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

- Rogue Medic

NIH clinical trial of remdesivir to treat COVID-19 begins

Tue, 25 Feb 2020 17:00:12 -0500 by
     

The University of Nebraska Medical Center (UNMC) in Omaha is the receiving facility for Americans repatriated with suspicion of infection with COVID-19 (COronaVIrus Disease 2019). UNMC will be enrolling patients in a double-blind study comparing standard treatment with an investigational antiviral drug against standard treatment with a placebo.[1]

The start of this study does not mean that anyone knows, or even has has good reason to believe, that remdesivir is an effective treatment in humans for COVID-19. Remdesivir is an investigational antiviral that has been tested on other coronaviruses, but has not been shown to be effective in treating humans. Remdesivir was also studied as a possible treatment for ebola virus (a filovirus), and was found to be effective in other species, but was not found to be effective in humans.
 

About Remdesivir Remdesivir is an investigational nucleotide analog with broad-spectrum antiviral activity – it is not approved anywhere globally for any use. Remdesivir has demonstrated in vitro and in vivo activity in animal models against the viral pathogens MERS and SARS, which are also coronaviruses and are structurally similar to COVID-19. The limited preclinical data on remdesivir in MERS and SARS indicate that remdesivir may have potential activity against COVID-19.

This is an experimental medicine that has only been used in a small number of patients with COVID-19 to date, so Gilead does not have an appropriately robust understanding of the effect of this drug to warrant broad use at this time.[2]
 

What is the most common symptom?

There does not appear to be any symptom that is always present.

Travel to China, or to the region of China where COVID-19 was first identified, or contact with people who were in contact with people known to be infected with COVID-19 are often present, but not always. Cough and fever appear to be the most common symptoms, but that are also not always present.

The full text of the first case in the US is worth reading.[3] A 35 year old male with a cough and no fever (37.2°C – 99.0°F), but he felt like he had a fever, went to an urgent care clinic, based on his symptoms and news reports. He did not test positive for anything else that is screened for. A sample was sent to the CDC (Centers for Disease Control and Prevention). He was treated with a variety of medications. A day after he was treated with remdesivir, he began to improve. Was he just getting better on his own? We do not know, but the research at UNMC should help to answer that question. Given the number of patients, and the already known distribution of patients, there should be plenty of participants, unless someone decides to promote the political witchcraft of “compassionate use”.[4] Then we may never know and remdesivir could become the blood-letting of the 21st century.

Footnotes:

[1] NIH clinical trial of remdesivir to treat COVID-19 begins Study enrolling hospitalized adults with COVID-19 in Nebraska.
Tuesday, February 25, 2020
National Institutes of Health (NIH)
News release

and –

NIH Clinical Trial of Remdesivir to Treat COVID-19 Begins Study Enrolling Hospitalized Adults with COVID-19 in Nebraska February 25, 2020
National Institute of Allergy and Infectious Diseases (NIAID)
News release

[2] COVID-19 Gilead Sciences Update On The Company’s Ongoing Response To COVID-19
Gilead Sciences
Article

[3] First Case of 2019 Novel Coronavirus in the United States.
Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, Spitters C, Ericson K, Wilkerson S, Tural A, Diaz G, Cohn A, Fox L, Patel A, Gerber SI, Kim L, Tong S, Lu X, Lindstrom S, Pallansch MA, Weldon WC, Biggs HM, Uyeki TM, Pillai SK; Washington State 2019-nCoV Case Investigation Team.
N Engl J Med. 2020 Jan 31. doi: 10.1056/NEJMoa2001191. [Epub ahead of print]
PMID: 32004427

Free Full Text from N Engl J Med.

[4] “Right to try” laws create tremendous legal uncertainties; FDA expanded access preferable The Goldwater Institute and the Kochs pushed “right to try” laws in an attempt to get rid of FDA oversight of access to investigational drugs. Instead, they created tremendous legal uncertainties, making the FDA’s expanded access program preferable for all.
Jann Bellamy
January 17, 2019
Science-Based Medicine
Article

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Filed Under: COVID-19, EBM, Evidence, Heresy, Research, Research Blogging, Science, Understanding

This Rhythm is Hilarious

Fri, 04 Jan 2019 12:46:23 -0500 by
 


Click on the image to make it larger.
 

Apparently, the second 12 lead was after 150 mg of amiodarone. The hilarity is the amiodarone.

I received this in an email. It is reported to have been posted on Facebook, but I choose not to have access to Facebook, so I do not have any more details. I am occasionally tempted to set up an account again, but I generally prefer intentional comedy.

