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

- Rogue Medic

Is placebo better than aggressive medical treatment for patients NOT having a heart attack?

Also to be posted on ResearchBlogging.org when they relaunch the site.
 

Is cardiac catheterization placebo better than aggressive medical treatment for patients not having a heart attack?

No.
 

The answer is not really different from before. This should not be surprising for anyone who pays attention to EBM (Evidence-Based Medicine). We should all pay attention to EBM, because it is the best way to find out what works.

Many routine treatments are not beneficial to patients, but are considered to be standards of care. We continue to give these treatments out of unreasonable optimism, a fear of litigation, or fear of criticism for not following orders. The difference between the banality of evil and the banality of incompetence does not appear to be significant in any way that matters.

PCI (Percutaneous Coronary Intervention) treatment does not add any benefit – unless you are having a heart attack.

The placebo group received sham PCI in addition to optimized medical treatment. this did not provide any benefit over actual PCI in addition to optimized medical treatment. The patients in the placebo group received all of the same medications that the patients in the PCI group received.

Why is this news today?

A recent article in The Lancet is encouraging snake oil salesmen and snake oil saleswomen to claim that it shows the miracle healing power of placebos, but this is not true.

Apparently, Big Placebo (the multi-billion dollar alternative medicine industry) is trying to use this to promote their scams (homeopathy, acupuncture, Reiki, naturopathy, prayer, . . . ).

Big Placebo seems to think that this study shows that placebo is better than medical treatment. A placebo is an inactive intervention that is undetectable when compared with the active treatment. The placebo group received the same aggressive medications that the treatment group received.
 

All patients were pretreated with dual antiplatelet therapy. In both groups, the duration of dual antiplatelet therapy was the same and continued until the fial (unblinding) visit. Coronary angiography was done via a radial or femoral arterial approach with auditory isolation achieved by placing over-the-ear headphones playing music on the patient throughout the procedure.[1]

 

What is new about this?

A much larger study a decade ago showed that aggressive medical therapy was as good as PCI and aggressive medical therapy. The difference is the use of sham PCI to create a placebo group for comparison, rather than using a No PCI group for comparison.
 

CONCLUSIONS:
As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy.
[2]

 

Compare that with the conclusion (interpretation) of the new paper.
 

INTERPRETATION:
In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy.
[1]

 

The unfortunate outcome is that we will have fewer hospitals providing PCI, so patients with heart attacks (STEMI – ST segment Elevation Myocardial Infarctions) may have to wait longer for emergency PCI, which really does improve outcomes.
 

What other Standards Of Care are NOT supported by valid evidence?

Amiodarone is effective for cardiac arrest, whether unwitnessed, witnessed, or witnessed by EMS.

Kayexalate (Sodium Polystyrene) is a good treatment for hyperkalemia. Anything that causes diarrhea will lower your potassium level, but that does not make it a good treatment, unless you are in an austere environment (in other words – not in a real hospital).

Amiodarone is effective for VT (Ventricular Tachycardia).

Backboards are effective to protect against spinal injury while transporting patients.

Blood-letting is effective for anything except hemochromatosis (and some rare disorders).

More paramedics are better for the patient.

Prehospital intravenous lines save lives.

IV fluid saves lives in hemorrhagic shock.

Oxygen should be given to everyone having a heart attack.

The Golden Hour is important.

Driving fast saves lives. For only some rare conditions, it probably does – and that depends on traffic.

Flying people to the hospital saves lives. Again, for only some rare conditions, it probably does – and that depends on traffic and distance.

Tourniquets are dangerous. As with anything else, if used inappropriately, they are dangerous, but tourniquets save lives.

Prehospital intubation saves lives.

Ventilation in cardiac arrest improves outcomes (other than for respiratory causes of cardiac arrest, which are easy to identify).

Epinephrine improves outcomes in cardiac arrest. It does produce a pulse more often, but at what cost to the long-term survival of the patient and the patient’s brain? PARAMEDIC2 should help us to identify which patients benefit from epinephrine, since it is clear that many patients are harmed by epinephrine in cardiac arrest. If we limit treatment to patients reasonably expected to benefit from the treatment, we can improve long-term survival.

And there are many more.

