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

- Rogue Medic

Since the World is Ending Today, What Should We Do?


Oh no! It is the end of the world, again. What should we do?

If the end of the world causes you anxiety, you are probably already prescribed some anti-anxiety medicine. I recommend that you follow the directions on the label and stop annoying less anxious people. Avoid combining your sedatives with other sedatives (alcohol, heroin, propofol, . . . ) and find a way to distract yourself from what you do not understand.

Lunar activity is said to mark the END OF TIME, with some religious groups believing it to be a sign of the JUDGEMENT DAY.[1]


The end of times has probably been predicted since before writing was first used to record anything. There is one consistent thing about these predictions. They have been completely wrong. Eventually, one will be right, but that will probably be something we learn about from scientists, who will be the first to observe evidence of any problems.

What do scientists predict about the super moon? It will appear a little bit bigger and brighter than most normal full moons. That will be the only noticeable difference from a normal full moon.

Lunar activity is said to mark the END OF TIME, with some religious groups believing it to be a sign of the JUDGEMENT DAY.[1]


We are still waiting and none of the predictions have come true. None of the predictions are any more likely than any other predictions.

But what about he tsunami caused by a super moon?

Supermoons have been proven to cause sea levels to rise as the gravitational pull of the Earth’s closest neighbour increases as it gets closer.[1]


That is not true.

The relative amount of influence is proportional to the object’s mass and distance from the earth.[2]


The difference in distance will be tiny.

Here is what the distance will be from our planet to the super moon.

Aug 10 5:46 PM         356,922 km         221,796 mi         Closest for this year [3]


And here is what the distance was for the full moon on January 1, 2014.

Jan 1 9:01 PM         356,945 km         221,811 mi [3]


Only 15 miles different.

There is one important thing to understand about a 15 mile difference in the distance between the moon and us. It is not something that humans can notice without machinery to measure the distance.

Jul 28 3:39 AM         406,547 km 252,634 mi         Farthest away this year [3]


That is a difference of 30,838 miles between the farthest and closest distances. That is a 12% difference. The difference between the 2nd closest full moon and the super moon is 15 miles.


Or 1 our of 14,787. If this is seen by some as prophetic, important, or ominous, it is because those describing the problem lack all sense of perspective.

Some people are claiming that this is important, because they have no idea what they are commenting on, or they are trying to profit from the gullibility of others, or . . . .

But the moon being this close is unprecedented!

Jan 30 8:59 AM         356,606 km         221,600 mi         Closest for this year[4]


That was the closest distance between the moon and the earth in 2010. 221,600 miles. Today’s end of the world distance – because it is so incredibly close – is 221,796 miles or 196 miles farther than it was in 2010. So much for unprecedented. So much for scary.

If you think that the minuscule difference in distance was enough to cause a disaster, you seem to have the same problem with perspective as the prophets of doom.

If this were indeed the case, we would expect to see a correlation between rate at which earthquakes occur and the perturbations to the gravitational field. The dominant perturbation in the earth’s gravitational field generates the semi-diurnal (12 hour) ocean and solid earth tides which are primarily caused by the moon (due to its proximity) and the sun (due to its large mass). No significant correlations have been identified between the rate of earthquake occurrence and the semi-diurnal tides when using large earthquake catalogs.[2]


No valid mechanism, no perspective, and no evidence?

The only thing useful out of this is as another example of frauds taking advantage of the vulnerable, but we have no shortage of examples of that. We don’t even have a shortage of people defending the frauds.


[1] SUPERMOON LIVE: Beautiful lunar event could trigger ‘END OF DAYS’
By: Nathan Rao
Published: Sun, August 10, 2014
Sunday Express

[2] Can the position of the moon or planets affect seismicity?
Earthquake FAQ
Berkeley Seismological Laboratory Outreach Program

[3] Moon distances for UTC
Information page

[4] Moon distances for UTC
Information page


Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition?

Today we get hit with a double whammy – Friday the 13th and a full moon. This will not happen again until August of 2049.

Is there anything about Friday the 13th, or the full moon, or the combination that would make today worse than usual?

Let’s look at the evidence.

The last combination of Friday the 13th and a full moon was in October 2000. Somebody decided to compare patient volumes by category against other full moon days and also against the average volume.

