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

- Rogue Medic

The Oleandrin Scam Exposes Incompetent Doctors

President Trump has made another medical recommendation. This one is more dangerous than the last. As long as a lot of physicians are willing to harm patients in order to promote their political agenda, President Trump is willing to keep playing doctor and providing them with ways to harm patients. We can hope that the FDA (Food and Drug Administration) takes action to protect patients from such doctors.

Hydroxychloroquine was supported by low-quality research, but some physicians couldn’t wait to promoted it. That is alternative medicine – the opposite of competent medicine.

When high-quality evidence on the use of hydroxychloroquine in humans with COVID-19 was published, these physicians insisted that the research was politically motivated, each time a new high-quality study was published. That is the argument used by alternative medicine, not real medicine. Every high-quality study shows that there is no benefit from hydroxychloroquine for COVID-19 patients. The risks are greater than the potential benefits. Competent and ethical physicians should limit the use of hydroxychloroquine to well-controlled research.

Now we have a more extreme danger to patients from alternative medicine and promoted by President Trump. Oleandrin is an extract of the oleander plant and is not supported by any research in humans. The only research supporting oleandrin as a COVID-19 treatment is in test tubes, which means that this is not even as well tested as the vaccine approved by President Putin earlier this month. If there is any use in humans, it would be in a Phase 1 trial. Not even that level of research has been done, yet.

The obvious image to use to explain this is from xkcd.

The mouse over text states: Now, if it selectively kills cancer cells in a petri dish, you can be sure it’s at least a great breakthrough for everyone suffering from petri dish cancer.

Oleandrin, and thousands millions of other chemicals, kill coronaviruses in petri dishes. Killing cells in petri dishes does nothing to help patients.

For more detailed information read this article or this article or listen to this podcast.

.

Is Hydroxychloroquine Effective Against COVID-19?

     
As with any popular treatment, there are plenty of people who want us to ignore the research, or to focus on giving people hope. That is not a reasonable, or ethical, approach to medicine. That is not even a medical approach to medicine. If we lower our standards enough, we can claim that everything works, but that would kill a lot more people than only using treatments based on EBM (Evidence Based Medicine). Should we make excuses for lowering our standards, and killing people, or should we insist on raising our standards?

There is currently a pandemic, so there is a bit of a rush to find something that works, which some people mistake for a need to provide hope. If you want hope, you can pray and there should not be any harmful effects of praying. However knowing that you were being prayed for by others has been associated with a significantly higher incidence of complications. In other words, praying for yourself or others is fine, but telling others that you are going to pray for them is probably harmful, even though your intent is to help.[1]

The reasonable way to look at taking medicine is take only those treatments that have been demonstrated to improve outcomes for people with the studied diagnosis, when you have that diagnosis. Everything else is a crap shoot, where you don’t even know the risks – and there probably is no benefit.

Why do I state that the risks to the person taking the treatment are unlimited, but the benefits probably do not exist?

That is the history of the study of treatments. Almost everything proposed as a treatment has been more harmful than beneficial. It would be nice if this were not true, but reality doesn’t care about being nice. All of alternative medicine falls into the category of probably more harmful than safe and unlikely to be of any benefit, other than a benefit to the finances of the person selling the alt med.

Is hydroxychloroquine alternative medicine? Hydroxychloroquine is approved as real medicine for malaria, lupus erythematosus, and rheumatoid arthritis.[2] For these diagnoses, hydroxychloroquine is not alternative medicine. For everything else, the use is off-label, which is a legal way of saying alternative medicine, as far as the FDA (Food and Drug Administration) is concerned. Sometimes off-label use can be supported by good evidence, but the treatment has not been submitted to the FDA for approval for that diagnosis, but that is not the case with hydroxychloroquine. The FDA issued an EUA (Emergency Use Authorization) for hydroxychloroquine limited to adults and adolescents who weigh 50 kg (approximately 110 pounds) or more, who were hospitalized with COVID-19, and for whom participation in a clinical trial was not available, or participation was not feasible.[3]

Why are those limitations important?

1. If a treatment is effective, diverting patients from clinical trials will delay learning that the treatment is effective, which will significantly decrease the number of lives saved.

2. If a treatment is not effective, diverting patients from clinical trials will delay learning that the treatment is not effective, which will significantly decrease the number of lives saved, because patients are receiving a useless distraction from effective treatment.

3. If a treatment is harmful, which is much worse than just being not effective, diverting patients from clinical trials will delay learning that the treatment is harmful, which will significantly increase the number of patients killed.

All of those results – and those are the possibilities – are ignored by those who reject research. No treatment, however good, will be purely beneficial. All treatments have adverse effects. however, the reverse of that is not true. A treatment that is harmful often does not provide any benefit.

The odds are always against the patient. Any doctor trying to just do something is endangering patients. Kitchen sink medicine (throwing everything at the patient, just in case) has always been bad medicine.

