Without science, medicine is just a bunch of placebos.

- Rogue Medic

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

.

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

[4] What do you do when a patient wakes up during CPR?
Tue, 08 Mar 2016
Rogue Medic
Article

[5] Ketamine For Anger Management
Sun, 06 Mar 2016
Rogue Medic
Article

[6] The RAD-57 – Still Unsafe?
Wed, 03 Feb 2016
Rogue Medic
Article

[7] Should you hold your breath while intubating?
Tue, 19 Jan 2016
Rogue Medic
Article

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‘Narcan by Everyone’ Does Not Seem to be Such a Good Idea

 
Now that we have almost everyone giving naloxone (Narcan) to suspected heroin overdose patients, the fatality rate must have dropped. The panacea must have worked. My criticism of the Narcan by Everyone programs must have made me a laughing stock.[1],[2],[3],[4]

No.

Does that mean that I am a prophet and that you should worship me?

No.

Explanations exist; they have existed for all time; there is always a well-known solution to every human problem — neat, plausible, and wrong. H.L. Mencken.

I have been pointing out that the plans assumed that there would not be any unintended consequences. I explained what some of the unintended consequences would be. Many people used logical fallacies to justify ignoring the likelihood of unintended consequences. The reasonable thing to do would have been to study the implementation, so that problems would be noticed quickly.

Misdiagnosis – giving naloxone to people who have a change in level of consciousness that is not due to an opioid (heroin, fentanyl, carfentanyl, . . . ) overdose.
 

Six of the 25 complete responders to naloxone (24%) ultimately were proven to have had false-positive responses, as they were not ultimately given a diagnosis of opiate overdose. In four of these patients, the acute episode of AMS was related to a seizure, whereas in two, it was due to head trauma; in none of these cases did the ultimate diagnosis include opiates or any other class of drug overdose (which might have responded directly to naloxone). Thus, what was apparently misinterpreted as a response to naloxone in these cases appears in retrospect to have been due to the natural lightening that occurs with time during the postictal period or after head trauma.[5]

Bold highlighting is mine.

 

Failure to ventilate – not providing ventilations to a patient who is not breathing. These patients are often hypoxic (don’t have enough oxygen to maintain life) and hypercarbic (have too much carbon dioxide to maintain life). If the patient is alive, ventilation should keep the patient alive, even if naloxone is not given or if the naloxone is not effective. If the patient is dead, giving naloxone will not improve the outcome.[6]

But . . . But . . . But . . . Narcan is the miracle drug!
 


Image credit.
 

In Akron, a small Ohio city, medical examiner Dr. Lisa Kohler has seen over 50 people die of carfentanil since July. Police Lieutenant Rick Edwards says his officers are “giving four to eight doses of [naloxone] just to get a response.”[7]

 

“Every day our paramedics start CPR on someone surrounded by empty naloxone vials… people give the naloxone and walk away,” she (Ambulance Paramedics of BC president Bronwyn Barter) said in an interview.[7]

 

Where should we start?
 

All patients considered to have opioid intoxication should have a stable airway and adequate ventilation established before the administration of naloxone.[8]

 

We keep making excuses for solutions that are neat, plausible, and wrong. Why don’t we start acting like responsible medical professionals and do what is best for our patients?
 

Thank you to Gary Thompson of Agnotology for linking to this for me.

Go read Response: ‘What happens when drugs become too powerful for overdose kits’

Footnotes:

[1] The Myth that Narcan Reverses Cardiac Arrest
Wed, 12 Dec 2012 20:45:29
Rogue Medic
Article

[2] Should Basic EMTs Give Naloxone (Narcan)?
Fri, 27 Dec 2013 14:00:22
Rogue Medic
Article

[3] Is ‘Narcan by Everyone’ a Good Idea?
Tue, 03 Jun 2014 23:00:38
Rogue Medic
Article

[4] Is First Responder Narcan the Same as First Responder AED?
Wed, 18 Jun 2014 17:15:43
Rogue Medic
Article