One of the oldest superstitions is about Friday, the number 13, and a full moon. There exists a very popular belief in the relationship between the number 13 and Friday as well as the moon’s phase and the incidence of bad luck. Among the emergency department “folklore” belongs the theory that shifts on such dates are always busy ones.[1]


We compared the number of overall admissions divided into medical, nontrauma-related surgical emergencies, mild and moderate trauma, multiple injured patients, and attempted suicides, on the full moon days and nights from February 2000 to Friday, October 13, 2000 with the average admission rate per day during this period.[1]


Here are the numbers.


Nothing unusual there.


Still nothing unusual.


A higher number of non-trauma surgical emergencies on Friday the 13th with the full moon, but this is the only one category. Does anything else suggest a connection?

Trauma will clearly show the power of this double hex day to do harm.


That seems to be beneficial. That can’t be right.


That, too.

This is downright depressing.


Worse than depressing – even the suicides were not increased.

The data analysis showed no significant difference between Friday the 13th of October compared with our average full moon admission rate (Table 2).

Even fewer trauma patients were seen on this day compared with other full moon days and nights. Furthermore, the present study could not show any difference in the admission rate on days with a full moon, compared with a normal day, disappointing once again a lot of believers in “hospital folklore.”[1]


It isn’t proof, but there is plenty of other evidence against full moon superstition and others.

Maybe someone will collect data on the volumes from today and compare them with normal days and with normal full moon days.

I have written about full moon superstitions before.

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008


[1] Friday the 13th and full-moon: the “worst case scenario” or only superstition?
Exadaktylos AK, Sclabas G, Siegenthaler A, Eggli S, Kohler HP, Luterbacher J.
Am J Emerg Med. 2001 Jul;19(4):319-20. No abstract available.
PMID: 11447523 [PubMed – indexed for MEDLINE]


The Power of the ‘Death’ Chant will protect Us


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

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


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

How does that produce a reasonable approach?

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


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

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

Image credit.

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


When did that happen?

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

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

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

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

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

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

Please provide evidence to support your claim.

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

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

This is how we lower standards in EMS.

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

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

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


The Main Stream Media and Superstition

Tomb of Lazarus image credit.

This sad story is resulting in a lot of promotion of superstition.

A girl went in for a routine operation and died.

My condolences go out to the family.

The mother of a 13-year-old Northern California girl declared brain dead after a routine tonsillectomy says her daughter had expressed fears she wouldn’t wake up after the surgery.[1]


This is the kind of comment that people will use to promote the superstition of precognition and other psychic powers.

Did she know what was going to happen?


Did she worry about what was going to happen?

Yes, it is what people do. We worry.

Is there any connection between that worry and the outcome?

There is no reason to believe that there is any connection.

The family claim to need time for a miracle.

“The medicine has not worked. It’s time to let God work,” said Omari Sealy, McMath’s uncle. “We are calling on God and calling on our faith.”[2]


How much time does it take for a miracle?

Since miracles defy the laws of nature, no time would be needed.

Why is life support needed for a miracle?

Since miracles defy the laws of nature, no life support would be needed.

No time or equipment is needed for a miracle.

Only a suspension of the laws of nature is needed for a miracle, so depriving other children of the care that could be provided by the staff and equipment devoted to this brain dead child is not necessary.

What is the history of miraculous recovery from death?

Lazarus and Jesus.

What kind of life support did they have?


Take a look at the picture. A morgue is more high tech than that tomb.

What kind of legal injunction did they require?


Both were buried in tombs.

The family could make an arrangement with a mortuary to wait for a miracle, but they should not interfere with the care of other patients who are not dead.

Is that cold?

Does the belief in miracles depend on the use of medicine?

Medicine cannot do anything for brain death, so requiring the use of medicine is of no benefit to the child.

Being cold allows other children to receive the care that could be provided by the staff and equipment devoted to this brain dead child.

This family is going through something no family should go through, but they are increasing the likelihood of another family having a bad outcome by depriving other patients of care.

Miracles are not a part of medicine.


[1] California girl had fears before tonsil surgery
By Associated Press,
Updated: Friday, December 20, 12:01 PM
Washington Post
Health & Science

[2] Family of Comatose Teen Battles Hospital for ‘Time to Let God Work’
Dec. 18, 2013
By Colleen Curry
Good Morning America


Happy Friday the 13th

This is a day for superstitious people to pretend that there is some sense to their superstition.

The number 13 will somehow cause bad things to happen.

This is from the elevator of the local Best Hospital in the World. While it is an administrative decision, what about administrative decisions that affect patient care.


