Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Hundreds of Medical Groups Send a Vaccine Safety Letter to the President

autism-organic
Image credit
 

The rate of autism diagnosis has increased dramatically as people eat more organic food, but that does not mean that organic food causes autism. The way to find out is to study this.

Researchers have looked for any reason to believe that vaccines, or vaccine ingredients, cause autism. The results are the same, regardless of whether the study is in America, Europe, Asia, . . . , and regardless of whether the study is run by private organizations, governments, corporations, or universities.[1]

For example, does thimerosal cause autism? Here is just one study looking for causation. There isn’t even a correlation.
 

CONCLUSIONS:
The discontinuation of thimerosal-containing vaccines in Denmark in 1992 was followed by an increase in the incidence of autism. Our ecological data do not support a correlation between thimerosal-containing vaccines and the incidence of autism.
[2]

 

If thimerosal causes autism, why does the rate of diagnosis of autism continue to increase after the removal of thimerosal?
 

Hundreds of medical organizations sent a letter to President Trump in an attempt to get the president to look at the evidence, rather than listen to the scientifically naive activists promoting conspiracy theories.
 

On behalf of organizations representing families, providers, researchers, patients, and consumers, we write to express our unequivocal support for the safety of vaccines.[3]

 

Unequivocal support means that they are completely confident that vaccines are safe, not that vaccines are 100% safe, Nothing is 100% safe, so demanding for 100% safety is an argument against everything – even breathing isn’t 100% safe.
 

Globally, vaccines prevent the deaths of roughly 2.5 million children per year.1 And, data shows that just for children born in the United States in 2009, routine childhood immunizations will prevent approximately 42,000 early deaths and 20 million cases of disease with savings of more than $82 billion in societal costs.2 [3]

 

Scare stories discourage us from doing what is best for our children.
 

RESULTS:
A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively.
[4]

 

Polio would have been eradicated by now, if it weren’t for the opposition of anti-vaxers.

Should we listen to those who, although they may mean well, do not understand what they are doing, or should we listen to doctors?

Doctors vaccinate themselves and their children because they understand that vaccines are safe and vaccines work.

Footnotes:

[1] 75 studies that show no link between vaccines and autism UPDATED to 107
Just the Vax
Friday, March 7, 2014
Edited to fix links and to add more studies for a new total of 107 on 11 March 2014
Guest blog, compiled by Allison Hagood, Luci Baldwin, Kathy McGrath and Nathan Boonstra and originally published on the “Your Baby’s Best Shot” Facebook page. I am grateful for the permission to repost!
List of studies

[2] Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data.
Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner AM, Andersen PH, Mortensen PB.
Pediatrics. 2003 Sep;112(3 Pt 1):604-6.
PMID: 12949291

[3] Dear Mr. President:
February 7, 2017
AAP (American Academy of Pediatrics)
Letter in PDF format

[4] Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States.
Roush SW, Murphy TV; Vaccine-Preventable Disease Table Working Group..
JAMA. 2007 Nov 14;298(18):2155-63.
PMID: 18000199

Free Full Text from JAMA

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2018 ACLS/PALS/NRP – AHA-ILCOR Guideline questions are being reviewed until 02-21-2017

AHA2015 - 2018
 

In preparation for the 2018 ACLS/PALS/NRP/CPR Guidelines (maybe 2017) the AHA (American Heart Association) and ILCOR (the International Liaison Committee On Resuscitation) are reviewing the questions they ask to examine the evidence, or the lack of evidence, on various interventions addressed by the guidelines for the:
 

First Aid Task Force (Public comment on PICO prioritization has recently closed. PICO categorization public comment period was open from October 10 to 24, 2016)

Advanced Life Support Task Force (Public comment on PICO categorization is NOW OPEN until 12:00 AM CST on February 21st, 2017!)

Basic Life Support Task Force (Public comment on PICO categorization is NOW OPEN until 12:00 AM CST on February 21st, 2017!)

Pediatric Life Support Task Force (Public comment on PICO categorization is NOW OPEN until 12:00 AM CST on February 21st, 2017!)

