulized drug? Yes, of course. It’s just incredibly unlikely, particularly given that her daughter’s reaction was 15 hours after the dose.

Rogue Zebra would have none of it:

So I filed a FAERS report. This episode is not normal for this child. I cannot accept the dismissal by our care team that “correlation does not equal causation.” Neither should you. File your VAERS and FAERS reports.

There you have it, in a nutshell. This is the thinking that is responsible for the antivaccine movement, an utter refusal to accept the possibility that the post hoc ergo propter hoc is a logical fallacy.

As I’ve said before, this is a fallacious way of thinking to which we are all prone. Refusal to admit that our personal observations are generally not a very good way to impute medical causation is also a form of arrogance, for which the humility of skepticism, which tells us that our ability to determine causation based on our own personal experiences is nowhere near as good as we think it is, is the cure. Most human beings have a hard time accepting this, particularly with respect to people and things they care deeply about.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

82 replies on “The fixed mindset of medical pseudoscience”

Yesterday I had my flu shot (though they looked at me funny when I asked for extra preservative). Later that day a friend bought me a gin and tonic. I think that’s pretty conclusive.

The difficult bit is knowng when you are seeing false patterns. Sometimes it’s obvious – I once thought I saw a ghost when driving at night; of course it was just a whisp of mist, but my brain interpreted it as a person in a trench coat crossing in front of the car. That pattern was easy enough for to dismiss, but I don’t know what patterns I am accepting erroneously. Yes a decent grounding in science helps, but as you say Orac that sceptical humility should aalways be on hand.

A short acting medication like albuterol causing all those symptoms > 12 hours after administration?


Must’ve been the dihydrogen monoxide in the nebulized solution that did it.

You could argue that science is largely about overcoming human susceptibility to logical fallacies like this. I recently read a book (‘The Drunkard’s Walk: How Randomness Rules Our Lives’ by Leonard Mlodinow) that argues persuasively that much of human activity is based around thinking we see patterns in what is essentially noise – economics, business and sport for example. I hadn’t previously heard of experiments where subjects guess which colored light will light up next in which rats outperform humans because humans still think they see patterns in random noise even when told it is random while rats simply choose the color that appears most frequently. One wonders why this ability evolved in humans; presumably false positives (mistaking a bush for a tiger) are less detrimental to passing on the genes than false negatives (mistaking a tiger for a bush), but I wonder why haven’t rats and other animals haven’t evolved a similar ability.

After reading the description of symptoms, I’m with Orac and think that a viral illness is a far more likely explanation, possibly due to something she ate (undercooked meat? bad veggies? old mayonnaise?) or exposed to a virus from someone else several days earlier.

Sometimes, when A and B are correlated, it’s because A causes B. Other times, it’s because B causes A (we can rule that one out in this case, because we have established that A preceded B–in my field, the relative timing isn’t always clear). There are other cases where some third factor C causes both A and B (e.g., if you are taking antibiotics for a condition that has diarrhea as a possible symptom, and the diarrhea starts after you take your first dose of antibiotics). You need a scientific model to determine which of these three options best describes reality.

Then you have the false positives. A p value of 0.05 means there is a 5% probability the observed relationship was the chance result of what you would get if the null hypothesis were true. In practice, false positives seem to be more common, given the bias toward publishing positive results.

The human brain is good at detecting patterns, particularly if you are looking for those patterns. It’s easier to fool yourself than to fool other people.

To some extent, it’s perfectly reasonable to try and identify a recent change that could explain some new symptom or illness – for example, doctors will ask if anything’s changed in your routine when they take a medical history. The problem is that people like Rogue Zebra “fall in love with their hypothesis,” as my old PI would say – they refuse to accept evidence (or even common sense) that disconfirms their original intuition. Everyone is prone to this to some extent; the problem with antivaxxers and alt-med types in general is that they elevate intuition (especially “Mommy intuition”) over empirical evidence in principle, effectively trapping themselves in their own cognitive biases.

TL;DR: Don’t believe everything you think.

Am I the only one who sees the ‘nym “Rogue Zebra” and thinks of the old adage about hearing hoofbeats?

A rather à-propos choice of ‘nym, considering. Who sees symptoms like that and doesn’t immediately think of food poisoning or one of those awful 24-hour gastro bugs? A never-before-heard-of adverse reaction to a different route of administration of a medication already known to be well-tolerated by the child is a pretty honkin’ big zebra.

@ delta-orion:

I thought the same thing. Most people see horses, she sees zebras and is a rogue one yet.

At any rate, I notice that of late TMR features few of the originals ( Mama Mac, Mamacita, Mam Bear, Blaze etc- see list at top right) I know that one, BK, died last year.

I scanned over the past two months and notice that it’s mostly the newbies- Zebra, Karma, Juicy Fruit, ShamROCK, Green Bean Girl, Raven et al ( OH, those ‘nyms!), guests including woo-providers and regulars like the Professor and the Rev ( the former edits the entire mess)

A while back, they added Team TMR which had its own book and raises money for woo treatments. Then there was a fallow period with much less posts.

I wonder what those original founding members are up to these days?- Quite a few were part of panels at Autism One and I know that they do facebook and other social media.
Perhaps they’ve gone on to better things- advisers and counsellors for the woo-entranced.