Footnotes:

[1] Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial.
Al-Lamee R, Thompson D, Dehbi HM, Sen S, Tang K, Davies J, Keeble T, Mielewczik M, Kaprielian R, Malik IS, Nijjer SS, Petraco R, Cook C, Ahmad Y, Howard J, Baker C, Sharp A, Gerber R, Talwar S, Assomull R, Mayet J, Wensel R, Collier D, Shun-Shin M, Thom SA, Davies JE, Francis DP; ORBITA investigators.
Lancet. 2017 Nov 1. pii: S0140-6736(17)32714-9. doi: 10.1016/S0140-6736(17)32714-9. [Epub ahead of print]
PMID: 29103656

[2] Optimal medical therapy with or without PCI for stable coronary disease.
Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS; COURAGE Trial Research Group.
N Engl J Med. 2007 Apr 12;356(15):1503-16. Epub 2007 Mar 26.
PMID: 17387127

Free Full Text from N Engl J Med.

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Have a Slow, Quiet Friday the Thirteenth

Also to be posted on ResearchBlogging.org when they relaunch the site.
 

 

Superstitious appears to be common among medical people, so this may be seen as offensive. If you doubt me, comment that it is slow or quiet and see how many respond negatively, while they do not receive any criticism for their superstition-based complaints. Rather, people will make excuses for coddling the superstitions of those who are entrusted with the lives of patients.

The evidence does not support their superstitions.

One study did appear to show that women die in motor vehicle collisions more often on Friday the 13th, but that appears to be due to a lack of understanding of statistics by many who cite the article.
 

An additional factor is anxiolytic medication, used by significantly more women than men in Finland (7), which has been reported to reduce attention span and worsen driving performance (8). . . . Why this phenomenon exists in women but not in men remains unknown, but perhaps the twice-as-high prevalence of neurotic disorders and anxiety symptoms in women (7) makes them more susceptible to superstition and worsening of driving performance.[1]

 

The author suspects that those people with conditions that could be diagnosed as neuroses or anxiety disorders may be disproportionately affected by superstition.

In other words, superstition is not an external force affecting you. You are doing it to yourself.

The sample size was national, but still small, and was not able to adjust for many possible confounding variables, so the study would need to be replicated using a much larger data base to be useful.

In other superstition news – the next apocalypse, in a long line of predicted apocalypses, is going to be this Sunday – the 15 of October, 2017, according to David Meade. Meade twice previously predicted that a magical planet would hit the Earth and kill us all. This time he claims that his calculations are accurate, because that was the problem with his previous calculations – inaccuracy, not that they were a superstition deserving of derision.

If you are superstitious, and feel that your neuroses/anxieties will cause you to harm others, or yourself, you may want to stay home today and Sunday – perhaps even until you are capable of grasping reality.

Of course, we would never base treatment on superstition in medicine.

Amiodarone is the go to antiarrhythmic drug for cardiac arrest and ventricular tachycardia, but there are much safer much more effective drugs available. We have our own prophets misrepresenting research results to make it seem that using amiodarone for these is a good idea. The research says these preachers are wrong. The next guidelines will probably promote the superstition and reject the science.[2],[3]

Ventilation during cardiac arrest has been shown to be a good idea only for patients who arrested for respiratory reasons. We do a great job of identifying these patients. We have our own prophets misrepresenting research results to make it seem that providing ventilations for these is a good idea. The research says these preachers are wrong. The next guidelines will probably promote the superstition and reject the science.[4]

Medicine is full of superstition and superstitious people.

Why?

Too many of us believe the lie that, I’ve seen it work.

I have also written about the superstition of Friday the 13th here –

Acute coronary syndrome on Friday the 13th: a case for re-organising services? – Fri, 13 Jan 2017

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] Traffic deaths and superstition on Friday the 13th.
Näyhä S.
Am J Psychiatry. 2002 Dec;159(12):2110-1.
PMID: 12450968

Free Full Text from Am J Psychiatry.

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

There are a dozen links to the research in the footnotes to that article. There are also links to other articles on the failure of amiodarone to live up to its hype.

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

[4] Cardiac Arrest Management is an EMT-Basic Skill – The Hands Only Evidence
Fri, 09 Dec 2011
Rogue Medic
Article

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Comment on Irresponsibility and Intubation – The EMS Standard Of Care

 

I wrote about the petition to protect paramedic incompetence in Irresponsibility and Intubation – The EMS Standard Of Care

Nathan Boone responded with the following comment
 

You’re forgetting about the rural medic out there.