[5] Acute heroin overdose.
Sporer KA.
Ann Intern Med. 1999 Apr 6;130(7):584-90. Review.
PMID: 10189329 [PubMed – indexed for MEDLINE]

[6] The Kitchen Sink Approach to Cardiac Arrest
Mon, 16 Feb 2015 16:00:53
Rogue Medic
Article

[7] What Happens When Drugs Become Too Powerful for Overdose Kits?
Dr. Blair Bigham
Oct 4 2016, 12:11pm
Article

[8] Naloxone for the Reversal of Opioid Adverse Effects
Marcia L. Buck, PharmD, FCCP
Pediatr Pharm. 2002;8(8)
Medscape (free registration required?)
Clinical Uses

.

Happy Bill of Rights Day – 225 Years Old

bill-of-rights-hero-lg-1
 

The Bill of Rights was ratified on December 15, 1791, which makes today the 225th anniversary of being signed into law. The Bill of Rights protects the interests of minorities from oppression by tyrannical majorities. This is why we are not really a democracy, but a constitutional republic.

If a majority decides that a minority should not be entitled to the same rights as the majority, or promotes some rationalization of the difference as not being a valid difference, that minority can appeal to the courts for relief. On the other hand, there are no absolute rights, which would invalidate all other rights.

You can be executed for a crime you did not commit, even if you can prove that you are innocent. You have to appeal to the governor or president for intervention. As the Supreme Court decided –
 

Held: Herrera’s claim of actual innocence does not entitle him to federal habeas relief. Pp. 6-28.[1]

 

Due process of law does not require that the innocent be set free. Life, Liberty and the pursuit of Happiness are not to be found in the American Constitution. Life, Liberty and the pursuit of Happiness are not to be found in the Bill of Rights.

Rights also come with responsibilities. We need to respect the rights of others, no matter how much we might think that others cannot be trusted to make those decisions, while we claim to be able to make these same decisions, not just for ourselves, but for others.

If people of different races want to marry, the state governments are not permitted to use their authority to sanction marriages to deprive citizens of their right to marry based on tradition. States rights have limitations, just as individual rights have limitations.

Discriminating against citizens of a politically incorrect group for decades, or even centuries, is not a justification for continuing to deprive them of equal treatment under the law.

Others may use their freedom, which always comes with responsibilities, in ways we do not like, but that is part of the price of freedom.

Even though slavery was legal at the time of ratification of the American Constitution and Bill of Rights, and is still endorsed by the Bible, we have recognized that slavery is bad. Our Constitution caught up with a lot of the rest of the world.

The Bible still endorses slavery and says that I can sell my daughter as a sex slave.

What progress we are making. In the Middle Ages they would have burned me. Now they are content with burning my books. – Sigmund Freud

The Bill of Rights is much better than the Bible. Go blaspheme in celebration of the Bill of Rights, which protects us from those who would burn us, or our writing, or otherwise punish us for being honest.

Footnotes:

[1] Herrera v. Collins (91-7328), 506 U.S. 390 (1993)
Argued October 7, 1992
Decided January 25, 1993
US Supreme Court
Decision

 

In criminal cases, thetrial is the paramount event for determining the defendant’s guilt or innocence. Where, as here, a defendant has been afforded a fair trial and convicted of the offense for which he was charged, the constitutional presumption of innocence disappears. Federal habeas courts do not sit to correct errors of fact, but to ensure that individuals are not imprisoned in violation of the Constitution. See, e.g., Moore v. Dempsey, 261 U.S. 86, 87-88. Thus, claims of actual innocence based on newly discovered evidence have never been held to state a ground for federal habeas relief absent an independent constitutional violation occurring in the course of the underlying state criminal proceedings.

 

.

SWAT Fuel – Suing Me to Defend Their Scam

swat-fuel-stop-exposing-our-scam-or-we-will-sue
 

Earlier, I wrote about SWAT Fuel, explaining why SWAT Fuel’s amphetamine-like products are a scam and providing evidence.
 

