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

- Rogue Medic

Texas bill would let firefighters, EMTs carry firearms

 

There is a bill in Texas to require employers to allow EMS personnel to carry guns on the job.
 

“I would be in favor of leaving guns in the hands of police officers,” Waco Fire Chief Bobby Tatum said. “We have a specific mission to save lives and property, and I think carrying a firearm would cross the line in that regard.” [1]

 

What is the possible benefit?

As I have written about this before –

When would armed EMS make any difference?

Other than those times it makes things worse, when would it make a difference?
 

Below, Dara O’Briain spends a minute on the frustration of trying to explain to people, who don’t understand statistics, that crime rates are definitely going down. Following that, I provide evidence.
 


 

And they go, but the fear of crime is rising.

Well, so what? Zombies are at an all time low, but the fear of zombies could be incredibly high.

 

Here is the murder rate in America from 1960 to 2012 (the most recent data available from the FBI when I made the graph for Thanksgiving in 2015). The 2012 murder rate was 4.7 per 100,000. 2013 and 2014 were lower, both at 4.5 per 100,000.
 

US Murder Rate - 1960 - 2014
 

This is the murder rate in Canada compared with the murder rate in America and whether the death penalty has an effect on either. In the chart, the murder rate of Canada is on a scale that is tripled to show similar changes year to year. This chart is a decade old, but the murder rate in the US and Canada continued to drop in the newer data.
 

Murder rates US vs Canada 1950 - 2005 aa
Source: John J. Donohue III, Justin Wolfers, Uses and Abuses of Empirical Evidence in the Death Penalty Debate, Discussion Paper No. 1949 (January 2006) available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=870312.
 

What about in the Good Ol’ Days, when everything was so much better than now?
 

Homicide rates (per 100,000 people) 14th - 20th centuries - Millennium by Ian Mortimer a
 

In the Good Ol’ Days, things were not good and few people lived long enough to get old.
 

I regularly criticize What if . . . ? fear mongering.

This is one of the greatest harms of EMS. We need to stop this dependence on scaring people with stories of monsters in closets. We need to deal with reality.

This fear mongering is lowering ourselves to the level of alternative medicine.
 

What will happen the first time someone in EMS shoots someone, fires a gun, points a gun at someone, or just brandishes a gun?

Was it justified?

What will the repercussions be?

When would any outcome have been better if EMS carried guns?

How would it have been better?

Assume that only 10% of the people in EMS who will carry guns on the job are below average (yes, that means that 90% are above average). How much trouble can that 10% cause?

Assume that only 1% are below average. How much trouble can that 1% cause with below average decisions?

There is nothing in this bill to prevent that 1% from carrying on every call. The carry license is both the floor and the ceiling for qualification for armed EMS.[2]
 

Sometimes doing nothing is the best thing we can do, but some people need to do something, even though there is no reason to expect it to do any good. This is another case of doing something just to do something.

If we are going to change how we do things, we should insist on thorough documentation of every intervention, just as we should for any other EMS intervention. The bill does not mention any kind of tracking of the effects of this legislation.[2]
 

Can employers require training/skills verification? Only possession of a valid carry license is mentioned. No further skill requirement is mentioned in the bill.[2]

What will happen to the insurance rates for the employer? Insurance companies are not looking to donate money to make EMS feel good.

Will people leave EMS in order to get away from partners they don’t trust with guns? How many do that now for bad driving?

Will we end up with more people who couldn’t get onto the police force, because lights and sirens and guns is better than lights and sirens?

Will EMS providers in Texas be told that this is a replacement for the raise they were going to get?

If some people feel unsafe without their guns, because they mistakenly believe that the murder rate is increasing, when it is definitely dropping, in what other ways are they making bad decisions? Will giving the confused fear of rising crime people guns act as a security blanket, so that they will feel safer and focus on their patients? Or will the confused fear of rising crime people use the guns to act on some other confusion? It probably won’t be that simple.
 

PS – Is this a Constitutional issue?

Employers are permitted to limit some other important civil rights, such as speech, during work hours. We can always choose to work in jobs that permit us to be armed on the job. Security guard, police officer, corrections officer

Of course corrections officers have to carry guns. They are surrounded by inmates.

Actually, corrections officers do not carry guns when they are around inmates. It seems that introducing a gun into that environment is not considered a good idea.