 

No. I am not.

Are you suggesting that bad airway management for a longer period of time is less harmful than bad airway management for a shorter period of time?
 


 

Where we are with our patients for more then a hour, not 5 mintues.

 

The harm from incompetent airway management does not depend on distance from the hospital. Intubation even kills patients in the hospital.

You may believe that the efficacy of voodoo is directly related to the distance from the hospital, but it appears to be only your belief that increases.

Voodoo does not work, regardless of the distance from the hospital.

If the paramedic cannot manage an airway, the paramedic should not be permitted to intubate.
 

Sometimes air- craft isn’t available if its raining or on another call.. You want us to use a bvm and take chance of filling the patients stomic up for over a hour.. Yes we can be extremely careful and do everything in our power not to fill the stomic but there’s some patients out there who have difficult airways where bagging can be extremely difficult and or impossible.

 

Give incompetent paramedics dangerous tools to try to manage difficult airways because of distance? Wouldn’t it be better to try to make them competent – or to limit intubation to competent paramedics?

Intubation and BVM (Bag Valve Mask) are not the only forms of ventilation.
 

Rsi does save patients in rural areas, we need intubations..

 

Maybe. Maybe not. Maybe RSI kills more patients than it saves.

Actually, what I mean to write is, Maybe paramedics using RSI kill more patients than they save.

If you want to claim otherwise, prove it with high-quality research.

Unless you can provide high-quality research, your plastic airway religion is just another alt-med scam.

If your patients are important, then you need to demand that we find out what is best for the patients.
 

Do I believe that Rsi is risky and their is some medics out there who would rather make the patient more hypoxic then before until they give up and go to a secondary airway..absolutely.. But to take it away from Rural Medics when we can have anything to burn patients to anaphylactic reactions and to take our ONLY definitive airway;away from us..

 

You seem to think that RSI (Rapid Sequence Induction of anesthesia) becomes less risky the farther you are from the hospital.

Why?

Incompetence for a longer period will be expected to cause more harm.

Sometimes the incompetence of the paramedic doesn’t kill the patient.
 

Trauma patients were significantly more likely to have misplaced ETTs than medical patients (37% versus 14%, P<.01). With one exception, all the patients found to have esophageal tube placement exhibited the absence of ETCO2 on patient arrival. In the exception, the patient was found to be breathing spontaneously despite a nasotracheal tube placed in the esophagus.[1]

 

The patient clearly did not need intubation.

As with the crash of Trooper 2 in Maryland, the survival of the patient for hours in the woods, in the rain, following the helicopter crash that killed all of the other healthy people on board, was clear evidence that there was no reason to send this patient to the trauma center by air.

The same argument was provided by people, including Dr. Thomas Scalea, the head of Shock Trauma – If you don’t let us have our toys, people will die![2]

The rate of helicopter transport of trauma patients was dramatically cut.

That was almost a decade ago and we are still waiting for the dead bodies.

I expect that the same failure of prophesy will occur, when incompetent paramedics are prevented from intubating.

I expect that the fatality rate will decrease, when incompetent paramedics are prevented from intubating.
 

I think you’re out of your mind.

 

Many religious fanatics do.
 

In the city, I can maybe defend you. But the studies need to be done out in the sticks as well. I believe that we should have to go outpatient surgery every year or 2 or have number set of how many we need in that time period successfully to keep our skills sharp..

 

Every year or two?

WTF?

You don’t want to be taken seriously, do you?

This is something that requires a lot of skill and practice, so I get just a tiny bit, every other year. Trust me with your life.
 

After a Rsi and I have no one in the back but myself for over an hour.., I can place the patient on a vent and care for my patient. If RSI is taken away. I loose the capability to monitor my patient, and would be more focused on bagging my patient, or making sure the secondary away isn’t failing and I’m filling the stomic on the vent, because it can happen.

 

It is just a staffing issue.

That is different.

Competence isn’t needed when you are in the back by yourself.

Why are you opposed to competence?

Where is a single reasonable argument that intubation improves outcomes?

Where is a single reasonable argument that rural paramedics have an intubation success rate that is above 95%?