Rogue Zebra description of the symptoms leads me to think of some type of GI infection possibly from food or water. Some of the suspect critters would be salmonella, norovirus, listeria, giardia, crpto etc. The time between onset and infection could be up to 3 or 4 weeks.

Because of the amount of time it takes for onset of a foodborne illness (FBI) it is very difficult to find the causation in most cases. Indeed in most FBI events the causal food is never found. With the Chipotle’s E. coli O26 outbreak the number of people affected has gone down because they had not eaten at Chipotle’s.

Many who frequent TMR and the like seem educated enough to read reasonably well, but also use CAM treatments. They pore over vaccines’ and medicines’ information sheets, seeking evidence for their ideas, but cannot understand the information cautioning about the data on VAERS ( (“The report of an adverse event to VAERS is not documentation that a vaccine caused the event.. . . Reports vary in quality and completeness. They often lack details and sometimes can have information that contains errors. . . . No proof that the event was caused by the vaccine is required in order for VAERS to accept the report. VAERS accepts all reports without judging whether the event was caused by the vaccine.. . .”). They dismiss the “quack Miranda warning” associated with CAM, but likewise ignore the qualifiers for VAERS reports. It is thinking both warnings are lies, that CAM has to protect themselves from the Big Evil Pharma Government Orgnaization (BEPGO(tm)) and BEPGO are protecting themselves or trying to hide the truth.

As our esteemed host has pointed out, we can all be subject to such thinking. The hard part is trying to counter it in ourselves. Even so, it can be difficult not to attribute willful ignorance to some of the more fervent, as it may be for them when challenged by others.

I’ll stop now, not wanting to contest with our host or brevity-challenged posters.

Because of the amount of time it takes for onset of a foodborne illness (FBI) it is very difficult to find the causation in most cases. Indeed in most FBI events the causal food is never found. With the Chipotle’s E. coli O26 outbreak the number of people affected has gone down because they had not eaten at Chipotle’s.

That is, unless it’s staph food poisoning. That sucker is very predictable in onset, about 3 to 6 hours after consumption, and has a very characteristic clinical pattern. How do I know? I got it once. It was lunch, and by the time it was time to head home (about five hours later), I had some nasty bouts of vomiting and felt really sick for about a day.

and thinks of the old adage about hearing hoofbeats?

I hear hoofbeats in the night, I expect it to be a guy with two half-coconuts. PS I am not a conspiracist.

I got it too, with salmon….i blew chow everywhere about 3hrs after….EVERYWHERE…didn’t even have time to make it to the bathroom

Yup. That’s exactly what happened. I actually threw up in my car and had to pull over on the shoulder of the expressway. Then I got to finish my drive home in a driver’s side seat full of vomit. At least the next wave held off until I got home. My wife is a saint; she cleaned up the mess because I was in no condition to do it myself.

Stories like this always remind me of what an ER doctor friend of mine told me long ago. 98% of people who enter the ER with food poisoning name the wrong source for the infection. That is how well people can identify causation.

Years ago M Seligman described a bout of gastrointestinal symptoms that happened to himself after eating a food, symptoms which he rationally attributed to a viral infection.
But even if he knew (!) it had been a virus, that food nauseated him so much, as to render him unable to eat it anymore for a long period.* Same happened to me because of symptoms after eating rabbit.
What we accept rationally, not always is accepted by deeper parts of our brain.
* Seligman MEP, Hager JL. Biological boundaries of learning. The sauce-bearnaise syndrome.  Psychology Today 1972; 6, 59-61, 84-87.
(By the way, even when vomit is induced in rats by methods unrelated to food, they refuse to eat again the food they had eaten before vomiting. May be they aren’t as intelligent as Krebiozen pretend).

Several years ago, I ate dinner on a Saturday night with a companion- we had quite different meals EXCEPT for dessert which was a sort of layered cake with cream, filling and toasted coconut on top. Whilst eating, I thought -” Ooo, that cream seems a bit crunchy”, perhaps dried out * i.e really OLD). So I didn’t finish it.

About 36 hours later- Monday am- I became quite disastrously and extravagantly ill. Later the other person reported that he got even more sick than I was at work at nearly precisely the same time and had to go home.

The moral of the story is not to eat cream if it is at all crunchy.

@ perodatrent @ #19
Rats aren’t physically capable of vomiting due to their gastric anatomy. You can however make them very nauseous and link the nausea to a food item or an odor, and they will avoid that item in the future like the plague. (Bad analogy, but still…..)


I hear hoofbeats in the night, I expect it to be a guy with two half-coconuts. PS I am not a conspiracist.

You might have watched to much Monty Python.

@ perodatrent:

They behave, in fact, like the “superstitious pigeons” who, fed on a random schedule, repeat whatever movements they were doing right before they were fed.

Rats aren’t physically capable of vomiting due to their gastric anatomy. You can however make them very nauseous and link the nausea to a food item or an odor, and they will avoid that item in the future like the plague.

It’s actually pretty smart and a good survival strategy, if you think about it.

I expect it to be a guy with two half-coconuts

Brought, no doubt, by two non-migratory African swallows.

Seligman MEP, Hager JL. Biological boundaries of learning. The sauce-bearnaise syndrome. Psychology Today 1972; 6, 59-61, 84-87.

Also known as the Tequila Syndrome or the Green Benedictine Syndrome.

