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Comment by colechristensen | Hacker News Reader

There is a point to enforcing it, but sometimes it is way overdone.

It is a license to speak truth about a profession and perform it. Making bullshit illegal. It works for certain professions where the individual can be a commodity and the customer can't reliably determine the trust themselves.

When you're designing bridges or homes or public infrastructure, a lot of times it can be very difficult to pick a good expert (which is necessary, these things can screw up and end lives and waste billions), so you have professional organizations which do the verification for you. Somebody else makes the "hiring decision" which is fine.

But if you lose focus of what the purpose is, you get bureaucratic zealots who follow regulations without any attention to what they are for.

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You do make a good point. It makes me think of the occasional video of a registered nurse standing in front of a City Council saying things like vaccines cause Autism, or the COVID-19 vaccine has tracking chips in it.

Seeing that makes me think that they should lose their license, which goes against the feeling I feel in this engineers case.

That makes me worry that I'm making my decision based on if I think what they're saying is correct or not, not if they should have the right to say it.

I think the key is what you get to say while claiming "I am an X, therefore (implicitly) trust what I say"

Whether it's a medical professional, architect, engineer, etc., I don't have a problem with the speech and actions of a person being regulated by a professional organization while they are claiming to be of that profession. i.e. legally protecting the term doctor/nurse/engineer/lawyer/etc. is just fine.

If you are not, you need to make it clear that you are indeed not a licensed professional.

The difference is that one of those is not like the others. There really is no such thing as an unlicensed (medical) doctor, nurse, or lawyer. While most engineers are not licensed as such--and PEs don't even exist for many branches of engineering. Of course, they can't say they're PEs if they're not but there really isn't a default assumption, aside from perhaps in civil engineering, that an engineer asserting expertise in something is licensed.

In Canada it's more like the former -- you aren't allowed to even call yourself an engineer unless you have a P. Eng.

Fair enough. I was talking US where PEs are fairly rare outside of civil engineering and other subsets of engineering that deal with regulatory bodies a lot.

Generally in the US engineer is used pretty loosely. Some states are stricter. But even those who are, like apparently Texas, my first-hand experience is that most people don't pay much attention.

Should the nurses lose their license if there is an element of truth to what they are saying? For example, vaccines probably don't cause autism, but it's possible they could be an aggravating factor. Further research necessary.

>Further research necessary.

The autism link to vaccines isn't at the "further research necessary" stage, it is at the "not absolutely impossible but much evidence against" stage.

The only reason the link exists at all is that vaccines and first signs of autism can happen at similar times and often a vaccine will make a person/small child briefly feel unwell which gets pointed to as a "first sign" because humans find patterns where there aren't any and want something, anything to blame instead of not knowing.

Until it's absolutely impossible, further research is necessary. Who knows? It could be a combination of things. Perhaps vaccines are not aggravating factors by themselves; maybe you also need to combine them with, I don't know, Tylenol or another pain killer.

Saying the equivalent of "the science is settled" is always not true because how could we possibly know all of the variables that matter. And in science, all factors matter.

>Until it's absolutely impossible, further research is necessary.

There is no such thing, you can study something until the heat death of the Universe and still have a nonzero uncertainty.

>Saying the equivalent of "the science is settled" is always not true because how could we possibly know all of the variables that matter. And in science, all factors matter.

There is a wide gap between "further research is necessary" and "the science is settled" and you seem to be arguing on both sides depending on if that argument is in favor of the autism link. The link stopped being an interesting or pressing scientific question, the necessity or urgency of continuing to research it is quite low and anyone making funding decisions would be wise to allocate mostly elsewhere. There's no problem with continuing to search if a research group wants, researching unpopular questions is important, but let's not misrepresent the state of the research and the reasonable conclusions which can be drawn from the data. "further research necessary" is a phrase that evokes a sense that there is little evidence on which to base conclusions, there may be a hint of an effect, perhaps with contradictory evidence. This is not the case for the autism link, there is indeed a large statistically sound corpus of evidence pointing in the "no link" direction.