There is a good discussion of the evidence in two podcasts:

15. Covid-19: Is There a Case for Hydroxychloroquine?
Stimulus with Rob Orman, MD (who also hosts the ERCast)
July 30, 2020
Podcast page

Dr. Orman does not specifically mention the Arshad study, which claims to show a benefit in patients treated with HCQ (HydroxyChloroQuine), AZM (AZithroMycin), and HCQ+AZM (HydroxyChloroQuine + AZithroMycin), but that does not change the conclusion of an examination of the evidence.[4]


COVID-19 Treatment Update: Can We Just Stop Wasting Time on Hydroxychloroquine
Written by Salim Rezaie
July 6, 2020
Podcast page

Here is the most important point from Salim Rezaie about the outcomes from the Arshad study:

As most patients in this trial receiving HCQ or HCQ + AZM received steroids and the patients receiving AZM alone or neither therapy had far fewer patients receiving steroids, the likely mortality benefit of this trial is due to the steroids and not the HCQ or HCQ + AZM


Dr. Rezaie concludes: This study should not change clinical practice of not prescribing these medications.

The Arshad study is being used by proponents of hydroxychloroquine alternative medicine to try to contradicting higher quality research, which is the reason it is not real medicine. When there is only low quality evidence, we should be cautious in recommending any treatment. When the high quality evidence shows that the low quality evidence is misleading, we should ignore the low quality evidence until there is high quality evidence to support the findings of the low quality evidence. Don’t expect that to happen.

The reason most medical research is overturned is the reliance on low quality evidence.[5], [6], [7], [8]


Footnotes:

[1] Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer
Herbert Benson 1, Jeffery A Dusek, Jane B Sherwood, Peter Lam, Charles F Bethea, William Carpenter, Sidney Levitsky, Peter C Hill, Donald W Clem Jr, Manoj K Jain, David Drumel, Stephen L Kopecky, Paul S Mueller, Dean Marek, Sue Rollins, Patricia L Hibberd
Am Heart J. 2006 Apr;151(4):934-42. doi: 10.1016/j.ahj.2005.05.028.
PMID: 16569567

Our study had 2 main findings. First, intercessory prayer itself had no effect on whether complications occurred after CABG. Second, patients who were certain that intercessors would pray for them had a higher rate of complications than patients who were uncertain but did receive intercessory prayer.



[2] Hydroxychloroquine Sulfate tablet
INDICATIONS AND USAGE
Daily Med
FDA Label


[3] Frequently Asked Questions on the Revocation of the Emergency Use Authorization for Hydroxychloroquine Sulfate and Chloroquine Phosphate
FDA
Page as PDF download

Q. Why did FDA grant the EUA for hydroxychloroquine sulfate (HCQ) and chloroquine phosphate (CQ) for the treatment of COVID-19 initially?
A. On March 28, 2020, BARDA requested and FDA issued an Emergency Use Authorization (EUA) for emergency use of oral formulations of chloroquine phosphate (CQ) and hydroxychloroquine sulfate (HCQ) for the treatment of COVID-19. Based on the scientific information available to FDA as of that date, the Agency determined that CQ and HCQ may be effective in treating COVID-19 and that the known and potential benefits of CQ and HCQ outweighed the known and potential risks for this use. The agency limited the use of authorized products to adults and adolescents who weigh 50 kg (approximately 110 pounds) or more, who were hospitalized with COVID-19, and for whom participation in a clinical trial was not available, or participation was not feasible.



[4] Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19
Samia Arshad,a Paul Kilgore,b,c Zohra S. Chaudhry,a Gordon Jacobsen,e Dee Dee Wang,d Kylie Huitsing,a Indira Brar,a George J. Alangaden,a,c Mayur S. Ramesh,a John E. McKinnon,a William O’Neill,d Marcus Zervos,a,c,⁎ and Henry Ford COVID-19 Task Force1
Int J Infect Dis. 2020 Aug; 97: 396–403.
Published online 2020 Jul 2. doi: 10.1016/j.ijid.2020.06.099
PMID: 32623082

PMCID: PMC7330574 (Free Full Text from PubMed Central)


[5] Why Most Published Research Findings Are False
John P. A. Ioannidis
PLoS Med. 2005 Aug; 2(8): e124.
Published online 2005 Aug 30. doi: 10.1371/journal.pmed.0020124
PMID: 16060722

PMCID: PMC1182327 (Free Full Text from PubMed Central)

The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance.



[6] Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices
Vinay Prasad and John PA Ioannidis
Implement Sci. 2014; 9: 1.
Published online 2014 Jan 8. doi: 10.1186/1748-5908-9-1
PMID: 24398253

PMCID: PMC3892018 (Free Full Text from PubMed Central)

Abandoning ineffective medical practices and mitigating the risks of untested practices are important for improving patient health and containing healthcare costs. Historically, this process has relied on the evidence base, societal values, cultural tensions, and political sway, but not necessarily in that order. We propose a conceptual framework to guide and prioritize this process, shifting emphasis toward the principles of evidence-based medicine, acknowledging that evidence may still be misinterpreted or distorted by recalcitrant proponents of entrenched practices and other biases.


[7] Observational studies often make clinical practice recommendations: an empirical evaluation of authors’ attitudes
Vinay Prasad 1, Joel Jorgenson, John P A Ioannidis, Adam Cifu
J Clin Epidemiol.
2013 Apr;66(4):361-366.e4.
PMID: 23384591   DOI: 10.1016/j.jclinepi.2012.11.005

It is common to see new studies contradict previous adopted standards of care [25,26]. Even the results of highly cited studies can be refuted [7], and the replication rate tends to be low for claims made from observational designs [7]. We have previously noted that the most common correlate for reversal of standards of care was the original adoption of a practice based on nonrandomized evidence alone [27]. The studies examined here offer many recommendations that may be precarious or erroneous. If adopted, such practices may need to be reversed in the future after having been detrimental to health, health finances, and the reputation of medical science.