What upsets me the most about this, is that the child may have an underlying issue. And rather than investigating why she had such a episode or “reaction” the guardian has instead blamed a drug that very likely was helping the child. My sister in law used nebulizer albuterol, and she had her own set of reactions that prompted her to investigate what was wrong with her lungs. This person’s mentality is dangerous, it seems to allow an individual to dismiss other potential problems by blaming a medicine that makes no effort in hiding it’s side effects.

The last time that I knew I had a food or waterborne illness, I spent 8 hours on a bus traveling in Nepal with only 1 stop. I was very proud of how I kept from messing up myself and others around me. Taking cypro really helped me survive the day.

I found the article below on and though it was very appropriate for this discussion.

What is science?

Posted on November 20, 2015 by Doug Powell

Neil deGrasse Tyson writes, if you cherry-pick scientific truths to serve cultural, economic, religious or political objectives, you undermine the foundations of an informed democracy.

scienceScience distinguishes itself from all other branches of human pursuit by its power to probe and understand the behavior of nature on a level that allows us to predict with accuracy, if not control, the outcomes of events in the natural world. Science especially enhances our health, wealth and security, which is greater today for more people on Earth than at any other time in human history.

The scientific method, which underpins these achievements, can be summarized in one sentence, which is all about objectivity:

Do whatever it takes to avoid fooling yourself into thinking something is true that is not, or that something is not true that is.

This approach to knowing did not take root until early in the 17th century, shortly after the inventions of both the microscope and the telescope. The astronomer Galileo and philosopher Sir Francis Bacon agreed: conduct experiments to test your hypothesis and allocate your confidence in proportion to the strength of your evidence. Since then, we would further learn not to claim knowledge of a newly discovered truth until multiple researchers, and ultimately the majority of researchers, obtain results consistent with one anther.

This code of conduct carries remarkable consequences. There’s no law against publishing wrong or biased results. But the cost to you for doing so is high. If your research is re-checked by colleagues, and nobody can duplicate your findings, the integrity of your future research will be held suspect. If you commit outright fraud, such as knowingly faking data, and subsequent researchers on the subject uncover this, the revelation will end your career.

It’s that simple.

This internal, self-regulating system within science may be unique among professions, and it does not require the public or the press or politicians to make it work. But watching the machinery operate may nonetheless fascinate you. Just observe the flow of research papers that grace the pages of peer reviewed scientific journals. This breeding ground of discovery is also, on occasion, a battlefield where scientific controversy is laid bare.

Science discovers objective truths. These are not established by any seated authority, nor by any single research paper. The press, in an effort to break a story, may mislead the public’s awareness of how science works by headlining a just-published scientific paper as “the truth,” perhaps also touting the academic pedigree of the authors. In fact, when drawn from the moving frontier, the truth has not yet been established, so research can land all over the place until experiments converge in one direction or another — or in no direction, itself usually indicating no phenomenon at all.

Once an objective truth is established by these methods, it is not later found to be false. We will not be revisiting the question of whether Earth is round; whether the sun is hot; whether humans and chimps share more than 98 percent identical DNA; or whether the air we breathe is 78 percent nitrogen.

The era of “modern physics,” born with the quantum revolution of the early 20th century and the relativity revolution of around the same time, did not discard Newton’s laws of motion and gravity. What it did was describe deeper realities of nature, made visible by ever-greater methods and tools of inquiry. Modern physics enclosed classical physics as a special case of these larger truths. So the only times science cannot assure objective truths is on the pre-consensus frontier of research, and the only time it couldn’t was before the 17th century, when our senses — inadequate and biased — were the only tools at our disposal to inform us of what was and was not true in our world.

Objective truths exist outside of your perception of reality, such as the value of pi; E= m c 2; Earth’s rate of rotation; and that carbon dioxide and methane are greenhouse gases. These statements can be verified by anybody, at any time, and at any place. And they are true, whether or not you believe in them.

Meanwhile, personal truths are what you may hold dear, but have no real way of convincing others who disagree, except by heated argument, coercion or by force. These are the foundations of most people’s opinions. Is Jesus your savior? Is Mohammad God’s last prophet on Earth? Should the government support poor people? Is Beyoncé a cultural queen? Kirk or Picard? Differences in opinion define the cultural diversity of a nation, and should be cherished in any free society. You don’t have to like gay marriage. Nobody will ever force you to gay-marry. But to create a law preventing fellow citizens from doing so is to force your personal truths on others. Political attempts to require that others share your personal truths are, in their limit, dictatorships.

Note further that in science, conformity is anathema to success. The persistent accusations that we are all trying to agree with one another is laughable to scientists attempting to advance their careers. The best way to get famous in your own lifetime is to pose an idea that is counter to prevailing research and which ultimately earns a consistency of observations and experiment. This ensures healthy disagreement at all times while working on the bleeding edge of discovery.

In 1863, a year when he clearly had more pressing matters to attend to, Abraham Lincoln — the first Republican president — signed into existence the National Academy of Sciences, based on an Act of Congress. This august body would provide independent, objective advice to the nation on matters relating to science and technology.

Today, other government agencies with scientific missions serve similar purpose, including NASA, which explores space and aeronautics; NIST, which explores standards of scientific measurement, on which all other measurements are based; DOE, which explores energy in all usable forms; and NOAA, which explores Earth’s weather and climate.

These centers of research, as well as other trusted sources of published science, can empower politicians in ways that lead to enlightened and informed governance. But this won’t happen until the people in charge, and the people who vote for them, come to understand how and why science works.