Everything you need to know is in the first 12 lead.

Things that do not matter:

Distance to the hospital.

Time of onset.

Last meal.

National Registry certification.

Et cetera.

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Filed Under: ACLS, Assessment, Cardiology, Critical Judgment, Heresy, Pharmacology, Placebo, Understanding, V Tach

Baltimore Hospital Dumping Patients – Is it that simple?

Mon, 22 Jan 2018 22:35:05 -0500 by
 
You watch the video and wonder how could anyone be so callous and cold, to leave someone outside with only a hospital gown to wear – especially when it is so cold outside.

Is what we are seeing callous, or uncaring?

In the video farther down, there is a nice discussion of the problems, which are much more complicated than somebody being refused care for some bad reason.

I found a site that did mention her clothes being with her, but stated with her clothes and belongings scattered on the sidewalk. Here is the picture they posted. The clothes are in plastic patient belongs bags.
 


 

Psychotherapist Imamu Baraka was walking near the University of Maryland Medical Center’s midtown campus location when he saw a woman being dropped off by security at a bus stop with her clothes and belongings scattered on the sidewalk.[1]

 

Why didn’t she put her clothes on?

One of the first things discharged patients will do, if they can, is put their own clothes on.

There is no evidence that anyone was refused care. That would be an EMTALA (Emergency Medical Treatment and Labor Act) violation, resulting in a very big fine, which would be reported. Maybe I am wrong, but I do not expect that an investigation will end with any finding of any refusal to provide care.

But we saw it on the video!

No. I think that you saw someone being removed from private property for bad behavior in a hospital gown, and she refused to put on her own clothes on (the clothes in her bag) for reasons of her own.

Here is a video explaining this in more detail, but a couple of notes about people mentioned in the video.

Charlie Gard was an infant with irreversible MDDS (Mitochondrial DNA Depletion Syndrome). The doctors and nurses seem to have understood this, but parents, politicians, preachers, and the press thought that it would be a good idea to torture Charlie Gard with an experimental treatment with no expectation of a better outcome.

How would Solomon decide? To torture, on the ridiculously small chance of a better outcome, or to do not further harm?

Peter Gallogly is a doctor, who was selectively recorded on video to make it seem as if his unprofessional behavior was unprovoked. If you watch the video of Dr. Gallogly, realize that it is edited to distort reality. If you watch the ironically named Project Veritas videos of abortion clinics, they are similarly edited to distort reality, which is why they have been rejected as evidence in court. You might as well watch a Michael Moore film, if you want a highly edited distortion of reality.

The Delnor nurse protected staff from an escaped prisoner, when the corrections officer apparently fled. The nurse ended up being abducted for hours, grazed by a bullet, pistol whipped, and raped, but was reported as being unharmed after the inmate was killed.

 


 

We need to learn how to find out accurate information for ourselves, rather than blindly accept propaganda from far left or far right news sources. Even the mainstream news will often get information in specialized fields wrong and not realize it. When the story is from a specialized field, such as medicine, we should obtain our information from trustworthy people in that field.

More information on Charlie Gard.

More information on Peter Gallogly.

More information on the Delnor nurse.

All of the videos are from ZDoggMD.com

–

Footnotes:

–

[1] Video shows Baltimore hospital discharging half-naked woman into cold winter night
Ana Valens
Jan 11 at 7:27AM | Last updated Jan 12 at 3:36AM
The Daily Dot
Article

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Filed Under: Critical Judgment, Ethics, Evidence, Heresy, HIPAA, Narrative Fallacy, Understanding

The March for Science is a March for Honesty and Accountability

Mon, 24 Apr 2017 02:00:13 -0400 by

 

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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Filed Under: Critical Judgment, Ethics, Evidence, Heresy, Research, Risk Management, Science, Understanding

Happy Play God Day

Mon, 09 Jan 2017 23:59:24 -0500 by
 
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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Filed Under: Blasphemy, Critical Judgment, Heresy, Understanding

Happy Bill of Rights Day – 225 Years Old

Thu, 15 Dec 2016 23:00:34 -0500 by
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.

 

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Filed Under: Blasphemy, Censorship, Civil Rights, Corruption, Critical Judgment, Ethics, Heresy, Law, Politics, Understanding

Flag burning, patriotism, and reality

Tue, 29 Nov 2016 15:00:00 -0500 by

flagburningtrump2a

Tweet by President-elect Donald Trump on flag burning
 

Is appearance more important than reality?
 