Footnotes:

[1] Texas bill would let firefighters, EMTs carry firearms – The bill would implement a statewide policy requiring jurisdictions to allow responders to carry while on duty
EMS1.com
Feb 14, 2017
By EMS1 Staff
Article

[2] Texas House Bill 982
Bill Text: TX HB982 | 2017-2018 | 85th Legislature | Introduced
TX State Legislature page for text of HB982

.

Imagine if Ebola Spread in America

 
What if there were an Ebola epidemic in America?

In the aftermath of the spread of Ebola in America, would we have Congressional hearings like this?
 


 

 

Dr. Oz – My show is about hope.[1]

 

Translation – Hope sells.

You can rape people who are desperate, but as long as you give them hope, it is OK.[2]
 

A traditional healer, practicing naturopathy in Sierra Leone, appears to be the main reason for the spread of Ebola from Guinea into Sierra Leone.
 

“She was claiming to have powers to heal Ebola. Cases from Guinea were crossing into Sierra Leone for treatment,” Mohamed Vandi, the top medical official in the hard-hit district of Kenema, told AFP.[3]

 

It is a mistake to state that Ebola never would have spread, but this was just another alternative medicine practitioner selling hope, fortunately with a much smaller audience than Dr. Oz.
 

“It is a disease that spreads very fast, without regard for academic or economic status, political affiliation, age, ethnic grouping, gender or religion.”[3]

 

Ebola also doesn’t care about hope. Hope helped to spread Ebola.
 

The other end of the alternative medicine market is fear. People preach that there are government conspiracies so evil that the conspirators kill anyone who might expose the conspiracy, but can’t manage to keep Mike Adams[4] from spreading paranoia.

Blame the CDC (Centers for Disease Control and Prevention) for everything.
 

Alternative medicine and conspiracy theories are all fun and games, until someone spreads a deadly epidemic.

They assume that we are supposed to be healthy, and they sell empowerment to be healthy, but they blame the victim when the quackery does not work.
 

Based on what is known to date, I do not worry overmuch about the spread of Ebola in the US. Direct contact is not a very efficient way to transmit infections, especially infections that are rapidly fatal.[5]

 

Ebola requires more than good health to prevent transmission, but the people promising hope and trying to scare us away from real doctors do not seem to understand that.

Is it easy to become infected with Ebola?

Only if we do not know what we are doing and do not have appropriate PPE (Personal Protective Equipment). Quacks believe in magic, because they do not understand science.
 

Thirty year of following infection control procedures and I have yet to catch an infection from a patient. I remember at the start of the AIDS epidemic there were those who refused to care for AIDS patients due to worries of catching the disease. It never worried me since I knew the modes of transmission and I did not partake of those behaviors.[5]

 

We should ignore the quacks and listen to people who understand what they are doing, but it is difficult to resist the temptation to believe in magic – Naturopathy, herbalism, homeopathy, Reiki, acupuncture, . . . .

It is also difficult to resist the temptation of an easy explanation. Conspiracy theories provide simple explanations for complex problems. As with the belief in magic, this is not a new problem.

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.

We continue to enrich those who promote hope. We continue to enrich those who spread fear. We continue to ignore those who try to understand, because understanding requires work, and that is asking too much. We need to ask for evidence, examine the evidence critically, and not fall for things because they appeal to our biases.
 

For a more information from Science-Based Medicine read – Ebola outbreaks: Science versus fear mongering and quackery

Footnotes:

[1] Weight-Loss Product Advertising – Witnesses testified on ways to protect consumers from false and deceptive advertising of weight-loss products.
June 17, 2014
C-SPAN
Page with embedded video.

[2] Dr. Oz Shows How He Lies with Bad Research
Tue, 17 Jun 2014
Rogue Medic
Article

[3] Sierra Leone’s 365 Ebola deaths traced back to traditional healer
AFP | 20 August, 2014 08:26
Times LIVE
Article

[4] Mike Adams is a Dangerous Loon
Steven Novella
July 25, 2014
Neurologica
Article

[5] Yet another plague panic
by Mark Crislip
August 8, 2014
Science-Based Medicine
Article

.

Opponents of EBM Now Have More Evidence to Justify Their Rejection of Evidence


 

Those scientists clearly can’t get it right. They are constantly changing the guidelines to correct their mistakes. Why don’t they just do it right the first time.