Neil deGrasse Tyson, author of Space Chronicles: Facing the Ultimate Frontier, is an astrophysicist with the American Museum of Natural History. His radio show StarTalk became the first ever science-based talk show on television, now in its second season with National Geographic Channel.

You can however make them very nauseous and link the nausea to a food item or an odor, and they will avoid that item in the future like the plague. (Bad analogy, but still…..)

It’s been many a year since my Psych 101 class, but I seem to recall my professor referring to this as “taste aversion” and saying that it was quite common across the animal kingdom, for obvious evolutionary reasons.

To which my reaction was, oh, that’s why I still cringe at the thought of maple walnut ice cream, even though I know full well that I just happened to get carsick shortly after having eaten some … when I was four. (Still true today. Just thinking about the combination of ice cream + maple squicks me out something awful. Even though I love maple syrup on just about anything else.)

“We were escorted to a room by a nurse who wheeled in a cart for a pulmonary function test (PFT). Crash has difficulty clearing mucous and secretions”

Was anyone else confused by this? For awhile there I thought she was referring to the cart as “Crash” (though I’d expect an ailing crash cart to be spewing epinephrine and lengths of IV tubing, not mucus).

Kreb: I’ve been commenting along these lines for awhile now. The human brain is a pattern-recognition machine at multiple levels (we actually see things that aren’t there via gestalt patterns built-in to out optical processing systems), and this has evolved as a survival mechanism. Other animals DO process correlation as causality, only to a lesser degree. (If I walk into the room with the kibble bowls at a certain time of day, the cats think they’re going to get dinner.) Why we do it more is fairly obvious – unlike animals whose primary defense mechanisms are physical skills, as ‘naked apes’ we must survive by using our big brains.

Science is not so much about overcoming susceptibility to logical fallacies, as marking off domains where simple and fast pattern recognition is counter-productive. In the routines of everyday life, even the most science-minded of us don’t stop to consider the range of possible explanations of observed phenomena. Digging into such things takes considerable time and resources, and is simply not pragmatic for most of our quotidian decision-making.

Perhaps some form of learned pattern recognition is how we identify those phenomona that should be pulled out from our ‘standard’ mental processes, and subjected to more thorough evidential tests for causality. I’d guess this would have something to do with the importance of the phenomenon, and it’s suitability for taking the time to investigate. For example, if you’re in the market to but a house, finally find one you like and can afford after a long search, but see signs that correlate with structural damage, you don’t scotch the deal then and there, but get a thorough expert inspection to see if those ‘symptoms’ are the result of something more simple and easy to fix, or how thorough the damage is and what it will cost to repair.

Thus, perhaps, what Rogue Zebra and other anti-vaxers exhibit is actually a failure of this sort of pattern recognition, extending from an overdose of confirmation bias rooted in more complex psychological processes: the usual suspects of AV illogic – narcissistic tendencies, need to have a scapegoat for the ‘damaged’ child (which is actually a projection of the damage done to life ambitions by the burden of caring for a special needs kid), etc.

My hypotheses, in sum,
1) ‘Normal’ people draw scientifically unwarranted causal conclusions ll the time as this is a necessity in negotiating everyday life.

2) ‘Normal’ people also have schema to sort out those things which must be subjected to a more rigorous causal logic.

3) In ‘movement’ anti-vax activists these schema are made dysfunctional by more root-level psychological factors,

4) If they were capable of applying logic to the question of why their children have ASD, they would – as this fits the criteria of importance and suitability for investigation,

5) Since ‘the vaccines damaged my child!’ is their bedrock first principle, pointing out the logical fallacy involved will not affect them in any way.

6) The value of pointing out this logical fallacy in the anti-vax mind in a public forum like RI lies in addressing the wider public for whom the issue is not a central or immediate concern. Since they’re processing ‘the data’ quickly and routinely, they are likely to think the correlation-causality connection makes sense. Furthermore, within the way the issue is framed by the anti-vaxers, the causal association falls under the ‘false positives protect you, but false negatives threaten you’ evolutionary hard-wiring. It’s not that we mistake bushes for tigers, but that we correlate a rustling in the bushes with an impending attack by a predator, so we run away or climb a tree. We don’t check to see what really causing the rustling, as we might wind up as lunch in the process. By the same token, if third parties at a distance and with low time-for-investment-and-investigation perceive a negative outcome (ASD) appears to follow event-type ‘X’ (vaccination), their default process will be make a quick decision and move on to other matters in their everyday lives. That is, they will err on the side of caution, conclude a causal relation is probable, and run away…
7) Once we get these distanced third parties to pay closer attention and give more time to the question, re-framing it around the threat to things they care about posed by VPDs, it will typically get pulled out of the everyday-life processing pattern, and they will be open to the evidence that no causal link there actually exists. Which is why, post Disneyland, most sensible folks will vax their kids and support measures like SB277.

All that aside. Sbm advocates care very deeply about public health, public acceptance of the lessons of good science, and the problems posed by various form of pseudo-science. This frequently leads them to abandon the humility of skepticism for ‘arrogant’ quick-pattern-recognition causal explanations of why people – especially folks who fall for pseudo-science – think what they think and do what they do. You know, because they’re ‘stupid’, etc. etc.