[8] Contradicted and initially stronger effects in highly cited clinical research
John P A Ioannidis
JAMA. 2005 Jul 13;294(2):218-28. doi: 10.1001/jama.294.2.218.
PMID: 16014596   DOI: 10.1001/jama.294.2.218

Free Full Text from JAMA

Of the 45 eligible highly cited studies with efficacy claims (Table 2), 7 (16%) were contradicted by subsequent research, and another 7 (16%) were found to have initially stronger effects. In all these 14 cases (BOX 1), subsequent studies were either larger or better controlled (randomized vs a nonrandomized original study). The findings of 20 highly cited articles (44%) were replicated (also with a larger sample size in subsequent research compared with the original highly cited study) and 11 (24%) had remained largely unchallenged.58-78



.

Hydroxychloroquine – The More You Know, The Worse It Looks



Do you want to use a drug that was never based on any good evidence, but only a hunch? Try hydroxychloroquine. The president says, What have you got to lose?


Kitchen sink medicine is a remnant of the Dark Ages, but it has not been eliminated from medicine. It is the argument from ignorance. If you can’t prove that the treatment is harmful, the treatment is wonderful. If you can prove the treatment is harmful, you are part of a conspiracy.


This is further evidence that hydroxychloroquine is harmful. The higher the quality of the evidence about hydroxychloroquine, the worse hydroxychloroquine looks.


Today, Lancet published this study comparing almost 15,000 patients receiving several different experimental treatments with about 80,000 patients not receiving any of the experimental treatments. This should convince reasonable people that there is no justification for treating patients with hydroxychloroquine outside of a well controlled randomized trial.


The comments on articles about the study are full of the usual anti-science, anti-vax, alternative medicine propaganda. Their religion has failed, but they keep preaching.


After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality.[1]


The evidence shows that you are twice as likely to die if you receive hydroxychloroquine.


Don’t listen to anti-science, anti-vax, anti-medicine preachers, because they are not interested in your health.


What have you got to lose?


What are you treating, you politics/religion or your health?


If your goal is to treat your religion, go ahead and use the magic elixir and maybe you will not be harmed by it.


If your goal is to treat your health, avoid magic claims about treatments, regardless of the treatment. Use treatments that work in the real world.


What have you got to lose?


You are twice as likely to lose your life. Among survivors, the significant adverse effect rate was much higher in the hydroxychloroquine groups. This is the highest quality research so far and there is no good news for the hydroxychloroquine.


Read the full paper and think for yourself. Don’t listen to those making excuses to promote their agenda. Your health has never been important to those who reject science.


It is unfortunate that we do not have some treatment that works well, but that is not a good reason to bet your life on bad medicine. More people survive with better health with conventional treatment.



Footnotes:


[1] Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis
Prof Mandeep R Mehra, MD, Sapan S Desai, MD, Prof Frank Ruschitzka, MD, Amit N Patel, MD
Lancet. Published:May 22, 2020
DOI:https://doi.org/10.1016/S0140-6736(20)31180-6


Free Full Text from Lancet.


.

NIH clinical trial of remdesivir to treat COVID-19 begins

     

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

.

Happy Darwin and Lincoln Day 2019

 

Today we celebrate two 210th birthdays. Both stood up to right wing religious fanatics and were attacked for it. One was assassinated.

The first birthday boy is Abraham Lincoln, who might have been the most famous aggressively pro-civil rights, do gooder, Social Justice Warrior president – except that secession began before Lincoln even took office. The slave states were so afraid of what Lincoln might do that they didn’t even wait to find out. They didn’t use any valid legal means to try to win their case, but essentially stated, We’re leaving and we’re taking these parts of America, because we believe they belong to us and secession is 9/10ths of the law. We double dog dare you to enforce the law – and just to comply with the wording of the Constitution of the United States, we are going to open fire on the United States Army. The hurt themselves and the rest of America by promoting secessionists’ devotion to enslaving those not white and the secessionists’ adamant opposition to states’ rights. Yes, the secessionists’ claimed to be fighting for states’ rights, but liars lie.
 

Treason against the United States, shall consist only in levying war against them, or in adhering to their enemies, giving them aid and comfort. No person shall be convicted of treason unless on the testimony of two witnesses to the same overt act, or on confession in open court.

The Congress shall have power to declare the punishment of treason, but no attainder of treason shall work corruption of blood, or forfeiture except during the life of the person attainted.[1]

 

Ironically, those who seceded were Democrats, but the parties have flipped and the Republicans are now the anti-civil rights party.

The following statement is from Sen. Barry Goldwater, who was the 1964 Republican and Conservative candidate for president, but now would be rejected by the Conservatives and the Republicans.
 