Why do people burn the American flag?

There may be many reasons, but the essence appears to be an attempt to shock people to recognize what the flag burners see as hypocrisy.

What is the purpose of prohibiting burning of the American flag?

Some people place more value in this symbol of America (the flag), than they do in what makes America great (the Constitutional protections of the rights of Americans).

Is President-elect Trump an opponent of the American Constitution? Is President-elect Trump just engaging in a politically correct theatrical display for people who do not seem to understand that the American Constitution doesn’t care if their feelings get hurt?
 


 

In 1798, Congress passed, and President John Adams signed, the Alien and Sedition Acts.[1] These restricted eligibility to vote, restricted immigration, allowed for increased deportation of aliens considered dangerous, and made criticism of the federal government illegal. This is one example of Founding Fathers acting in a way that is contrary to what many consider their original intent.

Recently deceased Supreme Court Justice Antonin Scalia voted in the majority to protect flag burning in 1989.[2] Did Justice Scalia hate America, hate the American flag, or is it more complex than an early morning tweet can express?

In 1943, during World War II, the Supreme Court decided on a variation of this concept. Is it Constitutional to force people to demonstrate patriotism?
 

To believe that patriotism will not flourish if patriotic ceremonies are voluntary and spontaneous instead of a compulsory routine is to make an unflattering estimate of the appeal of our institutions to free minds.[3]

 

Real patriotism is not a politically correct compulsory display.
 

But freedom to differ is not limited to things that do not matter much. That would be a mere shadow of freedom. The test of its substance is the right to differ as to things that touch the heart of the existing order.[3]

 

The American Constitution does not authorize thought crimes.
 

If there is any fixed star in our constitutional constellation, it is that no official, high or petty, can prescribe what shall be orthodox in politics, nationalism, religion, or other matters of opinion or force citizens to confess by word or act their faith therein. If there are any circumstances which permit an exception, they do not now occur to us.[3]

 

What about those who claim that Americans have risked their lives, and even died, to protect the sanctity of the American flag? Does service in any branch of the American military contain any oath to protect the American flag?
 

(a) Enlistment Oath .-Each person enlisting in an armed force shall take the following oath:
“I, ____________________, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to regulations and the Uniform Code of Military Justice. So help me God.”[4]

 

The So help me God is optional, since there is no truth to the myth that there are no atheists in foxholes and the American Constitution prohibits all religious requirements for service.

The oath is to protect the American Constitution, which protects flag burning. The oath is not to protect the American flag.

Even Jesus stated opposition to this kind of political theater.
 

5 “When you pray, you are not to be like the hypocrites; for they love to stand and pray in the synagogues and on the street corners [a]so that they may be seen by men. Truly I say to you, they have their reward in full. 6 But you, when you pray, go into your inner room, close your door and pray to your Father who is in secret, and your Father who sees what is done in secret will reward you.[5]

 

What does it say about America that we reward theatrical patriotism, rather than respect for the Constitution which makes America great?

Or is President-elect Trump taking initial steps to try to get Citizens United v. Federal Election Commission[6] overturned by expressing that not everything is protected expression? Who can tell with someone who expresses himself in such a vague manner?

Is appearance more important than reality?

–

Footnotes:

–

[1] Alien and Sedition Acts
1798
Primary Documents in American History
Library of Congress page

–

[2] Texas v. Johnson, (1989)
No. 88-155
Argued: March 21, 1989
Decided: June 21, 1989
United States Supreme Court
case

–

[3] West Virginia State Board of Education v. Barnette (No. 591)
Argued: March 11, 1943
Decided: June 14, 1943
case

–

[4] §502. Enlistment oath: who may administer
Text contains those laws in effect on November 28, 2016
US Code page

Amended in 1962 – inserted “So help me God” in the oath, and “or affirmation” in text.

–

[5] Matthew 6:5-6
New American Standard Bible (NASB)
You can go to the site and look up all of the other versions of the Bible or just pick up a Bible and read this.
Bible Gateway
Bible

–

[6] Citizens United v. Federal Election Commission
2009
case

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Filed Under: Appearances, Blasphemy, Censorship, Civil Rights, Critical Judgment, Ethics, Law, Politics, Public Relations, Understanding

Why US EMS will never get to sit at the adult table – The Appeal to Authority

Sun, 04 May 2014 12:00:39 -0400 by
 

Do you like articles that inveigh against EMTs/paramedics and EBM (Evidence-Based Medicine)?

Here are some samples from a rant by my friend Mike.
 