Finally, somebody is recognizing that a treatment should only be eliminated when there is clear evidence that it harms patients – and only when we have run out of excuses to ignore the irrefutable evidence.
 

The 2015 American Heart Organization (AHO) Cardiovascular Care Guidelines will introduce three new levels of evidence in addition to the current existing levels of evidence
In addition to the current levels of evidence classes the AHO’s 2015 guidelines will include Class IVa (Anecdotal Evidence), Class V (Provider Opinion) and Class XI (Treatments Not Proven to Not Work)
[1]

 

When I was in paramedic school we were told the rules. Intubation is the most important treatment, because the airway is the most important part of patient care, because Airway begins with A, Breathing begins with B, and Circulation begins with C. A comes before B and B comes before C.

Do you think that is a coincidence? No. There’s a reason for that. We are supposed to treat the airway first – no matter what. A paramedic can only have one thought in his head at a time, so it has to be the one best thought. Airway always comes first. Did you ever try to live without an airway? Well, did you? It just doesn’t happen. The Gold Standard of Airway is intubation, so we have to intubate people or they will be dropping like flies. You don’t hear about people surviving in places where medics don’t intubate. Dead! All of ’em. Dead! It’s a fact.

This is serious business people. Every second counts, but there are a lot of seconds, so we don’t count seconds. We count minutes. So every minute counts, but only with an Airway. Without an Airway, you are dead, but you are only dead after we race your cadaver to the hospital and a doctor pronounces you dead and mutters something under his breath about us being straight out of the Dark Ages. We do respect the classics. We have to honor our roots. We can’t be eliminating traditional treatments just because they seem to harm patients.
 

AHO includes the following in the new guidelines, section IVa (Anecdotal Evidence): “Many people have seem something work or they know of someone who has seen something work, or perhaps have heard of someone who knows someone that has seem something work. If a treatment has been said to work in the past then it stands to reason that it will work again. The AHA now accepts anecdotal evidence as equivalent to and just as valid as a Class I intervention provided that the evidence is no more than 4 degrees of separation from the person.”[1]

 

They shouldn’t have left out treatments based on animal research. We have to include everything. It doesn’t matter that people do not do as well with these treatments as animals do. Don’t you love dogs and cats, or are you some kind of monster? If a treatment can bring a dog back to life then that is good enough for grandpa. If cancer can be cured in animals, but we don’t give the treatments to people we are killing people. It is a Big Pharma conspiracy to find cures and then hide them from everyone, because that is why these scientists do all of this research – so they can have the cures for themselves and watch us die. If it works in animals, there is no reason to not use it in people.

All of this research is just too expensive.

We need to just use what we know works.
 

Go read the full article.

Footnotes:

[1] Heart Organization Endorses New Level of Evidence Guildlines
Call The Cops
Posted by: RJ Beam
8/20/2014
Article

.

Dr. Edward Tobinick Sues Barbara Streisand – or something equally foolish


Dr. Edward Tobinick might not be a quack, but his behavior suggest otherwise.
 

Having a medical degree does not mean not a quack.

Using FDA (Food and Drug Administration) approved drugs does not mean not a quack.

Having a medical web site that does not have the word “quantum” all over the place does not mean not a quack.

Threatening to sue people for writing about the lack of evidence for his treatments does not mean not a quack.
 

Dr. Edward Tobinick is suing Science-Based Medicine for writing about Dr. Edward Tobinick’s dubious medical practices.

That strongly suggests that Dr. Edward Tobinick is a quack.
 

The claims and practice of Dr. Tobinick have many of the red flags of a dubious medical practice, of the sort that we discuss regularly on SBM. It seems that Dr. Tobinick does not appreciate public criticism of his claims and practice,[1]

 

Essentially, what Dr. Edward Tobinick is saying is, Your valid criticism of the way I apparently take advantage of patients might discourage patients from shelling out money for my untested treatment.

or –

Your valid criticism of the way I apparently take advantage of patients might encourage patients to ask reasonable questions about my untested treatment – questions that I cannot honestly answer.
 

Etanercept might work, but so might steroids, or ribavarin, or eye of newt, or a kick in the groin.

All of these treatments are equally valid. Oddly, the patients receiving a kick in the groin will probably report the fewest symptoms after treatment. 90% of the kick in the groin patients claimed to be cured and not in need of any further treatment.