When we make decisions based on superstition, how much harm do we do to our patients?

We will probably never know, because we use superstition to justify ignoring evidence or to justify preventing research to obtain evidence.

A black cat crossing your path will somehow cause bad things to happen.

A backboard and collar forced on a patient will somehow protect the spine from forceful worsening of an injury.[1]

A broken mirror will somehow cause bad things to happen.

Giving fentanyl to someone in pain will prevent them from giving consent to treatment.[2]

Speak of the devil and he will appear.

Response times matter for patients who are not dead.

This is based on superstition, because the only response times that have been shown to matter are for cardiac arrest.[3]

How much less superstitious are people in medicine than anyone else?

Probably even more superstitious.

Identifying information obscured to protect the superstitious.

People will wave their hands around to manipulate your imaginary energy fields.

People fall for this at many hospitals that claim to be the Best Hospital in the World.[4]

They are just demonstrating their lack of understanding of the placebo effect, random variation, reversion to the mean, and other things that lead us to believe that nothing is something.

Nothing Superstition is harm.


[1] The cause of neurologic deterioration after acute cervical spinal cord injury.
Harrop JS, Sharan AD, Vaccaro AR, Przybylski GJ.
Spine (Phila Pa 1976). 2001 Feb 15;26(4):340-6.
PMID: 11224879 [PubMed – indexed for MEDLINE]

All but two patients had complete injuries at admission. One patient with incomplete injury and another that was neurologically intact had early complete cervical cord injuries after cervical immobilization.


Four of the five patients in the early group (mean age 56 years) developed neurologic worsening during application of cervical immobilization less than 24 hours after injury.

[2] Refusal of base station physicians to authorize narcotic analgesia.
Gabbay DS, Dickinson ET.
Prehosp Emerg Care. 2001 Jul-Sep;5(3):293-5. No abstract available.
PMID: 11446548 [PubMed – indexed for MEDLINE]

Nevertheless, the notion that a patient’s decision-making capacity may be compromised by “excessive” analgesia seemingly permeates medical practice, but is not evidently supported by the medical literature.11


Even a more disturbing possible coercion is the possibility that when pain medication is withheld prior to consent, the patient is either directly or indirectly made to understand that once he or she provides consent, that pain medication will be given as a “reward” for agreeing to the procedure.

[3] Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort.
Newgard CD, Schmicker RH, Hedges JR, Trickett JP, Davis DP, Bulger EM, Aufderheide TP, Minei JP, Hata JS, Gubler KD, Brown TB, Yelle JD, Bardarson B, Nichol G; Resuscitation Outcomes Consortium Investigators.
Ann Emerg Med. 2010 Mar;55(3):235-246.e4. Epub 2009 Sep 23.
PMID: 19783323 [PubMed – indexed for MEDLINE]

Free Full Text with link to Free Full Text PDF Download from PubMed Central

To date, patients with out-of-hospital cardiac arrest remain the only field-based patient population with a consistent association between time (response interval) and survival.18,19 Despite the paucity of outcome evidence supporting rapid out-of-hospital times for the broader population of patients activating the 911 system, EMS agencies in North America are generally held to strict standards about intervals, particularly the response interval.

[4] Shock Trauma Infested With Evil Spirits
Wed, 10 Jun 2009
Rogue Medic


Blue Moon 2012 – Except parts of Oceanea


Tonight is a Blue Moon and a Friday the Dyslexic 13th Full Moon.

As conspiracy theorists say, That can’t be a coincidence!

Of course it can be a coincidence.

The next Blue Moon is in 2015, unless you are near the International Date Line, in which case the Blue Moon is not this month, but at the end of next month (and then in 2015).[1]

Click on images to make them larger.

Does anything special happen during a Blue Moon?

There is more light, but they are really only uncommon.

The full moon does not have an influence on our lives, except to annoy the superstitious, to provide more light, and to give me another reason to throw some light on the lunacy of full moon superstition.

Image credit.

“Have you university types ever looked at whether dog bites happen more around the full moon? It’s a well known fact that they do.”[2]

They could accept the old farmer’s tale or they could examine it. It appears that even though the farmer seems to be set in his belief, he is still open to evidence.

The influence of the full moon remains one of the more resilient popular explanations of a wide range of mostly traumatic or bizarre events. There is a pale reflection of this in epidemiology—recall bias—where those affected by a rare or severe disease are more inclined to associate unrelated non-disease exposures to the disease.[2]

This is a lighthearted look at the numbers of admissions for dog bites and whether there is any association with the full moon.