Mark my word, if and when these preachers get control of the [Republican] party, and they’re sure trying to do so, it’s going to be a terrible damn problem. Frankly, these people frighten me. Politics and governing demand compromise. But these Christians believe they are acting in the name of God, so they can’t and won’t compromise. I know, I’ve tried to deal with them.[2]

 

Modern America has moved so far to the right, that Goldwater would probably be accused of being a socialist and a communist by various members of the right wing media. Sen. Goldwater also opposed government intrusion into the personal lives of LGBT people, because he was opposed to the big government that much of the right wing wants to use to force their lifestyle on everyone.

At that time, the right wing media being condemned by Sen. Goldwater was just beginning a resurgence. The ironically named Moral Majority was preaching its Christian sharia law to gather a lot of followers. Jerry Falwell, Sr. was their leader and Barry Goldwater condemned that earlier, less powerful, Falwell. His son, Jerry Falwell, Jr. seems to be able to tell our current president what to do, but a lot of people manipulate the president.
 

I think every good Christian ought to kick Falwell right in the ass.[3]

 

Since the Civil War, the propaganda machine of the secessionists has been more successful. They have been able to place statues of the traitors throughout the states they led in treason to show everyone that the secessionists still maintain power in spite of being defeated on the battlefield. Why don’t we have statues of Benedict Arnold?

We could celebrate Robert E. Lee for his opposition to secessionists after the war and for Lee’s unintentional(?) destruction of his cavalry at Gettysburg. Pickett’s Charge may have been the final straw for the Army Promoting Expansion of Slavery.

The second 210th birthday boy is Charles Darwin, who is remembered for explaining the diversity of life on Earth. Evolution explains the evidence showing the progression from the simplest life form to the current diversity of life – a diversity which appears to be decreasing due to our failure to value our children above our politics. Extinction is a part of that explanation. Extinction was once thought to be an argument against evolution, because it would violate God’s perfect plan, but eventually, extinction became undeniable, too. Oddly, people still deny biology. Evolution is so essential to biology, that Theodosius Dobzhansky wrote a paper titled, Nothing in Biology Makes Sense Except in the Light of Evolution.[4]

It is interesting that the science denial that affects biology, Creationism, is promoted most aggressively in the same slave states Bible Belt that fought against the United States of America in favor of treating diversity as a justification for violence.

It was science that helped the liberal Christians to convince the rest of America that slavery is wrong – something that much of the often less Christian rest of world already understood.
 

Book that Changed America - cover 1
 

As I wrote in 2017:

Darwin provided scientific evidence for a common origin, which gave a scientific argument to those criticizing slavery. How is it moral to enslave other humans? Well, the Bible repeatedly endorses slavery and Jesus never criticized slavery. Jesus actually used slavery as an analogy for belief in God, with believers as slaves and the slave owners as God.

Contrariwise, those who focused on the good parts of the Bible and avoided the bad parts, used Darwin’s book as the basis for advocating for a more moral approach to our fellow humans. Those who read the Bible differently from the advocates of slavery saw that they were not along. Science also opposed the moral abyss of slavery.

Not to spoil the ending, but the abolitionists were not successful at reasoning with those in the Bible Belt to end slavery in America. We ended up with over 600,000 Americans dead over different interpretations of the Bible on how to treat humans.[5]

The anti-science of Young Earth Creationism, the most basic form of Creationism, is the belief that the particular version of the God of that sect of believers literally just poofed itself into existence, then created life in its current diversity and that mutation can never produce a beneficial outcome.

For some bizarre reason, this God has organs of evolution. A true only one of its kind creature would not be male, nor would it be female, but the plot holes are numerous and demonstrate the impossibility of the story, when promoted as accurate. What other creature(s) God need sexual organs for? How did this God evolve them? Most Christians seem to view the two contradictory Creation stories in Genesis (Genesis 1 vs. Genesis 2) as metaphorical. How else do you defend something that dramatically changes when you turn to the next page? Hallucinogens? Hypoxia? Dementia? Metaphor – it is poetic, rather than literal. At least, that is the only reasonable approach.

Some Creationists take a shot at creating a middle approach. These not-so-literalists claim that microevolution is real, but macroevolution is impossible. These are real terms, but not the way the not-so-literalist Creationists use them.

These Creationists see that microevolution is undeniable, so they try to move the goalposts to try to protect their belief in Separate Creation.

Here is a further irony. These not-so-literalist Creationists claim that while they cannot deny that evolution happens on a small scale, they absolutely refuse to accept that it continues. Evolution is required to stop. Although they cannot provide any kind of evidence to support their claim and scientists provide plenty of evidence that evolution is not stopped, they continue to make this claim.

The irony gets even greater, because when you are dealing with apologists, the excuses will differ, thus the increasing disagreements among the dozens/hundreds/thousands of flavors of Creationism. Some of these micro yes, macro no Creationists claim that the restriction on evolution prevents the development of any new species, because they just can’t seem to understand that a lot of change can produce a dramatic difference. Other micro yes, macro no Creationists claim that this restriction prevents the evolution of any new genus. They claim that the story of the Ark saving 8 people from the murderous God of the Bible is the reason. This story is borrowed from the Babylonians, who taught the Israelites to write during the Babylonian captivity.[6]

Anyway, the story of the Ark mentions 19 Every beast, every creeping thing, and every fowl, and whatsoever creepeth upon the earth, after their kinds, went forth out of the ark.[7] This is a justification for being able to put billions of creatures on one supposedly seaworthy vessel. Not everything had evolved at the time, some evolved after their kinds after they disembarked. Two contradictions attacked with one excuse. Brilliant!