Even 95% means that some of your patients don’t end up with a properly placed endotracheal tube. What do you think happens to them?

Does your EMS agency have a better than 95% intubation success rate?

If you can’t manage at least 95%, why do you believe you can manage intubation?

Is each intubation on video, or do they just believe whatever you tell them?

If you want to be taken seriously, these are just some of the essential points to address.
 

This is not a new topic. You might also read the series below:

In Defense of Intubation Incompetence – Part I

In Defense of Intubation Incompetence – Part II

In Defense of Intubation Incompetence – Part III

How Accurate are We at Rapid Sequence Intubation for Pediatric Emergency Patients – Part I

How Accurate are We at Rapid Sequence Intubation for Pediatric Emergency Patients – Part II

Footnotes:

[1] Misplaced endotracheal tubes by paramedics in an urban emergency medical services system.
Katz SH, Falk JL.
Ann Emerg Med. 2001 Jan;37(1):32-7.
PMID: 11145768 [PubMed – indexed for MEDLINE]

Free Full Text PDF

[2] Helicopters and Bad Science
Thu, 09 Oct 2008
Rogue Medic
Article

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Irresponsibility and Intubation – The EMS Standard Of Care

 

There is a petition to save EMS intubation, but it claims to be a petition to save patients. The petition is not to save patients.
 


Image source
Details here and here.
 

The petition states that its intent is to protect patients, but it does not provide any evidence. It only makes the same claims that every other quack makes to promote his snake oil.

We are worse than homeopaths, because homeopaths do not actively harm patients by depriving patients of oxygen, as we do when we intubate.
 

 
We are the quack, witch doctor, homeopath, horseshit peddlers Dara O’Briain is describing.

 

Today we are possibly facing the removal of the most effective airway intervention at our disposal as paramedics, endotracheal intubation.[1]

 

Most effective?

There is some evidence that intubation can be – in limited situations, by highly trained, competent people – beneficial. There is also plenty of evidence that intubation is harmful. It is easy to kill someone by taking away the patient’s airway.

Most effective?

No.

This petition does not mention evidence, so it has no credibility when it comes to claims of whether intubation is effective. This petition expects us to believe in a faerie tale of magical improvement with intubation. This petition wants us to clap for Tinkerbell, because If we believe hard enough, it just might come true. Grow up.
 

Please sign this petition so that these patients have a chance to live[1]

 

Prove that requiring higher standards for intubation would take away a patient’s chance to live.

Prove that intubation improves outcomes.

This is a petition to keep standards low for paramedics.

This petition does not mention competence, or even what is involved in competence, because this petition is opposition to competence.

This is the Protect Incompetent Paramedics from Responsibility Petition.

Responsibility is for professionals. In EMS, we reject responsibility.

We are more concerned with whether our shoes are shiny, than whether we are harming, or helping, our patients. The reason EMS exists is to improve outcomes for patients.

We don’t deliver competent care, but only the appearance of competence. We are medical theater, putting on a fancy show. The TSA (Transportation Security Administration) is the same – all appearance and no substance.

Most effective? Maybe intubation is the most effective theater.

The outcomes of our patients are affected, but we refuse to learn if we are helping, harming, or doing equal amounts of harm and help.

We actually oppose learning. We are willfully ignorant – and proud of our defiant stand for ignorance.

How much hypoxia do we cause in our attempts to place the so called gold standard? The actual gold standard is helping the patient to protect his own airway, but who cares what’s best for the patient? Not those who sign the petition.

How much vomiting, and aspiration, do we cause?

How much airway swelling do we cause?

How many airway infections do we cause?

How much harm do we cause?

We don’t know. We don’t care. We oppose attempts to find out.

We are EMS and we believe that our actions should be protected from examination, because we are beautiful and unique snowflakes who demand our participation trophies without doing real work required to be competent.

Go ahead, snowflakes, demonstrate your incompetence by signing the petition, because this protect intubation petition is really a protect incompetence petition.

If we want to continue to intubate, and we want to improve outcomes for our patients, we need to demonstrate that intubation by EMS provides significant benefit and which patients are most likely to benefit. We can’t do that because we don’t care enough about our patients.
 

Brian Behn has a different reason for not signing the petition for low standards – Why I am Not Signing The Petition About Intubation.

