Science and the AAAS sell their souls to promote pseudoscience in medicine

Some obscure trinary programming languages that never became anything more than a novelty is more useful, in your mind, than the very system you are using right now.

He also gets the Setun story wrong, but anyway, I'm reminded of a time many years ago when I was briefly subjected to Hilary Putman's nattering about quantum mechanics.

^ "Putnam"

Greg- Most of the "testing" many of the old remedies got was simply attributing improvements to whatever remedy they received. Modern medicine is tested far more rigorously.

Now, do you understand how complex computer systems are? Operating systems have a large number of bugs because they are incredibly complex. If you understood half of what the programmers of Windows Vista were doing, you'd be amazed that they could get something like that built at all!

@Gray Falcon

Thank you for the correction. You are right, at least as far as zebra's comments have demonstrated thus far.

And reposting this bit so it doesn't get forgotten by our exemplar of upstanding reason and logic who makes the rest of us look like benighted neanderthals:

If fewer people have standard medical interventions, which mostly have a high harm value on my x axis, and instead have low y-axis treatments that may be only placebos, the population overall benefits.

Prove it. Run the numbers and show your work. If, overall, real medicine decreased while nonsense increased, what would the actual numbers be. Give us the concrete answer. I’m certain you must have it, since you’re so sure of the answer that you’ve ignored and casually dismissed all of the issues that the rest of us have brought up. No dodging this, by bloviating about how our logical skills are wanting. Concrete numbers based on real data showing that the overall population would benefit by decreased real medicine and increased woo. Your calculations should include effects on patient perception (e.g., Bob’s belief that ginger tea is just as good or better than real antibiotics).

zebra, explain to me how lying to you about the efficacy of Ginger tea can be expected to save your life while refusing to lie to you about the efficacy of ginger tea can be expected to cost you your life.

Then explain to me how either would be preferable to simply explaining why I'm refusing to prescribe antibiotics for a viral infection.

Greg, I admit I'm curious about one thing re: your 'life guard' technique.

I'm a fan of MMA (been watching it since UFC#1). In all that time I've never seen anyone attempt a submission by applying pressure on the lymp nodes under the arm pits to stop their oppnent from breathing and quickly subdue him. All manner of chokes which also stop the body from breathing, of course, but never this--despite the fact that any number of positons that commonly come up in MMA grappling could easliy be transitioned to apply such pressure. After taking an opponent's back, the aggressor typically will spend a great deal of effort trying to get his arm under teh opponent's chin to apply a rear-naked choke, when it would be simplicity itself to simply squeeze him under the armpits in modified bear-hug.

There's nothing in the rules prohibiting attempts to do this. so why do you think that is? Why are all these highly trained competitors ignoring this apparently devastingly effective technique? if it 1) exists and 2) actually works, that is...

The problem with zebra's "What's the harm?" line of thinking is that it's all well and good in the short-term for acute, self-limiting illnesses using low-dose herbs that have a very low likelihood of causing adverse effects. But it falls apart once you get into herbs that are not without serious risk, other nonsensical treatments with no basis in reality, and attempting to treat more serious illnesses. He ignores the greater context and long-term effects, not to mention hand-waving aside what currently occurs in actual medical school curricula that teach CAM.

"Krebiozen

January 13, 2015

Greg Young,

Engine vibration and the vibration of water on the hull felt very nice.

You may be one of those people that are susceptible to the alleged autonomous sensory meridian response. Put on some headphones and check out YouTube for lots of videos that are supposed to induce this effect – they just give me the creeps but evidently some people love them."

Thanks I'll try this out.

" Some obscure trinary programming languages that never became anything more than a novelty is more useful, in your mind, than the very system you are using right now."
You would have to take that up with those interested in using it to develop artificial intelligence.

"
JGC

January 13, 2015

Greg, I admit I’m curious about one thing re: your ‘life guard’ technique."
I was curious about how the method was supposed to work as well.
I don't think you'll see a method intended for use in the water being used in MMA, and not likely to see any technique intended to help the other guy instead of harming him.
There are methods used by attendents at mental hospitals that are intended only to gain temporary control over a violent patient without harming them.
The same area is mentioned in some martial arts as a point to strike a devastating blow.
In Yoga the same general area, though not exactly the same spot, is a pressure point for improving respiration.
The article on that women's self defense course described this in terms of a stealth technique. The rapist would not realize what the victim was doing and contune his efforts using up his oxygen without realizing his breathing had stopped and pass out without knowing what had happened.
I doubt MMA fighters expect to be raped, at least not in the missionary position.
The roll up, if thats the term still in use, does resemble a rough sex act, but its not, though it is much like a method for dominating and raping female captives mentioned in an old Arab text.
There are some old and not widely known methods of controlling another person. Griping the upper lip is an old Russian police method for dealing with drunken women, I don't think it would be so effective on a male.

Most of the techniques I was taught either had no name or the people I learned from simply didn't bother with naming techniques. I learned some very devastating techniques, I'm sure you probably know some of these but you probably couldn't use them in competition because they are all intended to kill or cripple.
Just mentioning some thing I've heard of and read about doesn't mean I endorse its use.

@Greg Young

I don’t think you’ll see a method intended for use in the water being used in MMA, and not likely to see any technique intended to help the other guy instead of harming him.

Why not? As described by you, applying pressure under the armpits has the end result that the person this move is applied to is either paralyzed momentarily or temporarily stops breathing, rendering them unconscious. 1) Why would this not be able to be applied in an MMA ring? 2) How would this help the opponent of the person using this move?

There are methods used by attendents at mental hospitals that are intended only to gain temporary control over a violent patient without harming them.

They are grappling techniques meant to restrain an individual; they are not techniques used to render the patient unconscious through some magical button (sorry, pressure point) that the attendant can press.

jgc

Since I am really getting sick of the nonsense from greg, let me give you some input on armpits. Have you never been instructed about using crutches? Sure, you don't want to crunch that area.

But, think about the body mechanics involved in striking there unless your opponent is in the "hands up don't shoot" position. The odds of hitting the point with sufficient force at a precise enough angle to cause anything but minor annoyance is very low.

Where this probably got started is in fighting with swords or sticks, particularly if some kind of body armor is involved. Then, it's a great idea, because again visualize the body mechanics when you are using the stick.

Your comment to me is gibberish. I wrote a very clear paragraph explaining my position and you making up some other incoherent question is not an answer.

And Todd still needs to read the Emanuel article, which answers his question.

@zebra

I did read the Emanuel article, but that does not answer the question that I posed to you based on the claim that you made. The Emanuel article only states that routine annual physical exams are unlikely to improve health outcomes for people. It does not say that annual physical exams lead to more harm. It does not say anything about introducing pseudoscientific crap into the patient-doctor relationship.

Let me remind you, again, what you wrote:

If fewer people have standard medical interventions, which mostly have a high harm value on my x axis, and instead have low y-axis treatments that may be only placebos, the population overall benefits.

Once again: prove it. Run the numbers and show your work. If, overall, real medicine decreased while pseudoscientific nonsense increased, what would the actual numbers be. Give us the concrete answer. I’m certain you must have it, since you’re so sure of the answer that you’ve ignored and casually dismissed all of the issues that the rest of us have brought up. No dodging this, by bloviating about how our logical skills are wanting. Concrete numbers based on real data showing that the overall population would benefit by decreased real medicine and increased woo. Your calculations should include effects on patient perception (e.g., Bob’s belief that ginger tea is just as good or better than real antibiotics).

If you think that Emanuel's article answer this, then you have absolutely no business lecturing anyone about their logic or reasoning skills.

As for the life guard, his argument was more easily understood, he couldn’t understand that his particular field had evolved so much, that people did not always look at the problem in the same way as they do now.

It's cute that you're telling yourself that that's what my argument was.

It's not like having spent loads of time learning and practicing approach, carry, and release techniques would have given me any sort of idea of what would or wouldn't be physically easy or even possible in the water.

That I've never heard of it certainly supports my skepticism, but as you say, it proves nothing. *Of course* it's possible that there is some historical detail I've never heard of. Duh. But you can't find even a sliver of evidence that such a technique was used or would even work, in or out of the water. All you've got is, well, some unspecified person told me about this, so many years ago that I can't even remember the details, but I think it's plausible so it must be true and anyone who thinks it sounds fishy should just shut up.

I'm not sure why it's so hard for you to acknowledge the possibility that whoever told you this story might have been wrong about it. People have told me oodles of things over the years, many of which I had no reason to doubt at the time, that I later found out were exaggerated or untrue. No big deal.

Todd:

"The Emanuel article only states that routine annual physical exams are unlikely to improve health outcomes for people. It does not say that annual physical exams lead to more harm"

It says exactly that and I quoted part. The harm is costs and opportunity cost, and direct harm through overtreatment.

And yes, you are engaging in poor logic or rhetorical fallacy-- it's called equivocation, or "no true Scotsman". Whatever I say, you can say "but that's not proof", because I don't know what your definitions are.

We have many instances like what Emanuel discusses, the antibiotic thing, or back pain, or any number of tests and interventions that are scientifically determined to have no benefit and, in many cases, potential harm even beyond cost and opportunity cost. That provides "proof of concept".

Now, do you have some criterion by which we can decide when we are providing "the greatest good for the greatest number"?

So far the only thing I've heard is "waaah, but that means doctors wouldn't be completely honest about TM."

"1) Why would this not be able to be applied in an MMA ring?"
They used to fill the arena in Rome with water and stage mock sea battles. They haven't done the same during MMA matches that I'm aware of.
You should have some idea just how difficult it is to use common techniques meant for dry land when in the water with nothing to stand on and nothing to anchor you other than your grip on the opponent.