Without evidence, and with his opposition to evidence, Dr. Edward Tobinick is just a quack with a brainstorm. Nothing original there.
 

Dr. Edward Tobinick injects etanercept (Enbrel) around the spine. This is not something he covered in his dermatology residency, so has he injected etanercept into the spine yet?

Why etanercept? Etanercept is an immune suppression/anti-inflammation drug. Inflammation is a problem with everything, so preventing/reversing inflammation is the simplistic cure. If this worked in real people, and not just in the hypotheses of pathophysiologists, steroids would have cured everything decades ago.

Perhaps Dr. Edward Tobinick is imitating Dr. Michael Bracken, who is able to produce improved outcomes with steroids (anti-inflammation drugs) for spinal injury, but only when he is in charge of the data.[2]

At least Dr. Michael Bracken published some research to support his claims. Dr. Edward Tobinick just wants us to believe that his interpretation of pathophysiology is miraculously prescient.
 

Evidence? We ain’t got no evidence. We don’t need no evidence! I don’t have to show you any stinkin’ evidence!
 

Maybe Dr. Edward Tobinick does have some valid evidence.

Maybe Dr. Edward Tobinick is just hiding the valid evidence because it is proprietary. 😉

Here are a couple of comments by Dr. Novella on science and the importance of evidence. They probably were not directed specifically at Dr. Edward Tobinick, but they do apply to him.
 

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?

 

Science is the way we learn what works.

Dr. Edward Tobinick’s criticism is evidence that he does not understand science.

Is any treatment, that is not based on evidence, likely to provide a benefit to patients?
 

History is strewn with ideas that were intuitive and made sense at the time, but were also hopelessly wrong.

 
Alternative medicine, opposition to EBM (Evidence Based Medicine), and opposition to SBM (Science-Based Medicine) are all the same mistake – evidence denialism.

Evidence denialism is devotion to being hopelessly wrong and remaining ignorant of being wrong.
 

Barbara Streisand?[3]

Footnotes:

[1] Another Lawsuit To Suppress Legitimate Criticism – This Time SBM
Posted by Steven Novella
July 23, 2014
Science-Based Medicine
Article

[2] Cochrane and a Significantly Biased Review of Steroids for acute spinal cord injury
Fri, 25 May 2012
Rogue Medic
Article

[3] Streisand effect
Wikipedia
Article

Maybe there is no such thing as bad publicity for a quack, but the publicity associated with this law suit means that people will associate the name quack with Dr. Edward Tobinick, or vice versa.

Dr. Edward Tobinick is stating I am not a quack.

Reasonable people are hearing –

I, Dr. Edward Tobinick, am a quack.

.

The Ethics of Intervention – 1


Image credit. Is the Give tPA propaganda loud enough?
 

Many of us in medicine want to be more aggressive in treating patients with untested/poorly tested treatments.

We’ve got to do something!

What we ignore is the harm that comes from being aggressive with wishful thinking.

Dr. Ryan Radecki points out that we still have no effective way to manage post-thrombolysis intracranial hemorrhage. This is a real problem that is ignored by many proponents of tPA (tissue Plasminogen Activator – Alteplase).
 

If the widespread proponents of tPA would like to subject ever-increasing numbers of patients to this complication, perhaps they ought to put as much energy into developing new treatments for hemorrhage as they do vilifying tPA skeptics?[1]

 

Why don’t we clamor for a treatment for the problems caused by tPA aggressive intervention with tPA?
 


Image credit.
 

We recite the usual platitudes –

If it helps just one patient . . . .

Yet, if it harms more than it helps – it is bad.

Why is that math so difficult?

An intervention that cannot be shown to be beneficial should be assumed to be harmful until after there is evidence to the contrary. If that evidence never exists, it will be just one more dangerous treatment avoided.

Why?

Because almost every treatment that has been tried has been more harmful than beneficial.

There is no reason to assume that this does not also apply to the treatments based on a modern understanding of pathophysiology.

Why does expert opinion seem only to favor the experts who are hopelessly optimistic pro-interventionists?

Why doesn’t critical judgment support pro-interventionist expert opinion?

Why doesn’t history support pro-interventionist expert opinion?

Why doesn’t reality support pro-interventionist expert opinion?

Is reality biased against endangering our patients in the absence of valid evidence that our treatments are safe and effective?

Yes.

Reality doesn’t care what we want.

If reality cared, the patient would not have the medical condition to begin with.