Here is the bottom line, at the top of the page, they have too little education, do not understand science, and are too simple minded.[1]

 

Apparently, an EMT irritated him. I have occasionally been a source of irritation for Mike.

EMS does have too little education, but the problem is less about the quantity, than it is about the quality. If EMS education were more evidence-based that would improve the quality, but it would not make Mike happy.

People do not understand science. Things appear to be improving in both EMS and medicine. This article is an ironic example of the problems with medicine, with understanding science, and with the use of evidence.

There is really only one example of the use of valid evidence –
 

Maybe you were even one of those services that “forced” your local hospital to institute the now questionable practice of hypothermia based on “science?” More sad news, you were duped.[1]

 

I have written about the research which shows that prehospital therapeutic hypothermia with IV (IntraVenous) fluid does not work.[2],[3],[4],[5]

Mike does not explain how he came to the conclusion that the science pathophysiology was wrong. Was it a lucky guess?
 

You should do yourself a favor and go read some of the many websites on science based medicine compared to “evidence based medicine.”[1]

 

Mike follows this recommendation with a list of some of the potential problems with research. We do need to better understand research, but a lack of perfection affects everything, so imperfection is not a reasonable criticism of EBM or SBM (Science-Based Medicine).
 

I have yet to see an EMS provider pick up a study they like and try to reproduce it.[1]

 

How would having each individual reproduce each study, be relevant to anything? If I do not study something myself, I cannot use the research?

Later he exaggerates the problems with EMS research. Was he mocking himself here? Is he mocking himself there? Both? 😳

What is important in interpreting medical research, is that we are able to read a study in a way that we can identify flaws in the study, see if the researchers found ways to control for as many variables as possible, recognize possible biases, et cetera.

It is not necessary for each person reading/citing a study to reproduce that study. What matters is that the therapeutic hypothermia research has been replicated.[6],[7],[8],[9]

I did not set up any studies to reproduce the therapeutic hypothermia studies, because the information is in the paper. When the information is not there, that is a flaw. I did explain that prehospital therapeutic hypothermia with IV fluid is an example of why it is wrong to extrapolate from pathophysiology about untested treatments.
 

If it was possible to create and publish a study that showed what to do or what was best for patients in every conceivable situation, why would we need healthcare providers at all?[1]

 

There is a website that creates quotes like this for the wisdom of Deepak Chopra. It generates random fictional quotes that sound like what Chopra would say (e.g. – “Interdependence belongs to the flow of bliss”). See what you get. Maybe I should create a quote generator for Mike.[10]

Would any reasonable person suggest that it is possible to create and publish a study that showed what to do or what was best for patients in every conceivable situation?

Why does Mike?
 

That’s right, no double blind random placebo controlled studies on the validity of CPR. No prospective treatment studies on unconscious people who cannot be advised on and consent to the risks. No deviating from “the standards” or “commonly accepted” modalities of care. Sometimes you can get a waiver, but it is easier to walk on water and part seas.[1]

 

The therapeutic hypothermia patients were conscious and gave consent to participate in the study?

Think about that and how much Mike understands what he is writing about.

Consciousness was a reason for exclusion from these studies. Why doesn’t Mike know this?

Pick up any study with human patients. It will explain how the ethical consent was handled for the patients in that study.
 

Nazi Germany is the closest anyone has come to unbiased human experimentation.[1]

 

The Nazis were obtaining consent?
 

This is followed by some brave attacks on straw men, then praise for the parachute study – a satire paper that is based on a logical fallacy.[11],[12]

There is nothing wrong with using logical fallacies for satire. Did Mike intend his manifesto as satire or as spectacular irony? 😳
 


Volunteers eager to participate in unbiased Nazi experiments?
 

Most EMS providers simply don’t have the education, time, or resources to check that sort of stuff. They read a study, and assume this evidence has been met.[1]

 

That may apply to most doctors, too. It isn’t the right way to approach research, but it is a criticism of the reader, not the evidence.

Then Mike valiantly lashes out at some more straw men.
 

What can EMS, and doctors, do to better understand research?

Read some of the many analyses of evidence that are available for free on the internet. I frequently write about the problems with research, but I do not make the mistake of claiming that EMS research is useless.