"2) How would this help the opponent of the person using this move?"
The technique was intended to prevent further damage to the lungs by the victim breathing in water instead of air while immobilizing him so the rescuer could get him out of the water to resusitate him, not so you could beat him down.
If done during a match with a opponent whos fully aware that he's in a fight the move would not be effective. You couldn't expect that he would not know that you are trying to disable him.
Its obviously not intended for an MMA match.
Since we are on the subject have you told the mighty penguin the dangers of letting your legs get in front of the agressor when pinned in the position I described?
I think the Ranger unarmed combat video made that clear but perhaps you can explain it better.

Also I'd like your opinion on his claim that the U S military knew little or nothing about the martial arts during WW2 and his belief that the U S had no involvement in Korea before WW2.
Also would you agree that in a real fight, not a competition, you must go on fighting despite injury and whether or not you know you can win.
Would you not also agree that many times someone who has no hope of winning will fight only to do as much damage as he can before he dies.

" The odds of hitting the point with sufficient force at a precise enough angle to cause anything but minor annoyance is very low."
It doesn't require a precise angle, the area is at least as big as the palm of your hand. You should have noticed that what I posted about striking the area mentioned the nerve near the surface and the arteries behind that.
You've watched to many movies were they use a finger tip on a tiny spot no one knows about, or mr spock knocking someone out by squeezing their shoulder.
Boxers often screw up by not covering that area. You can see the effects when the opponent gets under their guard. Even with thick boxing gloves to distribute the force over a wider area a blow there reduces the fighters wind.
Often after a blow to this area the fighter will all but collapse trying to hold onto the man who hit him while trying to get his breath back, too many hits there and he may not be able to continue.
Perhaps you don't know the difference between under the arm pit and in the armpit. Using a crutch won't come any where near to putting pressure on the area I described.
Near as I can remember the spot is about one hand's breath under the armpit, or below the armpit if that makes it easier to visualize.

The area would be a point they might have wished to strike if a man were wearing body armor, though most body armor was worn over a padded jack or gambeson. With a mace or war hammer the padding wouldn't help much.
Before anesthetics they sometimes used cruder methods to render a patient unconscious for a couple of minutes so they could probe for a musket ball or dig out an arrowhead.
These days they can stop all respiration and even stop the heart during some surgical procedures. They have to work very fast of course.
I seem to remember reading of some of the old pressure point methods being used to render the patient unconsious in a book called "the Century of the Surgeon".

So narad do you also believe the U S had no military involvement in Korea before WW2?
Enquiring minds want to know.

I don’t think you’ll see a method intended for use in the water being used in MMA, and not likely to see any technique intended to help the other guy instead of harming him.

I can't recall seeing any methods intended to be used in the water in traditional Korean martial arts, either, yet that's seems to be what you're attributing its development to (those apocryphal Korean warrior monks).

There are methods used by attendents at mental hospitals that are intended only to gain temporary control over a violent patient without harming them.

Funny--my wife (who as a medical social worker has worked in direct care, was trained in and routinely required to engage in the physical restraint of adult clients) has never heard of this either.

The article on that women’s self defense course described this in terms of a stealth technique.

What article was that again? I can't seem to find the citation i your posts.

I doubt MMA fighters expect to be raped, at least not in the missionary position.

You do know what a BJJ closed guard looks like, right?

Just mentioning some thing I’ve heard of and read about doesn’t mean I endorse its use.

Or, apparently, that the thing you're mentioning actually exists.

"
Gray Falcon

January 13, 2015

Greg- Most of the “testing” many of the old remedies got was simply attributing improvements to whatever remedy they received. Modern medicine is tested far more rigorously."
Yet tens of thousands of people were paralyzed by a flu vacine, hundreds got meningitis from another more recent drug tragedy.

"Now, do you understand how complex computer systems are? Operating systems have a large number of bugs because they are incredibly complex. If you understood half of what the programmers of Windows Vista were doing, you’d be amazed that they could get something like that built at all!"
Excuses excuses, fix my old PC right now do you hear dag nabit.
Seriously when has a similar argument helped when a new car gets recalled. People want what they buy to work without a huge hassle.
Vista worked well for me until it required so many upgrades.
When the last upgrades installed it crashed. I wiped it and reinstalled the OS then the moment it was fully updated it crashed again.
If I do get it running again I'll have to disable the upgrade function completely or just not connect it to the net.
Others had even worse problems and the OS is now one of many Micro Soft failures on the junk pile.
Maybe they have a hidden self destruct that activates the moment the warranty runs out.

zebra, I interpreted your comment " I certainly wouldn’t want you for a doctor if you wouldn’t tell a lie to save my life" to communicate two things: that you believe it would be ethical for a doctor to lie to a patient to save their life, and that thsi argues it is also ethical if they lie to them by implying ginger tea may be beneficial in treating viral infections. Isn't the only way the latter could rationally follow be if there evidence demonstrated not lying to patients to get them to consume ginger placed their lives in jeopardy?

Or are you perhaps suggesting that if we can ethically lie, in specifici circumstances, to achieve a specific goal (saving a life) we must be able to ethically lie in any circumstances to achieve any goals?

@zebra

You made a very broad, overreaching claim that you are continuously refusing to back up. Once again, you wrote:

If fewer people have standard medical interventions, which mostly have a high harm value on my x axis, and instead have low y-axis treatments that may be only placebos, the population overall benefits.

I asked you to provide concrete calculations/numbers showing that if fewer people overall (i.e., not just those seeking annual physicals or treatment for self-limiting conditions) get real medical treatment, and that instead they get TM/TCM/CAM/placebo/magic, that that would actually benefit the population as a whole.

I am not equivocating at all. I recommend you brush up on your logical fallacies, if you're so intent on accusing others of making them. You made a specific claim. I called you to task on that specific claim. You have yet to provide support for that claim and instead point to evidence supporting an entirely different claim as somehow supportive of your own.

I thought I was pretty clear on what I was looking for. Now, are you actually going to back up your claim, or are you going to continue to dodge and try to distract away from your it? Another option is to admit that you were wrong to make that claim, that you were overly hasty, and that you do not, in fact, have any evidence to support the claim.

@Greg Young: Why not write your own operating system? You can use that trinary programming language you told me about earlier.

jgc,

No it doesn't follow.

This is just the old and silly dorm-room philosophy argument:

Would you lie to save a life? Of course.

Then, you can't argue that you should never lie in order to do good, the only question is how do you decide when it is OK.

I argue that it is OK to use the language I provided about ginger tea, which you are characterizing as a lie but I don't. Nothing in it is an actual lie. It fits into what I consider ethical behavior for doctors. I have a rational basis for that, which is that it is the doctor's job to do the best for the patient's health, and for patients in general.

Think about the ethics of being a corporate officer. Your job is to maximize stockholder profits. If that means dumping toxic waste in the river, you are being ethical in the context of your job, but not in the context of society. It's all contextual.

"
I doubt MMA fighters expect to be raped, at least not in the missionary position.

You do know what a BJJ closed guard looks like, right?"
https://www.youtube.com/watch?v=KKxD5kdOkk0
So tell us how many times you've been raped during a match, and how many times you've seen fighters trying your technique end up rolled up with their head pulled into the chest of the guy on top?
The agressor in that position is far back as if having consenual sex, not pressing down on a smaller weaker woman in a position intended to dominate and crush.
In any case the guy on the bottom in that video can still be rolled up unless he is very fast.
If every woman were as strong and fast as an MMA fighter there would be far fewer rapes.
Sexual Predators prey on the weak not on the strong.
When strength is not on your side you use stealth and guile.

"Funny–my wife (who as a medical social worker has worked in direct care, was trained in and routinely required to engage in the physical restraint of adult clients) has never heard of this either."
Ask her what methods she has used in handling violent patients, I'd seriously like to hear of these methods. At Eastern State Hospital they often had to send in what they called the tanks. From what I'm told they wore heavy padded armor and are generally the size of front linemen.At least some of the patients there were violently criminally insane.
I think they closed down Lionsview long ago. I believe this was the hospital depicted in "The Snakepit". Its not far from here.

Yet tens of thousands of people were paralyzed by a flu vacine, hundreds got meningitis from another more recent drug tragedy.

I'll note that this is a manufacturing, not a drug, tragedy. There was nothing wrong with the drug itself (methylprednisolone) and there's no indication that methylprednisolone's clinical safety testing prior to FDA approval was insufficient. The problem was instead with a compounding center (the New England Compounding Center) which was operating in violation of their state licensure and whose manufacturing processes weren't compliant with FDA regulations, resulting in the widespread release of contaminated vials.

I'm unable to find any instance where "of tens of thousands of people were paralyzed by a flu vacine"--can you be more specific?

Todd,

"I asked you to provide concrete calculations/numbers showing that if fewer people overall (i.e., not just those seeking annual physicals or treatment for self-limiting conditions") get real medical treatment."

Todd, you are doing exactly what No True Scotsman describes, which is trying to move the goalposts by saying "*real* medical treatments".

Annual exams and treatment for self-resolving conditions are exactly what I and Dr Emanuel are talking about.

What you have to do is give your definition of "benefiting society as a whole."

If 1000 people save money, and one person dies, you could count that as benefiting society as a whole. It's exactly how society operates right now in the USA.

If 1000 people give their money to medicine without receiving benefit, instead of subsidizing the one person, then society as a whole doesn't.

If 1000 people give half that money to TM, and the other half to save the individual, that's a better outcome.

Now, I'm being honest and giving you an idea of my criteria. You are playing No True Scotsman.