Education, Implementation and Teams Task Force (Public comment on PICO categorization is NOW OPEN until 12:00 AM CST on February 21st, 2017!)​

Neonatal Life Support Task Force (Public comment on PICO categorization is NOW OPEN until 12:00 AM CST on February 22nd, 2017!)[1]

 

Some questions are obvious and will be continued, such as 428. This is the review of antiarrhythmic drugs for cardiac arrest. Recent research shows no benefit to patients from amiodarone, or lidocaine.[2]

What do the 2015 ACLS Guidelines recommend?
 

Amiodarone may be considered for VF/pVT that is unresponsive to CPR, defibrillation, and a vasopressor therapy (Class IIb, LOE B-R).

Lidocaine may be considered as an alternative to amiodarone for VF/pVT that is unresponsive to CPR, defibrillation, and vasopressor therapy (Class IIb, LOE C-LD).[3]

 

Outside of controlled trials that are large enough to provide useful answers, amiodarone and lidocaine have no place in the treatment of cardiac arrest.
 

Much less obvious is 808, the suggestion that we should ventilate patients in the absence of evidence of benefit from ventilation – at least there is no evidence of benefit for the patient. Hands-only CPR seems to annoy doctors, nurses, paramedics, EMTs, . . . .

Why are we still ventilating adult cardiac arrest patients with cardiac causes of their cardiac arrest in the absence of evidence of safety and in the absence of evidence of benefit?
 

Why is there any question about 788? Results from Paramedic2 should be available next year. Is epinephrine in cardiac arrest better than a placebo?[4]

This is the first time we will have valid evidence to start to decide what to do with a treatment we have been using for over half a century based on the weakest of evidence. Paramedic2 is unlikely to answer many questions, such as which cardiac arrest patients should receive epinephrine and which should not, but it will be a start.
 

Then there is 464Drugs for monomorphic wide complex tachycardia. Considering the recent publication of PROCAMIO and the absence of discussion of tachycardia and bradycardia in the 2015 Guidelines, it is bizarre that this is among the questions recommended for elimination. Since there was no recommendation on treatment of ventricular tachycardia in the 2015 ACLS Guidelines, the recommendation from 2010 continues unchanged.

What did PROCAMIO show? If we give a high enough dose of amiodarone to actually try to treat the arrhythmia, major adverse cardiac events are more common than any benefit.[5]

Are we using amiodarone just to make stable ventricular tachycardia unstable?

Procainamide is safer and more effective.

Cardioversion is safer and more effective.

Adenosine is safer and probably more effective.[6]

Doing nothing is safer and only slightly less effective.

What about blood-letting for stable ventricular tachycardia?

Blood-letting is probably safer and maybe just as effective as amiodarone.[7]

Footnotes:

[1] ILCOR Continuous Evidence Evaluation
AHA (American Heart Association) and ILCOR (the International Liaison Committee On Resuscitation)
ILCOR 2016-2017 PICO categorization and prioritization public comment page

[2] Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest.
Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW, Christenson J, Egan D, Ornato JP, Weisfeldt ML, Stiell IG, Idris AH, Aufderheide TP, Dunford JV, Colella MR, Vilke GM, Brienza AM, Desvigne-Nickens P, Gray PC, Gray R, Seals N, Straight R, Dorian P; Resuscitation Outcomes Consortium Investigators..
N Engl J Med. 2016 May 5;374(18):1711-22. doi: 10.1056/NEJMoa1514204.
PMID: 27043165

Free Full Text from NEJM

[3] 2015 Recommendations—Updated
Part 7: Adult Advanced Cardiovascular Life Support
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
2015 Recommendations—Updated

[4] Paramedic2 – The Adrenaline Trial
Warwick Medical School
About

[5] Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study.
Ortiz M, Martín A, Arribas F, Coll-Vinent B, Del Arco C, Peinado R, Almendral J; PROCAMIO Study Investigators.
Eur Heart J. 2016 Jun 28. pii: ehw230. [Epub ahead of print]
PMID: 27354046
 

The primary outcome, major adverse cardiac events within 40 minutes of infusion initiation, for procainamide vs. amiodarone, was 9% vs. 41%, p = 0.006. Severe hypotension or symptoms requiring immediate direct current cardioversion (DCCV) occurred in 6.3% vs. 31.0%. Results were similar in patients with structural heart disease (n = 49).