Many others write about EMS and emergency medicine research. I described some of the best sites a year ago.[13]
 

Read some of these –

Life in the Fast Lane Research Review

The EMSB Digital Research Library

Skeptical Medicine

Mill Hill Ave Command

EMS Patient Perspective

Street Watch: Notes of a Paramedic

A Day in the Life of an Ambulance Driver

EMS 12 Lead

SMART EM

EM Crit

Emergency Medicine Literature of Note

Canadian Prehospital Evidence Based Protocols

SOCMOB Blog – Standing on the corner, minding my own business in the ER

prehospitalresearch.eu

The Poison Review

PHARM – PreHospital And Retrieval Medicine

EM Lyceum

Emergency Medicine Ireland

Skeptics’ Guide to Emergency Medicine

Dr. Bryan Bledsoe
 

For an accurate description of SBM, read the site that originated the concept –
 

Science-Based Medicine

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Footnotes:

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[1] Why US EMS will never get to sit at the adult table
The5Conflicts
April 26, 2014
Article

–

[2] The Relentless Optimism of a Stalker Applied to Medicine
Wed, 23 Apr 2014
Rogue Medic
Article

–

[3] EMS Dinosaurs and the Slow Gazelles – EMS Office Hours
Wed, 12 Feb 2014
Rogue Medic
Article

–

[4] What Can EMS Expect From 2014? #2 Prehospital Therapeutic Hypothermia
Tue, 31 Dec 2013
Rogue Medic
Article

–

[5] Is Earlier Better for Therapeutic Hypothermia? Part I
Wed, 20 Nov 2013
Rogue Medic
Article

–

[6] Targeted temperature management at 33°C versus 36°C after cardiac arrest.
Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, Pellis T, Stammet P, Wanscher M, Wise MP, Åneman A, Al-Subaie N, Boesgaard S, Bro-Jeppesen J, Brunetti I, Bugge JF, Hingston CD, Juffermans NP, Koopmans M, Køber L, Langørgen J, Lilja G, Møller JE, Rundgren M, Rylander C, Smid O, Werer C, Winkel P, Friberg H; TTM Trial Investigators.
N Engl J Med. 2013 Dec 5;369(23):2197-206. doi: 10.1056/NEJMoa1310519. Epub 2013 Nov 17.
PMID:24237006[PubMed – indexed for MEDLINE]

–

[7] Effect of Prehospital Induction of Mild Hypothermia on Survival and Neurological Status Among Adults With Cardiac Arrest: A Randomized Clinical Trial.
Kim F, Nichol G, Maynard C, Hallstrom A, Kudenchuk PJ, Rea T, Copass MK, Carlbom D, Deem S, Longstreth WT Jr, Olsufka M, Cobb LA.
JAMA. 2013 Nov 17. doi: 10.1001/jama.2013.282173. [Epub ahead of print]
PMID: 24240712 [PubMed – as supplied by publisher]

–

[8] Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest*.
Bernard SA, Smith K, Cameron P, Masci K, Taylor DM, Cooper DJ, Kelly AM, Silvester W; Rapid Infusion of Cold Hartmanns Investigators.
Crit Care Med. 2012 Mar;40(3):747-53. doi: 10.1097/CCM.0b013e3182377038.
PMID: 22020244 [PubMed – indexed for MEDLINE]

–

[9] Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial.
Bernard SA, Smith K, Cameron P, Masci K, Taylor DM, Cooper DJ, Kelly AM, Silvester W; Rapid Infusion of Cold Hartmanns (RICH) Investigators.
Circulation. 2010 Aug 17;122(7):737-42. doi: 10.1161/CIRCULATIONAHA.109.906859. Epub 2010 Aug 2.
PMID: 20679551 [PubMed – indexed for MEDLINE]

Free Full Text from Circulation.

–

[10] The enigmatic wisdom of Deepak Chopra
random fictional Deepak Chopra quotes
Quote generator
 

It has been said by some that the thoughts and tweets of Deepak Chopra are indistinguishable from a set of profound sounding words put together in a random order, particularly the tweets tagged with “#cosmisconciousness”. This site aims to test that claim! Each “quote” is generated from a list of words that can be found in Deepak Chopra’s Twitter stream randomly stuck together in a sentence.

 

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[11] Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.
Smith GC, Pell JP.
BMJ. 2003 Dec 20;327(7429):1459-61. Review.
PMID: 14684649 [PubMed – indexed for MEDLINE]

Free Full Text from PubMed Central.

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[12] Does the parachute study prove that research doesn’t matter? Part I
Wed, 22 Aug 2012
Rogue Medic
Article

–

[13] Some Excellent New Medical-Research Sites
Fri, 24 May 2013
Rogue Medic
Article

.

Filed Under: Critical Judgment, Heresy, Research, Understanding
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