So tell us how many times you’ve been raped during a match, and how many times you’ve seen fighters trying your technique end up rolled up with their head pulled into the chest of the guy on top?

Never, and I don't know what technique you're characterizing as mine in "fighters trying your technique" you're speaking of. I'm pointing out I've never seen anyone, when they've achieved a mounted, closed or half guard, or full back position, ever try to finish a fight using this apparently devastating technique of applyng pressure to the lymph nodes in their opponent's armpits.

In any case the guy on the bottom in that video can still be rolled up unless he is very fast.

I'm not asking why the guy on the bottom isn't squeezing the top-mounted guy's armpits to escape: I'm asking why theh guy on top or who's taken an opponetn's back doesn't finish him with it, rather than attempting something like a kimura orrear naked choke instead.

I mean it would rapidly trick his body into not breathing, right?

At Eastern State Hospital they often had to send in what they called the tanks. From what I’m told they wore heavy padded armor and are generally the size of front linemen.

My wife (all-be-it a large woman) never required such padding. The methods she used were simply what at the time standard paractice for physical restraint (with anything resembling joint locks, choke holds, etc.--common to martial arts traditions.-strictly prohibited).

@zebra

Todd, you are doing exactly what No True Scotsman describes, which is trying to move the goalposts by saying “*real* medical treatments”.

I thought it fairly clear from my other comments that when I say "medicine" I am talking about those practices and treatments supported by science. And since the original post was all about real medicine (i.e., that which has been shown to work) vs. the other stuff (that which has either not been shown to work or been shown not to work), I figured that the meaning was rather straightforward. But then, you have been desperately trying to redefine words to fit your argument, rather than changing your argument to fit the definitions the rest of us are using.

What you have to do is give your definition of “benefiting society as a whole.”

Well, since you used the term in your claim, I'd say that it is up to you to give your definition. For myself, I would say that the definition would constitute improvement in overall health, including the reduction of risks and maximization of benefits. That's what I read your claim as implying, since we've been going on and on about health, rather than the monetary costs or savings.

So, hopefully that clears things up. Now, please provide your calculations and concrete numbers that support your claim. Stop dodging.

Todd,

I said in a comment to Obrien that I include the cost factor, and there's opportunity cost as well. Do you understand opportunity cost? It's what you keep suggesting will happen; people spend money on TM and not on 'real' medicine. I just explained that if people spend money on e.g. antibiotics for a cold, less is available for 'real' medicine.

Now, maybe you have some problem with quantitative thinking but what Emanuel describes is exactly what I said:

"If fewer people have standard medical interventions, which mostly have a high harm value on my x axis, and instead have low y-axis treatments that may be only placebos, the population overall benefits."

Yearly checkups are standard medical interventions.

If there were fewer of them, the population overall would benefit. There would be more money for 'real' medicine.

You are clearly confused somehow about what seems like an obvious fact. Maybe it isn't NTS after all, but you have to more clearly articulate what you think is going to happen in my scenario-- for yourself as well as me.

“If fewer people have standard medical interventions, which mostly have a high harm value on my x axis, and instead have low y-axis treatments that may be only placebos, the population overall benefits.”

Still waiting for any evidence demonstrating that standard medical interventions mostly (or even as likely as not) qualify as "high harm".

Basically binary is yes or no, trinary is yes-no-maybe- could you repeat the question.
I'm gonna stick to binary logic and say "No, this is wrong".

Martin Gardner described ternary logic in a Mathematical Games column back in (if memory serves) the late 70s.

@zebra

Here are some things that also fall under "standard medical interventions":

surgery/chemo/radiation for cancer
ECMO for respiratory failure
kidney dialysis
organ transplantation
immunosuppressive therapy
setting broken bones
insulin for diabetes
antiviral therapy for HIV/AIDS
diagnostic lab tests for infections
physical therapy
epipens for anaphylactic shock
vaccinations
trauma surgery
anesthesia

You seem to have a rather myopic view of what constitutes "standard medical interventions". This may have something to do with the problems in your reasoning that I listed up at comment #225.

Now, in addition to JGC's request that you show that standard medical interventions mostly qualify as "high harm", you still need to show your evidence that if people use less "standard medical interventions" (which includes, but is not exclusive to, those I just listed above) and instead of those interventions use TM/TCM/CAM/placebo/magic, that the population overall will benefit (with benefit including population health, not only monetary considerations).

I continue to await your concrete numbers supporting the claim that you made.

Greg's also managed to mix up ternary computing and fuzzy logic. Two very different subjects: Fuzzy logic actually uses a continuum of 0 to 1: 0 is utter uncertainty, 1 is absolute certainty. That's where the AI research is.

I believe this was the hospital depicted in “The Snakepit”. Its not far from here.

Once again it proves easier to simply make things up than to spend 30 seconds determining that, no, it had nothing to do with Tennessee.

Greg’s also managed to mix up ternary computing and fuzzy logic.

If anyone is in need of hilarity, let me introduce relentless self-promoter Florentin Smarandache and his concept of 'Neutrosophy' whereby a statement can be True, False or Other (essentially Van Vogt's "Null-Aristotelian" thinking but without the teleportation).

Todd, JGC

Most medical interventions have greater potential for harm than placebos because by definition, placebos don't have any physical effect. That's a generalization which is not disproved by saying 'but some acupuncture needles could be infected'.

So, once again:

“If fewer people have standard medical interventions, which mostly have a high harm value on my x axis, and instead have low y-axis treatments that may be only placebos, the population overall benefits.”

There does seem to be some problem with quantitative reasoning here.

"Fewer people having standard medical interventions"

is not identical to

"Some of the people with broken bones will get acupuncture instead of a cast"

Which, I've finally figured out, seems to be what you are suggesting.

If we *only* take what Emanuel is saying as correct, my contention is quantitatively valid. And there are obviously other cases like the antibiotic prescriptions for colds, and many tests, and many back surgeries, and so on. Reducing those activities meets the stated condition.

Sadly, I have to point out that I've heard very similar crazy quantitative reasoning to what I think yours is-- from climate denialists, who think "average temperature" means it will be a pleasant 2 degrees warmer outside of their window every day of the year.

@zebra- You made the statement. You back it up.

"ever try to finish a fight using this apparently devastating technique of applyng pressure to the lymph nodes in their opponent’s armpits."
Who ever said you would?
You are making the same mistakes your friends have already made. You speak as if what you don't know makes you an authority.
You won't see you friends dig a knuckle into the carotid sinus either. You won't see them lever an eye ball out of the socket.
Theres a lot of stuff you'll never see in a competition, not without someone going to jail as a result or being sued for everything they own.
"My wife (all-be-it a large woman) never required such padding"
Then I guess they'll just have to stop manufacturing the stuff, since she doesn't need it at the adult care facility.
Does she wear her anti-bite gloves at work?

The film I was thinking of was "Suddenly Last Summer".
Elizabeth Taylor rather than Olivia de Havilland. Very similar depictions of the hospital. Both very beautiful actresses.

http://en.wikipedia.org/wiki/Donald_Knuth
At least some agree with me that the trianary system shows promise.

The yes-no-maybe bit was in an article on the use of trinary code for constructing realistic characters in video games.
I thew in the "can you repeat the question" because its a line from a theme song from a TV series about a dysfunctuional family. It sort of fits, the third option prevents things from coming to a dead end.
I haven't seen much in the way of seriousness here, so who cares.

So...just in case anyone is attacked by a dog and remembers the advice on this thread about applying pressure the axillary region in order to subdue the dog. Don't do that. I've been a veterinary technician since 2001, and have done a lot of reading on behavior and restraint techniques and I have never, ever heard of this. As a practical matter it sounds extremely dangerous.

Also the eyeball pressure thing. I'm sorry if someone else addressed it and I missed it. But that's called a vagal maneuver. We do it sometimes to try to stop a supraventricular tachycardia. You can also rub on the neck over the carotoid artery. Neither maneuver will cause the animal to faint or stop breathing or whatever. And I've never seen nor heard of anything in the axilla causing a vagal response.

https://positively.com/animal-advocacy/dog-bite-prevention/what-to-do-w… Very good advice on what to do if you are attacked by a dog.

http://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/basics/t… This article talks about coughing and holding your breath and straining, but we can't ask animals to do that. Hence the other techniques I mentioned.

"The methods she used were simply what at the time standard paractice for physical restraint (with anything resembling joint locks, choke holds, etc.–common to martial arts traditions.-strictly prohibited)."

Professional use of force
"This can range from a weekend combat course for the public to takedown and control tactics for police and orderlies in mental hospitals."
http://www.nononsenseselfdefense.com/four_focuses.html#self-defence
Takedown and control, sounds like martial arts to me.

Oh, fer chrissakes:

In Yoga the same general area, though not exactly the same spot, is a pressure point for improving respiration.

Ayurveda treats the marmas* as points that one can make a swirling motion over for fun and profit, although the legitimacy of this is disputed. A subset has use as objects of meditiation in Ashtanga yoga.

Oh, and the manas you're trying to fall back on to support your magic lifesaving armpit maneuver really don't sound promising.

Take it away, Sushruta Samhita:

An injury to the stanamula marmas situated immediately below each of the breasts and about two fingers in width, fills the thorax with deranged kapha, brings on cough, difficult breathing and proves fatal.

An injury to any of the stanarohita marmas, situated above the nipples of the breasts about two fingers in width, fills the cavity of the thorax with blood, producing symptoms of cough and asthma, and ends fatally.

* The top photos on this guy's site are a riot.

The film I was thinking of was “Suddenly Last Summer”.

Then the assertion is even dumber: Tennessee Williams wasn't from Tennessee.