There is no gap between "the science is settled" and "further research is necessary". Either it is settled, or research is necessary.

I am not arguing that vaccines could cause autism. What I am arguing is that we don't know what causes autism and that we don't know if vaccines are an aggravating factor. That seems like an important question to me.

By the way, there can be a "large statistically sound corpus of evidence" for "no link" and still be wrong. Most importantly, all of that evidence could have missed important factors.

But beyond that point, as the medical field has lied to us more and more this past year, I no longer take what they say at face value. I dig in myself. And while they have convinced me that there is no direct link, they haven't convinced me that vaccines are definitely not an aggravating factor.

Why should they lose their license? They don't need to understand the mechanics of vaccines or immunity to be a proficient nurse, as long as the standard of care they provide follows recommendations and they listen to the doctors around them regarding patient care.

What benefit is there? One fewer person in a critical role due to an incredibly punitive decision is obvious downside. It's like sending someone to jail for a speeding ticket. Absolute fucking madness.

The benefit would be if the downside of having one fewer person doing that work is less than the downside of multiple people hearing wrong advice from someone whose license implies they won't talk nonsense about healthcare.

I've no clue myself where the line should be drawn, but there's at least a debate to be had (by people who understand the scenarios a lot better than me). For example, would you say the same about a nurse who tells every patient they see that smoking cigarettes is the best way to prevent cancer, even if apart from constantly saying that they were doing a fine job in other areas?

Well, is she advising her patients not to get vaccines? Because then she's not following the guidelines for standard of care.

Ok, edit my hypothetical person to not advising their patients, but standing at the hospital entrance after their shift telling all other patients that cigarettes are good for you.

But that's not what's happening either. Why don't we represent the reality with itself. She's expressing an idea publicly that she thinks is important for public safety. She is not hurting her patients by doing this. Idiots are dangerous, but the cure is worse than the disease, if the cure is to destroy people for non-violently expressing their concerns genuinely doing what they believe is in the best interest of the community.

I'm not going to pretend to have an answer for what we should do about people like her, but I do know that destroying their lives (squashing genuine, well meaning dissent) is not the answer.

Right, as I said in my first comment I don't consider myself able to judge where the line should be drawn regarding this real person, so I created a hypothetical person to see if you still believed it would be ridiculous to fire any nurse for anything they say outside work hours.

Yes, if she's giving her patients bad medical advice that goes contrary to accepted best practices then she should be asked to stop or find work elsewhere. And if she's standing in the hallway doing the same with people who aren't her patients she could probably be safely fired for being a nuisance. There are appropriate public forums for disagreement and in the hallway of your hospital is probably not it.

Your honest view is that if a nurse is committing medical malpractice the furthest extent of punishment should be "find work elsewhere"?

You are using quite an uncharitable interpretation of what I actually said. Elsewhere being not necessarily a hospital, in this case, but at best a hospital that agrees with her medical advice.

Or are you proposing that she be thrown on the streets, jailed, exhiled, or executed? What do you propose? I too can be uncharitable but that probably doesn't lead to productive conversation.

You are leaving zero space between “cannot work as a nurse” (or “cannot submit testimony as an expert witness in engineering”) to to “life is ruined.”

Furthermore you do seem to be consistently saying a nurse, at a hospital, giving medical advice that doesn’t meet standards of care should not face normal malpractice charges not even face a suspension of license. (Just go to a quack hospital!)

I mean yeah that is position, but like I said elsewhere in this thread, I can’t distinguish it from libertarian “license to toast” bullshit.

The nurse was using their profession as a credential in order to give dubious healthcare advice, this is a strong signal that they may be giving other equally questionable advice in their professional setting which is a risk to the patients they are supposed to be serving and a liability to their employer.

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