Some of the not-so-literalist Creationists accept that evolution is possible, as long as it does not produce a new species, because that would be too much. They insist that there must be an artificial limit on evolution.

Other not-so-literalist Creationists accept that evolution is possible, as long as it does not produce a new genus, because that would be too much. They insist that there must be an artificial limit on evolution.

Still other not-so-literalist Creationists accept that evolution is possible, as long as it does not produce a new family, because that would be too much. They insist that there must be an artificial limit on evolution.
 


Taxonomic Rank, from Wikipedia page
 

No matter what they have to invoke, all flavors of Creationist insist that there is some sort of artificial limit on evolution. Some Creationists insist that all evolution is prevented, while others accept varying amounts of evolution, rather than try to reject the overwhelming evidence.

We flawed humans must be explained, but their ambiguous creator must just be believed in all of its million different interpretations, and with all of its impossible contradictions – and all of the other Gods are just made up by people.

Footnotes:

[1] Constitution
Article III, Section 3
The Legal Information Institute
Article III

[2] Barry Goldwater
Wikiquote
 

Said in November 1994, as quoted in John Dean, Conservatives Without Conscience (2006).

 

[3] Barry Goldwater
Wikiquote
 

Said in July 1981 in response to Moral Majority founder Jerry Falwell’s opposition to the nomination of Sandra Day O’Connor to the Supreme Court, of which Falwell had said, “Every good Christian should be concerned.” as quoted in Ed Magnuson, “The Brethren’s First Sister,” Time Magazine, (July 20, 1981).
According to John Dean, Goldwater actually suggested that good Christians ought to kick Falwell in the “nuts”, but the news media “changed the anatomical reference.”
Dean, John (2008). Broken Government: How Republican Rule Destroyed the Legislative, Executive, and Judicial Branches. Penguin Group. “I know because I was there when he said it.”(2006).

 

A further irony is that there is nothing in the Bible that is even slightly critical of abortion, but the Bible thumpers lie about this. If you claim that Thou shalt not kill applies to abortion, you have to find someplace – any place where the Bible refers to abortion as killing. The Bible does not make that claim. The Christian sharia promoters make far more judgmental claims (judge not, lest ye be judged), because irony knows no bounds among fundamentalists.

The Bible states that life begins with the first breath. Genesis 2:7 and Job 33:4 and that a fetus is not a person Exodus 21:22. The Biblical literalists need to reinterpret the words to massage the meaning to be able to come up with something that allows them to claim their interpretation of their God agrees with them.

There is condemnation of divorce, by Jesus, but the religious right has chosen to vote for divorced leaders in order to get the political power that they want. Almost everything Jesus says in the Sermon on the Mount (Matthew 5-7) is a condemnation of the goals of the religious right in America today, but that is not the only place where Jesus condemns the religious right in America today.

Why do so many right wing Christians hate Jesus so much that they blaspheme Jesus?

If you want more information than provided above, read these:

The ‘biblical view’ that’s younger than the Happy Meal
February 18, 2012
Fred Clark
Article
 

In 1979, McDonald’s introduced the Happy Meal.

Sometime after that, it was decided that the Bible teaches that human life begins at conception.

 

and

The Not-So-Lofty Origins of the Evangelical Pro-Life Movement
February 5, 2013
Jonathan Dudley
Religion Dispatches
Article
 

Although evangelicals were mostly silent on abortion after Roe v. Wade, they were not silent on other political issues. Paul Weyrich, one of the evangelical right’s most influential founders, recalls that the movement initially emerged to defend racially segregated Christian schools from government intrusion:

 

Abortion was chosen as the rallying cry, because the religious right were losing ground defending segregation. Now abortion is the headline, while the religious right still work for segregation by more politically correct means.

[4] Nothing in Biology Makes Sense Except in the Light of Evolution
Theodosius Dobzhansky
The American Biology Teacher, Vol. 35, No. 3 (Mar., 1973)
Article in PDF format
 

I am a creationist and an evolutionist. Evolution is God’s, or Nature’s method of creation. Creation is not an event that happened in 4004 BC; it is a process that began some 10 billion years ago and is still under way.

 

Does the evolutionary doctrine clash with religious faith? It does not. It is a blunder to mistake the Holy Scriptures for elementary textbooks of astronomy, geology, biology, and anthropology. Only if symbols are construed to mean what they are not intended to mean can there arise imaginary, insoluble conflicts. As pointed out above, the blunder leads to blasphemy: the Creator is accused of systematic deceitfulness.

 

[5] The Book That Changed America: How Darwin’s Theory of Evolution Ignited a Nation
Randall Fuller

Read ‘The Book That Changed America’ for Darwin Day 2017
Sun, 12 Feb 2017
Rogue Medic
Article

and

Kirkus Review

and

January 24, 2017
Randy Dotinga
Christian Science Monitor
Review

[6] The Ark Before Noah: Decoding the Story of the Flood
Irving Finkel

Kirkus Review

and

How the ark changed shape
13 February, 2014
Will Gore
Catholic Herald
Article/Interview

Here is part of that interview with Irving Finkel from Catholic Herald:
 

We also discuss the negative reaction that his theories might provoke in some Christian quarters. He admits that those who tend towards a literalist reading of the Bible will never be persuaded of its links to the Babylonian era.