I don’t want to single out any individual or forum, but overall, in my various forays into ‘skeptic-land’ on the Web, I see plenty of prescriptions for skeptical humility for other people, and far to little of it practiced by ‘skeptics’ directed toward themselves. This occurs with varying frequency and to various degrees, of course, but IMHO to whatever extent it does, it does not help the cause at all.

When skeptics call for more education in ‘critical thinking’, the goal is typically for doctors and scientists to become more adept at recognizing and debunking pseudo-science, not to be rigorous about their own non-medical/scientific assertions. Key skeptic principles like ‘crank magnetism’ and ‘false balance’ are applied far too broadly and crudely, in ways that lack valid evidential support and fly in the face of multiple ought-to-be-obvious counterfactuals. As solid as skeptics tend to be on matters of ‘hard’ science – chemistry, biology, physics, etc. – they stumble repeatedly on the terrain of human thought and behavior – questions far too complex to be plumbed along the model of the sciences.

In science terms, there are simply too many factors to control for, and isolating the independent variable is all but impossible. In ‘real’ science, both the independent and dependent variables are usually concrete physical things. Not so in the ‘social sciences’. To take one paradigmatic example, Bandura (1963) concluded that viewing ‘violent’ moving pictures caused increased ‘aggression’ in children. The study design: one group of kids was shown a short ‘violent’ film, the other a short ‘non-violent’ film. (Neither film was identified, nor it’s content or style described.) After the screenings, the subjects were laced in a room with a Bobo Doll placed in the center, and ‘aggression’ was measured by how often the different groups struck the doll. If you can’t come up with five fatal flaws in that ‘study’ in five minutes, you might need a remedial course in skepticism.

To condense/paraphrase Orac, above; ‘We are all prone to impute causation based on personal observation. This is a form of arrogance for which the humility of skepticism is the cure.’ Wise words. Let’s do more to heed them.

Science especially enhances our health, wealth and security, which is greater today for more people on Earth than at any other time in human history.

Unless you count the impending disaster of climate change, and all the victims of modern warfare, the tools of both being among the ‘successes’ of gains in scentific knowledge. NdgT is overestimating both the self-regulating mechanism of the sciences, and it’s uniqueness among the professions, but let’s skip the success rate issue and grant that science has established an extraordinary volume of objective truths that exist outside of our (direct) perceptions of reality. Objective truth is merely a tool. It can be used to harm, impoverish, or threaten. Some truths can be bent equally to good or band ends. Others have a built-in moral bias one way or the other, if only depending on the social/cultural/economic contexts in which they emerge. Science without morality, truth without justice, are bankrupt. Dr. Tyson should (re?) read Player Piano, Cat’s Cradle, Brave New World, and in non-fiction America By Design and Labor and Monopoly Capitalism before issuing another blast of Duning-Kruger about the great benefits of science.

Our host’s blog post on this page has 1217 words (not including the quoted text) with a Gunning Fog Index of 14.06.

sadmar’s post above is 1197 words, with a Gunning Fog Index of 15.34.

One of the two needs to be condense[d]/paraphrase[d].

(GFI measured at

Scepticism, like science, arises out of a human capacity to observe the self and question it as though it were part of the outside world.
One can ask: ” Am I wrong in what I’m seeing or thinking?”

Piaget and others describe people as being ‘naïve scientists’ who observe the world and form hypotheses about how it functions- which they can test. Children construct a naive physics/ causality after experimenting with motion and gravity ( moving about, throwing things and dropping objects) and eventually, through interaction with others, a naïve psychology and sociology. As they reach adolescence they become more able to understand their own experience in abstract terms and learn to appreciate those reciprocal realities wherein OTHERS’ views matter and are incorporated into their own as they fathom that not everyone has the same point of view.

So we talk about METAcognition and executive functioning which are indeed forms of self-criticism and self-regulation. Freud wrote about reality testing and the roles of society ( others) in determining our views as an antidote to that primordial egocentrism- which may persist longer than usual in some people.

Science is a formal method for remedying human error based upon human cognition which is itself subject to error ( illusions, visions, delusions, flights of fancy, dreams, imagination, bias) and well aware of it.

Some of those we write about appear to lack the capacity for self-critique and that can be a real problem when trying to live independently as an adult in western society.

The other possibility is that they are aware of their errors and are merely writing for an audience who wants to hear that view of the world for its own purposes.

@Johnny # 34: Are you joking? Whoever came up with the test needs to revisit the premise underlying it.

Kiwi fruit. I have been unable to eat kiwi fruit for 30 years. The watermelon on the same salad bar tasted really off, but my lizard brain settled on the kiwi. I’m just glad my lizard brain got over an aversion to dates in 4-5 years.

I admit I suffered through very similar issues after adding advair to my more usual albuterol during an especially bad period of bronchitis tending to asthma. It stuck around for quite a while (a week or more?), testing found no other cause, and it did clear up after I stopped the advair.

This all ties in with pertussis mom’s “best way to clear the lungs is through the rectum!” We should be GLAD we got the runs! Body naturally healing itself! *cough* Yeah.

Since no one else has said it yet: Though there is sometime a basis for them, our FAERS are often unfounded

# 37 Emma Crew

Peanut butter balls.

I had a very nasty flu 30 or 35 years ago and as I lay (slightly delusional) in the living room, my sister was making peanut butter balls in the kitchen.