How to scam the police – SWAT Fuel
 

Now, I am being threatened with a law suit, unless I remove what I wrote, all of the comments (even the fawning SWAT Fuel fanboy comments), and cease writing about SWAT Fuel.

Is SWAT Fuel a scam?

SWAT Fuel, Inc. has not provided any evidence of safety.

SWAT Fuel, Inc. has not provided any evidence of efficacy.

I asked for evidence.

I was threatened with a lawsuit.
 

Will I remove what I wrote? Will I stop criticizing the amphetamine-like products of the SWAT Fuel scam?
 

molon_labe-1a
 

Should I pretend that SWAT Fuel’s amphetamine-like concoctions are safe, when even SWAT Fuel cannot provide valid evidence of safety?

I do not approve of poisoning the police, the military, or anyone else. SWAT Fuel, Inc. needs to provide valid evidence that their amphetamine-like products are safe.

Should I pretend that SWAT Fuel’s amphetamine-like concoctions are effective, when even they cannot provide valid evidence of efficacy?

Amphetamine-like? If we are to believe their advertising, SWAT Fuel is even stronger than amphetamines – SWAT Fuel was described as being like strapping a JATO rocket to your back! SWAT Fuel does not seem to use that terminology any more. I ridiculed that language and they changed. Coincidence? I don’t know, but maybe I can persuade them to develop some ethics and produce some valid evidence.
 

How to scam the police – SWAT Fuel
 

.

Acupuncture vs intravenous morphine in the management of acute pain in the ED

ResearchBlogging.org
 

What does elaborate placebo mean?

An elaborate placebo is a placebo that does better than a pill, or injection, apparently because the patient has more invested in the belief the placebo will work. An injection of a placebo (saline solution) may be more effective than a pill of real pain medicine because of the ceremony involved in giving the placebo through IV (IntraVenous) access. A placebo that is more expensive tends to have more of an effect than a less expensive placebo.[1],[2]

Acupuncture requires a lot of investment on the part of the patient. A more elaborate placebo might be fire walking. I don’t know of any research on fire walking as a treatment for pain, but I would not be surprised if it is extremely effective.
 

fire walking 1
Image credit. Do not try at home.
 

We know that acupuncture is just a placebo because research shows that sham (fake/placebo) acupuncture works just as well as real acupuncture. Sham acupuncture generally means using toothpicks (rather than needles), not penetrating the skin, but always using locations that are not qi points.[3],[4],[5]

If the essence of acupuncture is the magic of the qi points, but the same effect is produced when staying away from the qi points, the qi points aren’t doing anything.

This study did not use a sham acupuncture group. We have no reason to expect real acupuncture to provide more pain relief than sham acupuncture, so how should we use this information?

Should we have people providing fake acupuncture in the ED (Emergency Department)?

If so, how should we do this?

Since it is not the acupuncture, but the patient’s reaction to the ceremony of the placebo that appears to be providing the pain relief, how many different ways might we vary the treatment to improve the placebo effect?

Should we set up a fire walking pit?

What are the ethical concerns of using placebo medicine, when the placebo appears to provide similar, but safer, relief than real medicine?

What are the ethical concerns of using deception to treat patients?
 

Acupuncture versus intravenous morphine in the management of acute pain in the emergency department 1 with caption
 

Overall, 89 patients (29.3%) experienced minor adverse effects: 85 (56.6%) in morphine group and 4 (2.6%) in acupuncture group; the difference was signi ficant between the 2 groups (Table 3). The most frequent adverse effect was dizziness in the morphine group (42%) and needle breakage in the acupuncture group (2%). No major adverse effect was recorded during the study protocol. (See Table 4.)[6]

 

If we ignore the problems with this study and with the problem of lying to patients to make them feel better, can we expect research journals to look more like alternative medicine magazines with article titles like –

How to lie to patients, so that . . . .

