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

- Rogue Medic

Avoid the Stigma of Premature Press Release



Photo credit

There is so much wrong with this press release, that it might be used as an example of what to avoid, when making statements about medical treatment.

January 12, 2011 – CIRC Trial Concludes Successfully[1]

This raises a question.

What does concludes successfully mean?

Back in 2006, there was ASPIRE,[2] which was stopped early due to dramatically worse outcomes for the patients treated with the AutoPulse®. The great news is that this time the AutoPulse® did not appear to result in dramatically worse outcomes. Yay! Yippee! Yahoo!

Yawn.

What do the results show?

We don’t have the results, yet. They haven’t even completed entering the data. All we have is something that did not get kicked out of the study for being too dangerous for use on dead people, which is what happened last time.[2]

Double yawn.

What comes after the title, even before the dateline?

INVESTOR CONTACT:

A. Ernest Whiton
Chief Financial Officer
ZOLL Medical Corporation
+1 (978) 421-9655

MEDIA CONTACT:

Diane Egan
ZOLL Medical Corporation
+1 (978) 421-9637
degan@zoll.com
[1]

This is not a medical press release, but something to get investors to buy more stock. That is part of what the investor relations department does. They are also able to provide a lot of information about the company.

This press release is being sent around to medical people as evidence that the AutoPulse® is the answer to the prayers of someone who just found her father collapsed, unresponsive and pulseless, in the living room.

So, what does the press release say about the performance of the AutoPulse®?

First, there is a sub-headline –

CIRC (CIRCULATION IMPROVING RESUSCITATION CARE)TRIAL CONCLUDES SUCCESSFULLY
First Large Scale Resuscitation Trial to Reach a Statistically Significant Result
[1]

More yawning.

January 12, 2011─CHELMSFORD, MASS.–ZOLL Medical Corporation (Nasdaq GS: ZOLL), a manufacturer of medical devices and related software solutions, announced today the successful conclusion of the ZOLL-sponsored CIRC trial. The trial’s Data Safety Monitoring Board (DSMB) closed enrollment when an analysis of the data showed the load-distributing band (AutoPulse® Non-invasive Cardiac Support Pump) to be equivalent to manual chest compressions.[1]

As good as CPR?

WTF?

There is something else that is as good as CPR. It is called CPR.

Zoll, manufacturer of AutoPulse, has given the county 72 of the $15,000 machines. Each band is disposable and costs $125 to replace. Hillsborough Fire Rescue also gets $149,000 annually for training and personnel costs associated with the trial.[3]

“On behalf of all the CIRC investigators, we are excited about the conclusion of enrollment and look forward to presenting complete results later this fall. . . . ” said Dr. Wik.[1]

They have concluded enrollment and will not be able to present their results for at least 9 months.

This is kind of like a couple that is trying to conceive celebrating the birth of their child just because they had intercourse. This is more than a little premature.

Dr. Wik added, “EMS around the world will look at the CIRC result as positive for AutoPulse. They know how difficult it is to perform manual CPR on a regular basis. My gut feeling is that the CIRC results will increase AutoPulse interest.”[1]

OK. CPR is not easy, but does that mean that we should spend $15,000 for each ambulance and $125 for each patient, just to make things a little bit easier?

PS Be wary of scientists offering gut feelings.

I try not to think with my gut. If I’m serious about understanding the world, thinking with anything besides my brain, as tempting as that might be, is likely to get me into trouble. Really, it’s okay to reserve judgment until the evidence is in.[4]

So why are we having a press release when the evidence is not in?

Richard A. Packer, CEO of ZOLL commented, “We are pleased to see the CIRC trial successfully concluded and the AutoPulse equivalent to a Class I AHA recommended therapy. While we would have liked to have seen a superior outcome, this finding unequivocally confirms the AutoPulse’s role in improving resuscitation.”[1]

To clarify what he means. CPR is a Class I recommendation –

Generally for Class I recommendations, high-level prospective studies support the action or therapy, and the benefit substantially outweighs the potential for harm.[5]

The AutoPulse® does not appear to be statistically worse than CPR, but this is premature, since they haven’t even finished entering the results into their database.

