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

- Rogue Medic

Ignorance and Misunderstanding Science

Wed, 28 Apr 2010 12:55:04 -0400 by
An interesting way to look at the evaluation of science is presented in last night’s Frontline episode Vaccine Wars.

One of the ways that misinformation is spread about science is mentioned by Dr. Paul Offit. Dr. Offit is portrayed by the anti-vaccinationists as corrupt, because he made a lot of money creating a vaccine for an illness that kills hundreds of thousands of lives of children each year.[1] Almost all of the children, who will have their lives saved by this vaccine, live in other countries. The opponents of vaccines will tell you that they do not care about children dying in other countries. They are only interested in creating suspicion and fear about the health of children in this country.

The anti-vaccinationists defend Dr. Andrew Wakefield. What did Andrew Wakefield do? He took hundreds of thousands of pounds from lawyers to create a study to make it look like the MMR (Measles/Mumps/Rubella) vaccine causes autism. Nobody has been able to scientifically reproduce this study. An important parts of the scientific method is that research must be capable of being reproduced. Research that cannot be reproduced is flawed. Flawed is the polite way scientists have of saying BS.

The General Medical Council ruled he (Andrew Wakefield) had acted “dishonestly and irresponsibly” in doing his research.[2]

Do the anti-vaccinationists criticize Andrew Wakefield for creating a fake scare about the MMR vaccine?

Do the anti-vaccinationists criticize Andrew Wakefield for selling out to a bunch of lawyers, who are only looking for a multi-million pound settlement?

Do the anti-vaccinationists realize there is a problem when Andrew Wakefield is forced out of his job at Thoughtful House, an autism advocacy organization?[3]

Do the anti-vaccinationists realize there is a problem when another of Andrew Wakefield’s research papers is retracted as bad science – so bad that it is unfit for publication?[3]

No. The anti-vaccinationists defend Andrew Wakefield.[4] Barbara Loe Fisher is the head of the National Vaccine Information Center and claims to be “dedicated to preventing vaccine injuries and deaths through public education and defending the informed consent ethic.”[5] Informed consent is important. Informed consent requires that we provide accurate information about the risks and benefits of any medical decision. Barbara Loe Fisher acts as if screaming, Evil! Evil! Evil! at every opportunity is providing informed consent. She is misinformed. Those who listen to her are also misinformed. To be fair, Barbara Loe Fisher is most accurately described as a liar.

Frontline describes Barbara Loe Fisher as vaccine watchdog. This is an interesting choice of words. She is a watchdog in the way that a dog trained to kill anything that moves is a watchdog. Her goal appears to be the elimination of vaccines. Maybe they would describe Timothy McVeigh as a government watchdog. McVeigh’s death toll is likely to be much lower than Barbara Loe Fisher’s. How many children will die because of Barbara Loe Fisher’s lies?

Several months ago, Barbara Loe Fisher sued Dr. Paul Offit for libel for comments he made to a reporter. Barbara Loe Fisher also sued the reporter and sued the periodical. This is the part she sued about –

“Scientists, bound only by reason, are society’s true anarchists,” he has written — and he clearly sees himself as one. “Kaflooey theories” make him crazy, especially if they catch on. Fisher, who has long been the media’s go-to interview for what some in the autism arena call “parents rights,” makes him particularly nuts, as in “You just want to scream.” The reason? “She lies,” he says flatly.[6]

Dr. Offit writes a lot about vaccination and the anti-vaccine/pro-disease movement. In order to try to stop Dr. Offit, dishonest people will resort to law suits, just as the BCA (British chiropractic Association) did when Simon Singh pointed out that the BCA was telling lies. Simon Singh was telling the truth, while the BCA was trying to silence him with a libel charge. That did not work. The result was that there was much more exposure of the lies of the BCA.

Barbara Loe Fisher had her case dismissed.[6] I guess it is not libel to call Barbara Loe Fisher a liar. Maybe it is just accurate.

It is interesting that Barbara Loe Fisher started her misinformation warehouse based on the pertussis vaccine scare. When Andrew Wakefield’s Lancet paper was published, there was no scientific basis for the panic, but the media jumped all over it. The media have been encouraged to scare people by public menaces, such as Barbara Loe Fisher. Her business model is to sell fear and books, based on the thoroughly debunked autism/vaccine fraud. Barbara Loe Fisher is a liar. She will encourage you to endanger your child, but she does not present any legitimate reason to avoid vaccines. She lied about the pertussis vaccine. She lies about all vaccines.

Here is what was written comparing the original fraudulent Wakefield vaccine scare paper to the scare over the pertussis vaccine. This was before the abundant research that has made it clear that there is no vaccine/autism link. Even then, the scientists realized that this was nonsense. The anti-vaccinationists haven’t figured it out, yet.

The experience with pertussis in the 1970s was also based on anecdotal case reports linking pertussis vaccination with infant brain damage.9 Again a temporal link between a vaccine and a devastating childhood condition whose natural peak onset was at the very time when most children received that vaccine was misinterpreted as a causal relation. A national study eventually showed that, while there was a temporal association with encephalopathy, any risk of lasting damage was so rare as to be unquantifiable.10 But the initial report, then as now, attracted media attention; parental and professional anxiety soared; and national immunisation rates fell from 80% to 30%. The number of susceptible children rose, and in the 12 years after 1976 three major pertussis epidemics accounted nationally for over 300000 notifications and at least 70 deaths. The suffering of families experiencing long miserable illnesses was considerable, and in some cases long term damage ensued. Some parents came to believe that an immunisation they had approved had damaged their child.[7]

Jenny McCarthy has said that we need to bring back the diseases that are prevented by vaccines.[8] Jenny McCarthy believes that the vaccines are more dangerous than these diseases that kill millions

Dr. Offit does research on vaccines and talks to people about vaccines – they threaten to kill him.[9] All of the research supports Dr. Offit. His is the rational approach.