Reality is neutral, but we are biased in favor of thinking that we know what is best for others.

We consistently provide evidence that we are wrong, then we ignore that evidence and make lame excuses that it wasn’t our fault.

We need to grow up and admit that it is our fault when we harm patients with expert opinion.

Footnotes:

[1] tPA ‘Em & Let ‘Em Bleed
Monday, April 28, 2014
Posted by Ryan Radecki
Emergency Medicine Literature of Note
Article

.

The Relentless Optimism of a Stalker Applied to Medicine

 

She really does love me, she just has trouble showing it (even though she probably does not even know I exist).

This is the way stalkers think.

Insert any woman you consider to be extremely attractive. For me, the choice is more Diane Lane, than Miley Cyrus (and Kelly Grayson seems to have Christina Hendricks locked up all to himself).
 


Image credit.
 

This is the way believers in alternative medicine think.

This is the way believers in anecdote-based medicine think.

Anecdote-based medicine is the intuitive, I’ve seen it work approach to medicine that is not different from alternative medicine in any important way.

Almost always, these anecdote-based treatments are found to be harmful. Not beneficial is the same as harmful, because a treatment that provides no benefit, but exposes the patient to the risks of an unnecessary treatment is dangerous.

Clearly, Diane Lane and Josh Brolin are getting divorced because she wants to be with me, right?

I just need to believe and it will work.

I just need to ignore all objective evidence and it will work.

I just need to trust my inner stalker.

Right?
 

As much as I would like to think that there is something about me that appeals to beautiful women who do not even know I exist, I should not ignore reality.
 

Does this also apply to EMS treatments?

Prehospital IV therapeutic hypothermia has not demonstrated any benefit when begun by EMS and has demonstrated harm. The outcomes all trend toward harm, so a meta-analysis may show a statistically significant decrease in survival.[1],[2],[3],[4]

We just need to believe and it will work.

We just need to ignore all objective evidence and it will work.

We just need to trust our inner stalkers.

Right?

Should we maintain unreasonable optimism?

What if there really is a benefit?

It is much more likely that there really is harm.

Even though harm is more likely, it is more difficult to recognize.
 


 

The intervention reduced core body temperature by hospital arrival, and patients reached the goal temperature about 1 hour sooner than in the control group. The intervention was associated with significantly increased incidence of rearrest during transport, time in the prehospital setting, pulmonary edema, and early diuretic use in the ED. Mortality in the out-of-hospital setting or ED and hospital length of stay did not differ significantly between the treatment groups.[4]

 

If we cannot provide evidence of improved outcomes, all we have is wishful thinking.

Wishful thinking kills.
 

Diane Lane may really want me, but there is no rational reason to believe this.

Prehospital IV therapeutic hypothermia may really work, but there is no rational reason to believe this.

The same is true for every other treatment that is not supported by evidence of improved outcomes that matter.

We should expect harm, not benefit.

It is irrational to expect benefit, but many of us do expect benefit because we are irrational optimists and we do not pay for our mistakes. Our patients are the ones who pay for our mistakes.

Footnotes:

[1] 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.

[2] Podcast 113 – Post-Cardiac Arrest Care in 2013 with Stephen Bernard – Part I
EMCrit
Podcast page with links to research mentioned in the podcast.

Podcast 114 – Post-Arrest Care in 2013 with Stephen Bernard – Part II
EMCrit
Podcast page with links to research mentioned in the podcast.

[3] 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]

[4] 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]

.

Creationism and the Politics of Ignoring Reality – Part 1

 

National Review Online has an odd apologist for Creationism claiming that without the secular left, Creationism would not be a problem.

Of course, he does not appear to think that Creationism is a problem, only that criticism of Creationism is a problem.
 


Image credit. Click on images to make them laerger.
 

No one thinks about creationism more than the secular Left.[1]

 

There is an outbreak of Ebola virus in Guinea.

While Creationists will tell us that since humans and monkeys are not related, they cannot have the same diseases. However, Ebola virus comes to humans from monkeys. Monkey DNA and human DNA are almost identical. We have small genetic differences that make a big difference in genetic expression, but these are terms that have to do with science and Creationism is about rejecting science that makes the Creationists uncomfortable about their beliefs in their Gods.
 