Mr. Packer continued, “It will be some time before the complete picture unfolds as there are still some 400 patients that have yet to be entered into the database, and numerous sub-analyses to be completed. We look forward to publication of the trial’s details.[1]

We look forward to actual results, but right now we are celebrating not being kicked out of the study early as a danger to dead patients.

We believe the CIRC trial is the largest privately funded trial ever undertaken in the field of resuscitation. We introduced this technology to the market on the strength of earlier studies and with FDA clearance.”[1]

We have spent so much on this that we can’t image anything less than success.

“The AutoPulse is currently included in the just released 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science as a Class IIb intervention with a recommendation for additional studies,” he added. Mr. Packer concluded, “This outcome, had it been available, could have improved the recommendation related to the AutoPulse in the Guidelines.[1]

That still depends on what the outcome of this study actually is. We won’t know what the results are for about a year.

Suppose this expensive device is as good as CPR.

Does being as good as CPR mean that the AutoPulse® deserves a Class I recommendation?

Absolutely not.

Then there is this from the standard disclaimer required for investment advice – remember that this press release is not medical advice, this is investment advice

Because such statements are subject to risks and uncertainties, actual results may differ materially from those expressed or implied by such forward-looking statements.[1]

In other words, wait for the research to be published, otherwise you may end up just another example of PPR (Premature Press Release).

Does anyone remember Cold Fusion?[6]

There may be something useful to be gained from work on cold fusion, but the stigma as a result of the exaggerated claims made at a press conference continues to discourage many scientists from working on cold fusion.

Misleading expectations can produce a very negative backlash.

I will write more about the original study (ASPIRE[2]) that found the AutoPulse® to be unsafe for use on dead people.

I also wrote Extensive injury after use of a mechanical cardiopulmonary resuscitation device.

This patient treated with the AutoPulse® was not a trauma patient, but the injuries produced are examples of severe multi-system trauma. Why wouldn’t the patient get better when treated with a device that produces these injuries?

Maybe waiting for good evidence is a very good idea.

Footnotes:

[1] January 12, 2011 – CIRC Trial Concludes Successfully
Zoll
Press Release

[2] Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial.
Hallstrom A, Rea TD, Sayre MR, Christenson J, Anton AR, Mosesso VN Jr, Van Ottingham L, Olsufka M, Pennington S, White LJ, Yahn S, Husar J, Morris MF, Cobb LA.
JAMA. 2006 Jun 14;295(22):2620-8.
PMID: 16772625 [PubMed – indexed for MEDLINE]

Free Full Text from JAMA with link to Free Full Text PDF

[3] Life or death question: Is man or machine better at CPR?
Rebecca Catalanello, Times staff writer
In Print: Saturday, January 10, 2009
St. Petersburg Times
Article

[4] The Demon-Haunted World : Science as a Candle in the Dark (1995)
by Carl Sagan
Ch. 11 : The Dragon in My Garage, p. 180
Quote from Wikiquote

[5] AHA Classes of Recommendations and Levels of Evidence
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 2: Evidence Evaluation and Management of Potential or Perceived Conflicts of Interest
Medications for Arrest Rhythms
Development of the AHA Guidelines
Free Full Text Article with links to Free Full Text PDF download

[6] Cold Fusion
Wikipedia
Article

.

Lies, Damned Lies, and Medical Science – Part I

Also posted over at the new podcast specifically for EMS research – EMS Research Podcast. On episode 2 we discuss several topics, including the article Lies, Damned Lies, and Medical Science, by David H. Freedman. This article suggests that medical research is always wrong. Since we were discussing this on a podcast about research, I would have expected much more interest in this critical topic.

Since this is an article about the research done by Dr. John Ioannidis, does the article accurately represent the research of Dr. Ioannidis?

First, let’s look at the evidence provided in the article and the way it is presented.

Just as I was getting the sense that the data in drug studies were endlessly malleable, Ioannidis, who had mostly been listening, delivered what felt like a coup de grâce: wasn’t it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it’s the questions that are biased, not the answers,” he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?[1]

There are not many direct quotes in the article, rather there are many interpretations of what Dr. Ioannidis says. This is one of the problems with the article. The article purports to be about the problems with the objectivity of medical research, but the author of the article is constantly inserting his own opinion where we should be reading the words of Dr. Ioannidis.

“Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all.” – David H. Freedman.