CC 542

I originally heard of the eyeball thing for landing fish, particularly northern pike. I've done it, and it may have worked (I don't consider anecdotes data), but... it takes serious self-control, and I lost my nerve as many times as I successfully executed the maneuver. I am fond of my fingers.

You do this with *dogs*???

At least some agree with me that the trianary system shows promise.

Your belief that your error-laden babbling about how "trinary programs can mimic the operations of the brain to some extent" has anything to do with what Knuth wrote is just another illustration that your modus operandi is to liberally combine delusions of grandeur with statements that are so hopelessly confused and ill defended as to be functionally indistinguishable from simply making shіt up.

Here's a hint, Greg. Learn the basics of the basics of a subject before you start commenting on it.

At this point I'm wondering if GY still believes that the person running rings around is a "mud turtle trying to hump a river rock".

Greg: You believe in recovered memories and other theories that have been widely discredited, cite a very unreliable life-saving/disabling technique, and cite a number of unreliable sources. Why the hell would I believe anything that you said?

^ rings around him. What seemed like a biting witticism doesn't seem quite so biting or witty with a typo in it :-(

Allow me to revisit this:

At Eastern State Hospital they often had to send in what they called the tanks. From what I’m told they wore heavy padded armor and are generally the size of front linemen.At least some of the patients there were violently criminally insane.
I think they closed down Lionsview long ago. I believe this was the hospital depicted in “The Snakepit”. Its not far from here.

Rose Williams was lobotomized at Farmington State Hospital in Missouri. This, to all lights, is what becomes "Lion's View" in Suddenly, Last Summer. Note that the play has nothing to do with "the tanks" in "padded armor." Maybe the film version of The Snake Pit has some such lurid imagery, but Mr. Young has disavowed that it's what he was referring to.

Now, how in G-d's name does one manage not only to fail to figure out that the movies weren't documentaries, but to flatly assert that one lives near a fictional institution?

^ (And no, I'm not going to get back to the AQB tonight, I'm going to be lazy and make this again and start sorting out some word salad.)

What seemed like a biting witticism doesn’t seem quite so biting or witty with a typo in it

I'm delighted by the compliment all the same.

"to flatly assert that one lives near a fictional institution?"
"Lyons View Pike became the site of the first "Hospital for the Insane" under the aegis of William Lyon's daughters' property donation in 1874 and Lakeshore Mental Health Institute still occupies a large section of that property."
http://www.sequoyahhills.org/history.html
Tired of humping that river rock yet mister turtle?
Do more than 30 seconds of googling and you might find out stuff you never imagined.
Tennessee Williams supposedly wrote the play based on his personal experiance at Lyons View. The name appears as Lion's View as well as Lyons View.
It was also called Eastern State.
A girl friend of mine was committed there for nyphomania, She wasn't really a nympho, she just liked sex and had daddy issues.

You should be embarassed by the childish glee you expressed at finding an IMDB page. If you knew much about movies you wouldn't have needed to check out the IMDB page to recognize that the movie I was thinking of was "Suddenly Last Summer".

http://www.asylumprojects.org/index.php?title=East_Tennessee_Hospital_f…

"The East Tennessee Hospital for the Insane was built on land previously owned by Capt. William Lyon, after more than a dozen years of funding stops and starts and political infighting. The East Tennessee Hospital for the Insane opened in 1886 with 99 patients transferred from the older Tennessee Lunatic Asylum in Nashville. In 1920, the facility's name was changed to Eastern State Hospital as part of a program to rename all of the asylums in the state."

Theres a Williams Estate for sale at Lyons View, possibly a relative.
My sister met Tennesse Williams socially not long before his death.
There were many of the old time film screen writers in Knoxville in those days. A stroke rehab center at Fort sanders is named after actress Patricia Neal.
I met british actor Anthony Quayle at a country club function after he put on a play there . He took a teaching position in Knoxville as well. A very cool guy.
In Williams day the Eastern State Hospital at Lyons View was well known. If he wasn't there as a patient he likely knew some who were.

"Williams-Richards House, 2225 Riverside Drive. The oldest part of the house was built in 1842 by John Williams II, grandson of Knoxville founder James White and great-grandfather of playwright Tennessee Williams. The house was on the 2007 Fragile 15; the owner has since fixed roof, gutter and soffit damage. Knox Heritage says it hopes that with continued work, this will be the building's last "Fragile" appearance. "

The Eugenia Williams Mansion is in Lyonsview itself. Don't know if she is also related to Tennessee Williams.
http://www.knoxnews.com/knoxville/life/cormac-mccarthy-home-vacant-scho…
Most of the old money in Knoxville are related.

Krebiozen

At this point I’m wondering if GY still believes that the person running rings around him is a “mud turtle trying to hump a river rock”.

To be fair, a mud turtle could run rings around Greg and still take time out to hump a river rock.

Greg has mastered the art being fractaly wrong.

BTW
The reason the Russians dropped the trinary computer due to expense was not based on projected per unit cost. To develop the computer and manufacturing techniques cost more than adopting existing bianary computer technology that they could buy, lease or outright steal.
The Russians were big on buying stolen U S computer programs, a practice that came back on them when we planted defective programs that caused an explosion at a Russian facility that could be seen from orbit.

"fractaly"
I'm unfamilar with that word.

The Russians were big on buying stolen U S computer programs, a practice that came back on them when we planted defective programs that caused an explosion at a Russian facility that could be seen from orbit.

Citation please.

Seems like Narad's google fu failed him there.

It also would appear that some here don't recognize that there's a world outside of wikipedia.
As far as computer code I could care less except when the one who writes it doesn't test it very well before palming it off on the public.
I do find it odd when someone considers ignorance of a topic to be a badge of authority.
Perhaps that mind set is why theres so little faith in modern medicine.

Canadian software CIA logic bomb.
"The Trans-Siberian Pipeline, as planned, would have a level of complexity that would require advanced automated control software, Supervisory Control And Data Acquisition (SCADA). The pipeline used plans for a sophisticated control system and its software that had been stolen from a Canadian firm by the KGB. The CIA allegedly had the company insert a logic bomb in the program for sabotage purposes, eventually resulting in an explosion with the power of three kilotons of TNT. The CIA was tipped off to the Soviet intentions to steal the control system plans by documents in the Farewell Dossier, a document collection provided by KGB defector Vladimir Vetrov. Seeking to derail their efforts, CIA director William J. Casey followed the counsel of economist Gus W. Weiss[2] and a disinformation strategy was initiated to sell the Soviets deliberately flawed designs for stealth technology and space defense. Working with the Canadian firm that designed the pipeline control software, the CIA had the designers deliberately create flaws in the programming so that the Soviets would only get a compromised program. It is claimed that in June 1982, flaws in the stolen software led to a massive explosion of part of the pipeline.

National Security Council staffer Thomas C. Reed documented the operation in his book, At the Abyss: An Insider's History of the Cold War. In 2004, Reed, a former Air Force secretary of the Reagan administration, wrote that they had added a Trojan horse to equipment that the Soviet Union obtained from a company in Canada. "

Of course Narad will post only the claims of a single KGB agent to claim this never happened.

If the Russians had put more money into developing their Trinary Computer and written the software instead of stealling it they might have come out ahead.

zebra

If fewer people have standard medical interventions, which mostly have a high harm value on my x axis

Apparently zebra is entitled to their own facts. These include the majority of drug allergies being fatal and alt med treatments never having significant harmful effects.

""
C.C.

January 13, 2015

So…just in case anyone is attacked by a dog and remembers the advice on this thread about applying pressure the axillary region in order to subdue the dog. Don’t do that. I’ve been a veterinary technician since 2001, and have done a lot of reading on behavior and restraint techniques and I have never, ever heard of this. As a practical matter it sounds extremely dangerous.

Also the eyeball pressure thing. I’m sorry if someone else addressed it and I missed it. But that’s called a vagal maneuver. We do it sometimes to try to stop a supraventricular tachycardia. You can also rub on the neck over the carotoid artery. Neither maneuver will cause the animal to faint or stop breathing or whatever. And I’ve never seen nor heard of anything in the axilla causing a vagal response.

https://positively.com/animal-advocacy/dog-bite-prevention/what-to-do-w… Very good advice on what to do if you are attacked by a dog.

http://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/basics/t… This article talks about coughing and holding your breath and straining, but we can’t ask animals to do that. Hence the other techniques I mentioned"

I have great respect for vets, but I've raised large agressive dogs all my adult life and I've broken up pit bull attacks on neighbor's dogs on several occasions. I have some experiance in handling dogs that get out of order.
When you lift a heavy uncooperative dog with hands under armpits he will usually settle down and let you put him in the truck.
I've used techniques of sweeping the dog's fore legs out from under him and pinning him on his back to put his eye drops in. This was a 120 pound Pitt/Plott bearhound mix breed with muscles like the batman suit and the largest fangs I've seen on a dog. He was not really vicious but he was rambunctious and stubborn with a quick temper.

This site agrees that the pressure points under the armpits are useful in controlling a vicious dog.
http://www.fightingarts.com/reading/article.php?id=337
At least some of what they have to say is based on methods used by U S Army dog handlers.

Unless a dog is mad or has been abused he won't continue doing something if its conterproductive, otherwise we couldn't train them.

You should be embarassed by the childish glee you expressed at finding an IMDB page.

"Glee"? IMDB? I wouldn't touch the sewer of IMDB with a fυcking windowpole.

If you knew much about movies

Uh-oh, it's time to play Most Knowledgeable Person again.

you wouldn’t have needed to check out the IMDB page

And embarrassingly project.

to recognize that the movie I was thinking of

As opposed to the one that you actually specified.

was “Suddenly Last Summer”.

