dras knowledge

Saturday, February 28, 2004

JAMA article states Hospitals kill 137k per year.

Gary Null, an online nutritional supplement pusher, publishes Online excrement about how death is the fault of a the US system of Healthcare. Mr. Null has waved the following article as the banner of truth behind his blather.-dr


http://jama.ama-assn.org/cgi/content/abstract/279/15/1200. The authors conclude that 76,000-137,000 hospitalized patients died in 1994 from reactions to drugs administered as prescribed. Don't you consider these figures alone to be shocking? And they don't include ADRs that hospitals don't recognize as such or classifed other ways to avoid lawsuits. They also don't include ADR deaths outside hospitals. If the FDA is doing so well, why does this happen?"


My reply:
Are you suggesting that 76,000 to 137,000 ADR deaths in 1994 are the result of the FDA's inability or failure to identify dangerous actions of drugs?

The authors conclude "While our results must be viewed with circumspection because of heterogeneity among studies and small biases in the samples, these data nevertheless suggest that ADRs represent an important clinical issue." Anyone can implicate anything as to why the numbers appear high.

At any rate, this has been an oft cited study by anyone who wants to make an argument against the medical establishment. It's used the same way an anti-Christian will pluck passages out of the Bible to discredit the entire religion.

No one should hang a hat on any numbers from this study without following the full course since it's publication:

Comment in:
JAMA. 1998 Apr 15;279(15):1216-7.
JAMA. 1998 Nov 25;280(20):1741; author reply 1743-4.
JAMA. 1998 Nov 25;280(20):1741; author reply 1743-4.
JAMA. 1998 Nov 25;280(20):1742-3; author reply 1743-4.
JAMA. 1998 Nov 25;280(20):1742; author reply 1743-4.
JAMA. 1998 Nov 25;280(20):1742; author reply 1743-4.

A google search will likely reveal many other credible comments made in the lay press.

I would also highly suggest a look at this critique of the study:
http://www.medscape.com/viewarticle/408052_print (access is free)
Kvasz M, Allen IE, Gordon MJ, Ro EY, Estok R, Olkin I, Ross SD. Adverse drug reactions in hospitalized patients: A critique of a meta-analysis.MedGenMed. 2000 Apr 27;2(2):E3. PMID: 11104449
CONCLUSION: Meta-analysis was invalid because of heterogeneity of the studies. Most of these studies did not report the data needed for incidence calculations. The methodology used was seriously flawed, and no conclusions regarding ADR incidence rates in the hospitalized population in the United States should be made on the basis of the original meta-analysis.

Friday, February 27, 2004

History of Salk Polio Vaccine

What part of the following is compelling information against vaccinations?
I guess we have the right to subscribe to whatever information suits our beliefs, and ignore anything contrary or label it as merely unreliable, politically or financially motivated propaganda.

http://www.unicef.org/newsline/poliopkglmilestones.htm
Milestones in global polio eradication