The discredited Andrew Wakefield is defended by those, who want us to ignore the research. Since the research continues to show the same thing – vaccines are safe – they lie. Their’s is the irrational approach.

Even the courts have ruled that there is no evidence of any link between autism and vaccines.[10]

Apparently, the anti-vaccinationists are facing the worst kind of conspiracy. A conspiracy that will not stop. A conspiracy of truth.

Footnotes:

^ 1 Rotavirus vaccine
Wikipedia
Article

^ 2 MMR scare doctor ‘acted unethically’, panel finds
By Nick Triggle
Page last updated at 17:35 GMT, Thursday, 28 January 2010
BBC News
Article

^ 3 Andrew Wakefield: Destined for even more disrepute
Respectful Insolence
Article

^ 4 Dr. Andrew Wakefield and his compelling courage, as recounted by Barbara Loe Fisher
Natural Health strategies
Article

^ 5 Barbara Loe Fisher
Wikipedia
Article

^ 6 Barbara Loe Fisher’s lawsuit against Paul Offit dismissed
Left Brain/Right Brain – Autism Blog
Article

^ 7 MMR vaccination and autism 1998.
Nicoll A, Elliman D, Ross E.
BMJ. 1998 Mar 7;316(7133):715-6. No abstract available. Erratum in: BMJ 1998 Mar 14;316(7134):796.
PMID: 9529392 [PubMed – indexed for MEDLINE]

Free Full Text                 Free PDF

^ 8 Jenny McCarthy on Autism and Vaccines
By Jeffrey Kluger
Wednesday, Apr. 01, 2009
Time Magazine
Article

^ 9 Stomping Through A Medical Minefield
The author of a new book about autism says exactly what he thinks about vaccines and other hot topics.
By Claudia Kalb
Published Oct 25, 2008
Newsweek
Article

^ 10 2010: Another bad year for the anti-vaccine movement, as the Special Masters rule
Respectful Insolence
Article

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Filed Under: Critical Judgment, Heresy, Science Tagged With: , ,

Education Problems, Autism, and Vaccines

Thu, 18 Mar 2010 00:01:35 -0400 by
Monday I wrote about the problems that can result from national standards. We do need to raise our education standards. An excellent example can be seen in the faulty logic used by those claiming that vaccines cause autism.

Hypothesis: Vaccines cause autism.

Experiment: Compare the rate of autism in groups with differences in vaccination methods. There are many ways this can be done, depending on the way the vaccine is hypothesized to cause autism.

However, the people claiming that vaccines cause autism do not accept the research that has been done. They claim that it is obvious that vaccines are dangerous and no amount of science will change their minds.

Vaccines contain thimerosal. Thimerosal is mercury. Mercury causes brain damage. The brain damage caused by mercury is exactly the same as autism. Mercury is one of the most toxic substances on the planet, so we have to stop poisoning children with it.

Clearly, this is a problem. We have a substance so dangerous that it must produce close to 100% brain damage. It is good that these public spirited people have raised this alarm.

Wait!

Using faulty logic, we can prove almost anything. Here is one example.

Zeno’s paradoxes provide several. Here is just one.

In a race, the quickest runner can never overtake the slowest, since the pursuer must first reach the point whence the pursued started, so that the slower must always hold a lead.[1]

Once the pursuer reaches the spot where the slower runner was, the process repeats infinitely. Since distances can be made ever smaller – there is no distance so infinitesimal, that is not made up of an infinite number of even smaller infinitesimal distances. Therefore, the faster runner can never catch up to a slower runner, who has just a tiny head start.

Using a different paradox, Zeno proves that the runner cannot even first reach the point whence the pursued started.

That which is in locomotion must arrive at the half-way stage before it arrives at the goal.[2]

The same endlessly repeating problem of infinitely divisible space is the explanation.

However, we know that these are not impossibilities. It is only by proposing an explanation that sounds reasonable, that these become confusing.

The way we find out the truth is simple. We test the claim.

Anyone capable of walking can walk across a room. There is no need to break the motion up into smaller and smaller parts. The motion is continuous.

Similarly, the problem of thimerosal only appears insurmountable. The only way to determine the accuracy of the claim is to test it.

The single study, that has supported any connection between thimerosal and autism, had such fatal flaws that it was retracted by the journal that published it. In 2004, most of the authors of the study had their names removed from the study, when they became aware of the fraud involved. The study was funded by lawyers hoping to win a big settlement from drug companies. All the lawyers needed was a study that showed this connection. About half a million dollars later, Andrew Wakefield was able to produce just such a study.

One problem with the explanation that thimerosal is such a toxic substance is that the occurrence of autism is supposed to happen so quickly after the vaccination, that the connection is inescapable. Some parents describe the onset of autism symptoms resembling somebody turning off a switch.

This study investigated if the discontinuation of thimerosal-containing vaccines paralleled a decrease in the occurrence of autism. The incidence of autism remained fairly constant during the period of use of thimerosal in Denmark, and the rise in incidence beginning in 1991 continued even in the group of children born after the discontinuation of thimerosal. The amount of thimerosal used in vaccines changed during the study period with less amount of thimerosal administered in the period 1970–1992. Moreover, the thimerosal-containing vaccine was gradually phased out meaning that the incidence rates should decline gradually if thimerosal has any impact on the development of autism. However, an increase (rather than a decrease) in the incidence rates of autism was observed.[3]

So much for throwing a switch.