I'm sure there's a name for the idea that one's words and deeds are only an imperfect proxy for one's "thoughts," which are presumably broadcast in Pure Form and Receivable by Tuning In to The Cosmic Mind, within which you apparently believe yourself to operate a high-powered transmitter, but, sorry, no.

Theres a Williams Estate for sale at Lyons View, possibly a relative.

So Tennesse Williams bought the totally-not-fictionally-named mental hospital and constructed an estate on its smoldering remains and gave it to a relative?

My sister met Tennesse Williams socially not long before his death.

Do you have any evidence that she didn't injure one of his delayed-death manas?

There were many of the old time film screen writers in Knoxville in those days.

Tennessee Williams died in 1983. How, exactly, does an imaginary, massive immigration to Knoxville by screenwriters 40 years later represent anything other than wholesale desperation on your part?

A girl friend of mine was committed there for nyphomania

I think this speaks for itself.

^ "later than the writing," that is. And it should have been 30, or 25, whatever.

And I completely forgot to ask The Expert what he thought of John Huston's interpretation of Iguana, including with respect to the one-act version.

Ah, well.

I do find it odd when someone considers ignorance of a topic to be a badge of authority.

I find it vastly more odd when someone demonstrates, over and over, that determined ignorance with regard to a seemingly bottomless, largely self-advanced, pit of topics is supposed to be a "badge of authority," but maybe that's just me.

@Greg Young:

I'll get back to you on the Trans-Siberian Pipeline tomorrow; at the moment, I'm a bit exhausted from traveling, and I have to get up in the morning for a Ukrainian class I'm taking mostly for the fun of it. Suffice it to say, for the moment, that Thomas Reed's account is implausible for several technological and historical reasons.

BTW
The reason the Russians dropped the trinary computer due to expense was not based on projected per unit cost. To develop the computer and manufacturing techniques cost more than adopting existing bianary computer technology that they could buy, lease or outright steal.

You don't say.

Hey, rather than simply disgorging whatever happens to surface in your roiling, "nonlinear" head, how about getting back to melatonin's being "proven [sic] in clinical trials to improve liver function in those with previous liver damage"?

I wasted time on that one, and here you're pretending that a True Cinephile rejects the surviving fragments of the film adaptation of On Jordan's Stormy Banks?

" How, exactly, does an imaginary, massive immigration to Knoxville by screenwriters 40 years later "
Who said anything about a "Migration"? Tennessee Williams had family here.
You don't know diddly about the entertainment industry and you've proven that.
You also have no idea of Tennessee Williams connections with Knoxville.
https://www.google.com/url?q=http://en.wikipedia.org/wiki/Old_Gray_Ceme…
The man was scandalous around here. Great talent though.

"how about getting back to melatonin’s being “proven [sic] in clinical trials to improve liver function in those with previous liver damage”
I already posted that, look back to posts 258 and 259 the links are there..
Whats the matter Pinky, losing confidence in your google fu?
Perhaps your memory is fading or humping that river rock for so long has worn you down.
So far all you and your fan club have done is talk about how much you don't know, then try to google your way to knowledge you haven't earned.

Whats the matter Pinky, losing confidence in your google fu?

Um, sure thing. You've just confirmed that you still haven't figured out what the words "clinical trial" mean.

Everybody sing!

Keep on a-diggin' your hole
Som're else bey diggin' dat hole!
 Deeper, that's the major drawback
–Of the verticle phase of linear thinking!

I couldn't figure out a line to complete the stanza, so I didn't bother much with the meter.

But over time, Lyons View became synonymous with insanity and terror. Authors such as Tennessee Williams, Cormac McCarthy, and Peter Taylor have all published stories that featured a state asylum called "Lyons View" or "Lion's View." No matter how it was spelled, authors used the name to convey images of a place where people were sent away forever.
http://www.wbir.com/story/news/local/2014/07/18/lakeshore-historic-hosp…

So by your own standards you "lied" when you said Lions View was a fictional institution.

"Although the term "clinical trials" is most commonly associated with the large, randomized studies typical of Phase 3, many clinical trials are small. They may be "sponsored" by single researchers or a small group of researchers, and are designed to test simple questions. In the field of rare diseases, sometimes the number of patients is the limiting factor for the size of a clinical trial."

"The present study represents the follow-up of our initial observations designed to investigate whether in patients with nonalcoholic steatohepatitis (NASH) the beneficial effect of 12-week course of melatonin (MT) on liver enzymes could be maintained with prolonged period of treatment and to analyze whether biochemical treatment responses could be sustainable after melatonin discontinuation. Forty two patients with histologically proven NASH (30 treated with melatonin 2x5 mg daily, 12 controls receiving placebo) enrolled to our previous 3-month study agreed to take part of subsequent 12 weeks treatment followed by 12-week follow-up period. Enrolled patients had biochemical determinations every six weeks during the melatonin treatment period and again after 12 weeks of follow-up. Significant reduction in median alanine aminotransferase (ALT) levels between baseline and week 18, week 24 and follow-up was observed in both MT-treated and control group: 43% and 31%, 42% and 33%, 32% and 31%. Aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) levels decrease significantly only in MT-treated group. In MT-treated group mean percentage change in AST level below baseline at week 18, at week 24 and at follow-up was 45%, 33% (p<0.05) and 8% (ns), respectively. The evolution of GGT levels was as follows: the mean percentage reduction in GGT below baseline level at week 18, 24 and follow-up was: 48%, 52% and 38% (p<0.05), respectively. In both MT-treated and control group plasma cholesterol, triglicerydes and glucose concentrations as well as plasma alkaline phosphatase persisted within normal values during the prolonged study period. Plasma concentration of melatonin (pg/ml) in MT-treated group averaged 7.5±3.5 at baseline and increased to 52.5±17.5 at 24th week. The results of our study demonstrating beneficial effect of melatonin on liver enzymes in patients with NASH would seem to encourage further controlled trials of melatonin given over a longer period of time with liver histology as end point."

"Small clinical trials may be appropriate and even a necessity in various contexts that include, but are not limited, to rare diseases. Being able to conduct them with scientific rigor is of increasing importance in the current regulatory and scientific environment. The Food and Drug Administration (FDA), in collaboration with the National Institutes of Health (NIH) Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), conducted a 2-day public course titled The Science of Small Clinical Trials. This course presented an overall framework and provided training in the scientific aspects of designing and analyzing clinical trials based on small study populations."

https://events-support.com/events/FDA-NIH_Science_Small_Clinical_Trials

Greg, why aren't you submitting your posts by hand, with paper? Preferably after coming here on foot or riding a horse. After all, they've been doing those things for centuries, far longer than computers or horses, shouldn't those ways be better?

@zebra

“Fewer people having standard medical interventions”

is not identical to

“Some of the people with broken bones will get acupuncture instead of a cast”

No sh*t. I did not realize that. Thank you so much, O Great and Powerful One, for pointing that out to me. But then, when you made your comment, you weren't exactly specific. You opted, instead, for a broad, sweeping statement, rather than limiting yourself to, for example, only those standard medical interventions that have low likelihood of actually having any beneficial effect.

Let's look, again, at what you wrote, (annotations added):

If fewer people have standard medical interventions [unspecified, which implies inclusion of the whole of standard medical interventions], which mostly have a high harm value [not low, not moderate, but high, an assertion yet to be demonstrated] on my x axis, and instead have low y-axis treatments [in plain language: completely or mostly ineffective treatments, the implication being that this only includes TM/TCM/CAM and excludes ineffective "standard" medical interventions] that may be only placebos, the population overall benefits [in the context of our discussion, this suggests health benefits, but zebra's subsequent comments suggest this just means economic benefits].

So, are you now telling us that when you made the sweeping generalization above that you really only meant those standard medical interventions that had a low probability of actually doing anything helpful for the patient? Well, I don't think anyone would deny that if we reduce overuse of unnecessary and most likely ineffective treatments that carry a risk that the population overall would benefit, but that's not what you said, originally, so any miscommunication is your own fault.

If that is the case, then you still have several problems to be resolved. First: you must demonstrate that these treatments (we'll assume just the ineffective ones) have a "high harm" value. Please define "high harm" and how it differs from "low" and "moderate" harm. I would take it to mean that the risk of serious injury or death is high. Taking that definition, you'd need to show that, say, routine physicals have a high likelihood of leading to serious injury or death of the patient.

Second, you must demonstrate that replacing those interventions with TM/TCM/CAM/placebo/magic would have a net benefit (again, this should include health, and not only economics) as compared with just simply not having those standard medical interventions (again, assuming only those interventions with a low likelihood of benefiting the patient) and, say, trying to educate the patient. After all, paternalism and condescension is so last century.

So, zebra, let's see your calculations. Concrete numbers showing how many suffer actual harm from the standard (but ineffective) medical treatments, how many would not suffer direct harm from the CAM treatment used in place of the standard Tx, how many would suffer direct harm from the CAM Tx, and how many would suffer indirect harm from the CAM Tx (e.g., Bob).

zebra's first post read, in part,

Here’s the problem:

1. Western, reductionist medicine discovered vitamins and their effects.

2. Western statistical methods determined that taking vitamin supplements, except in rare cases, has no benefit and in some cases may be harmful.

3. Vitamins are still being sold and consumed in vast quantities.

And then there’s gluten-free water…

How do vitamins sit on the xyz coordinate system compared to "ginger tea"?

zebra
We do it with dogs in order to stop a supraventricular tachycardia. I've done it myself. It's pretty rewarding when it works.