 

[6] Adenosine for wide-complex tachycardia – diagnostic?
Thu, 23 Aug 2012
Rogue Medic
Article

[7] Blood-Letting
Br Med J.
1871 March 18; 1(533): 283–291.
PMCID: PMC2260507
 

Physicians observed of old, and continued to observe for many centuries, the following facts concerning blood-letting.

1. It gave relief to pain. . . . .

2. It diminished swelling. . . . .

3. It diminished local redness or congestion. . . . .

4. For a short time after bleeding, either local or general, abnormal heat was sensibly diminished.

5. After bleeding, spasms ceased, . . . .

6. If the blood could be made to run, patients were roused up suddenly from the apparent death of coma. (This was puzzling to those who regarded spasm and paralysis as opposite states; but it showed the catholic applicability of the remedy.)

7. Natural (wrongly termed ” accidental”) hacmorrhages were observed sometimes to end disease. . . . .

8. . . . venesection would cause hamorrhages to cease.

 

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Does use of Lights and Sirens save lives?

AmboLights
 

A recent Fire Chief Magazine and the current JEMS have some articles on the use of lights and sirens and the effect on patient outcomes. Doug Wolfberg, one of the EMS lawyers who might be trying to defend your choice on use of lights and sirens, states –
 

Few cows are more sacred in fire service based EMS than the ones that flash, wail and yelp. The use of emergency lights and sirens is an inseparable part of everyday EMS life.[1]

 

and –
 

Yet when we look at the actual evidence, a few things become apparent about RLS use. First, it’s proven to be dangerous. Second, it’s not proven to be beneficial.[2]

 

In another article, several of the top medical directors in the country state –
 

Unlike fire emergencies, which can grow exponentially and spread quickly, only a small subset of medical emergencies is truly time sensitive. Most don’t dramatically worsen in the course of a very few minutes, and they don’t spread from person to person.[3]

 

In rare cases, such as those where we are not able to control bleeding, or breathing, and the hospital is close enough that the patient won’t be dead by the time we get there, does use of lights and sirens save lives? In those rare cases? Sometimes.

Wouldn’t it be better to improve the quality of the people treating these patients, rather than increase the speed of transport?

When is the last time you transported a patient to the emergency department for something that needed to be done immediately to save the life of the patient?

Why not do that before transport?

Was it out of your scope of practice, did you not know what was going on, did you not feel comfortable performing the skill, could you not make up your mind about what to do, . . .?

Can’t place an endotraceal tube successfully? Use an LMA (Laryngeal Mask Airway), King Airway, BVM (Bag Valve Mask or resuscitator bag), stimulate the patient to breathe for himself, . . .

Can’t place an IV successfully? The IV is not a life line, but you can place an IO (IntraOssesous) line, apply direct pressure to bleeding, lay the patient flat (Trendelenberg does not improve things for the patient, although it might make you feel like you are doing something good), consider IM (IntraMuscular) or IN (IntraNasal) administration of medication, . . .

But it is an emergency!
 

We used to drive cardiac arrests to the hospital quickly, because we thought that was better.

We were wrong. If we do not resuscitate people prior to arrival at the hospital, they will probably stay dead. Driving fast just increases the odds that we will be as dead as the patient.

There has never been any good evidence to support driving fast.

We need to develop a better understanding of the treatment we provide. We need to provide better assessments (and continue to assess). We need to provide appropriate treatment on scene prior to transport. We need to rush less.
 

Do you believe in frequent lights and sirens transport?

Here is a dare for you.

Keep track of the times you transport with lights and sirens (these should be sentinel events) and document the actual life saving treatment provided in the emergency department in the first 10 minutes.

Keep track of this for a month, or a year.