Using the logic of the anti-vaccinationists, this must be evidence that thimerosal protects against autism.

There are many reasons for using this chart. The chart is from the same study as the paragraph that is above it, so it was handy. It is dramatic. It makes it easy to see that there is no connection between when thimerosal was in the vaccines (up until the vertical line) and autism (begins to increase just as the thimerosal is removed). There are other studies that show the same information. The evidence is clear.

There is no reason to believe that vaccines cause autism.

Then there is the comment that is supposed to silence disagreement. If you don’t have an autistic child, you cannot understand anything about autism. Unless you agree with the anti-vaccinationists. It doesn’t matter if you know what you are talking about, if you agree with them.

Therefore, if I want to know what is the best treatment for something, I should ignore doctors and ask a parent of a child with the condition. Using this logic, the most knowledgeable parent would be one with a child sick for the longest time with that disease. If being a parent of a sick child confers expertise, then the longer that illness continues, the greater the expertise conferred by this faulty logic.

If my child is sick, I am not going to look for parents with the same condition. These parents may have a lot of useful information about many things. However, the abilities to understand assessment, diagnosis, and treatment are not infections transmitted from the children to the parents.

The doctor to go to is also not the one treating children who do not get better. The anti-vaccinationists might conclude that the greatest expert is a parent who had at least one child die from the illness. They are persuaded by emotion, not reason.

There is a further problem with, I refuse to listen to anyone who does not have an autistic child. These parents even ostracize other parents of autistic children unless those parents agree with the emotional claims of the anti-vaccinationists about thimerosal. Catch-22 has nothing on them.

What about the mercury?

Thimerosal is C9H9HgNaO2S or sodium ethylmercurithiosalicylate. Mercury is Hg. Thimerosal is not mercury, but a compound that contains mercury. Being in a compound changes the characteristics and the effects of elements.

An example that people in EMS should understand is chlorine (Cl). This is so toxic, that it was used as a poison gas. Mix it with sodium (Na), which is also extremely toxic, and you have sodium chloride. Sodium chloride (NaCl) is known as common table salt. Sodium chloride is also the ingredient in normal saline, which we inject into the veins of just about every patient with a serious medical condition.

According to the anti-vaccinationists, No amount of mercury is safe. Based on what? Using the same criteria (Because I say so!), no amount of sodium or chlorine would be safe in the body. After all, they are toxic.*

The video below is less than 10 minutes long, but does a great job of explaining ways in which science keeps us from attributing too much to anecdotes, such as this. He was a normal little boy, until he received the vaccine. Autism is diagnosed at the time that children receive vaccinations. This is true, even for children who do not receive vaccinations. Since the vaccines do not cause autism, the only thing avoiding vaccination does is to endanger children.

The explanations that sound good, but are not supported by research are examples of narrative fallacy. I have written more than a little bit about narrative fallacy, because it is important. Using this devotion to reasonable sounding explanations, even though research demonstrates that these explanations are wrong, is a problem. Fortunately, in medicine there is more of an understanding of science. If that were not the case, we might be still bleeding patients to get rid of bad humors.

Narrative Fallacy –

Narrative Fallacy I

How did this happen? – Research

Narrative Fallacy II

CAST and Narrative Fallacy

C A S T and Narrative Fallacy comment from Shaggy

Some Research Podcasting Comments

Shaggy Comments on Some Research Podcasting Comments.

Spine Immobilization in Penetrating Trauma: More Harm Than Good?

EMS EdUCast – Journal Club 2: Episode 43

Education Problems, Autism, and Vaccines

Footnotes:

^ * This does ignore the obvious problem that both hyponatremia and hypocalcemia are fatal conditions, even though sodium and calcium are toxic. If only there were some kind of medical expert to explain cutting edge toxicology. Somebody like Paracelsus.

^ 1 Zeno’s paradoxes
Wikipedia
Achilles and the tortoise
Article

^ 2 Zeno’s paradoxes
Wikipedia
The dichotomy paradox
Article

^ 3 Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data.
Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner AM, Andersen PH, Mortensen PB.
Pediatrics. 2003 Sep;112(3 Pt 1):604-6.
PMID: 12949291 [PubMed – indexed for MEDLINE]

Pediatrics has the free full text and free PDF available at their site.
Free Full Text                 Free PDF

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Filed Under: Critical Judgment, EMS EduCast, Heresy, Narrative Fallacy, Science Tagged With: , , ,

Comments on The Catch-22 of Homeopathy and Patient Choice – Part I

Fri, 05 Mar 2010 02:36:59 -0500 by
In the comments to The Catch-22 of Homeopathy and Patient Choice, Mark p.s.2 makes a couple of comments about science stinking. What is he really saying?

Mark p.s.2 appears to be striking back, to try to defend homeopathy. Not by offering some evidence of the way that homeopathy actually works, or some evidence that it actually does lead to improved survival for patients treated with homeopathy. Actually, homeopathy could lead to improved survival, if a massive overdose of the water were consumed by someone with potentially fatal dehydration. Of course, the whole idea of consuming a large quantity of anything is antithetical to homeopathy, so homeopaths might reject this unintentional healing as somehow impure.

No. Mark p.s.2 responds by claiming that science/medicine has examples of misbehavior.

This is true. Nobody should try to pretend otherwise. We are human, whether we understand science or oppose science. Humans are fallible. Humans give in to temptations to abuse the trust that is put in them. Scientists are human. This should not be news to anyone.

Then what is his point?