He hopes, though, that he is handling the topic sensitively. He is at pains to point out, for example, that, despite what some headlines have suggested, he is not claiming the Bible story to be wrong and that Noah’s Ark should be round. He has, he says, simply traced the origins of the story found in Genesis.

Finkel has resolved to make sure he maintains a sense of humour when dealing with critics. He’s obviously very content with the conclusions he has drawn. Behind that big beard it’s not hard to detect a smile as he says: “I can’t imagine somebody will find something that proves my ideas wrong, so if people reject them it doesn’t matter. People often reject things they don’t like and not necessarily on logical grounds. If I give a lecture and people throw vegetables, then so be it.”

 

Here is a video of a presentation by Irving Finkel.
 


 

[7] Genesis 8:19
King James Version
Verse at BibleHub in all versions

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The Grinch Who Stole Reality

 

And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so?

It came without ribbons epi.

It came without tags amio.

It came without packages oxygen, boxes tubes or bags.

And he puzzled and puzzled ’till his puzzler was sore. Then the Grinch thought of something he hadn’t before.

Maybe Christmas living, he thought…doesn’t come from a store drug.

Maybe Christmas living, perhaps…means a little bit more!

 

With apologies to Dr. Seuss (Theodore Geisel) for the modification of his parable.

There are important differences between the minimal criteria for life and the criteria for a meaningful life. Many of us don’t like to think about that, because many of us don’t like thinking. Thinking can be hard. Making excuses for not thinking – priceless (at least, as long as you don’t think about it).

We have been focusing on the least honest way of reporting outcomes – a pulse – Oooh!, or maybe even 30 days of a pulse – Oood-Ahhh! After all, reality does not support continuing to do what we have been doing. If we admit that we have been causing harm, then we may have to take responsibility for our actions.

We do not want to take responsibility for our actions. We were only following orders.

Doctors, PAs (Physician Assistants), NPs (Nurse Practitioners), nurses, paramedics, EMTs, techs, . . . do not want to take responsibility for what we get paid for. Accountability is for people who think – not for us.

We have blamed science/evidence for requiring that we confront reality. As explained by Dr. Seuss, we want simple answers that do not require understanding. Give us algorithms to mindlessly follow. Give us mnemonics.

We have been giving epinephrine (adrenaline in Commonwealth countries) for over half a century with no evidence of safety or improvement in the outcome that matters most.

Why?

We haven’t wanted to know.

The first study to look at the effect of placebo vs. epinephrine on neurological survival was cut short – with only a tiny fraction of what would be needed to produce any kind of statistically useful information, except for some of the true believers, who made the same kinds of mistakes that have been made for other discarded treatments – treatments discarded due to failure to work, discarded due to harm, or discarded due to both.

Don’t study this. Just believe. Belief makes us feel good. Attack science for encouraging understanding.
 

This study was designed as a multicentre trial involving five ambulance services in Australia and New Zealand and was accordingly powered to detect clinically important treatment effects. Despite having obtained approvals for the study from Institutional Ethics Committees, Crown Law and Guardianship Boards, the concerns of being involved in a trial in which the unproven “standard of care” was being withheld prevented four of the five ambulance services from participating.[1]

 

In addition adverse press reports questioning the ethics of conducting this trial, which subsequently led to the involvement of politicians, further heightened these concerns. Despite the clearly demonstrated existence of clinical equipoise for adrenaline in cardiac arrest it remained impossible to change the decision not to participate.[1]

 

What was the conclusion produced by the Jacobs study?
 

CONCLUSION: Patients receiving adrenaline during cardiac arrest had no statistically significant improvement in the primary outcome of survival to hospital discharge although there was a significantly improved likelihood of achieving ROSC.[1]

 

As the homeopaths put their spin on studies that do not really support their claims, people who do not understand science put similar spin on the results of this. For example, if you take a Bayesian approach[2], but distort it to mean that you give extra weight to everything that supports your belief and take away credit from everything else, you can claim that this is an example of science proving that epinephrine works.

Another way of doing this is to claim that you don’t give the 1 mg dose of epinephrine, therefore the study does not apply to your patients. After all, you are just engaging in a poorly documented, unapproved study, which allows you to think of the survivors as examples of the drug working and make excuses for the rest. Of course, if you don’t give the 1 mg dose of epinephrine, is there any evidence that your treatment is safe or effective? No.

Rather than insisting that this method of dosing patients be studied, in order to determine if it really is safe or if it really is effective at anything other than getting a pulse in a brain-dead body, claim to be ahead of the science.

Why find out what is really best for the patients, when there are so many ways of declaring victory and running away?

In 2018, we had the results of the next study of placebo vs. adrenaline (epinephrine in non-Commonwealth countries, but only Commonwealth countries have bothered to do the research). The conclusion was the same as the conclusion for the only previous study.
 

CONCLUSIONS: In adults with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30-day survival than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine group.[3]

 

Has anyone else stated that the use of epinephrine should be limited to controlled trials?

Not that I know of.