2002
Europe certified polio-free on 21 June.
Globally, only ten countries are polio-endemic at the beginning of 2002.
A funding gap of US$ 275 million threatens the global polio eradication goal.
Rotary launches the Polio Eradication Fundraising Campaign with the goal of raising US $80 million through 2003.
2001
Globally, twenty countries are polio-endemic at the beginning of 2001.
Just 480 wild poliovirus cases are reported worldwide in 2001.
2000
2979 wild poliovirus cases are reported worldwide - a 99% decrease from 1988.
The WHO Western Pacific Region is certified polio-free on 29 October.
Seventeen west and central African countries vaccinate 76 million children during unprecedented 'synchronized' national immunization days (NIDs).
Over 240 000 childhood deaths are averted through administration of Vitamin A during polio immunization days in over 50 countries.
A poliovirus importation from Angola to the island nation of Cape Verde, polio-free for over a decade, resulted in 56 cases of paralysis, including 17 deaths.
1999
The World Health Assembly unanimously endorses WHA resolution 52.22 to accelerate the activities of the Global Polio Eradication Initiative.
A large polio outbreak strikes Angola, paralysing more than 1000 children and causing over 50 deaths.
The first national immunization days in DR Congo and Sierra Leone - two conflict-affected and polio-endemic countries - are undertaken.
1998
134 million children are immunized against polio on a single day in India.
National immunization days are conducted for the first time in Somalia and southern Sudan.
1997
Mum Chanty, a 15 month old girl paralysed by polio, is found on 19 March in Cambodia - the last case of indigenous polio in the Western Pacific Region.
A polio outbreak in India among a religious minority paralyses 800 children.
1994
The WHO Region of the Americas is the first Region to be certified polio-free, on 29 September.
1991
The last case of polio in the Americas is detected in Junín, Peru in August - paralysing a young boy, Luis Fermín Tenorio Cortez.
1990
At the World Summit for Children, WHO, Rotary International, CDC, UNICEF, partner organizations and many Heads of State reaffirm their commitment to the eradication of polio.
A huge outbreak in China during 1989 and 1990 causes over 10 000 polio cases.
1988
The World Health Assembly resolves to eradicate polio by the year 2000.
An estimated 350 000 polio cases occur worldwide, in over 125 countries.
Rotary International announces that its fundraising campaign has exceeded expectations, raising US$ 247 million for polio eradication, which today has grown to US $462 million.
1986
Rotary International launches a campaign to raise US$ 120 million to fight polio, providing the impetus to begin the polio eradication initiative.
1985
Seeing the success of the first national immunization days (NIDs) against polio to supplement routine immunizations in Latin America, the Pan American Health Organization resolves to eradicate polio from the Americas.
A three-day cease-fire held during El Salvador's civil war represents the first 'Days of Tranquillity' for polio immunization.
Rotary International launches a global health campaign to aid international agencies in immunizing children in developing countries. PolioPlus is the first and largest internationally coordinated private-sector support of a public health initiative.
1980
The World Health Assembly officially certifies the world free of smallpox - the first disease ever eradicated.
An estimated 500 000 children are paralysed by polio every year.
1960's
Immunization campaigns in Cuba and in Eastern Europe demonstrate that wild poliovirus can be eliminated in large geographic areas using the oral polio vaccine (OPV). OPV rapidly becomes the vaccine of choice for most national immunization programmes.
1957
Dr Albert Sabin introduces the oral polio vaccine (OPV), easier to administer and less costly than Salk's inactivated polio vaccine (IPV).
1955
Salk's polio vaccine is approved for general use in the US.
1954
The first vaccine against polio, the inactivated polio vaccine (IPV) developed by Dr Jonas Salk, succeeds in mass field trials in the USA.

Wednesday, February 25, 2004

Parady of an On-line health device

There are several internet kooky health device scamming goning on, this is my attempt to break into the genre.-dr


I don't know why I just waisted an hour creating this. Why, for some reason, does my version below still sound more credible than the original found at this site?http://www.homeographic.com/

Whollyhomegrownopathy:
Whollyhomegrownopathy is science. It uses specially prepared drops of water exposed to visual images that represent healthy body processes. It is based on the droplet of water's ability to absorb the essence represented in the visual image. One drop of water is capable of absorbing and delineating several images at the same time.

In fact, a droplet of water seems to have a large capacity to hold the essence of any number of images it is exposed to. Could it be the same as a mirror not only being able to store every gaze cast upon it, but to also be able to reflect the essence of any gaze back into another human being, at any given time? Only further research may answer these perplexing questions.

How to Make Whollyhomegrownopathy Drops

You will need a source that can accommodate an F-stop (Aperture) of 8 and 22 along with a variable exposure speed of 60-125 milliseconds. (Otherwise visual images may be too dark, too bright, or too blurred to be absorbed by the droplet of water.) That is exactly what the Fujizappicator produces, so you have the most important item already. You will also need a special image projection and framing apparatus that can be assembled from parts available at a local hardware store. These and assembly instructions are detailed in the Fujizappicator New Owner's Guide. (Remember, your original Owner's Guide will not have this instruction. We've had to rewrite the guide to accommodate this new science. The New Guide is available at this website, or Amazon.com.)

Once your image projection apparatus is prepared, place a bottle of water directly on one side and facing the spot where the visual image is to be projected. Then, one at a time, place any of the desired clear transparency visual images prepared by your Fujizappicator (and picked up from Fotomat) into the apparatus and let them project for exactly 20 seconds each. Warning, during this process do not obstruct the projected image, or the space between the bottle of water and the projected image as this can result in a confused absorption of the image's essence. You have now created a BOTTLE COPY of the healthful essence of each projected image. Depending on the variety of drops made, different therapeutic goals can be accomplished.

Whollyhomegrownopathy Drops Can Strengthen
The most important goal is to clean your organs of all the toxins and parasites. Simply taking a droplet containing the visual image of a healthy body part will do just that for a corresponding sick body part. I have found by adjusting the F-stop and exposure speed on the Fujizappicator to create different images has slightly different therapeutic effect. Imagine, custom make your own perfect remedies!