Dave Konig also comments on the petition for low standards – Is ET Intubation Joining Backboards In Protocol?

Footnotes:

[1] Allow paramedics to continue to save lives with endotracheal intubation!
Anthony Gantenbein United States
Petition site

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D10 in the Treatment of Prehospital Hypoglycemia: A 24 Month Observational Cohort Study

ResearchBlogging.org
 

Why treat hypoglycemia with 10% dextrose (D10), rather than the more expensive, potentially more harmful, and less available, but traditional treatment of 50% dextrose (D50)? Why not? The only benefit of 50% dextrose appears to be that it is what people are used to using, but aren’t we used to starting IVs (IntraVenous lines) and running fluids through the IVs?

We should be much more familiar with running in fluid, than in pushing boluses of syrup.

What happens when we have temporary shortages of 50% dextrose? Do we stop treating hypoglycemia? Are we supposed to panic, because we can no longer follow tradition? No. We give the more appropriate, and lower, dose of the much lower concentration of dextrose. We provide better care because of our need.
 

Despite the traditional use of D50, there is a minimal amount of data to support it as the standard of care.[1]

 

Is 10% dextrose the perfect treatment for hypoglycemia? No, but it does appear to be less likely to cause harm than the current overtreatment with 50% dextrose.
 

Seven patients had a drop in blood glucose after D10 administration, all of 10 mg/dL or less except for one patient with a drop of 19 mg/dL who had an insulin pump infusing that was not removed by EMS personnel during D10 infusion.[1]

 

Is that any different from what happens with 50% dextrose? If this is different from D50, how does the potential harm from giving too much dextrose to most hypoglycemic patients compare to the potential harm of giving a first that is too small to fewer than 1% of hypoglycemia patients?
 

There were no reported adverse events related to dextrose infusion. Six patients who received intravenous D10 were pronounced dead in the field during the period of study. On investigator review, all patients had altered level of arousal or were in cardiac arrest prior to arrival of EMS personnel and their deaths were deemed to be unrelated to dextrose administration.[1]

 

Dextrose does not reverse death, so there is no reason to expect a better outcome for dead patients with a higher concentration of a drug that does not reverse death. Go read the excellent review of the evidence on hypoglycemia, death, and the potential of dextrose to improve outcomes from death.[2]

But is 10% really better? We don’t have any good research, but is there any good reason to give all 25 grams of dextrose in a syringe of 50% dextrose if the patient wakes up before the full dose has been administered? Would we continue to give the entire syringe of morphine, or fentanyl, or most of the other drugs that we give, if our assessment shows that the patient no longer meets the protocol criteria for administration of the drug?
 


 

76% of patients received only 10 grams of dextrose, rather than the usual 25 grams. While it is not known if any of these patients required any further dextrose, or oral glucose, while in the hospital, they should have been awake enough to take any further dextrose orally, as they would the rest of the time.

23% of patients received only 20 grams of dextrose, rather than the usual 25 grams.

Fewer than 1% of hypoglycemia patients received a dose as large as we traditionally give.
 

We do not appear to be concerned with harm from administering more aggressive treatment than is justified by the evidence.

We do appear to be concerned about our anxiety of deviating from the traditional too much is not enough approach to hypoglycemia.

Footnotes:

[1] D10 in the Treatment of Prehospital Hypoglycemia: A 24 Month Observational Cohort Study.
Hern HG, Kiefer M, Louie D, Barger J, Alter HJ.
Prehosp Emerg Care. 2017 Jan-Feb;21(1):63-67. doi: 10.1080/10903127.2016.1189637. Epub 2016 Dec 5.
PMID: 27918858
 

Of the 1,323 patients administered D10 during the study period, the 452 patients excluded from the study cohort for the aforementioned reasons were similar demographically to the study cohort. The median initial blood glucose was the same at 37 mg/dL and the median age was also 66. There were slightly more women at 229 (51%) in the excluded group compared to the cohort.