Do you have anything?

Was it really something that saved the patient’s life?

If you do come up with something, does it amount to more than 1% of lights and sirens transports?

If we have almost always beenwrong about what is going on, should we be endangering everyone on the road to cover for our ignorance?

Footnotes:

[1] Why running lights and sirens is dangerous
Fire Chief
June 5, 2016
By Douglas M. Wolfberg, Esq.
Article

[2] Pro Bono: EMS Use of Red Lights and Siren Offers High Risk, Little Reward
JEMS
Wed, Feb 1, 2017
Doug Wolfberg
Article

[3] The Case Against EMS Red Lights and Siren Responses
JEMS
Wed, Feb 1, 2017
S. Marshal Isaacs, MD, FACEP, FAEMS , Carla Cash, MD , Osama Antar, MD , Raymond L. Fowler, MD, FACEP, DABEMS
Article

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Normal Sinus Rhythm is Not a Good Description

What is the rhythm 1a
 

Is Normal Sinus Rhythm a good description of this rhythm?

Is it sinus?

Is it normal?

Dr. Steven Novella writes about normal and some of the meanings of normal.
 

This findings, if confirmed, has several implications. First, it is just good to know how our brains typically work. “Normal” is a combined judgment about what is actually happening and what “should” be happening. This confirms what was observed in health care, especially psychiatry, that there is a moral judgment in deciding what is normal.[1]

 

Too often, we seem to try to apply what we think something should be to our mistaken description of what something is.

As an example, an ECG (ElectroCardioGram) showing a regular, or slightly irregular, sinus rhythm is often described using the misleading term normal sinus rhythm.

Normal suggests that there is nothing wrong with the rhythm, or with the heart, when it is not unusual for a patient to have a heart attack with a normal sinus rhythm being accurately displayed on the ECG.

We are subconsciously telling ourselves, Nothing to see here. Move along.

We are fooling ourselves and discouraging investigation of what may be causing problems by unnecessarily adding the term normal.

In this setting, normal does not add any information, but suggests that we know more than we actually know.

Why lie to ourselves?

Because we trust ourselves and don’t bother to check our assumptions to see if they are valid.
 

What is the rhythm 1
 

It is clearly sinus, but what information do we add by calling it normal?

Footnotes:

[1] What Is Normal?
Steven Novella
Feb 02, 2017
Neurologica
Article

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I helped a Naturopath kill my son, because I believe in Quackery

tamara-ryan-lovett1

 
Would you kill this kid?

Like clapping for Tinkerbell, killing children for superstition is part of keeping reality at bay.

Am I too harsh?

7 year old Ryan Lovett died of strep, meningitis, and pneumonia. His slow death, over 10 days, is reported to have been extremely painful. His death was also preventable with real medicine, so I am not even remotely harsh.

Ryan Lovett’s mother is a true believer in magic. Defending her irrational beliefs means avoiding everything that has valid evidence of benefit. Oddly, she did call 911, after her son started seizing. Ryan Lovett could not be resuscitated by EMS.

Ryan Lovett’s mother took him to a Naturopathic clinic for an echinacea mixture. Meanwhile, her neighbor, not trained in the deadly art of Naturopathy, was trying to convince Ryan Lovett’s mother to take Ryan to a real hospital.
 

La Pointe (Barbara La Pointe, a former friend of Lovett’s who used to take Ryan to her home on weekends) testified she visited Ryan and his mother the day before he died. She described Ryan as being “in a state of supreme suffering” and offered to take the mother and son to a hospital or doctor, but Lovett refused.[1]

 

Naturopaths claim that they will tell patients to go to a real doctor if the patient has a serious illness, which requires real medicine, not the usual self-limiting illness that patients recover from in spite of the Naturopath’s prescriptions.

Ryan Lovett will tell you that doesn’t work. No, Ryan Lovett can’t tell you, because nobody at Naturopathic clinic did what Naturopaths claim their extensive training in quackery prepares them to do – send the patient to a real doctor.