A newspaper headline has nothing to do with science. Newspaper headlines are the interpretation of isolated research by non-scientists for an audience of non-scientists. There is plenty of excellent coverage of the problems with this kind of bad journalism at Gary Schwitzer’s HealthNewsReview Blog.

Do journalists do a good job of reporting science?

No.

Does that mean that medical science is a Lie?

Does that mean that medical science is a Damned Lie?

If we are buying what Dr. Mr. Freedman is selling, then medical science is not just a lie, but a damned lie. After all, Dr. Mr. Freedman is a journalist presenting medical research in a way designed to sell the most copies and make a lot of money to get the most people to read his story.

The reporting of medical science press releases from non-scientists publicizing the research done by scientists is not a significant part of the problem. Only the science is the problem – at least, if we are buying what Dr. Mr. Freedman is selling.

“Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?” – David H. Freedman.

According to Dr. Mr. Freedman?

Or

According to Dr. Ioannidis?

As I intend to point out further, these two answers are not within six sigma of each other in the same ballpark.

His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.[1]

Scientists publicly admitting that there are problems?

Journalists writing about scientists pointing out the limitations of the research that they publish?

Or

Journalists promoting the new cure for cancer in humans every time something is shown to correlate with less growth of cancer in a single mouse.

The job of a journalist is to ask the tough questions.

The job of a journalist is to understand the material being presented.

The job of a journalist is not to republish a press release from a drug lab, sometimes just cutting and pasting the entire press release into the newspaper, magazine, or web page.

Still, we often get nothing more than press releases forwarded by the news media.

Is this a failure of science?

To be continued in Lies, Damned Lies, and Medical Science – Part II and later to be continued in Lies, Damned Lies, and Medical Science – Part III.

Footnotes:

[1] Lies, Damned Lies, and Medical Science
The Atlantic
by David H. Freedman
Article

.

Does CNN have Any Credibility Left?

Apparently, Jon Stewart is now writing material for CNN. The network that I have criticized for their incompetent reporting of medical topics, has decided to branch out into comedy.

Wolf Blitzer, who either has a great poker face, or really believes what he is saying, claims that SNL (Saturday Night Live) has not been completely accurate in their portayal of President Obama. Wait! Let me check my calendar. Maybe I had a Rip van Winkle episode, here. No, I did not sleep until April Fool’s Day, nor is it mischief night. This is just CNN demonstrating that the future of journalism is definitely not on their network.

Next, CNN investigates professional wrestling to see if WWE is as scripted as reality TV.

Jon Stewart did a great job of reporting on the way CNBC covered financial news during the financial crash of a year ago. Jon Stewart had me laughing and had me impressed with his understanding of finance. CNN? Not so much.

This just in – CNN has unearthed an incredible story. Amos ‘n’ Andy were white. They were wearing makeup. Stop the presses!

I should send in a resume. Their hiring standards are incredibly low. I, Hildy Johnson, have experience covering executions. Nah, too obvious.

Just kidding. This is CNN. Nothing is obvious to them.

In the video, there is a guy assessing the accuracy of the facts presented in the comedy skit. He makes a big deal of claiming, that even though everything else is accurate, you can’t tell the difference between Afghanistan and Maybery. I guess, I just misunderstood why George Will was writing that it is Time to Get Out of Afghanistan. I thought that George Will was saying that things are really bad – that we do not have any more chance of winning than the Soviets did a couple of decades ago, or the British over a century ago. Silly me – I was reading. CNN does not appear to be competing for an audience that reads.

Maybe we should ship CNN over to Afghanistan. The jihadists will be laughing so hard at these journalists that they won’t be able to shoot straight.

I wrote about CNN’s medical coverage of a brain dead baby. This was a year and a half ago. They still have not changed the video. I wrote to the station and I wrote to Dr. Sanjay Gupta. You know Ask Dr. Gupta, their medical expert. He is somebody who should be able to look at this and say, That is completely wrong. Change it. After all, Dr. Gupta is a neurosurgeon. For those of you who get your medical information from CNN and might not understand the big word, a neurosurgeon is a brain surgeon.

I am still waiting. The video is still there with the same completely wrong information. Maybe Dr. Gupta is still looking for his medical dictionary.