Greg
How did I know you would have a very specific set of expertise to trump mine? I read the link and I only found one time where he mentions pressure points in the axilla with no specifics. I wouldn't be surprised if it was a tender spot that would be quite painful if traumatized. I still don't see any evidence that one could immobilize a dog or cause apnea by hitting that point.

I just noticed with some amusement that when I pointed out to Greg at #157 that Tylenol is not "the cause of most liver failures in the U S", as he claimed, but the commonest cause of acute liver failure, which is not the same thing at all, he responded (four times) with a citation that says (my emphasis), "Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported", which is exactly what I wrote. Someone has some reading comprehension problems.

Most medical interventions have greater potential for harm than placebos because by definition, placebos don’t have any physical effect.

So your argument now is "Because standard medical treatments actually do something and may therefore cause side effects, society will benefit if more people rely instead on placebo treatments which, because they don't do anything, won't cause side effects"?

Greg: you’ve claimed that pressure on the lymph nodes under the armpits can “trick someone’s body into not breathing”, and that this is so effective as a submission that lifeguards have in the past been trained to employ it to subdue panicking or otherwise uncooperative subjects.

What you haven’t done is provide any evidence supporting those claims, and I’ll note I’ve never seen or heard of anyone employing this technique in any circumstance. I previously mentioned competitive MMA bouts in specific, since if this were an effective submission it would have obvious application in that context, to which you've responded in essence "Of course they don't use it in MMA because, although it's really, really effective and life guards were trained to use it, it wouldn't work."

So, to simplify things (and avoid further exposition of how smart you are, your performance on standardized tests, whether fictional asylums might have counterpoints in the real world, etc.) let me ask a couple of direct questions.

Is there any evidence demonstrating that pressure applied to the lymph nodes under the armpits causes a human subject to stop breathing?

Is there any evidence demonstrating this was ever taught to/adopted by life guards as an effective method to safely subdue a “panicked drowning man” during rescue since “If not done a drowning man could easily take the life guard down with him”?

"
Krebiozen

January 14, 2015

I just noticed with some amusement that when I pointed out to Greg at #157 that Tylenol is not “the cause of most liver failures in the U S”, as he claimed, but the commonest cause of acute liver failure, which is not the same thing at all, he responded (four times) with a citation that says (my emphasis), “Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported”, which is exactly what I wrote. Someone has some reading comprehension problems."
You should have mentioned this earlier. I'f you did mention the difference and that we were now speaking of all causes rather than the effects of medications I missed it.

Are you saying that I should have specified a "small clinical trial" rather than simply "clinical trial".

"What Causes Liver Failure?

The most common causes of chronic liver failure (where the liver fails over months to years) include:

"• Hepatitis B
• Hepatitis C
•Long term alcohol consumption
• Cirrhosis
•Hemochromatosis (an inherited disorder that causes the body to absorb and store too much iron)
•Malnutrition"

"The causes of acute liver failure, when the liver fails rapidly, however, are often different. These include:
•Acetaminophen (Tylenol) overdose.
•Viruses including hepatitis A, B, and C (especially in children).
•Reactions to certain prescription and herbal medications.
•Ingestion of poisonous wild mushrooms."

Since alcohol is an intoxicant rather than a medication, and the disscussion was about medications, it did not cross my mind that we were speaking of all possible causes of liver failure.
The slow degradation of the liver due to alcohol abuse is not quite the same as the Hepatoxic effect of medications which we were speaking of.

If anyone found a single case study of a liver failure caused by ingestion of Willow Bark I must have missed that as well.
Perhaps I should insist on a "Clinical Trial".

A single case of a known historical figure suffering from liver failure after treatment with Willow Bark would be helpful, but not conclusive.

No one posted of any toxic effects of Melatonin either, or made any condemnation of off label prescription.

Now whoever was in charge of testing Windows Vista should go to work finding a fix thats permanent.

As for horse and buggy days, WW 2 Rocketry reached a pretty high level for its day using only slide rules.
I've cut a 49 Plymouth loose from saplings that grew up through the engine compartment and split forming a fist like growth on the rear bumper, cleaned the points, filled the fuel line as well as the tank and it fired right up on the first turn of the engine.
You don't need computers for automobiles they just make some run more efficiently.
We never needed a diagnostic station to figure out why a pre 1968 automobile wouldn't start. Though my MGA was a bit of a mystery at times.

At no point have I condemned all modern tecnology, I just find it funny that some seem to believe that its without fault.

Greg: Why aren't you posting by delivering a hand-written note by horse?

"
Gray Falcon

January 14, 2015

Greg: Why aren’t you posting by delivering a hand-written note by horse?"
I suspect users of some modern products that rely on computerized ignition systems would find themself wishing they had a horse handy when their SUV goes belly up thirty miles from the highway in Nevada.

The fact that some herbal medications have proven to work better for me than some modern medicines doesn't mean I'm a Luddite.
The fact that I don't buy into any claim that all software has been properly tested before being sold to the public is based on known failures of software of many types.

Is Stephen Hawkings a Luddite because he has reservations about artificial intelligence?
" "It would take off on its own, and re-design itself at an ever increasing rate," he said.
"Humans, who are limited by slow biological evolution, couldn't compete, and would be superseded."

Wrong answer, Greg. The correct answer is the following: Scientific methodology. The same methodology that produced the modern medicine you disparage so heartily.

Then why does stuff like this happen?
"Back then, we thought that they were just being pedantic. But it's the kind of error that can burn up a $327.6 million project in minutes. It did in 1998, when the Mars Climate Orbiter built by NASA's Jet Propulsion Laboratory approached the Red Planet at the wrong angle. At this point, it could easily have been renamed the Mars Climate Bright Light in the Upper Atmosphere, and shortly afterward been renamed the Mars Climate Debris Drifting Through the Sky.

There were several problems with this spacecraft -- its uneven payload made it torque during flight, and its project managers neglected some important details during several stages of the mission. But the biggest problem was that different parts of the engineering team were using different units of measurement. One group working on the thrusters measured in English units of pounds-force seconds; the others used metric Newton-seconds. And whoever checked the numbers didn't use the red pen like a pedantic high-school teacher.

The result: The thrusters were 4.45 times more powerful than they should have been. If this goof had been spotted earlier, it could have been compensated for, but it wasn't, and the result of that inattention is now lost in space, possibly in pieces."

http://www.computerworld.com/article/2515483/enterprise-applications/ep…

You can call this human error but it was humans that wrote the software.
Over confidience in your product is not a virtue.

Greg- So, why haven't you written your own operating system?

This the methodology you were speaking of?
" In a world-first, CSL’s Fluvax mixed H1N1 swine flu with two strains of seasonal flu. Unlike Panvax, this new trivalent version of Fluvax had not been clinically tested in children before the TGA gave doctors the green light for mass vaccinations of healthy babies, toddlers and pre-schoolers.

What followed has shaken public confidence in one of the world’s most popular immunisation programs. In April last year, four days after baby Saba had her flu shot, Australia’s Chief Medical Officer, Professor Jim Bishop, made the unprecedented decision to ban nationally all the seasonal flu vaccines for the under-5s. Fluvax, the predominant vaccine, was triggering febrile fits in one in every 100 children – 10 times the expected rate. The side-effects, in some cases, were severe, and no-one could explain what had caused them. As the mystery continues, even eminent scientists and medical specialists are now quibbling over the efficacy of flu vaccines, how they are tested and how well they are monitored. With another flu season upon us and the medical community divided, what are we, the public, to make of it all?"

Waiting till children start dying is not very scientific, or is it?

Greg- So, why haven’t you written your own operating system? Clearly, it should be no difficultly for your superior mind.

""
Gray Falcon

January 14, 2015

Greg- So, why haven’t you written your own operating system? Clearly, it should be no difficultly for your superior mind."

Why don't you start testing Flu vaccines before they are realeased to the public. With your mad skills in product testing you should be able to make the transition easily enough.
Maybe you could build an AI to do the job for you.

Greg- What of worth have you produced, then?

I’ve cut a 49 Plymouth loose from saplings that grew up through the engine compartment and split forming a fist like growth on the rear bumper, cleaned the points, filled the fuel line as well as the tank and it fired right up on the first turn of the engine.

Yeah, they don't make batteries like they used to. And gaskets. And oil.

The points are going to be the least of your problems on some jalopy you found with trees growing through it.

You earlier silly remark about hand written messages reminded me of something.
A doctor examined my arm and was considering surgery. I mentioned the physical in 1968.
He applied for records of my physical. He was told records from that time frame could not be accessed. The hard copy existed but was in a storage facility in Virginia. They could not access them because the computer files had been wiped so they had no idea how to find them.
Later I learned that will transfering hard copy paper and micro film to digital storage some one , perhaps like your self in many ways , managed to wipe out a huge quantity of data.
Many older paper copies had already been disposed of.
The remaining paper copies could not be found because the crash wiped out the information on how to find them.

This became an issue during George W Bush's administration.
A mentally ill old man made accusations about Bush's military service. They had to search for months to find the documents to counter that claim.

Now the National Archive has all remaining information on those of us who were registered for Selective Service and were born before 1960.
Selective Service can no longer access that information.

Greg- You're so convinced of your brilliance, but have you created anything of worth?

Waiting till children start dying is not very scientific, or is it?

Yet again you demonstrate that you can't so much as quote from a newspaper story without inventing something to add to it.

In any event, if you weren't an ignoramus, you might have managed some primitive homework.*

Anyone with a grain of sense would realize that you can't run a clinical trial every time seasonal influenza vaccines are reformulated. The pediatric CSL split-virion TIV had been tested (PMIDs 19903213 and 23551933, NCT00959049).

* Rockman et al. is paywalled at Elsevier even though it's open-access (PDF). They've received a nastygram.