The neighbor was much smarter than everyone at the Naturopathic clinic, since she does not appear to have been indoctrinated in the death before medicine quackery of Naturopathy.
 

Ryan did not have a birth certificate and had never seen a doctor because his mother “did not believe in conventional medicine,”[1]

 

Evil conventional medicine? Pediatricians use evidence based medicine on their own kids and on themselves. They will even give you copies of research articles that show that their treatments do work. Medicine works even when the manufacturer is not able to influence the results of the research.
 


 

“The court specifically found that Tamara Lovett actually knew how sick he was and simply refused to do something and therefore gambled with his life,” he (Prosecutor Jonathan Hak) told reporters.[1]

 

That is a misunderstanding of medicine and gambling. Medicine is probabilistic. No treatment is 100% successful, so it depends on being prescribed for the right condition, in the right dose, having the fewest side effects, or having side effects that are least likely to make the patient worse, . . . , in order to make it more likely that the patient has a good outcome. That is gambling (putting the odds in the favor of the patient). Medical education is what helps the doctor, PA, NP, nurse, paramedic, EMT to assess the patient in a way that identifies the actual medical condition, to understand the risks and benefits of the available treatments, and to decide what is best for that individual patient.

Evidence-based medical education is better at putting the odds in favor of a good outcome than anything else.

Ryan Lovett’s mother wasn’t gambling, she was praying that her superstition had real magic powers. Maybe Ryan Lovett’s mother was praying that Ryan had a self-limiting illness, which would get better as long as the Naturopathic chemicals did not poison Ryan. Why take Ryan to the Naturopathic clinic at all, if the Naturopathic clinic just sells chemicals that are merely supposed to distract people and make the Naturopath money?
 

Doctors testified the infection would have been treatable had the boy, who also had meningitis and pneumonia, been taken to a doctor and given antibiotics.[1]

 

But this is just one rare case, so it is not fair to criticize Naturopaths for scamming the gullible. The Quack didn’t know the kid would die.
 

Canadians across the country have kept a close eye on the case. It is one of several in southern Alberta involving parents who were charged criminally after their children died of conditions that could have been treated with conventional medicine.[1]

 

Some people just can’t deal with reality.

Reality will eventually kill us, regardless of what we do. In the mean time, we can increase the odds of living a long healthy life by avoiding unnecessary treatment and limiting the treatments we do use to stuff that has valid evidence that it really works.

Footnotes:

[1] Tamara Lovett found guilty of negligence, failure to provide necessaries of life in death of 7-year-old son
By Meghan Grant, Drew Anderson,
CBC News
Posted: Jan 23, 2017 5:00 AM MT
Last Updated: Jan 23, 2017 5:33 PM MT
Article

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Acute coronary syndrome on Friday the 13th: a case for re-organising services?

ResearchBlogging.orgAcute coronary syndrome on Friday the 13th - a case for re-organising services 1
 
There has been a bunch of research on the likelihood of bad things happening on Friday the 13th. These researchers thought that the big problem with all of the available research is that the populations studied have been too small. The authors took information on over 56,000 patients with acute coronary syndromes, broke them down into 217 day/date combinations (Friday the 1st, Saturday the 1st, . . . ,Wednesday the 31st, Thursday the 31st), and compared the outcomes of those 216 groups with their Friday the 13th group.

Cut to the conclusion –
 

Conclusion: On most days, there was no difference in the 13-year mortality rate for patients admitted with their first ACS from that for “unlucky” Friday the 13th. However, patients admitted on five day/number combinations were 20-30% more likely to survive at 13 years. These findings could be explained by subgroup analysis inflation of the type I error, although supernatural causes merit further investigation.[1]

 

No. Supernatural causes do not merit further investigation, at least, not based on anything in this paper.

The authors used Friday the 13th as their normal date for comparison with every other date, but the outcomes from Friday the 13th are not the true statistical mean. The outcomes on Friday the 13th were just chosen because of the superstition being investigated. Friday the 13th is so close to the statistical mean that this mistake is easy to make.
 