I almost feel guilty for picking on such obvious idiots. Then I rememeber that they are getting paid for their incompetence. I guess Wolf Blitzer got into journalism, because the basket weaving class was too difficult. If Dr. Gupta is your surgeon, don’t bother writing, Other Side on the part of your head he is not supposed to operate on. That may be too complex. Maybe draw a skull and crossbones. Better yet just run away.

Maybe he did his residency with Mitchell and Webb.

CNN is Selling Snake Oil – All You Have to Do is Believe.

Atomic Nerds take some shots at CNN, as well. LOOK OUT, MR. PRESIDENT! MOCKERY! H/T The Smallest Minority – CNN Fact-Checks SNL.

.

Death of Jett Travolta – Part II

I wanted to hold off on criticism of this, since it appeared that more information would be forthcoming shortly. Since it does no longer appears that we will get more information,[1], [2], [3] I might as well comment based on the information that is out there.

Seizures are treatable.[4]

Jett Travolta was treated with Depakote,[5] one of many anti-seizure medications.

After a while, the Depakote was stopped.

No indication is given that any further treatment was attempted.

A seizure is the reported cause of death for Jett Travolta

There is no requirement for public release of any further information, since this death is considered a natural death.

A child has an illness.

That illness is not treated at time of the child’s death.

The child’s death is attributed to that illness.

Natural?

Then there are other ideas about what illness affected Jett Travolta.[6], [7]

Footnotes:

^ 1 Seizure Alone Caused Jett Travolta’s Death
Autopsy On Actor’s Son Shows No Sign Of Head Trauma; Grieving Family Prepares For Funeral
NASSAU, Bahamas, Jan. 6, 2009
Article

^ 2 Coroner Says Jett Travolta Autopsy Results May Never Be Released
FOX News
Monday, January 05, 2009
Article

^ 3 VIDEO: Dr. Cyril Wecht explains what pathologists were looking for in Jett Travolta autopsy.
The video is from the article above it. This may just bring you to that page. If so, scroll down to where you see the link on the page. it is not far down.

^ 4 Tonic-Clonic Seizures
David Y Ko, MD, Associate Professor, Laboratory Director, Department of Neurology, University of Southern California Medical Center
Soma Sahai-Srivastava, MD, Director of Neurology Ambulatory Clinics, LAC & USC Medical Center, Assistant Professor, Department of Neurology, University of Southern California
eMedicine
Article

^ 5 depakote (divalproex sodium) capsule for oral use
[Abbott Laboratories]
From DailyMed
Full Text . . . FDA PDF

^ 6 John Travolta’s brother Joey thought Jett had autism
The Dish Rag by Elizabeth Snead
Article

^ 7 More on Jett Travolta: an audio recording of L. Ron Hubbard talking about epilepsy
6 01 2009
Number 6-Anonymous Warrior
Blog post

.

RSI Problems – What Oversight?

In High-risk EMS procedure gets a low level of oversight,[1] an article in the Star-Telegram, Danny Robbins writes about problems with airway management in EMS, specifically RSI (Rapid Sequence Induction, sometimes referred to as Rapid Sequence Intubation). Danny Robbins is a reporter who has won a bunch of awards, does his homework, and puts out a balanced piece of journalism. For one thing, he seems to recognize the problem as one of oversight more than skill.

It appears that the AP (Associated Press) has picked up the story and there are abbreviated versions of it turning up all over Texas. The rest of the country may add to the commotion. There is a pretty good Interactive graphic: RSI with the story. One of the other papers to pick up on the AP redistribution is the Houston Chronicle in their abbreviated story Health officials question high-risk intubation procedures. Ordinarily, I would not mention the derivative story, but they have a comment section at the end of the article that is interesting. EMS1.com also has the story and a comment section.

The Interactive graphic: RSI is a bit misleading without the rest of their course to explain the steps and the importance of all parts of the procedure. There are two problems that I have with it. On the slide for RSI step 3, the suggestion that cricoid “Pressure prevents stomach contents from entering the airway,” is not accurate. Dr. Bryan Bledsoe, interviewed in this article, wrote about the shortcomings of Sellick’s Maneuver, or cricoid pressure on EMS1.com. Sellick’s Maneuver — Not the Panacea We Thought.