I cannot even stay in the same house if someone is cooking chocolate and peanut butter together. If I had eaten one, I’d probably be claiming my sister had tried to kill me.

@ Janet, #21
You are right.
I had in my mind a review (Testa TJ. Causal relationships and the acquisition of avoidance response. Psychological Review 1974; 81: 491-505) and I mis-remembered what it said about taste-aversion trials in rats.
Is there a better proof that one remembers what s(he) wants, and not what has really happened?

Holy Jeebus.
I got a second dose of post-exposure rabies shot today and I feel like crap as per package insert. Maybe I should throw a tantrum, too.

I sought out in-depth examples about how TMs confuse external reality with their personal biases and was rewarded at their facebook page which links to TMR TV, their latest endeavor.

( TMs can use their phones to tell their story and become a
Web Reporter TMR. Oh joy!)

I ask: Is your child your science project?

Christie Dames** interviews Original TM, Megan Davenhall,
( aka Sunshine- one of the less obnoxious TMs IMNSHO).

It seems that her son developed odd abilities ( memorising an entire book) and stopped growing and developing at age 2. He was given a dx of PDD NOS or Asperger’s.

She spent two years voraciously reading and ‘researching’ and tried various biomed treatments ( GFCF lead to illness which was interpreted as beneficial- a healing crisis I suppose). Now she wants to help others because she really needed that herself. Some doctors treated her badly.

She advises: ” Trust your instincts and question everything that goes into your child’s body- foods, medicines”. Her son was born “healthy” and will be healthy again. He is improving she says. She believes that she’s helped another child- a classmate- avoid some problems her child experienced.

As background, she says her father died*** when she was a teenager: he had Non-Hodgkins Lymphoma which she attributes to his time in Viet Nam and Agent Orange. When he was ill, he tried a macrobiotic diet.

Asked if she had any rule to break, she said that she was always told to listen to teachers or doctors; instead she says,
“Question authority”, read and google.

The facebook entries following relate other tales of confusing correlation with causation based upon the timing of the events.

Interestingly, I am presently reminded of an experiment in perception wherein subjects interpret abstract shapes moving in similar paths as one “following” the other and other human-like actions despite the images being merely circles.

** isn’t she from SF’s Commonwealth Club that featured TMs and other anti-vaxxers?
*** some woo-meisters cite parents’ or family members’ deaths or bad experiences with medicine prior to their own conversion.

Autism is not an immune-mediated disease.

– Paul Offit (Vaccines and Autism: A Tale of Shifting Hypotheses.

MJD says,

Genes + immune system + Environment = Autism

In my opinion eliminating any variable in this equation, at the moment, is MEDICAL PSEUDOSCIENCE.

The “fog index” can be badly abused as well as tricked: “Yesterday everyone saw elephants” is judged as “harder” than “Anon I curled a quoll,” even though the latter has two obscure words and dubious grammar.

Beyond that, as our host has said before, if people don’t like his style they can go read another blog.

(Or they can try rewriting one of the posts they dislike in Randall Munroe’s “Upgoer Five” style, just to see how easy that isn’t.)

The “fog index” can be badly abused as well as tricked: “Yesterday everyone saw elephants” is judged as “harder” than “Anon I curled a quoll,” even though the latter has two obscure words and dubious grammar.

I, for one, oppose quoll curling. Even if you do go anon. And on and on anon.

Same happened to me because of symptoms after eating rabbit.

Ah, rabbit. I haven’t touched it in nearly 30 years. I think it was a fancy Valencian joint in, ah, Madrid. The digestif was some red anise horror served ice-cold. The taxi driver on the way home asked my girlfriend more than once if she was sure we didn’t just want to go to the hospital.

The timing is all wrong for food poisoning, but the rabbit got the association. Seeing Le grand chemin maybe a year later might have cemented it, as I recall nothing of the film but one early scene.

A couple of years ago, Steve Milloy at Junk Science was humping a (unpublished) paper about Los Angeles asthma hospitalizations being uncorrelated with ozone measurements and sneering that the EPA was a gang of political hacks.

I put in some comments to the effect that asthma tends to be prevalent in the winter; ozone in the summer; leading to a baseline expectation of a strong anticorrelation such that a superficial lack of correlation is in fact suggestive of a link between ozone and asthma.

I then observed that if one of my sophomores had made such a fundamental error as to misdefine the baseline then I would have failed him and sent him back to elementary stats. Milloy, naturally, deleted my account and scrubbed the entire conversation.

# 41 perodatrent

Is there a better proof that one remembers what s(he) wants, and not what has really happened?

It does not even have to be what one wants to remember. See Constructing rich false memories of Committing Crime, Shaw & Porter 2015 Psychological Science 1-11.

And there is the example of Elizabeth Lotus (the doyen of false memory syndrome?) and her associates when some false memory work was challenged they ran another study where they convinced students that they had met Bugs Bunny at Disneyland. Check with your local cartoon addict to understand the problem.

Oh, dear, I just encountered Stagmom’s fill-in entry for the Weekly Fishwrap.

Fear sells. It’s the oldest trick in the Mad Men book. I read Subliminal Seduction and The Hidden Persuaders back in high school. Fear is a sales tool.

How on earth The Clam-Plate Orgy (also by Key) was omitted here is baffling.

How could anyone look at a quoll, and then want to curl it?

Slide it on the ice while people sweep in front of it with brooms? I guess if the quoll’s into that.