GY,
I hadn't noticed your comment about acetaminophen until I was reviewing this thread this morning.

Since alcohol is an intoxicant rather than a medication, and the disscussion was about medications, it did not cross my mind that we were speaking of all possible causes of liver failure.

You claimed at #132 that "Acetaminophen has been described as the cause of most liver failures in the U S". It may have been described as such but it isn't true. Most liver failures in the US are caused by alcohol. You made a mistake, there's no shame in that, why not just admit it? If it is true that, "it did not cross my mind that we were speaking of all possible causes of liver failure", why did you claim that acetaminophen was the greatest cause?

The distinction between acute liver failure and liver failure in general is important. There are about 2,000 cases of acute liver failure each year in the US, with about 42% (not even the majority of that) being caused by acetaminophen, that's about 840 patients every year. Chronic liver disease kills tens of thousands of people every year in the US (10.8 per 100,000 in a population of 350 million(PDF) is about 37,000).

You also claimed that, "in recommended doses it produces elevated rates of the waste products associated with liver failure". It doesn't, in common with several other drugs it does lead to elevated liver enzymes which return to normal when the drug is stopped. Liver enzymes are not "waste products associated with liver failure", and normal use of acetaminophen is not associated with elevated bilirubin which is a waste product associated with liver failure.

It may seem like I'm being pedantic but I don't think I am. You are clearly trying to exaggerate the adverse effects of acetaminophen, which isn't very helpful.

I'm surprised that you still seem to think that a lack of any evidence that willow bark is dangerous is evidence that it isn't. If you show me a study of several thousand people that found no adverse effects I will believe it is harmless. The lack of any historical evidence that it is dangerous is unconvincing, given the existence of Aristolochia and other herbal remedies with very serious adverse effects that were not noticed until very recently.

Tangentially, I'm always amused that those who hold up Vioxx as an example of the ill effects of pharmaceutical drugs (I'm not suggesting you have done so) ignore the fact that it required studies of thousands of people given high doses of the drug for more than 18 months to pick up its adverse cardiovascular effects. The truth is that we have no idea if the vast majority of herbal remedies and supplements have similar adverse effects simply because no one has ever done large enough studies to find out.

When such studies are done, some interesting results emerge. For example, one study of calcium supplements found that it increased the risk of heart attacks far more than Vioxx does, yet few people seem too concerned about that, for some reason.

According to the package insert, Afluria (Fluvax) was clinically tested in a multi-center, open-label Phase III in children 6 months to 8 years of age in Australia, in 2009, resulting in a warning added to the Afluria package insert stating the administration of CSL's 2010 Southern Hemisphere seasonal influenza vaccine had been associated with an increased number of reports relative to previous years of fever and febrile seizures following influenza vaccination in children predominantly below the age of 5 years of age on July 30, 2010.

So by your own standards you “lied” when you said Lions View was a fictional institution.

What the fυck is this supposed to mean?

In any event, great, the locals referred to Eastern State Hospital as "Lyons View." This does nothing to salvage the original idea of reference:*

At Eastern State Hospital they often had to send in what they called the tanks. From what I’m told they wore heavy padded armor and are generally the size of front linemen.At least some of the patients there were violently criminally insane.
I think they closed down Lionsview long ago. I believe this was the hospital depicted in “The Snakepit” [Suddenly, Last Summer]. Its not far from here.

* The phrase is used in the technical sense.

"
Gray Falcon

January 14, 2015

Greg- You’re so convinced of your brilliance, but have you created anything of worth?"

Have you?
Are any of your programs of actual worth?
Did you actually create them with no previous work done by others to get you started?

Did you invent any of the theraphies or drugs that you defend with such vigor?
How many patents do you hold?

"You claimed at #132 that “Acetaminophen has been described as the cause of most liver failures in the U S”. It may have been described as such but it isn’t true. Most liver failures in the US are caused by alcohol. You made a mistake, there’s no shame in that, why not just admit it? "
I just did. I made an error in not writing "Accute Liver Failure"
And the reason I didn't qualify was because we were disscussing Hepatoxicity of drugs, not the effects of chronic alcohol abuse.
I could have said all liver failures caused by medications and that would have been correct as well without adding "Accute " wouldn't it.

I think I made it clear from the begining that my communication skills are poor, and I've given reason's why this is so.
A few others here also have some problems with communication.

Take this for example.

When I posted
" I believe this was the hospital depicted in “The Snakepit” [Suddenly, Last Summer]. Its not far from here."
Depicted
de·pict
(dĭ-pĭkt′)
tr.v. de·pict·ed, de·pict·ing, de·picts
1. To represent in a picture or sculpture: Each page's border has designs that depict forest animals.

2. To represent in words; describe: stories that depict life on the frontier.

The movies mentioned "depicted" mental hospitals.
Lyons View ( Eastern State) is the hospital depicted in "Suddenly Last Summer".
The name Lyons Vue is what you often find on postcards with pictures of Eastern State Hospital.
As the site I quoted states it doesn't matter what spelling they used they were depicting the well known at the time horrors of the Eastern State Hospital at Lyons Vue.
The story "Suddenly Last Summer" was a fictional story but the depiction was of an existing hospital of the day that was still there many years later. The hospital at Lyons View today is Lake Shore Hospital.
The girl friend I mentioned was an example of how girls could be mislabeled as Nymphomaniacs and committed without just cause and subjected to attempts to force them to conform to some norm that others thought was how young girls should behave.
The age of consent in Tennessee is 18, In some states its 14, 15, or 16. A 16 year old girl losing her virginity would not have raised an eyebrow in most places.
I did not know this young lady till she was in her twenties. She was still very messed up by the treatment she had received at Lyons Vue as a teenager.
Having seen both "Suddenly Last Summer" and "the Snake Pit" the resemblence to the known horrors of the Eastern State Hospital at Lyons View is very obvious in both films.
Tennessee Williams used the name Lion's View in his depiction, the alternate spelling most commonly used locally.
How much time he spent in Knoxville I don't know, but he had family here and included Knoxville Landmarks in his writings.

Now if this little side trip has anything to do with the main topic here its that whats accepted as fact by the medical professionals is sometimes horrifyingly wrong.
Also that the culture of the day can skew the purposes of the supposedly all knowing medical profession into what we now consider barbaric misuses of the patient.

zebra:
Life is not fair, and neither is the Internet. RI is, on one hand, an open forum, and you get to post pretty much anything you want, phrased any way you want. On the other hand, RI is the living room of the long-time Minions, and if you want to have a genuine discussion here, certain house rules apply.

I'm not sure how much you want to have an actual debate, vs. how much you may just want to play the Dozens with the Minions. It seems to me you have something to say, but I think it's getting lost in the tit-for-tat-ism of this thread, to the point where it's about as useful to me as the whack-a-troll with Greg Young, which is to say a negative value on the utility scale.

So, a couple humble suggestions:
You repeatedly refer to Mephistopheles O'Brien as 'Obrien.' I'd guess that's a typing shorthand, but you might consider that misspelling a correspondent's name could add an unproductive note of hostiity to an exchange. And not that I'd expect you to know, but no one here refers to Mephistopheles O'Brien as 'O'Brien'. It's 'Meph' if you're feeling mutually collegial, or 'MOB' for more objective reference. I'd go with 'MOB' if I were you.

As the exchanges with Greg Young shows, the Minions like to play the Dozens. (I wouldn't encourage that.) Your posts here are atypical of the forum. The vast majority of comments here are either in general agreement with Orac's positions, or come from trolls wandering in from looney-woo-land. Over the many years this blog has been up, the regulars have developed a pattern-recognition / confirmation bias thing — a new commenter is likely to be interpreted as on-the-bus, or off-the-bus. In short, the Minions are inclined to see you as a troll.

Yeah, it's not fair. But you can see how testy the gang is. FWIW, I don't take them as arrogant, just short-sighted. I think they care really deeply about this stuff. Is Kreblozen paranoid about TCM in med schools in clinics? Yes, he is. Is that abnormal, more weird than anything I might be a little paranoid about in matters beyond this blog? I doubt it. Compared to a lot of other things happening in the world — endless wars, epidemic police shootings, global poverty — the travails of sbm vs. woo can seem trivial. But pull back to the big picture, and there are more than enough dead bodies and broken lives for people to be concerned, scared, piseed-off — especially when they feel it's their turf that has been wrongly usurped by invading hordes, their hard-earned knowledge and skill rendered moot by fools.

During my limited travels in skeptic-virual-ville, I've often felt consternation that "Skeptics" fail to apply their own standards to their own comments. They typically present their thoughts within the standard discursive markers of 'reason' and 'rationality', yet certain logical fallacies appear over and over*: straw-man re-framings of opposing points, assertions without evidence, goal-post shifting, ad hoc and cum hoc, appeal to consequences, false dichotomy, spotlight, cherry-picking, argumentum ad definitium, confusion of explanation and excuse....And I'm going to cite the Big 3 as 1) selective attention / logic chopping. 2) 'package deal' and 3) slippery slope (a phrase that gets used so often on the SBM blog, it seems the folks don't know it's a textbook fallacy).

That said, I can't think of instances where I'd say any of these have been deployed as conscious hypocrisy. I'm guessing it's just your basic confirmation bias yada yada yada.

Regardless, you can shout 'Ha! I caught you in a fallacy!' all day long without getting anywhere. Either the readers don't get past the 'Ha!' or they just don't recognize the fallacy (???). And, 'Ha! I caught you in a fallacy, stupid!' gets predictably worse results.

So the bottom line is, if you want to get into a debate about actual stuff here, you have to field the fallacies without getting snooty, take a bit of snark and snap without returning it — 'walk the high road'. (BTW, I make no claim to possess the discipline to follow my own advice. Doh!)