Then on the slide for RSI step 6, the CO2 (carbon dioxide) detector is, in my opinion, not appropriate for RSI. There should be a requirement for waveform capnography for all RSIs. The plastic piece stuck on the end of the tube contains some litmus paper that changes color to indicate the presence of an acid – carbon dioxide. It loses its ability to change color, react to CO2, in the presence of moisture.

Breathe in some dry air and when you breathe out, it will be moist. If you have ever seen a couple fogging up a car, exhaled moisture and cool night air are the reasons for the condensation on the windows. For another example of this, take a color change CO2 detector, open the package and breathe through the detector. Don’t worry, you won’t be ruining anything of value. How many breaths does it take until the litmus paper stops changing color? In my experience, these detectors fail on real patients – due to moisture – at ridiculously high rates.

If you wish to monitor CO2, use waveform capnography. A site that explains this in a lot of detail is Capnography for Paramedics. Waveform capnography is capable of providing far more than just information about tube placement. If the patient has a sudden change in cardiac output, waveform capnography will spot that before any other assessment method will. The patient regains a pulse, the CO2 increases significantly. The opposite is true if the patient arrests. Having trouble differentiating between CHF and asthma, or emphysema? Waveform capnography can be a tremendous help.

But let me just offer my modest opinion. Anyone intubating without waveform capnography is asking for trouble. There are very few exceptions. The printout from waveform capnography is more trustworthy than any other method of confirming placement. Including direct visualization. If anything bad happens to the patient, produce a couple of printouts of good CO2 numbers and you can be certain that the tube was not in the esophagus at the times the recordings were made.

Or you can use some other method and try to explain that the tube must have moved after it was placed correctly. Almost always this is what medical professionals, in an effort to be accurate, call a lie. Without any form of documentation it is easy to claim that some form of magical intervention caused the tube to move. “Winged monkeys sighted over ambulance after successful intubation. On arrival at the hospital the tube was found to be in the esophagus. News at 11.”

Read this excuse of the paramedic “training coordinator” for AMR (American Medical Response), who committed the one most unforgivable sin of airway management – he did not recognize that the tube was in the wrong place.

The paramedic, Jeffrey Dektor, stated in a deposition that he made two attempts to intubate Cannon, the second time with the ambulance stopped at a parking lot.

He testified that he believed his first attempt was successful but tried again with a larger tube when he noticed that Cannon’s oxygen saturation levels continued to decline. During that attempt, he said, the tube became dislodged.

Asked why he didn’t use any form of carbon dioxide monitoring, even though it would have been available on the ambulance, he replied: “I cannot state why I did not.”

Twenty minutes passed from the time of Dektor’s first attempt until Cannon was successfully intubated at Presbyterian Hospital, records show.[2]

The medical director did not have any problems with this. There are not words strong enough for such indifference. How can a medical director be complacent about a medic who cannot recognize a misplaced tube? Another way of describing a misplaced tube is a suffocation device.

Everybody seems to put the blame on the medic. The medic was doing what he was taught by the medical director. The medical director probably mentioned the end tidal CO2 device, but perhaps did not stress it enough and clearly did not do enough continuing education. The biggest problem with this infrequently performed skill is the lack of competent oversight.

Robert Kowalski, who was the hospital’s director of emergency medicine as well as Hunt County EMS medical director at the time, confirmed in his deposition that he was the physician who finally intubated Cannon.

He stated repeatedly during the deposition that the matter did not cause him any concern.

Kowalski, who now lives in Cadillac, Mich., said recently he doesn’t remember the case well enough to discuss its details.

“It was not a paramedic we had problems with, I can tell you that, because I know the [paramedics] we had problems with, and he wasn’t one of them,” he said.(article)

So, this is not one of the bad medics Dr. Robert Kowalski continues to allow to treat patients, in spite of his knowledge of their danger to patients. This abuse of a patient’s airway was an action that Dr. Robert Kowalski did not have a problem with. Should we blame the medic or the medical director. This is another example of the dangerous Medic X that I wrote about here, here, here, here, and here. Not that I have an opinion on this mistreatment of patients by medical directors.

Dr. Robert Kowalski knows the medics he has problems with, but only seems to know that he did not identify this medic as one of the problem medics. Did Dr. Robert Kowalski know any of his good medics? Did Dr. Robert Kowalski have any good medics?