Surprisingly, however, we also identified five potentially “lucky” days on which mortality rates were significantly lower, by 20-30%.[1]

 

When analyzing 217 samples, it is not surprising that some of the data deviate from average by an amount that is expected to produce no more than one significant deviation out of every twenty comparisons. The authors had over 200 comparisons, so we should not have been surprised by up to 11 day/date combinations with p values of less than 0.05. There were only 5. Should anyone go looking for supernatural explanations for statistically normal outcomes?

While Friday the 13th was not the statistical mean, it was very close. Look at the five potentially “lucky” days and how close the ranges are to 1.00. If the range crosses (includes) 1.00, the results are not statistically significant according to the prospectively determined criteria of the authors. Crossing 1.00 is just another way of expressing P <0.05. Sunday the 1st and Monday the 29th each produced outcomes 29% worse than Friday the 13th. Saturday the 31st produced outcomes that were 36% worse. If we compared these with the actual statistical mean, Monday the 29th and Saturday the 31st become significantly “unlucky” using a p value of less than 0.05 and all of the significantly “lucky” days become insignificant.

As we should expect, the most extreme benefit and harm both fall on the 31st. Only 7/12 (58.3%) of months have 31 days, so these days have much smaller sample sizes. With smaller samples, the appearance of deviance is expected to be greater. The actual deviation is less important, because the sample size is smaller.

Friday the 13th is only slightly different from the statistical mean, using the data in this paper, which may be the largest examination of a possible Friday the 13th effect.

Once again, the biggest problem with Friday the 13th is that we end up listening to people promoting superstition.
 

I have also written about this kind of superstition here –

The Magical Nonsense of Friday the 13th – Fri, 13 May 2016

Happy Friday the 13th – New and Improved with Space Debris – Fri, 13 Nov 2015

Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition? – Fri, 13 Jun 2014

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008

Footnotes:

[1] Acute coronary syndrome on Friday the 13th: a case for re-organising services?
Protty MB, Jaafar M, Hannoodee S, Freeman P.
Med J Aust. 2016 Dec 12;205(11):523-525.
PMID: 27927150

Protty, M., Jaafar, M., Hannoodee, S., & Freeman, P. (2016). Acute coronary syndrome on Friday the 13th: a case for re-organising services? The Medical Journal of Australia, 205 (11), 523-525 DOI: 10.5694/mja16.00870

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Happy Play God Day

 
January 9th is Play God Day.

OK. I’ll play. What could possibly go wrong.

I will start before The Beginning. I am everything and I am perfect.

Do I ruin that by creating something other than me? Am I lonely, bored, needy, neurotic, . . . ? What fallibility would inspire me to create creatures to slaughter? According to my biography, this is where I start to screw things up, but it could have been earlier.
 

play-god-day-1
 
Do I ruin perfection by creating something imperfect? Apparently. According to my biography, I do not accept that my far-from-perfect actions are demonstrations of my lack of perfection, but I make the rules, so I will torture you forever for pointing out my failures. It seems fair to me.

Remember that my name is Jealous and It isn’t bad when I do it. I said so. And it seems that I have to say so, because I can’t write. Why can’t I write? Why am I the worst communicator of all time? Remember, I will torture you forever for pointing out my failures.

Why would I choose to create evil and abolish my perfection? I didn’t create evil. Evil created itself and I use the existence of evil so that I can claim that I am better than something else. Don’t expect me to be reasonable. Remember, I will torture you forever for pointing out my failures. If I can create myself out of nothing, why can’t evil? And if I am not as good as I claim to be, maybe evil is not as bad as I claim that it is.

Was I ever perfect, if I can create evil, or let evil be created, or let evil create itself? So what if I get cranky and drown everyone on the planet, except for eight supposedly good people, who weren’t as good as I thought? Was everyone else really evil? What about their innocent fetuses? If I really wanted to get rid of all of the bad people, maybe I should have chosen passengers a little better. Maybe I could have just dealt with them individually. Look at me being surprised by something I didn’t anticipate, again.