[youtube]6cPasb5a1G4[/youtube]
 

Ebola will probably not make it to the US, this time, but it is expanding its range. We cannot make Ebola go away with prayer. We need medicine, which is based on valid science. The fewer people we have who understand biology, the longer it will take to find effective treatments.
 

To be sure, a small number of Christians fiercely and zealously defend the young-earth position, but their influence is vastly overstated by secular journalists who need them more than the church does.[1]

 

Journalists are creating a push to teach Creationism religion in science classrooms?

Apparently, it is only a small number, when David French is defending something by trying to get people to ignore it.

Why is a political writer so opposed to keeping non-science out of science education?

Science is not easy to understand and he appears to be upset that this version of Cosmos seems to explain science as well as the last version. For example, the eye is commonly used as an example of irreducible complexity, the Creationist way of saying, I don’t understand, therefore it is impossible.

Neil deGrasse Tyson explains the evolution of the eye pretty well in about 8 minutes below (I apologize for the advertising) –
 


 

At every stage of its development, the evolving eye functioned well enough to provide a selective advantage for survival and among animals alive today, we find eyes at all these stages of development – and all of them function.

The complexity of the human eye poses no challenge to evolution by natural selection. In fact the eye, and all of biology, makes no sense without evolution.[2]

 

There are no gaps in the evolution of the eye. We can see the various degrees of evolution of the eye in different species, including species with much better eyesight than our eyesight. So why do we assume that the claims of evolutionary gaps, from people who do not understand evolution, are true?

Do we ask the person who has trouble with a paper airplane to explain the theory of flight?

Do we ask the person who does not understand gravity to explain relativity?

The failure of Creationism may not even be because scientists do a better job of explaining science, but because of the ethical failures of those trying to discredit science. I will explain in Part 2.

Footnotes:

[1] The Left’s Strange Obsession With Evangelical Creationism
By David French
April 1, 2014 2:19 PM
National Review Online
Article

[2] Some of the Things That Molecules Do
Cosmos: A Spacetime Odyssey
Season 1, Episode 2
Fox
28:48
Video at Hulu.com

.

The Power of the ‘Death’ Chant will protect Us

 

In response to Up To, and Including, DEATH – The Anguish of Happy Medic is this comment from Garrett –
 

Upfront, I will admit that I’ve used similar phrasing and thought it stupid at the time. I think a big part of this comes not just from the litigious nature of US society, but in the uncertainly in the litigation process.

 

In other words, it is based on fear of the unknown.

How does that produce a reasonable approach?
 

I can just see it now: a minor cut which is treated with a 2×2 and tape. Done. However, a small clot gets jostled and makes its way to the brain leading to COMA and DEATH!

 

Please provide a real example of coma death because EMS was providing accurate informed consent/refusal information, rather than a prophesy of the death of the patient.

Otherwise, I assume that the example is an urban legend, made up to justify superstitious behavior.
 


Image credit.
 

On the witness stand:
“Did you let my patient know that they could have died without advanced medical treatment?”
“No – that’s highly unlikely and would only cause extra anxiety for the patient.”
“So unlikely that it … happened this time? Tell me, how do you explain that to her Poor, Orphaned children?”

 

When did that happen?

We should stick to Happy Medic‘s intelligent description of the possible complications.

If I am in court, my defense will be real, not a fairy tale.

But I used the magic incantation! This is not likely to convince a jury that you are a responsible person, but it may convince them that you are responsible for a bad outcome.

Why ignore real risks to the patient over some fixation on imaginary risks to you?

We are there to take care of the real patient, not our phobias.

That’s the problem – the odds of death occurring are pretty much the same as the odds of me having to testify about it.

Please provide evidence to support your claim.

Since this is just making up stories to scare kids sitting around the camp fire, we are just being silly.

We are ignoring reality and looking for a magic incantation to provide a cone of protection from lawyers.
 

This is how we lower standards in EMS.

In a decade, or two, I expect each EMS provider to be wearing a reflective vest, a helmet (with a flashing light on the helmet), and something that makes a sound like a backup alarm at all times. Maybe there will be a warning of Danger! EMS provider. Danger! along with the beeping. Someone could trip over an EMS provider!

As for refusals, they will be done by video link with a PA (Physician Assistant), because we have demonstrated that EMS is not capable of providing appropriate information for a person to make an informed decision about accepting/refusing care.

If our goal to avoid responsibility, we are too irresponsible to be allowed near patients.

.