It appears to be just a distraction. Look, science is not perfect. Therefore science has no right to criticize anything else. He is accusing science of hypocrisy.

This is wrong. Science, above all else, is about self-correction. Science is not perfect. Science never will be perfect. Neither will anything else, but science is continually working to become more perfect.

He points to a study that addresses problems in the reporting of studies to the FDA (Food and Drug Administration) and reporting of studies in medical journals.[1] This is research correcting problems in earlier research. If you scroll to the end of the Free Full Text, you will see that this is not something that researchers have ignored, dismissed, or taken lightly.

Mark p.s.2 is not criticizing science.

Mark p.s.2 is honoring science.

Without science, starvation would be a significant limit on population size, many minor cuts and scrapes would lead to death by infection, transportation would never need to make reference to any kind of speed limit, and vaccine-preventable illnesses would regularly wipe out large portions of the population, to mention just a few of the problems of life without science.

Science is not about covering up its mistakes. Some individual scientists may exhibit their humanity in attempting to cover up mistakes. Unlike anti-science, the scientific community does not cooperate with this.

Individuals, or even some groups, may be able to cover up problems for a while, but eventually they will be exposed. I have written about this before. I do not write to defend these abusers of science.[2], [3] I try not to play favorites, when I write to criticize abusers of science,[4], [5] but homeopaths deserve a special kind of absurd treatment.[6]

The most interesting part of Mark p.s.2’s comment is the basis for his criticism of science/medicine.

What does Mark p.s.2 choose?

Mark p.s.2 cites a case medical research that shows scientists working to correct some apparent abuses by other researchers. This is not an example of a problem of science. This is showing how science examines itself, seeks to identify errors, and seeks to correct these errors. If Mark p.s.2 had a valid point, then he has contradicted himself with this statement. Perhaps contradiction is the essence of homeopathy.

This research is clearly a case of science self-correcting.

Self-correction is something homeopathy and other anti-science/quackery/et cetera do not do.

Science – If we make a mistake, the only honest way to proceed is to admit the mistake and to correct the mistake.

Anti-science – If we make a mistake, we must cover it up. If anyone looks too closely at what we do, they will recognize the fraud.

Science keeps improving.

Homeopathy is still the same old fraud it was two hundred years ago.

Science makes progress.

Homeopathy makes magic memory water.

It is your health.

If homeopathy is such a miracle, why isn’t it any better than placebo. Where are the lives saved?

The only miracle about homeopathy is that people are gullible enough to believe in it.

Pretty much every foul pestilent thing on this planet has come into contact with that water. Why does it only remember the one thing the homeopath wants it to remember?

Magic.

Why would a memory of something that causes similar symptoms, regardless of how unrelated the cause, cure an illness?

Magic.

How does something become stronger when diluted down to nothing?

Magic.

Do you really want to trust your life to someone who lies to you?

Mark p.s.2 demands perfection from science.

Perfection will always be impossible.

Mark p.s.2 demands respect for homeopathy.

Respect for homeopathy will always be impossible, too.

Footnotes:

^ 1 Selective publication of antidepressant trials and its influence on apparent efficacy.
Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R.
N Engl J Med. 2008 Jan 17;358(3):252-60.
PMID: 18199864 [PubMed – indexed for MEDLINE]
Free Full Text         Free PDF

^ 2 A Comment on Dr. Reuben’s Fraudulent Science and Patient Care
Rogue Medic
Article

^ 3 Dr. Reuben’s Fraudulent Science and Patient Care
Rogue Medic
Article

^ 4 Andrew Wakefield and Cognitive Dissonance.
Rogue Medic
Article

^ 5 CBS Neck and Neck with CNN for Most Incompetent Network
Rogue Medic
Article

^ 6 Homeopathy Warning!
Rogue Medic
Article

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Filed Under: Critical Judgment, Heresy, Science Tagged With: ,

The Catch-22 of Homeopathy and Patient Choice

Sun, 28 Feb 2010 06:47:26 -0500 by
I have written about the fraud that is homeopathy before. Earlier this week, the British Parliament reviewed the evidence supporting on homeopathy and whether the NHS (National Health Service) should fund homeopathy. They have a lot to say. Let’s look at the area of patient choice.

Patient choice

98. Patient choice is an important concept in modern medicine. Medical practice used to be highly paternalistic, whereby the doctors would know what was best for patients and would prescribe whatever treatments they felt best. Today, doctors are trained to communicate with patients about their treatments and, while providing advice and guidance, ultimately enable patients to make informed choices, where possible, over treatment options and more control over the management of their conditions.

99. Indeed, patient choice was repeatedly cited in written submissions as a reason why homeopathy should be provided on the NHS.[120] The Minister stated:

I think there is an illiberality in saying that personal choice in an area of significant medical controversy should be completely denied, and I think the Government should be cautious about constraining that illiberality, or interfering with it. We should not take the view that patients should not be able to have homeopathic medicine when they want it.[121]

100. However, patient choice is not simply about patients being able to pick whatever treatments they like. They must understand the implications of their decisions, which means that patient choice must be informed choice. As Professor Ernst put it: “patient choice that is not guided by evidence is not choice but arbitrariness”.[122] The RPSGB echoed this view:

It is essential […] that the patient is given the appropriate information to make these informed choices and as a consequence it should be clear to the patient that there is no scientific evidence for homeopathy.[123]

101. We agree with Professor Ernst and the RPSGB. For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo—that is, homeopathy—may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice.[1]

The bold highlighting is in the original document. The RPSGB is the Royal Pharmaceutical Society of Great Britain.

If we lie to the patient, we are not behaving ethically.