 

[2] Using Dextrose in Cardiac Arrest
Wednesday, March 14, 2012
Mill Hill Ave Command
Dr. Brooks Walsh
Article

Hern, H., Kiefer, M., Louie, D., Barger, J., & Alter, H. (2016). D10 in the Treatment of Prehospital Hypoglycemia: A 24 Month Observational Cohort Study Prehospital Emergency Care, 21 (1), 63-67 DOI: 10.1080/10903127.2016.1189637

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The March for Science is a March for Honesty and Accountability


 

There were some great signs at the March for Science because the march was about truth and it is difficult to go wrong defending the search for truth. The only time people seem to oppose the search for truth is when truth is seen as a threat to their ideology and/or income.

It is difficult to get a man to understand something, when his salary depends upon his not understanding it! – Upton Sinclair.

Scientists are accused of being arrogant, apparently because scientists don’t waste their time on ideas that cannot be tested or on ideas that repeatedly fail objective testing. Scientists learn by providing the most honest way of assessing the truth – they do everything they can to eliminate bias and to eliminate the effects of anything that is not being tested.

Is that arrogant?

Arrogance would be refusing to allow everyone to criticize your work, but science requires that scientists be open about their work and invite their harshest critics to poke holes in their work.

This means that nonsense will not survive for long. The better hypotheses will survive. Logical fallacies are eventually exposed and we learn the truth.
 


 

This is why science rejects claims that fail experimentation and claims that cannot be tested. These claims are not science.
 

Flat Earth claims are rejected. There is abundant evidence that the Earth is not flat, but people still claim that the Earth is flat. There is no scientific controversy about whether the Earth is roughly spherical in shape.[1]
 

Creationism claims are rejected. Creationism contradicts almost all of the sciences (geology, astronomy, physics, biology, . . .), so Creationism would need to be supported by some very well tested evidence. Creationism is not supported by scientific evidence, but that does not stop Creationists from claiming to be scientists.

The clearest evidence that evolution is real is provided by DNA (DeoxyriboNucleic Acid). When we want to confirm the relationship among different people, we use DNA, because it works. DNA confirms that we are related to baboons, bananas, and bacteria. DNA is able to show how close those relationships are. There is no scientific controversy about whether humans evolved along with the rest of life on Earth.[2]

 

I did not get a clear picture of the sign, but I have not changed the words.

 

Anti-GMO claims are rejected. GMOs (Genetically Modified Organisms) are recognized to be safe, nutritious, important in the prevention of widespread famine, overall much more beneficial than their critics claim, and dramatically better organic foods. Those opposed to GMOs claim that organic foods would not produce a famine, if everyone were to eat organic foods. Those opposed to GMOs claim that modification is bad, even though humans have been modifying crops for over 10,000 years. We even use chemicals and radiation to cause mutations to crops that are still considered organic.
 

From 1930 to 2014 more than 3200 mutagenic plant varieties have been released[1][2] that have been derived either as direct mutants (70%) or from their progeny (30%).[3] [3]

 

There is no scientific controversy about the benefits of GMOs.
 


 

Climate change denial is rejected. Climate change is real and harmful. Some people (not scientists) claim that natural factors are causing the unnatural warming. Some people (not scientists) claim that the unnatural warming is a good thing. Some people (not scientists) claim that the unnatural warming isn’t happening. There is no scientific controversy about the reality of climate change.
 


This chart[4] does not include 2016.

If you are a climate change denier, you were counting on 2016 being something other than the hottest year on record. Three years in a row would be unprecedented. 2017 was hotter than 2016, which contradicts the denier arguments.[5] If you are a climate change denier, you should realize that denying science is not going your way. You have had some political successes, but you can’t deny reality forever. There is no scientific controversy about the reality of climate change.
 

Anti-vaccine claims are rejected. Anti-vaxers claim that vaccines are dangerous and that vaccines do not work. Do vaccines work? We should have eradicated polio by now, but anti-vaxers have discouraged vaccination. If you don’t like your children getting the polio vaccine, blame the anti-vaxers. We did eradicate smallpox in the 1970s. We stopped vaccinating against smallpox. Smallpox was killing 2 million people a year. If you don’t worry about smallpox, thank a scientist. There is no scientific controversy about the safety and efficacy of vaccines.
 

Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States – Table 1


 

In response to the evidence in Table 1,[6] anti-vaxers claim that improved sanitation and hygiene. The decrease in cases and deaths due to the various vaccine-preventable illnesses should be the same for all of these diseases, but that is not the case. The diseases have also produced epidemics when the vaccination level drops below herd immunity levels.[7] There is no scientific controversy about the safety and efficacy of vaccines.
 