Everyone else seems to be claiming that giving smaller boluses of epinephrine. or giving titrated infusions of epinephrine is different. Some claim that it is nihilism to refuse to believe in their slightly different treatment – at least until there is undeniable evidence of lack of benefit, or undeniable evidence of harm, or both.

Requiring evidence of benefit, before using a treatment on a patient is being reasonable.

Using inadequately studied treatments on people when they are at their most vulnerable is not good medicine.

A doctor’s oath to Apollo does not include a requirement to perpetuate dogma, but medicine is only slowly starting to focus on what is best for patients, rather than what is best for appearances.

Dr. Ryan Jacobsen addressed a similar dogma, when he got rid of the long spine board in the system where he was medical director. His description of the evidence applies to epinephrine (bolus, mini-bolus, infusion, patch, inhaler, down the tube, oral, whatever) –

Other than historical dogma and institutional EMS medical culture we can find no evidence-based reason to continue to use the Long Spine board epinephrine as it currently exists in practice today.[4]

I changed EMS to medical and the Long Spine board to epinephrine.

We have good evidence that if your loved one is a laboratory pig, rat, dog, . . . we can kill them and get them back neurologically intact with epinephrine – and with other treatments that have been discarded because they do not have the same effect on humans as on lab animals.

Let us treat your loved ones like the lab animals we think they are.

Don’t use EBM (Evidence-Based Medicine), because belief is more important than reality.

The world is a comedy to those that think; a tragedy to those that feel. – Horace Walpole.

Keep thinking. Keep demanding evidence. After the nonsense being preached by the believers is exposed, we can improve the outcomes for our patients, because medicine is about doing what is best for the patient, and not about protecting the dogma.

Footnotes:

[1] Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial
Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL.
Resuscitation. 2011 Sep;82(9):1138-43. doi: 10.1016/j.resuscitation.2011.06.029. Epub 2011 Jul 2.
PMID: 21745533

Free Full Text PDF Download from semanticscholar.org

[2] Bayesian inference
Wikipedia
Article

[3] A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest.
Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, Regan S, Long J, Slowther A, Pocock H, Black JJM, Moore F, Fothergill RT, Rees N, O’Shea L, Docherty M, Gunson I, Han K, Charlton K, Finn J, Petrou S, Stallard N, Gates S, Lall R; PARAMEDIC2 Collaborators.
N Engl J Med. 2018 Aug 23;379(8):711-721. doi: 10.1056/NEJMoa1806842. Epub 2018 Jul 18.
PMID: 30021076

[4] Johnson County EMS System Spinal Restriction Protocol 2014
Ryan C. Jacobsen MD, EMT-P, Johnson County EMS System Medical Director
Jacob Ruthsrom MD, Deputy EMS Medical Director
Theodore Barnett MD, Chair, Johnson County Medical Society EMS Physicians Committee
Johnson County EMS System Spinal Restriction Protocol 2014 in PDF format.

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Cardiac arrest victim Trudy Jones ‘given placebo’ – rather than experimental epinephrine

 

As part of a study to find out if epinephrine (adrenaline in Commonwealth countries) is safe to use in cardiac arrest, a patient was treated with a placebo, rather than the inadequately tested drug. Some people are upset that the patient did not receive the drug they know nothing about.[1]

The critics are trying to make sure that we never learn.

We need to find out how much harm epinephrine causes, rather than make assumptions based on prejudices.

When used in cardiac arrest, does epinephrine produce a pulse more often?

Yes.

When used in cardiac arrest, does epinephrine produce a good outcome more often?

We don’t know.

In over half a century of use in cardiac arrest, we have not bothered to find out.
 


 

We did try to find out one time, but the media and politicians stopped it.[2]

We would rather harm patients with unreasonable hope, than find out how much harm we are causing to patients.

We would rather continue to be part of a huge, uncontrolled, unapproved, undeclared, undocumented, unethical experiment, than find out what works.

Have we given informed consent to that kind of experimentation?

Ignorance is bliss.

The good news is that the enrollment of patients has finished, so the media and politicians will not be able to prevent us from learning the little that we will be able to learn from this research.[3]

Will the results tell us which patients are harmed by epinephrine?

Probably not – that will require a willingness to admit the limits of what we learn and more research.

What EMS treatments have been demonstrated to improve outcomes from cardiac arrest?

1. High quality chest compressions.
2. Defibrillation, when indicated.

Nothing else.

All other treatments, when tested, have failed to be better than nothing (placebo).

Footnotes:

[1] Cardiac arrest victim Trudy Jones ‘given placebo’
BBC News
23 March 2018
Article

[2] Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial
Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL.
Resuscitation. 2011 Sep;82(9):1138-43. Epub 2011 Jul 2.
PMID: 21745533 [PubMed – in process]

Free Full Text PDF Download from semanticscholar.org
 

This study was designed as a multicentre trial involving five ambulance services in Australia and New Zealand and was accordingly powered to detect clinically important treatment effects. Despite having obtained approvals for the study from Institutional Ethics Committees, Crown Law and Guardianship Boards, the concerns of being involved in a trial in which the unproven “standard of care” was being withheld prevented four of the five ambulance services from participating.

 

In addition adverse press reports questioning the ethics of conducting this trial, which subsequently led to the involvement of politicians, further heightened these concerns. Despite the clearly demonstrated existence of clinical equipoise for adrenaline in cardiac arrest it remained impossible to change the decision not to participate.