“The timing is all wrong for food poisoning, but the rabbit got the association.”

Instead of vomiting you might cough up a hare ball.

Michael J. Dochniak@44:

MJD says,

Genes + immune system + Environment + Unicorns = Autism

In my opinion eliminating any variable in this equation, at the moment, is MEDICAL PSEUDOSCIENCE.



[T]hey convinced students that they had met Bugs Bunny at Disneyland.

I’m impressed.
@Narad #53, oh the irony.

I have been wondering off-and-on for some time why it is that more people don’t have nausea-induced aversions to ginger ale. In our house when I was young, ginger ale was the go-to drink in cases of stomach upset, followed, when solid foods became possible, by jello and toast. I have no particular aversion to any of these things.
On the other hand, I do not want to know about red velvet cake, thankyouverymuch. The cake did not make me sick. We know this because nobody else was sick. Red velvet cake made with food coloring is not a fun thing to puke up. One tablespoon of red food coloring goes a long way; in this case it went back and forth to the bathroom several times without ever seeming to diminish in its capacity to make everything red.

Sadmar is acting like a concern troll again, and does not even realize it I think.

Briefly, because I’m not really interested in flaming anyone, Sadmar should realize that some of us have read Jameson, read the post-structuralists, read the neo-Hegelians, read the social constructionists, etc., etc., and are not impressed.

I see Jameson and Derrida in the same pile as Wakefield and his ilk, not an opposed one. Jameson in particular, one argued, vague assertion after another. Pseudo-scholarship.

Lots of with-it lit-crit folks are pleased to assume that the science types just don’t get this sort of Theory and just need to give it a chance. I gave it a chance. My conclusion is that the dullest, most ideologically-positivist scholar has a very narrow view of science, but that view is much, much more accurate than anything on offer from Derrida, Foucault, Jameson, or any other of their hyper-boring ilk.

We’ll never agree. Just know that some people have read your sources, with an open mind, and decided that they have no relevance to understanding science.

jrkrideau, # 52

Well, I believe it would be physically impossible for Bugs Bunny to pass gatekeepers at Disneyland.

Speaking of really dubious correlations, I just got back from my local Kroger’s with Mr. Bird and holiday fixin’s.

There is a whole section of organic stuff, with banners proclaiming that it’ll make you Feel Better as you Eat Naturally.
Can an entire supermarket section be required to post a Quack Miranda Warning?

*I was about to scoop up a bunch of celery at $2.39, when I noticed it was Organic and that the Pesticidal Corporate version was only $1.29 a bunch. Our other major local supermarket chain (Giant Predatory Bird) has a habit of putting expensive organic iceberg lettuce in the major refrigerated salad area and shunting the far cheaper non-organic iceberg off to the side in an inconspicuous location.

Quite a racket.

*anybody have a good recipe for sunchokes? I harvested a ton of them and there’s only so many I can cut up for salad.

@ Ledasmom:

You know that might be a case where herbalism ( spicism-?) actually works, i.e. has pharmacological action. IIRC there is research along these lines.

-btw- how’s the swan?

@ Dangerous Bacon:

Hey, elitists need something- Precious Purity ™ – on which to cling and to make them feel special.

Speaking of giant predatory birds, yesterday a very large hawk swooped down between two residential buildings- 20 feet from my car which I was starting- carrying what appeared to be a dead squirrel ( too big for a mouse/ rat) in her talons: it was so heavy she struggled to gain altitude in order to perch upon another buildings edge and show off.

This is SUPPOSED to be the City. Not-Back-to-Nature-ville.
Is nothing sacred?

Hilariously, I notice than Dan Olmsted Dan Olmsted has posted his weekend update in which he describes his sojourn at a mountaintop retreat: he describes himself to fellow travellers as journalist who is reviled ( my words, not his)

For once, accuracy reigns at AoA.

Then he asks for contributions.

Hilariously, I notice than Dan Olmsted Dan Olmsted has posted his weekend update in which he describes his sojourn at a mountaintop retreat

“GPS doesn’t work here”?

*anybody have a good recipe for sunchokes? I harvested a ton of them and there’s only so many I can cut up for salad.

Soups. They can be portioned and frozen.

# 64 Denice Walter

This is SUPPOSED to be the City. Not-Back-to-Nature-ville.

Consider where you live. The place is swarming with wildlife such as Falcons . You’re just lucky to see them.

Drivers hit deer on the DWP south of Eglington. The city has a formal Coyote Response Strategy which includes such brilliant ideas as “Assist with appropriate messages for signs in parks where there are ongoing coyote-related concerns (e.g. advising the public not to feed coyotes).

A friend of mine still has a tone of dread in her voice as she recounts battles with the racoons over the green bin and she moved out of the city 5 or 6 years ago.

@ Narad:

In his investigative, scholarly thoroughness, has he confused GPS with cell phone signals?

@ jkrideau:

Oh I know. It’s a veritable Nature Park out there. About 2 years ago on the first day of winter, I had to stop at a red light- to my right on train tracks, was huge stag** with quite a set of points, just posing.
Where does HE live? Behind the posh new condominiums?
Then, there are the foxes.

** Ever see the film *The Queen*?

The largest predatory bird I saw from my local park when I lived in Manhattan was a bald eagle. That was an unsuccessful reintroduction program* and might not count (though I put them on my life list), but the red-tailed and other hawks were well established, along with kestrels, peregrine falcons**, an assortment of herons, and of course mallards and Canada geese.