Why did I use such an inaccurate weapon? Why not use a laser? That would impress people. A technology that the creators of the Gods did not know about! That would have been much more impressive than a bigger than usual flood. Maybe I should have created better writers.

Why would I want to be such an abysmal failure as the Jewish/Christian/Muslim God? Maybe I just don’t think for myself. Maybe I was just created by people who were not aware of their prejudices and logical fallacies. Richard Feynman has comment on the reports of flying saucers, which I like to modify to apply just as accurately to the Gods.
 

It is not unscientific to make a guess, although many people who are not in science think it is. Some years ago I had a conversation with a layman about flying saucers God — because I am scientific I know all about flying saucers God! I said “I don’t think there are flying saucers Gods”. So my antagonist said, “Is it impossible that there are flying saucers Gods? Can you prove that it’s impossible?” “No”, I said, “I can’t prove it’s impossible. It’s just very unlikely”. At that he said, “You are very unscientific. If you can’t prove it impossible then how can you say that it’s unlikely?” But that is the way that is scientific. It is scientific only to say what is more likely and what less likely, and not to be proving all the time the possible and impossible. To define what I mean, I might have said to him, “Listen, I mean that from my knowledge of the world that I see around me, I think that it is much more likely that the reports of flying saucers God are the results of the known irrational characteristics of terrestrial intelligence than of the unknown rational efforts of extra-terrestrial supernatural intelligence.” It is just more likely. That is all.

 
The Character of Physical Law (1965)
chapter 7, “Seeking New Laws,” p. 165-166: video

 

I could have arranged for good people to be rewarded and bad people to fail. I used to have you believing that I did that and you humans abused people who were different, because that was a sign from me that those people are evil. Many of you haven’t stopped. I love irrational people. Billions of irrational people can’t be wrong, so keep killing each other over the right interpretation of my biography.

If I were going to be a God for a day, I might increase the ability of people to understand. A God capable of communicating in a way that people could agree on would suggest that the God is not made by people, but the only thing that Christians seem to agree on is that they like Jesus. A real God could have communicated a real message, but what should we expect from the guy who wrecked the Tower of Babel, which we have long since surpassed. Ooops.

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2016 – Amiodarone is Useless, but Ketamine Gets Another Use

amiodarone-edit-1
 

I didn’t write a lot in 2016, but 2016 may have been the year we put the final nail in the coffin of amiodarone. Two major studies were published and both were very negative for amiodarone.

If we give enough amiodarone to have an effect on ventricular tachycardia, it will usually be a negative effect.[1]

Only 38% of ventricular tachycardia patients improved after amiodarone, but 48% had major adverse cardiac events after amiodarone.

There are better drugs, including adenosine, sotalol, procainamide, and ketamine for ventricular tachycardia. Sedation and cardioversion is a much better choice. Cardioversion is actually expected after giving amiodarone.

For cardiac arrest, amiodarone is not any better than placebo or lidocaine. What ever happened to the study of amiodarone that was showing such wonderful results over a decade ago? It still hasn’t been published, so it is reasonable to conclude that the results were negative for amiodarone. It is time to make room in the drug bag for something that works.[2],[3]

On the other hand, now that we have improved the quality of CPR by focusing on compressions, rather than drugs, more patients are waking up while chest compressions are being performed, but without spontaneous circulation, so ketamine has another promising use. And ketamine is still good for sedation for intubation, for getting a patient to tolerate high flow oxygen, for agitated delirium, for pain management, . . . .[4],[5]

Masimo’s RAD 57 still doesn’t have any evidence that it works well on real patients.[6]

When intubating, breathe. Breathing is good. Isn’t inability to breathe the reason for intubation?[7]

Footnotes:

[1] The PROCAMIO Trial – IV Procainamide vs IV Amiodarone for the Acute Treatment of Stable Wide Complex Tachycardia
Wed, 17 Aug 2016
Rogue Medic
Article

[2] Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest
Mon, 04 Apr 2016
Rogue Medic
Article

[3] Dr. Kudenchuk is Misrepresenting ALPS as ‘Significant’
Tue, 12 Apr 2016
Rogue Medic
Article

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