If we tell patients the truth, the placebo (homeopathy) is not likely to provide any benefit, since patients need to believe in placebos for placebos to work.

Footnotes:

^ 1 House of Commons – Science and Technology Committee – Fourth Report – Evidence Check 2: Homeopathy
2 NHS funding and provision
The evidence check
Homeopathy on the NHS
Patient Choice

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Filed Under: Ethics, Fraud, Heresy, Science Tagged With: , ,

Storm – the movie

Sun, 10 Jan 2010 05:35:14 -0500 by
This is a wonderful way to think about the alternative medicine, which is just an alternative to rational thought. Since the alternative to rational thought is nonsense, animation may be the most appropriate medium to represent it. This is a trailer, but it looks as if the final product will be superb.

More information is available at the official site for the movie Storm.

h/t Respectful Insolence.

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Filed Under: Critical Judgment, Heresy, Movies, Science Tagged With: ,

2009’s Top Threat To Science In Medicine

Fri, 01 Jan 2010 14:51:30 -0500 by
ResearchBlogging.org













Science-Based Medicine, has a post by Dr. Val Jones – 2009’s Top 5 Threats To Science In Medicine.

I do not disagree with the list except, and what would one of my posts be without an except, the number one threat to science in medicine is much more of a problem. Our science education in grade school is where we fail our children. Before they even become adults, they are exposed to all sorts of magical thinking.

Full moons, speaking about something bad increasing the chances it will occur (a jinx), believing that something natural is safer than something manufactured – just because it is not man made, or just a belief in the stereotypical mad scientist bringing about horrors by using the scientific method of inquiry.

That is what science is. Science is a method of inquiry. Science is a tool we use to find out how the world works.

We see something that makes us think. Most people may form an opinion, but not look at this with a method designed to minimize the effect of our biases. And we all have biases.

It seems that there are more patients during a full moon. With a full moon falling at 19:15 GMT (Greenwich Mean Time) this past New Years Eve, this must have been a horrible night of death and destruction. Or was it?

We formulate a hypothesis.

The full moon causes accidents and/or illnesses, or makes accidents and/or illnesses even worse than they would be if there were no full moon.

We figure out what we need to control for to limit our variable to just the possible influence of the full moon. So, let’s look at a study that investigated the effect of a full moon on something that would be very difficult to misinterpret.
 

We postulated that on full moon days there would be more available moonlight, thus influencing individuals’ activities, and in turn, the propensity for cardiac arrest.[1]

 

Interesting. They are not really assuming that the cause of an increase in cardiac arrests would be due to some mystical property of the moon, but that it would be due to more moonlight. fortunately, it does not matter what the actual cause would be for an increase in cardiac arrests, if they set the experiment up properly.

What do they need to do?
 

This study was a retrospective analysis of a computerized billing database of ED visits.[1]

 

The study population consisted of CPR (CardioPulmonary Resuscitation) occurring daily at a cohort of seven hospital ED in northern New Jersey, USA, during the period of 1 January 1988 to 31 December 1998, comprising 4018 days over 11 years. Consecutive patients seen by an emergency physician were included. Emergency physicians see 80–95% of all ED patient visits and the vast majority of cardiac arrest patients. Private physicians see the remainder of the patients.[1]

 

Their theory was that the increased moonlight would lead to more activity; more activity would lead to more cardiac arrests; thus there would be more cardiac arrests during a full moon.

Did the investigators prove their hypothesis?

According to their table, which does not reproduce well, there is no increase in cardiac arrest incidence during a full moon. They actually recorded a decrease, but the difference is not statistically significant. The reported statistically significant difference in incidence of cardiac arrest is this. During the new moon, there is less likely to be a cardiac arrest treated by an emergency physician.
 

There were 2370233 patient visits in the database during the 4018-day (11year) period of study, with 6827 having the primary ICD-9 diagnosis of cardiac arrest.[2] Table 2 contains the time series regression results. Full moon days were not significantly different from other days (P=0.97). We had an 80% power to identify a difference of 4.5%. However, on average 0.12 fewer CPR occurred on new moon days than on other days (P=0.02). This translates into an average of 6.5% fewer CPR (95% confidence interval 1.3–11.7%) on new moon days than other days. In addition, the results for the potentially confounding variables are presented in Table 2.[1]

 

I left part of their original hypothesis off of the initial quote. The stated objective of the study is –
 

Objective
To determine the effect of the phase of the full and new moon on the variation in the number of daily cardiopulmonary resuscitations.[1]

 

In the discussion, they elaborate on their purpose –
 

Our results show a small but statistically significant decrease in the incidence of CPR with new moon days. We speculate that this may be secondary to a decrease in activity because of less available light on these days, as it has been shown that increased activity is a risk factor for sudden death[39]. Our initial rationale sought to identify and determine the size of any effect on the occurrence of cardiac arrest and its attempted resuscitation (‘CPR’) by lunar influence as a potential insight into an aspect of the occurrence of cardiac arrest. In addition, we sought to identify patient volume variation by lunar cycle potentially to allow for staffing modifications; however, the effect identified did not warrant this.[1]

 

This –
 

We postulated that on full moon days there would be more available moonlight, thus influencing individuals’ activities, and in turn, the propensity for cardiac arrest.[1]

 

Becomes –
 

We speculate that this may be secondary to a decrease in activity because of less available light on these days, as it has been shown that increased activity is a risk factor for sudden death[39] [1]

 

They have found a way to stick with their initial hypothesis by reversing it.