What is the best scam to relieve pain?

How much integrity do we sacrifice?

Since the ED does not appear to be the source of the increase in opioid addiction, should we sacrifice any integrity in pursuit of placebo treatments?

We have an epidemic of opioid addiction because of excessive prescriptions for long-term pain.

The answer is not to try to create an epidemic of magical thinking.
 

This paper was also covered by –

Emergency Medicine Literature of Note

NEJM Journal Watch Emergency Medicine

Life in the Fast Lane

Science-Based Medicine

And thank you to Dr. Ryan Radecki of Emergency Medicine Literature of Note for providing me with a copy of the paper.

Footnotes:

[1] Placebo effect of medication cost in Parkinson disease: a randomized double-blind study.
Espay AJ, Norris MM, Eliassen JC, Dwivedi A, Smith MS, Banks C, Allendorfer JB, Lang AE, Fleck DE, Linke MJ, Szaflarski JP.
Neurology. 2015 Feb 24;84(8):794-802. doi: 10.1212/WNL.0000000000001282. Epub 2015 Jan 28.
PMID: 25632091

Free Full Text from PubMed Central

[2] Commercial features of placebo and therapeutic efficacy.
Waber RL, Shiv B, Carmon Z, Ariely D.
JAMA. 2008 Mar 5;299(9):1016-7. doi: 10.1001/jama.299.9.1016. No abstract available.
PMID: 18319411

Free Full Text in PDF format from Duke.edu

[3] Acupuncture for Menopausal Hot Flashes: A Randomized Trial.
Ee C, Xue C, Chondros P, Myers SP, French SD, Teede H, Pirotta M.
Ann Intern Med. 2016 Feb 2;164(3):146-54. doi: 10.7326/M15-1380. Epub 2016 Jan 19.
PMID: 26784863

Free Full Text in PDF format from carolinashealthcare.org

[4] A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA.
Arch Intern Med. 2009 May 11;169(9):858-66. doi: 10.1001/archinternmed.2009.65.
PMID: 19433697

Free Full Text from PubMed Central

[5] Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial.
Goldman RH, Stason WB, Park SK, Kim R, Schnyer RN, Davis RB, Legedza AT, Kaptchuk TJ.
Clin J Pain. 2008 Mar-Apr;24(3):211-8.
PMID: 18287826 [PubMed – indexed for MEDLINE]

[6] Acupuncture vs intravenous morphine in the management of acute pain in the ED.
Grissa MH, Baccouche H, Boubaker H, Beltaief K, Bzeouich N, Fredj N, Msolli MA, Boukef R, Bouida W, Nouira S.
Am J Emerg Med. 2016 Jul 20. pii: S0735-6757(16)30422-3. doi: 10.1016/j.ajem.2016.07.028. [Epub ahead of print]
PMID: 27475042

ClinicalTrials.gov page for this study.

Grissa, M., Baccouche, H., Boubaker, H., Beltaief, K., Bzeouich, N., Fredj, N., Msolli, M., Boukef, R., Bouida, W., & Nouira, S. (2016). Acupuncture vs intravenous morphine in the management of acute pain in the ED The American Journal of Emergency Medicine DOI: 10.1016/j.ajem.2016.07.028

Espay, A., Norris, M., Eliassen, J., Dwivedi, A., Smith, M., Banks, C., Allendorfer, J., Lang, A., Fleck, D., Linke, M., & Szaflarski, J. (2015). Placebo effect of medication cost in Parkinson disease: A randomized double-blind study Neurology, 84 (8), 794-802 DOI: 10.1212/WNL.0000000000001282

Waber RL, Shiv B, Carmon Z, Ariely D. (2008). Commercial Features of Placebo and Therapeutic Efficacy JAMA, 299 (9) DOI: 10.1001/jama.299.9.1016