No coyotes, though, just skunks and raccoons.

*with fenced-off areas whose signs warned everyone to stay out because of the Endangered Species Act

**the fastest animal alive today, a dinosaur that lives by hunting other dinosaurs and catching them in midair. Thank you, Randall Munroe

@ #69 jrkrideau
I now live just a bit east of you (Ajax….)…. So far this year I’ve sighted opossum, raccoons, rabbits, skunks, fox, coyotes, martens, muskrats, a beaver (in Whitby) and wolves. Red Tail hawks, vultures, wild turkey by the score and a few kestrel (smaller cousin to the peregrines). I’ve narrowly missed a half dozen white tail deer….

…. and occasionally, a “lost” black bear will wander down the river valleys from “up North”….. Uxbridge has bear-proof garbage cans in their parks!

Denice Walter@70

In his investigative, scholarly thoroughness, has he confused GPS with cell phone signals?

Maybe it’s just that even satellites don’t reach whatever universe Dan lives in.

@ capnkrunch:

Upon reading/ hearing Dan, his allies and various woo-meisters what often shocks me is that they get so much simple stuff like this absolutely wrong.
This is general information that most people learn about from news, television, adverts – everyday general stuff. Most !2 year olds probably know this

Yet they present themselves as purveyors of information, educators, journalists and critics of SBM and science.

Simple information can be looked up. But assured of their own brilliance and status as ground-breaking researchers/ journalists/ messiahs- they just don’t look, they pontificate.
I hear mind-numbing errors regularly from PRN.

Chris- at RI- notes that Dan believes that there are no autistic Amish children and failed to observe that there is a special hospital for kids with similar conditions.

Unfortunately, there is now a new TMR project in which they narrate their own realities for a ( hopefully) wider audience through web TV. There are some slick, crappy, emotionally-fuelled music videos detailing their cause, their triumphs, their CHILDREN!!! and lord knows what other woo they’re distributing.

I wonder how wide their ultimate audience is? This nonsense filters down to join other woo-based dramatic fear mongering.
TMR lists 40-50K friends ( probably padded with all known relatives) and AoA manages a more meager number but folks like Mikey or Mercola ( although padded) boast more than a million each. Mini woo like TMR aids Mikey’s and others’ woo- pimping.


No surprise that scientists are as complex (or as complicated) as every other human being.

I don’t stress about the presentations because I know that not everyone is reached in the same manner. I’ve seen attitudes change here before The regulars appear open to evidence based statements, and barring evidence, logic and reason. And they’re willing to admit they’re wrong. This includes the OP. If it wasn’t like this, I wouldn’t visit.

Re nature I saw a bald eagle grab a duck, take it to its nest and start to eat it. That’s a scene that messes with your head.

@Johnny #34

Never heard of the gfi, but point well taken.
Orac’s posts are long enough, I only skim the comment section and ignore anything over a couple of paragraphs. Life is too short.

# 71 Denice Walter

Ever see the Queen? Yes, two or three times when she was holding up traffic. Oh the Movie, no but I have heard it was good . Heaven knows where the deer is living. They can be very unobtrusive and a lot of suburbs look like prime real estate for a deer. Perhaps he bought a condo?

# 73 Rann

I now live just a bit east of you (Ajax)

No, I think you live east of Denice (she of the raptor/deer etc. ), I’m a couple of 200K east of you (at the bottom end of the lake). It sounds a lot wilder in Ajax than here but I live downtown. I almost ran over a fox when cycling early one morning and there are the usual raccoons and squirrels but the bears, coyotes and deer seem to stick to the outskirts of town so far.

@ jrkrideau:

That wasn’t a non sequitur, the reason I asked about the film was because she ( actually Ms Mirren) sees a truly magnificent stag close up on her estate .Later she sees it dead. It’s symbolic.
-btw- I live QUITE a bit south and east – outside the great city of [redacted]**

** semi-anonymity concerns

“I emphasize the word “necessarily” because sometimes skeptics go a bit too far and say that correlation does not equal causation. ”

I might sound pedantic but no, it’s not going too far. Correlation does not equal causation, it mean correlation, nothing else. That’s why we use two words with two different meaning. Correlation might be a call to look closer at something and that’s all. And it is until we have a proof of causation, if not you might be biased before you see the result.

Due to living in LDCs and traveling just about everywhere in the world, I have some great food/waterborne illness stories. I have puked and shit so much over the years and devoured more Cipro than (insert deity of choice) ever intended for one human to consume.
Several years ago I took a group of people to parts of Ghana. None of them had ever been to SSA, all of them got sick on the trip, except for me, because I line my suitcase with Sesame Snaps and protein bars and consumed nothing other than bottled water and Fanta. Anyway, 11 puking shitting people, in areas mostly without proper lavs, and when I get home, Mr. Delphine picks me up from the airport and we go right out for a nice Italian dinner because my birthday had elapsed when I was away.
So we dine and I drink a bottle of red and eat a colossal quantity of very good pasta. I’m all self-congratulatory about my prudent “don’t eat/don’t drink” strategy because it has served me well over the years.
We get up from the table, walk to the car, and I gack all over the parking lot. Wish I could say I don’t drink red wine or eat pasta any longer…

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