More moonlight does not appear to lead to more cardiac arrests. Why this lack of correlation does not need to be explained is not in the paper. However, the correlation between fewer deaths during a new moon is something that they feel needs to be explained. Haven’t they just misappropriated a Willy Wonka quote? Strike that. Reverse it. Willy Wonka was reversing the meaning of what he was saying. That was the reason he needed to reverse the order.

The authors have not really changed the meaning, only the way they express it. More light/less light leads to more activity/less activity. This leads to more/fewer cardiac arrests.

While I do not dispute the results of this study, I do have a problem with the way they get from Point A to Point C. They seem to travel there by way of a study that shows that more activity leads to more cardiac arrest. Actually the study is of vigorous exertion, not just more activity, but the authors seem to have interpreted the study as couch potatoes live longer. The vigorous exertion study did show –
 

As expected, the base-line level of habitual exercise significantly attenuated the increase in the risk of sudden death that was associated with an episode of vigorous exertion in both the primary analysis and the three sensitivity analyses. Habitually active men had a much lower risk of sudden death in association with an episode of vigorous exertion than men who exercised less than once a week; however, the most active men’s risk remained significantly elevated during and after vigorous exertion in all analyses.[3]

 

There is no suggestion that these episodes of vigorous exertion occurred less frequently during the time of the new moon. According to the hypothesis of the full new moon study, the effect of the new moon should only be at night, when it would make a difference in the amount of available light. This might make more difference in rural areas, than in the suburbs, and more of a difference in suburbs, than in cities, due to the wonders of electrical lighting.

Is there any evidence to support this string of conclusions? I don’t think so.

That does not mean that this hypothesis is incorrect, just that their way of getting there is not supported by the information provided.

One very nice part of this study is the brief review of previous studies and whether they seemed to support, or refute, a connection between various activities and the full moon, but this post is already too long. I will write about other full moon research elsewhere.

Another problem is the way they define a full moon –
 

We identified full and new moon days that occurred during the study period from the United States National Oceanographic and Aeronautic Administration website. Using this information we created variables for full and new moon days to be used in a regression model of daily CPR, described below.[1]

 

So. What is their definition of a new moon, or a full moon? They have not made that clear, but it appears to be limited to one specific day during each lunar cycle.

Using NOAA’s (United States National Oceanographic and Aeronautic Administration’s) website, I found a page that identifies new moons, full moons, and other phases by entering the time period I want to look at. The problem I see is that there is not much detail about how they used this information, or if they were using the same part of NOAA’s website.

Why no discussion of this?

Why no discussion of their definition of new moon and full moon?

If their hypothesis is one that depends on the available light, why does the day before a new moon not count, or the day after, or two days before (or after)?

However, if they are looking for a mystical connection between the full moon and bad events, a case can be made that the full power of the full moon would be on one specific date.

If they are claiming that they are examining the effects of the amount of moonlight, how much difference is there in the amount of moonlight from one day to the next? Where is your cut-off? Why?

I think that their conclusion should be that they find no apparent mystical connection between the full moon and cardiac arrests treated by emergency physicians. Their attempts at explaining their results wander into narrative fallacy, which I have written about here, here, here, here, here, here, here, here, here, and here.

As I have stated before about the way we should look at explanations for scientific results –

Bet that the explanation is wrong.

This is one of the failures of our basic education of students. We do not make this clear to them. Yes, this was where the post started, with the failure of science education in the grade schools.

The media report that a certain study means X, even though the authors of the study may not have suggested that this is true. It is later found that the conclusion popularized by the media is wrong. The blame goes, not to the reporters misrepresenting the science, but to the science. We need to avoid creating explanations that are unsupportable and likely to be found to be in error. We need to stop telling fairy tales. We need to stop talking to media members, who spin research results with misleading explanations.

We have people graduating from high school, but unable to recognize the difference between good science and bad science. Unable to look at a study and determine if there is something there that is meaningful. This continues through college, and even medical school. Number 3 on the list was – Academic Medical Centers, so I am not the only one critical of these ivory towers. The top threat to science in medicine is the lack of understanding of what science is. We fail before the students ever get started. This lack of understanding is due to a lack of education in grade school.

We need to change how we teach science. Some do it well, but the debates on scientific topics in the media suggest that few have been well taught. The ignorant mobs are trying to keep themselves in scientific debates for which they are not even remotely qualified. We need to make it so that more are qualified.

We need to improve our basic science education, because we cannot rely on people from other countries coming here to do the science that we have become too ignorant to handle. Eventually, the destination of smart foreign-born scientists will not be the United States. We do not develop enough of our talent. We remain a scientific power because import talent. We do the same thing with grape pickers and day laborers. These seem to be the jobs that we will no longer do for ourselves. Scientist and day laborer are both looked at as undesirable. We need to change this.

It is in the earlier grades that the problems of bad science education are established. After that point it is a much more difficult task to correct this creeping indoctrination in magical thinking.

I think that this is the number one threat to science in medicine. All of the others only contribute to this.

Magical thinking is a form of corruption. As with other types of corruption, it usually does not start with a cannonball into the deep end, but a gradual acclimatization to more and more corruption. At some point, critical judgment is only a fond memory.

There must have been a time, in the beginning, when we could have said – no. But somehow we missed it. – Tom Stoppard.

We can still fix that problem in education for those in grade school.

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Footnotes:

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[1] Effect of lunar cycle on temporal variation in cardiopulmonary arrest in seven emergency departments during 11 years.
Alves DW, Allegra JR, Cochrane DG, Cable G.
Eur J Emerg Med. 2003 Sep;10(3):225-8.
PMID: 12972900 [PubMed – indexed for MEDLINE]

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[2] ICD-9 code definition from the study above

The physicians’ billing department assigns codes according to the International Classification of Diseases, Ninth Revision, and Clinical Modification [International Classification of Disease (ICD)-9 codes]. Patients were included as CPR if they contained any of the ICD-9 codes listed in Table 1 as one of their three primary diagnoses.