Ee, C., Xue, C., Chondros, P., Myers, S., French, S., Teede, H., & Pirotta, M. (2016). Acupuncture for Menopausal Hot Flashes Annals of Internal Medicine, 164 (3) DOI: 10.7326/M15-1380

Cherkin, D., Sherman, K., Avins, A., Erro, J., Ichikawa, L., Barlow, W., Delaney, K., Hawkes, R., Hamilton, L., Pressman, A., Khalsa, P., & Deyo, R. (2009). A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain Archives of Internal Medicine, 169 (9) DOI: 10.1001/archinternmed.2009.65

Goldman, R., Stason, W., Park, S., Kim, R., Schnyer, R., Davis, R., Legedza, A., & Kaptchuk, T. (2008). Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use The Clinical Journal of Pain, 24 (3), 211-218 DOI: 10.1097/AJP.0b013e31815ec20f

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When logic fails, throw propane on the fire?

 

Many of us have had discussions that became heated, because the other person would not see reason, we would not see reason, or neither of us would see reason. And that is if there are just two opinions involved.

Here is an article about someone who got a bit carried away with making his point and lost perspective.
 

A family argument over whether the Earth is flat or round became so heated that one of the participants threw a propane cylinder onto a campfire, prompting an intervention by firefighters.[1]

 

Flat Earth Hitler 1aa
 

I know. Dramatic, but harmless

Don’t worry.

Everybody knows that propane tanks have safety valves, so they don’t blow up.

Right?
 


 

It turns out that propane tanks do not share that opinion.

The following video does an excellent job of explaining why a full tank may take a while to explode. This is a BLEVE (Boiling Liquid Expanding Vapor Explosion), which any first responder should be familiar with. We should know enough to not throw, or even gently place, containers of flammable material on fires, unless intending to cause an explosion.
 


 

What about the topic of discussion? Is the earth flat?

Common sense tells us that the earth is flat.

Science, a systematic way for carefully and thoroughly observing nature and using consistent logic to evaluate results,[2] shows us that the earth is not quite flat.

There is an excellent short article explaining the way science has improved our understanding of the shape of the earth.
 

In the early days of civilization, the general feeling was that the earth was flat. This was not because people were stupid, or because they were intent on believing silly things. They felt it was flat on the basis of sound evidence. It was not just a matter of “That’s how it looks,” because the earth does not look flat. It looks chaotically bumpy, with hills, valleys, ravines, cliffs, and so on.[3]

 
 

Nowadays, of course, we are taught that the flat-earth theory is wrong; that it is all wrong, terribly wrong, absolutely. But it isn’t. The curvature of the earth is nearly 0 per mile, so that although the flat-earth theory is wrong, it happens to be nearly right. That’s why the theory lasted so long.[3]

 

There were observations that were not consistent with a flat earth. The rest of the article explains the way science showed us the more accurate answers.

Was the person right to throw a propane cylinder into a fire? No.

If the earth is not flat, does that mean that it is round? No.

Read The Relativity of Wrong and learn a bit about how science works and what it means to be wrong.

Footnotes:

[1] Police, firefighters called in after flat Earth debate turns heated – Man angered by suggestion Earth is flat threw propane tank into fire, police say
CBC News
Posted: Jun 14, 2016 5:09 PM ET
Last Updated: Jun 14, 2016 6:00 PM ET
Article

[2] Skeptical Quote of the Week
Quote by Dr. Steven Novella
The Skeptics’ Guide to the Universe
Podcast #410
May 25th, 2013
Synopsis
 

What do you think science is? There’s nothing magical about science. It is simply a systematic way for carefully and thoroughly observing nature and using consistent logic to evaluate results. Which part of that exactly do you disagree with? Do you disagree with being thorough? Using careful observation? Being systematic? Or using consistent logic? – Dr. Steven Novella.

 

[3] The Relativity of Wrong
By Isaac Asimov
The Skeptical Inquirer
Fall 1989, Vol. 14, No. 1, Pp. 35-44
Article from Tufts University

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