 

[3] Paramedic2 – The Adrenaline Trial
Warwick Medical School
Trial Updates
 

Trial Update – 19 February 2018:
PARAMEDIC2 has finished recruitment and we are therefore no longer issuing ‘No Study’ bracelets. The data collected from the trial is in the process of being analysed and we expect to publish the results in 2018. Once the results have been published, a summary will be provided on the trial website.

 

Edited 12-27-2018 to correct link to pdf of Jacobs study in footnote 2.

.

Happy Darwin Day 2018

 
Why do some people reject science? Evolution is just one aspect of science that some people claim, almost always without any scientific experience, is not real. The rest of the scientific community generally ignores these fringe dwellers, but politicians and the media love them.

The science deniers claim that scientists are arrogant, but science requires scientists to be transparent in their methods. Science requires scientists to invite criticism.

If you think that you can provide valid evidence to show that a scientific theory is wrong, you can expect to become rich and famous. Go ahead. Show the world that you know more than those arrogant scientists. I am sure that you will straighten those scientists out.
 


 

Science deniers are almost never open to criticism. Some even call for attacks on their critics. Mike Adams is one of the recent examples of these, but someone will probably do something more extreme before the decade is out.[1]

Flat Earthers, Creationists, anti-vaxers, climate change deniers, medicine deniers (alternative medicine quacks), anti-GMO activists, et cetera. They all lack credibility among scientists, because they all lack valid evidence. The same is true of Holocaust deniers, 9/11 Truthers, and others promoting revision of history without any valid evidence.

The most famous example of a victim of science deniers is probably Galileo, who was threatened with torture by the Inquisition (known as the Congregation for the Doctrine of the Faith since 1983), in order to coerce a recantation from Galileo for teaching the heretical idea of Nicolaus Copernicus that the Earth revolves around the Sun (helicentrism).
 

The proposition that the Sun is the center of the world and does not move from its place is absurd and false philosophically and formally heretical, because it is expressly contrary to Holy Scripture.[2]

 

In 1615, Galileo had been ordered to give up the said doctrine and not to teach it to others, not to defend it, nor even to discuss it;[2]

Don’t even discuss your ideas.

This time he was sentenced to house arrest for the rest of his life. His books, and other books on heliocentrism were prohibited by the Inquisition.

Ironically, many of the science deniers claim to be modern versions of Galileo, persecuted for their ideas. The reality is that they are ignored, because they do not produce valid evidence. Galileo was far from perfect, but he did produce valid evidence. Some of the evidence was misinterpreted by Galileo, but removing that evidence did not invalidate heliocentrism.

The scientific community does not prevent science deniers from publishing valid evidence.

The research presented by the science deniers has to meet the same standards as the rest of the research published in science journals.

The problem with the science deniers is that their research either does not meet the standards of publication in a science journal, does not contradict the existing research, or both.

What scientific evidence is there that Creationism is true?

Nothing.

The promotion of a claim as scientific, without any scientific evidence, is an excellent example of arrogance.

What scientific evidence is there that evolution is true?

Some people claim that evolution is anti-Christian, but this is not true. Most Christians accept that evolution is real. This is from BioLogos, a Christian science organization.

What does the fossil record show? [3]

The Smithsonian also has a lot of information specifically about human evolution.

Human Evolution Research [4]

DNA (DeoxyriboNucleic Acid) demonstrates how closely related any two living creatures are. You can see that we are related to other apes, as well as bananas and bacteria. Wikipedia’s primary rule for entries is that the information has to be supported by verifiable evidence. Here is the Wikipedia page on genetics, the science of examining DNA –

Genetics – Wikipedia [5]

Science is objective and has rules to eliminate, as much as possible, the role of prejudice.

As if that is not enough, science also takes all of its results and challenges people to find any flaws in the work.

Is there a problem with the way the evidence was obtained?

Is there a problem with the way the data were calculated?

Are there other valid interpretations that have not been considered (interpretations that are not ruled out by the evidence)?

DNA had not even been discovered at the time Darwin published On the Origin of Species.

DNA is probably most objective tool available for showing that all life on Earth has evolved from the same original species.

Footnotes:

[1] Mike Adams, Monsanto, Nazis, and a Very Disturbing Article
Discover Magazine
By Keith Kloor
July 22, 2014 5:05 pm
Article

[2] Papal Condemnation (Sentence) of Galileo
June 22, 1633
Trial of Galileo (1633)
Famous Trials
Professor Douglas O. Linder
Translation of Papal Condemnation

But whereas it was desired at that time to deal leniently with you, it was decreed at the Holy Congregation held before His Holiness on the twenty-fifth of February, 1616, that his Eminence the Lord Cardinal Bellarmine should order you to abandon altogether the said false doctrine and, in the event of your refusal, that an injunction should be imposed upon you by the Commissary of the Holy Office to give up the said doctrine and not to teach it to others, not to defend it, nor even to discuss it; and your failing your acquiescence in this injunction, that you should be imprisoned.

[3] What does the fossil record show?
BioLogos
Article

[4] Human Evolution Research
Smithsonian
Human Origins
Web page

[5] Genetics
Wikipedia
Web page

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