Table 1
International Classification of Disease 9 codes
427.4       Ventricular fibrillation
427.41     Ventricular fibrillation
427.5       Cardiac arrest
798.1        Death instantaneous
798.2      Death occurring less than 24h from onset of symptoms
798.9       Death unattended

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[3] Triggering of sudden death from cardiac causes by vigorous exertion.
Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE.
N Engl J Med. 2000 Nov 9;343(19):1355-61.
PMID: 11070099 [PubMed – indexed for MEDLINE]

Free Full Text from NEJM.

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Alves, D., Allegra, J., Cochrane, D., & Cable, G. (2003). Effect of lunar cycle on temporal variation in cardiopulmonary arrest in seven emergency departments during 11 years European Journal of Emergency Medicine, 10 (3), 225-228 DOI: 10.1097/00063110-200309000-00013

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Filed Under: Conventional Ignorance, EMS EduCast, Full Moon, Heresy, Narrative Fallacy, Science, Superstition Tagged With: , , ,

Correlation vs. Causation in a couple of videos for the hard of reading:-)

Sun, 04 Oct 2009 15:47:46 -0400 by
At Respectful Insolence is this pair of videos on correlation, causation, and the Hollywood ignorantists, who cannot tell the difference. Not that ignorance would stop Honest Jenny Killer McCarthy from telling everyone else to endanger their children. Generation Rescue, Jenny McCarthy, and the anti-vaccine movement: Confusing correlation with causation.

To get the most information out of these, watch them in full screen mode, so that you can read the print on the charts that are shown.

Part I:

Part II:

Here is the sidebar information posted at YouTube.

C0nc0rdance
October 01, 2009

When we make risky decisions about our health, it’s always good to be in possession of all the facts, to let our brains, and not our hearts, make the decision. Your child is thousands of times more likely to die from a preventable disease you didn’t vaccinate them against than to develop autism from a vaccine you did give them. The case for autism and vaccines is solely based on weak correlations and emotional responses.

Generation Rescue:
http://www.generationrescue.org/evidence-science/05-autism-and-vaccines.htm

CDC statement on the safety of vaccines:
http://www.cdc.gov/vaccinesafety/

Locate a flu vaccination center near you:
http://info.findaflushot.com/blog/tag/vaccination

Get vaccinated. Do it for the people who matter to you.

Very well done.

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Filed Under: Critical Judgment, Heresy, Science Tagged With: , ,

Correlation vs. Causation – repost for the Handover

Wed, 23 Sep 2009 18:22:41 -0400 by

This is a repost to fit in with the theme of the Handover over at Life Under the lights. Some coverage of research in comics by xkcd:

One of the amusing parts of xkcd is the mouse over text. It does not transfer to my blog (the text doesn’t transfer, the humor increases tremendously, or maybe not), but this is what pops up at the xkcd site:

Correlation doesn’t imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing ‘look over there’

Correlation is when things happen together. The whole purpose of the scientific method is to try to differentiate among the different correlations. Some will be purely coincidences. Some will be related, but some will not be the causes of what comes after them. And some will be causes.

All of the links in this are from the original article. The author trying to make his point, not me criticizing his points.

Cows with Names Make More Milk
By Robert Roy Britt, Editorial Director
posted: 27 January 2009 09:05 pm ET

Researchers in the UK say cows with names make 3.4 percent more milk in a year than cows that just feel, well, like cows.

There seems to be more than just names involved, however.

This sounds as if it is common sense. Call a cow by name and the cow will be more productive. People seem to prefer to be called by name, so why not cows?

Is this an example of anthropomorphic fallacy? Anthropomorphic fallacy is attributing human qualities to other creatures without any evidence to support these traits. Do cows feel happy? Do they feel sad? Do they feel unique? If they do, which is a big If, how do we recognize that the cow is feeling that feeling? What about an appearance that resembles a human expression of happiness, or sadness, or uniqueness (which would almost always be wrong)? Does that appearance mean the same on a cow as on a human?

The study, involving 516 dairy farmers and published online Tuesday by the journal Anthrozoos, found that “on farms where each cow was called by her name the overall milk yield was higher than on farms where the cattle were herded as a group,” write researchers Catherine Douglas and Peter Rowlinson of Newcastle University.

Nobody likes to be herded. Even a cow, one might presume. Indeed, the findings in fact point to an overall personal touch that — just a guess here — might say as much about the farmers as it does about the cows.

Precisely. There does not seem to be any attempt to control for variables in this study. Is the only difference between the farms that, some farmers called their cows by name, while other farmers did not? I called up Jimmy The Greek and he would not give me any odds on that bet. It seems that Jimmy The Greek, with no scientific research training, is able to recognize a major flaw in this research. And Jimmy The Greek has been dead for a dozen years.

Nobody likes to be herded?

I think that the economy is demonstrating exactly the opposite. There are a lot of people just begging to be herded. Tell us what to do! Save us! Is that not herd mentality? Nobody likes to be herded is what we would like to believe about ourselves, but a lot of people sure do seem as if they like to be herded. That freedom from the responsibility of having to think. They do seem to love it. Even the link provided does not support the claim that nobody likes to be herded.