EMS personnel work in an environment that can be noisy, bumpy, and distracting. Waveform capnography helps you to deal with those problems that interfere with a good assessment. To not use waveform capnography is very bad risk management. To not have a problem with not using waveform capnography is beyond reckless.

There are courses that do an excellent job of teaching medics, nurses, and doctors to use RSI safely. RSI is a tool. A tool can be misused by any tool. RSI is not dangerous. A poorly planned for RSI is dangerous. A poorly trained for RSI is dangerous. Unskilled people performing RSI is dangerous.

Having well trained people, with excellent oversight, perform RSI is not dangerous.

Probably the best known of the courses to teach all aspects of airway management from BVM to RSI is SLAM (Street Level Airway Management). Their courses are not cheap.When it comes to airway management, there is no such thing as cheap. If you do not pay to train your people well (doctor, nurse, medic) you will end up paying more for it in the end. They also have a book available on their site and elsewhere. Danny Robbins interviewed one of their instructors , Gene Gandy, for the article.

The issue of whether RSI should be practiced by ground EMS was underscored by the Cannon lawsuit, which charged that American Medical Response never retrained the paramedic who attempted to intubate Patricia Cannon even after the company, based in Greenwood Village, Colo., became aware of the facts of the case.(article)

When I make a mistake, which happens more often than I would like, I follow up by doing what I can to avoid making that mistake again. According to this article, AMR (American Medical Response) apparently does not see inexcusable mistakes that kill patients as any kind of a problem. It is unfortunate that there were no criminal charges brought against AMR and their medical director – Dr. Robert Kowalski.

Poor performance of RSI is an indication of poor medical oversight. RSI is a tool. As a tool, it can be used properly, or it can be misused. If it is allowed to be misused, that is the fault of the medical director. How can anyone say that the liability should be placed anywhere else?

That is plenty of writing for now.

Other posts about this:

More RSI Oversight

Misleading Research

Intubation Confirmation

More Intubation Confirmation

RSI, Intubation, Medical Direction, and Lawyers.

RSI, Risk Management, and Rocket Science

My other posts on OLMC requirements and Medic X are:

OLMC (On Line Medical Command) Requirements Delenda Est

OLMC for President!

OLMC = The Used Car Dealers of EMS?

OLMC For Good Medics

Fun with explosives – NTG.

Footnote:

^ 1 RSI procedure gets low level of oversight in Texas
The Star-Telegram article is no longer maintained at their site, but EMS1.com has what I believe is the full article on their site. This was published in various abbreviated formats by various news organizations. The abbreviated articles usually were attributed to AP or some other news organization, rather than to Danny Robbins.
High-risk EMS procedure gets a low level of oversight at JEMS.com

Now apparently only available at Free Republic.

^ 2 All quotes are from the same article. The current link I am using is High-risk EMS procedure gets a low level of oversight at JEMS.com

.

CNN is Selling Snake Oil – All You Have to Do is Believe.

CNN has recently run two stories that seem to have nothing to do with journalism. Rather, they mock journalism.

Brain-dead baby recovers trumpets the news that a baby who was brain-dead really recovered. In the story, not that anyone reads details any more, they only mention that the baby was pulseless. Nowhere in the story is there any mention that he was brain dead.

Should CNN change the misleading and unethical title?

No, this brings viewers and CNN can do anything to make more money.

In the more recent story, Man declared dead, says he feels ‘pretty good, in the article CNN claims that the man was brain-dead, but no medical staff are quoted. No mention of attempting to obtain comments from the doctor in charge of this man’s care.

His father, Doug, said he saw the results of the brain scan.

“There was no activity at all, no blood flow at all.”

Maybe I am a cynic, but I’m guessing that this is the first “brain scan” that he has claimed to have seen. We might want a second opinion, maybe from someone trained to interpret them.

Not if you are CNN or Associated Press – the attributed source of the story.

What happened to at least two sources?

What happened to common sense?

What happened to medicine?

It seems that CNN has become jealous of the ratings of reality TV shows and want to join in.

Well, reality TV is as much about reality as homeopathy is about patient care.

Maybe I will vary my patient pseudonym between CNN and Dr. Deborah Peel – two peas in a pod.