The beginning of the dates is the first full moon, although it is not marked. There is no peak at the beginning of the chart, so this was not done to mislead. It might be because there were so many days with very few dog bite admissions at that full moon.

Altogether 1671 accident and emergency admissions for dog bites occurred during the study period (938 males, 733 females), representing an overall mean admission rate of 4.58 per day. Figure 1 shows 18 peak days (notionally >10 admissions/day), with the maximum peak centring on the New Year break (the highest peak (24) occurred on New Year’s Day 1998). Full moons coincided with none of these peaks.

There were 12 full moons, but none of the excessive dog bite days were at the time of any of the full moons.


If there is any causal relationship between the full moon and serious dog bites, the occurrence of the peaks should be greater than predicted by chance.

By my calculation, there is just over a 64% chance of any of these 18 peak dog bite days and any of the full moons occurring together by chance in that one year period. A longer time period would be better for making this clear, but there does not appear to be any suggestion of any association between full moons and admissions for dog bites.

Overall, full moon days were associated with slightly lower mean admissions (4.6 compared with 4.8 per day).[2]

During the study, there were fewer serious dog bites during the full moon, than at other times.

As the plot of dog bite admissions and full moons clearly shows, more caution with dogs might be exercised over Christmas and especially at New Year—irrespective of the full moon.[2]

It may not be a good idea to try to make friends with strange dogs on those days.

Correction (8/21/2013 20:08) – Here is an article that shows I was wrong about the two full moons in a month definition of a full moon.

What’s a Blue Moon?
The trendy definition of “blue Moon” as the second full Moon in a month is a mistake.

Sky & Telescope
by Donald W. Olson, Richard Tresch Fienberg, and Roger Sinnott
July 27, 2006


[1] How often do two full moons happen in the same month?
Friday, August 31

[2] Barking mad? another lunatic hypothesis bites the dust.
Chapman S, Morrell S.
BMJ. 2000 Dec 23-30;321(7276):1561-3.
PMID: 11124174 [PubMed – indexed for MEDLINE]

Free Full Text from BMJ

Chapman S, & Morrell S (2000). Barking mad? another lunatic hypothesis bites the dust. BMJ (Clinical research ed.), 321 (7276), 1561-3 PMID: 11124174


Where is the evidence that Quiet and Slow are NOT Jinxes?

In medicine, there are a lot of superstitious people. Any occupation that involves intermittent rewards[1] is going to produce magical thinking[2] in some people. This is true in medicine, sports, gambling, speculation/investment, . . . .

If we do not understand what we are doing, we try to come up with explanations. However, the people least likely to come up with accurate explanations are those who do not understand. If we ask the Insane Clown Posse how magnets work, we get a foolish answer. Magnets are magic to them. Magnets do not work by magic, even though we cannot directly see them working and in spite of the similarity in spelling.[3]


Speak of the devil and he’ll appear.

Speak of the devil. The devil does not appear.

Say Slow, or Quiet, when it is slower than usual.

Does that cause some supernatural creature to make a frequent flier to call for the same thing he normally calls for, or make some little old lady fall, or make some guy have a heart attack, or make some child drown?


Have you tried using this power for good?

Say Raise.

Image credit.

It didn’t work?

It works for some people –

Deepak Chopra – one of the highest paid entertainers in the US.

Words do not have magic power, but people do have superstitions.

We become defensive of our childish beliefs and demand proof that they do not work. If I tell you that I can fly, due to some magical power, should anyone believe me?

Should I insist that people believe me, rather than ridicule my claim, unless they can prove that I cannot fly?

Of course not.

Does it matter if I am a four year old or a forty-four year old?

Yes. Magical thinking is expected from a four year old. This is a part of childhood development.

Magical thinking is something we are supposed to grow out of as we mature. Maturity appears to elude some of us for decades.

How can any of us defend this?

When we are unbiased in our use of evidence, we keep ourselves from self-deception.

When we primarily look for ways to defend our biases, we deceive ourselves.

Science is a way of trying not to fool yourself. The first principle is that you must not fool yourself, and you are the easiest person to fool. – Richard Feynman.

We can continue to fool ourselves, which is easy, or we can think for ourselves.


[1] Schedules of reinforcement

[2] Magical thinking

[3] Magnets


2009’s Top Threat To Science In Medicine


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 –

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


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.


[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]

[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

[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.

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