“Just as people respond better to the personal touch, cows also feel happier and more relaxed if they are given a bit more one-to-one attention,” Douglas said. “By placing more importance on the individual, such as calling a cow by her name or interacting with the animal more as it grows up, we can not only improve the animal’s welfare and her perception of humans, but also increase milk production.”

Improve … her perception of humans?

This is not doing much for my perception of this human they call Douglas. Excuse me for taking a bit of a speciesist view of this, but what evidence do we have that cows’ perception of humans has anything to do with life as a cow on a farm? Do they view us as benevolent creatures, more so if we call them by name? Do they view us as soft touches, to be manipulated as much as possible? How would we know?

Happy cows. Okay. Well, if you are a farmer (especially one with a small farm that struggles to be profitable by milking only a handful of cows) you probably would not argue with success. Cows, after all (and in case you thinking of judging them as dumb animals) are known to have a magnetic sixth sense and are not as prone to cow-tipping as you might have heard. Who knows what else they are capable of?

A magnetic sixth sense?

Birds have a similar ability to sense magnetic north. Comparing a cow brain to a bird brain is not making a case for intelligent cows.

Not as prone (a pun?) to cow tipping?

Again, this has nothing to do with intelligence. Cows do not sleep standing up. If the cow is standing, the cow is awake. Not being completely oblivious to one’s surroundings correlates with intelligence. Awareness is not the same as intelligence. A Venus Flytrap has enough awareness to catch flies, but that does not make it intelligent.

Dairy farmer Dennis Gibb, who co-owns Eachwick Red House Farm outside Newcastle with his brother Richard,

The Brothers Gibb?

Milkin’ the Cows sung to the tune of Stayin’ Alive. You know, the CPR song.

Well, you can tell by the way I name my cows,
I’m an udder man: no time to talk.
Bowels are loud and teats are warm, I’ve been excreted on
Since I was born.
And now it’s all right. It’s OK.
And you may milk another way.
We can try to understand
Callin’ their name’s effect on cows.

Whether you’re a twister or whether you’re a squeezer,
You’re milkin’ the cows, milkin’ the cows.
Feel methane breakin’ and everybody shakin’,
And were milkin’ the cows, milkin’ the cows.
Ah, ha, ha, ha, milkin’ the cows, milkin’ the cows.
Ah, ha, ha, ha, milkin’ the cows.

Naming cows is one thing, but do they teach them karaoke? Do they teach them to dance? How can you have a proper control group without these groups?

Sorry. I get just a little bit silly at times. Just a little bit.

Dairy farmer Dennis Gibb, who co-owns Eachwick Red House Farm outside Newcastle with his brother Richard, says he believes treating every cow as an individual is vitally important. “They aren’t just our livelihood — they’re part of the family,” Gibb said in a statement released by the university. “We love our cows here at Eachwick and every one of them has a name. Collectively we refer to them as ‘our ladies’ but we know every one of them and each one has her own personality.”

See?

The findings:

* 46 percent said the cows on their farm were called by name.
* 66 percent said they “knew all the cows in the herd.”
* 48 percent said positive human contact was more likely to produce cows with a good milking temperament.
* Less than 10 percent said that a fear of humans resulted in a poor milking temperament.

* 66 percent said they “knew all the cows in the herd.”

Isn’t that shepherds. . .

Have I mentioned that you should try the veal? Badump bump.

* Less than 10 percent said that a fear of humans resulted in a poor milking temperament.

Are they claiming that fear results in poor milking temperament?

Or are they claiming that fear of humans results in poor milking temperament?

I don’t have a big problem with categorizing certain responses as indications of fear. We cannot ask the cow what she is feeling, but we can guess. All that this would be is a great big guess. OK, I guess I do have a problem with this. Now, if you take that great big guess, not only take it for granted, but attribute a specific cause to the presumed fear, that’s just silly. Even sillier than my little rewrite of Stayin’ Alive.

Unless you have John Edwards reading the minds of these cows for you:

John Edwards – I sense something from over here. Something that begins with an M. Is it Moo?

Cow – Yes. That is what my mother, an unnamed cow, always used to say to me.

After all, the lack of continuing success for his show isn’t because John Edwards is a fraud. He’s just misunderstood by the cows in the audience. Yeah. That’s the ticket. He’s just misunderstood. By the cows.

“Our data suggests that on the whole UK dairy farmers regard their cows as intelligent beings capable of experiencing a range of emotions,” Douglass said. “Placing more importance on knowing the individual animals and calling them by name can — at no extra cost to the farmer –— also significantly increase milk production.”

The cows are intelligent beings?

Compared to what? Bacteria?

Maybe these intelligent beings should be allowed to vote.

This is at no extra cost to the farmer?

Clearly, these farmers do not understand cows. You call a cow by the wrong name and no milk for a week.

* Amazing Animal Abilities
* My Big Beef with Cloned Cattle
* Love of Milk Dated Back to 6000 B.C.

Robert Roy Britt is the Editorial Director of Imaginova. In this column, The Water Cooler, he takes a daily look at what people are talking about in the world of science and beyond.

Correlation:

Cows called by name.

AND

Cows produce more milk.

This is a correlation.

Does this equal causation?

Does calling the cow by name mean that the cow will produce more milk, than if you do not call the cow by name?

To quote from the xkcd comic – Well, maybe.

Just because the research does not exclude the obvious, and even less obvious, variables, does not mean that one does not cause the other. It is possible.

However, because of the lack of control of variables, and other flaws, it would be a huge mistake to suggest that there is evidence to support that conclusion. For all we know, it could be an error of measurement – there may not be any real difference.

This isn’t research. This is comedy.

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Filed Under: Critical Judgment, Heresy, Research, Science Tagged With: , , ,
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