Science is not perfect, but science is better than all other means of learning the truth.

When science produces mistakes, we learn about it from scientists, not from politicians, not from preachers, not from placebo pushers, not from psychics, and not from any other deniers of science.

Maybe the message of science got through.

Maybe we won’t need another March for Science.
 


??Gaby Mérida ??‏ @ThatSpanishLady Twitter
Click on the image to make it larger.

Footnotes:

[1] Flat Earth Rising
by Steven Novella
Neurologica
April 6, 2017
Article

[2] Objections to evolution
Wikipedia
Article

[3] Mutation breeding
Wikipedia
Article

[4] The 10 Hottest Years on Record
January 20th, 2016
By Climate Central
Article

[5] 2016 Was the Hottest Year on Record
Both NASA and NOAA declare that our planet is experiencing record-breaking warming for the third year in a row
By Andrea Thompson
January 18, 2017
Scientific American
Article

[6] 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.

[7] “Vaccines didn’t save us” (a.k.a. “vaccines don’t work”): Intellectual dishonesty at its most naked
by David Gorski
March 29, 2010
Science-Based Medicine
Article

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The Boy Who Cried Terrorist

 
This is the latest comment from Frederick Blum in response to what I wrote about his absurd defense of Dr. Tobinick.[1].[2] As you can see, in labeling appropriate respect for patients as terrorism, Frederick Blum completely lacks perspective.
 

I think a more apt description of what you are is ” Rogue Terrorist ” . Forget ” Rogue Medic. ” It’s not really you. Think about it.[3]

 

Think like Frederick Blum?

That might be torture.

If you honestly think that I am a terrorist, turn me in.

Go ahead.

It may be even worse to not turn in a terrorist, than to treat patients with inadequately tested medications.
 

If you see something, say something 1
 

“War is peace. Freedom is slavery. Ignorance is strength.”[4]

 

What do terrorists do?
 

You hide behind a cowardly mask exactly as terrorists do.[3]

 

Cowardly?

I have allowed Frederick Blum a forum to make baseless accusations.

I have responded with evidence.

I have not made threats.

Frederick Blum calls this cowardly?
 

You fabricate lies about people and assault them with ad hominem attacks, also exactly as terrorists do.[3]

 

Frederick Blum, provide some sort of evidence to support your imaginative accusations.

I have stated that Dr. Tobinick has failed to produce valid evidence of safety.

Do you have any evidence to show that this is not completely true?

I have stated that Dr. Tobinick has failed to produce valid evidence of efficacy.

Do you have any evidence to show that this is not completely true?

I have not lied.

I have criticized Dr. Tobinick for a failure to provide evidence of safety and efficacy. Using safe and effective treatments is an important part of what separates ethical medical practice from alternative medicine.

If people conclude that Dr. Tobinick is unethical because of what I have written, that is only reasonable.

Neither of you have provided even an iota to suggest any other conclusion.

By the way, have terrorists switched from killing people to using honest criticism? I wish it were so.
 

Really, you’re just another unremarkable terrorist.[3]

 

Is your unremarkable remark intentionally ironic?
 

You should change your anonymous cowardly handle to ” Rogue Terrorist. ” At least in doing so you would be honest about yourself.[1]

 

Without valid evidence of safety, we must conclude that Dr. Tobinick cannot honestly demonstrate safety.

Without valid evidence of benefit, we must conclude that Dr. Tobinick cannot honestly demonstrate any benefit.

If Dr. Tobinick’s treatment is safe and effective, why hide the evidence?

Footnotes:

[1] Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish
Thu, 24 Jul 2014
Rogue Medic
Article

[2] When Minions Attack
Sun, 26 Feb 2017
Rogue Medic
Article

[3] The comment where Blum cried Terrorist
comment on Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish
Frederick Blum
Comment

[4] 1984
George Orwell
Free Full Text from The University of Adelaide Library

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When Minions Attack

Minion vampire 1a
Image credit.
 

In the comments to Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish,[1] Frederick Blum (sometimes Frederick S. Blum) states that he does not like my criticism of Dr. Edward Tobinick for using inadequately tested treatment, on patients.
 