Fujizappicator Alchemy
CD4 cells of the thymus per the thyroid lobes, stimulate immune weapons YN BO LD, MISSING THINGS ARE ADDED. Ascaris lumbrioides, saliva and lymph all from a half-ounce glass bottle!! Rhodizonic acid over copies of copies get rid of negative cell-count load!! Fast Green CD8's cloned viral parasites expel the body of Fasciopolo eggs in the valves. Success of phagocytizing power system-wide, while taking "protective" drops. "Positive Aware" and other HIV news. YOU DID IT, let’s hope they listen.

Friday, February 20, 2004

Doppler Ultrasound Screening is not needed for anything

An on-line health clinic is selling these doppler ultrasound scans related to stroke risk saying they:
1. Stroke/carotid artery screening
2. Abdominal aortic aneurysm screening
3. Peripheral arterial disease screening (of lower extremeties).
---------------------------------------------------------------------------------------------

And what actions would they suggest one should take based on either a positive or negative result?

There are no standards of how this test should be incorporated into a risk assessment for vascular disease; that is, no one can reliably tell you what to do about the results except maybe to get your cholesterol checked, loose weight, eat better, see a doctor. You don't need this machine to tell you that. There are also no standards to say when the results are clinically significant. Your test could be interpreted as abnormal and you still may live a long disease-free life.

There are great standards for screening and assessing risk. Probably cheaper too: www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf

At best, this is an expensive way to promote health awareness, which is likely the only way this test can help one "avoid strokes."

(I would like to know how many abdominal aortic aneurysms they are finding while screening a general public.)

Thursday, February 19, 2004

Antibiotics cause breast cancer?

Right after my writ where I talk about researchers creating a pre-selection bias, the drawing of a bullseye after shots are fired, the following appears-dr

Yesterday's JAMA, today's headline:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14970061&dopt=Abstract
CONCLUSIONS: Use of antibiotics is associated with increased risk of incident and fatal breast cancer. It cannot be determined from this study whether antibiotic use is causally related to breast cancer, or whether indication for use, overall weakened immune function, or other factors are pertinent underlying exposures. Although further studies are needed, these findings reinforce the need for prudent long-term use of antibiotics.
Despite the author's own conclusions and the subsequent editorial in JAMA, get ready for Alt-Med fall out of anti-rx rants that will reference this.

Monday, February 09, 2004

Studies always conclude that there needs to be more study

Pilot and phase I validation studies often exist to provide statistical data with which other studies can be designed. They're usually not designed to provide a high confidence level.
One thing I notice about clinical studies (and not just restricted to alt-med) is that the premise for the study often gets lost in the authors conclusions - or the news article headlines. There may be a publishers bias to "report the positive" or "dig out something interesting or unanticipated in the outcome data to report." There may also be an unintended preselection bias where the authors speculate treatment effect for any often less than meaningful, yet clinically significant difference in treatment arms, regardless of the stated and/or controlled outcomes criteria. This is similar to drawing the bullseye after the shots are fired. Reporting or developing an abstract in this manner isn't necessarily bad, and the studies aren't necessarily unethical or not valuable. In the least they can provide a platform for further, more meaningful research. From these, however, you can't draw conclusions about any treatment, and they usually only muddy a meta analysis.

Overall, I agree that it seems there is much data and observation reported in clinical studies from which no meaningful conclusions are made. Based on the abstract, this study reports that all the people treated had good outcomes, and more study is needed to analyze just how and why people who are treated have such good outcomes. The design sounds a little funny if there was an emphasis on understanding the singular impact of acupuncture. The whole article may shed more light on my summation of the conclusion.

Friday, February 06, 2004

What's Biofeedback?

Biofeedback is big business. There's tons of opinion on the WWW. Simply put, biofeedback is physiologic information that is used in the attempt to self-control a physiologic process not normally considered to be under conscious or voluntary control. It's been practiced for the treatment of incontinence, anxiety, headaches, hypertension, movement disorders, incontinence, pain, asthma, Raynaud’s disease, insomnia, and others.

There are different types of biofeedback, for example, blood pressure is monitored and the individual may practice relaxation exercises or routines for hypertension. However, biofeedback is much more commonly used to address neuromuscular and pain disorders where electromyographic (EMG) measurements of muscle contractions can be used. This usually involves a commercial EMG biofeedback gizmo to provide the feedback data. Some are simple current measuring devices, some are fancy office-based computer integrated with multiple electrodes.

Often, physiatrists, chiropractors and sometime physical therapists will use different types of EMG biofeedback data to assist in diagnosis and to develop or recommend a treatment plan. There is likely a biofeedback device in incontinence clinics where information is used to help patients identify muscles that can be used in training for better bladder control. EMG biofeedback data used by MD directed rehab, pain and incontinence clinics as part of an overall intensive treatment program may be helpful in selected cases. But I'll admit, the good comparative clinical studies done so far probably haven't demonstrated biofeedback measurements are necessary or integral in the diagnosis or treatment of any condition.

There are those who will advocate methods of EMG biofeedback and biofeedback training as the tell-all, cure-all of much in medicine. Biofeedback therapy clinics and programs are deep within the realm of alternative medicine and are not widely incorporated into mainstream medicine, or reimbursed by third-party payors.

You will be overwhelmed in MEDLINE. So, here are my favorite references, which are tech analysis by the NIH and one by Medicare, and some "good" studies that have a placebo control arm and can single out the individual effect of biofeedback-very few studies meet both these criteria:

NIH Technology Assessment Panel. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA 1996;276(4):313-8
Centers for Medicare and Medicaid Services. Medicare Coverage Policy: Biofeedback for urinary incontinence. http://cms.hhs.gov/
Burgio KL, Goode PS, Locher JL, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002 Nov 13;288(18):2293-9
Morkved S, Bo K, Fjortoft T. Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence.Obstet Gynecol. 2002 Oct;100(4):730-9
Bush C, Ditto B, Feuerstein M. A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain. Health Psychol 1985;4(4):307-21
Dursun N, Dursun E, Kilic Z. Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Arch Phys Med Rehabil 2001; 82(12):1692-5
Bales GT, Gerber GS, Minor TX et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology 2000; 56(4):627-30

Wednesday, February 04, 2004

NCCAM comments on proving alternative medcines

Lots of tax dollars go toward the National Institute of Health's (NIH) office of Complimenteray and Alternative Medicine (NCCAM). Besides spending this money, they did get the following article published in JAMA-dr

Ethical Issues Concerning Research in Complementary and Alternative Medicine. Franklin G. Miller, Ezekiel J. Emanuel, Donald L. Rosenstein, and Stephen E. Straus JAMA 2004;291 599-604 (NIH including NCCAM affiliation)

The authors seem critical of current standards applied to the supplement industry: "..dietary supplements are not standardized, have high variability from one lot to another, may be adulterated with drugs or contaminated with heavy metals." And on another page: "The public interest served by demonstrating that drugs are safe and effective applies equally to herbal treatments, even though the current laws under which herbal products and other dietary supplements are regulated and marketed in the United States do not require proof of safety or efficacy."

In their discussion on placebo effect, the authors use "the fallacy of post hoc ergo propter hoc" to argue that ideally, a two arm study that control for placebo as well as a traditional treatment is needed to define comparative efficacy versus the CAM treatment. In reply to Dr. Kaptchuk's question: "Should a person with chronic neck pain who can not take diazapam because of unacceptable side effects be denied acupuncture that may have an 'enhanced placebo effect' because such an effect is 'bogus'?" an argument is presented that the answer could indeed be 'yes' if the placebo effect is determined not to be real, and can be attributed, for example, to a subject reporting to "please" the investigators or based on a belief that they are improved as a result of acupuncture treatment.

Overall, the authors argue that science based medicine should apply equally to CAM treatments. The impression I got was that such study is worthwhile because so much of CAM is prevalent in society today, there is scientific understanding to be gained, and society should know the proved benefit, or lack thereof, of individual CAM treatments.

Remember that this presentation from NCCAM is appearing in JAMA. I think many are waiting for anyone at NIH including NCCAM to be accountable for what has, and especially what has not, been accomplished thus far by NCCAM and all that govt. dough.

Monday, February 02, 2004

Buy a plot on the Moon!!

http://www.space.com/scienceastronomy/mystery_monday_040202.html
Lunar Embassy (lunarembassy.com)
"Every day hundreds of people fork over about $30 for 1-acre slices of the Moon and Mars. (Prices are going up: For roughly the same amount, prior to 2001, you could get 17,700 acres.) The cost includes shipping and handling of a deed, a map, and the lunar or Martian "Constitution and Bill of Rights," all printed on simulated parchment...

"...Lunar Embassy employs the word "novel" to describe its products. The word was suggest by lawyers 24 years ago, according to the FAQ, to 'help avoid any frivolous lawsuits from a foreign country.'
"(The words "novel" and "novelty" are employed by star-naming businesses as a way to avoid the impression that their sales involve official products.)"
My take: I've spent more than $30 in my life and gotton much less than a few novelty, suitable for framing, documents on simulated parchment. The perfect gift for someone who is hard to buy for.