The fact that you’ve censored my comments speaks volumes about the kind of person you are, ” Rogue Medic.”[2]

 

I have not censored Frederick Blum’s comments. All comments are moderated. Not all spam is caught by the spam filter.

Since Frederick Blum’s earlier, similarly absurd, comment was approved and appeared in the comments hours before this comment, what leads Frederick Blum to conclude that this is censorship?
 

What are you afraid of being found out for, that you’re no more than a charlatan ?[2]

 

You chose to use the word charlatan. Since the topic is Dr. Tobinick, is this use of charlatan a Freudian slip?
 

Frederick Blum also obsesses about my use of a pseudonym, although I provide links to valid evidence and Frederick Blum only makes excuses to distract from the absence of valid evidence for Dr. Tobinick’s treatment.

Frederick Blum complains that it is wrong to criticize Dr. Tobinick for his failure to post valid evidence, since Dr. Tobinick uses his real name.

Is valid evidence less valid when I use a pseudonym?

No.

This gullibility is one of the primary reasons scams are so successful.

Bernie Madoff, perhaps the biggest thief of all time, had people, like Frederick Blum, defending his business. A lot of people trusted that con man for the same reason.

What was Bernie Madoff’s motto?
 

Also to his advantage, Madoff was adept at both selfpromotion and client relations. His corporate slogan, “The Owner’s Name Is on the Door,” would reinforce his managerial image, as well as provide his growing list of wealthy clients with a reassuring declaration—a personal acknowledgement of his fiduciary responsibility to them.[3]

 

Is Dr. Tobinick a medical, and much more dangerous, version of Bernie Madoff? Is Dr. Tobinick’s name on the door just a confidence gimmick?
 

You can’t hide the truth about yourself forever. Eventually it is seen for what it really is – the truth.[2]

 

We would be able to determine the truth about Dr. Tobinick, if Dr. Tobinick would adequately test his treatment.

Is the treatment safe, as Dr. Tobinick uses it?

Is the treatment better than a placebo, as Dr. Tobinick uses it?

Is the treatment as good as any adequately tested treatments, as Dr. Tobinick uses it?

The only suppression of the truth is from Dr. Tobinick and his worshipers, such as Frederick Blum.

What is the treatment?
 

The list of conditions for which Tobinick claims or even has patented use of Enbrel include Alzheimer’s, stroke, traumatic brain injury, Parkinson’s disease, carpal tunnel syndrome, brain tumor, spinal cord injury, and back pain. That quite impressive for a doctor who isn’t even a neurologist. Tobinick is an internist who, prior to curing a long list of neurological diseases, specialized in laser hair removal.[4]

 

Why doesn’t everyone go to a laser hair removal specialist for inadequately tested treatments?

I am sure that the FDA and the insurance companies are being unreasonable in wanting evidence of safety and efficacy.
 

And, the truth is that you have devised a falsified and libelous campaign against someone who is not only innocent but a truly great medical scientist with a proven honest intelligence that surpasses almost everybody else in medicine today, Dr. Edward Tobinick, only to further your own loathsome self serving agenda.[2]

A proven honest intelligence? Where did you come up with that nonsense? If an intelligent person uses a dangerous treatment, the treatment is still dangerous.

Go ahead. I dare you, Frederick Blum. Stop making excuses and provide evidence to back up your unsupportable claims.

Footnotes:

[1] Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish
Thu, 24 Jul 2014
Rogue Medic
Article

[2] Censorship comment by Frederick Blum
comment

[3] Catastrophe: The Story of Bernard L. Madoff, the Man Who Swindled the World
Deborah Strober & Gerald Strober
Kindle Locations 1077-1079
Phoenix Books, Inc.

From the website of Bernie Madoff – http://www.madoff.com on December 15, 2008. In Appendix A (Kindle Locations 2760-2765)
 

The Owner’s Name is on the Door

In an era of faceless organizations owned by other equally faceless organizations, Bernard L. Madoff Investment Securities LLC harks back to an earlier era in the financial world: The owner’s name is on the door. Clients know that Bernard Madoff has a personal interest in maintaining the unblemished record of value, fair-dealing, and high ethical standards that has always been the firm’s hallmark.

 

[4] Enbrel for Stroke and Alzheimer’s
Science-Based Medicine
Steven Novella
May 8, 2013
Article

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