Of course, one could argue commenters should be able to speak as frankly as they desire, but that would seem to be at least potentially inconsistent with the ethic allowing a physician to tell less than the whole truth in order to achieve a positive health outcome. (Not to deflect this thread any further into abstract moral Philosophy, but the position 'Good ends can never justify questionable means' just strikes me as bat-guano insane...)

This is just my 2¢. I'm not trying to be a tone-cop. Just one person's thoughts, tossed out only FWIW. I do thank, you zebra, for the compliments on some of my remarks, but that just adds to the feeling I'd be remiss if I didn't note I find the attitude coming off in some of your comments kinda annoying...

Anyway, to pick one of the above listed 'fallacies' for a quick comment on this thread: 'selective attention / logic chopping' is when the core of an argument gets ignored to pick at some supporting component. A sort of 'red herring' but not brought from the outside, instead amplified from an alleged 'bad apple' already in the barrel. IMHO, though this is listed as a 'fallacy' it would only seem to be so where a topic of argument is agreed. On a web board, we have a certain freedom to change the subject, and react to whatever we make take issue with. An it also strikes me as a tango that takes two. Commenter 'A' makes argument 'Q' containing statement 'X' that is relatively trivial to 'Q'. Then commenter 'B' makes strenuous objection to 'X' in part by offering statement 'Y'. Then 'A' gets into defending 'X' by objecting to 'Y'. And 'Q's just left alone going 'Hey! What about me!' but the thread is waay to far downstream to hear. If I'm any less guilty of this than anyone else here, it's not by enough to act superior or brag. But I do think this thread has wandered far from the 'meat' of the topic. (About which I aim to say more, later — I'm sure y'all can hardly wait...)
___________
* BTW, I just looked up a number of those terms at:
http://www.logicallyfallacious.com/index.php/logical-fallacies

"As the exchanges with Greg Young shows, the Minions like to play the Dozens. (I wouldn’t encourage that.) Your posts here are atypical of the forum. The vast majority of comments here are either in general agreement with Orac’s positions, or come from trolls wandering in from looney-woo-land. Over the many years this blog has been up, the regulars have developed a pattern-recognition / confirmation bias thing — a new commenter is likely to be interpreted as on-the-bus, or off-the-bus. In short, the Minions are inclined to see you as a troll. "

I understand that I'm very much out of step. My education was entirely from books when a pocket calculator was unheard of and there were no computers in schools.
I did have an advantage in that our old public library held books that today would be fetching a fortune at auction.
Books like that are now hard to find or get access to except through the internet archive.
I still can't believe some of what I've seen posted here was at all serious.
I did find a text on Anesthesia that confirms some of what I remember about pressure points.

I'll leave this topic as it is with a couple of observations.
One is that the world can survive without IT professionals, but it can't survive without garbage men.
Number two is that just because a person hasn't heard of something and can't find it on the net after a two minute google search does not mean it didn't exist.

Greg- My job consists mostly of fixing the mistakes of people in the past, in particular the ones who are too enamored of the old ways to see their flaws.

And here are two thoughts for you:
1. Don't disparage IT professionals. The Internet isn't powered by the Pony Express.
2.. If there is no evidence whatsoever that something existed, then we have no reason to believe it exists.

Without having gazed at the comments after my last, with a moment between tasks, I note that Mr. Young's commanding presence did lead me to this some days ago.

“There!” said Mr. Greatheart, pointing to a vast cavern, out of which came tracks of a railroad, which ran along the sides of a bank for two hundred yards, and a broad carriage-road, two hundred feet wide, cut out of the solid rock fifty feet high and three hundred feet wide,—“look at that work, sir! That is the grandest achievement of men and devils combined! There you see the termini of the underground railroad, and of all the stage-lines, and private coaches, and expresses, by whomsoever fitted out.” And, while Mr. Greatheart was speaking, a carriage, drawn by two black blood horses, came out in full career. It was an express from Sterling City, driven by Alandresso, who brought out Deacon Gideon Graball. The old deacon had several large bladders tied under his armpits, and the fellow helped him out of the coach. Blind with terror, and gazing wildly around, the deacon saw nothing. His vulgar pride was gone now, and his cheeks were pale at last. Alandresso, as he busied himself adjusting the bladders, gave one glance of recognition to Frank; and, putting his hand upon the deacon’s shoulders, he hurried him into the river. Impelled by his nervous arms, the old gentleman went on tremblingly; but, so soon as the water reached to his armpits, the bladders lifted him off his feet, and swept him away. Frank would have rushed in, at the hazard of his life, to save him; but Mr. Greatheart held him back, saying, “Too late!”

Can someone who is not Greg tell me why a computer based on trinary logic (if there is such a thing) would give four options? Seems a little odd.

Greg: As I pointed out, I and a lot of others would prefer sources that aren't your orifices. And because you probably haven't left your house in years, I should probably inform you that public libraries still have books. Heck, some places still have microfilm. (I spent my senior year of college digging through that stuff- it'll probably catch up with me when I hit fifty.)

JGC re-framed zebra's argument as "if telling your patients the truth won’t get them to do what you want, [you] should tell them something other than the truth, so long as there’s a chance they’ll believe it and then do what you want."

This mis-states the argument by generalizing the case and removing the expertise of the physician, both in determining the proper course of care and in determining the individual patient's state of mind. Setting up such blatant straw-men may draw cheers from partisans, but it's unlikely to be persuasive to anyone else.

To score valid points, you would need to address a proposition more along these lines: "if telling a patient the truth won’t get that individual to undergo proper treatment, [you] should tell them something other than the truth, so long as you believe there's a good chance the specific thing you tell that person will lead to adoption of an appropriate standard of care.'

One example would be: A patient is suffering chronic pain to the point of neglecting diet and exercise, resulting in a reduced physical health beyond the pain itself. You have prescribed such painkiller meds as appropriate, but the patient's complaints remain, his general condition continuing to deteriorate. During an office visit he asks, with hope in his voice, "Hey, doc, what about acupuncture? My cousin Jenny in Jersey had real bad pain after surgery, but says she got acupunture and she felt way better and could do stuff!" The doc says, "Well, we have had a number of patients here report significant pain relief from acupuncture. I have to be honest though, and say that some acupuncturists claim it can cure a variety of physical disease that medical science has proven it can't. Was cousin Jenny being acupunctured for anything besides pain?" Patient says, "Not that she mentioned. She can be a little new-agey sometimes — I mean she's not nuts or anything, but that's why I asked you." The doc says, "OK, we have a acupuncture therapist here at the clinic, and I hear she's very good with patients, and doesn't try to tell people it cures cancer or anything. Like I said, some patients report significant pain relief, some don't. But then a lot of patients feel better from the pills you've already tried, and you didn't. So if you want to give it a shot, that makes some sense to me. But you have to promise me one thing." Guy says, "Sure, doc. What's that?" Doc says, "You keep me in the loop at all times. We'll have you make an appointment for a month from now to see how you're doing, and if anything unusual changes in your symptoms, you call me, OK?" Guy says, "Sure." He's smiling, hoping that maybe something will finallly help. Doc says, "Some folks do the acupuncture without the pills, some do it with the pills and say it works better that way. Another individual thing it seems. Were you having problems with side effects of the meds?" Guy says, "Not really. So as I noticed anyway. They just didn't seem to do much of anything." Doc says, "Tell you what, let me renew your scrip. That way you can experiment a bit, see if it makes any difference. Hows that sound?" Guy says, "Sounds good. More chances, right?" Doc says, "More chances. Now remember, these are the strongest meds I can give you without putting your system at risk. Even if they don't seem to be working, you can't exceed the dose on the label, and you can't toss in any other drugs on top of them, including booze and over-the-counter stuff." Guy says, "So that's why some patients go without the pills them?" Doc smiles, "You did not hear that from me." Guy says, "What about a little MJ, say a reefer a day?" Doc says, "What?" Guy says, a bit louder, "What about a little reefer, no more than a joint a day?" Doc cups a hand around his ear, "I'm sorry. For some reason I Can't Hear What You're Saying..." Guy says "Got it. So next month then?" Doc nods, starts writing the appointment slip, asks without looking up, "Another cousin?" Guy says, "My neighbor Mr. Stanley. 72. Retired Marine. A little shell-shocked maybe, but he can still drop and do 20." Doc shakes head, hands slip, "Give them that at the desk, and they can give you directions to the acupunture therapy office." Guy says, "Thanks Doc!" and leaves the office whistling.

So there's no underlying condition like asthma that going to not-be-addressed, because the physician has checked. If Guy experiences placebo effect fall-off, he reports it to the doc. If the acupuncture therapist starts trying to diagnose and prescribe, she gets fired from the clinic.

Remember this is a hypothetical meant to address the general ethical proposition of whether a real doctor MIGHT have cause to allow a patient to pursue some form of CAM. 'That's not what happens!' is irrelevant.

Now, I specifically constructed my hypothetical so the Doctor did not have to lie, merely not disclose 'the whole truth' (as if actual doctors ever do that about sbm, seriously!) But zebra had said "I certainly wouldn’t want you for a doctor if you wouldn’t tell a lie to save my life." So let's get to not-so-hypothetical case of actual lying. I shall pass on ginger tea and viral infections, and go for bigger game: a claim that a natural food diet regime can aid the treatment of cancer.

Not 'cure', 'Aid', However, for purposes of argument I shall assume we agree that any dietary regime has no effect whatsoever on the propagation or reduction of cancer cells in the human body.

My not-quite-hypothetical is Jess Ainscough. Ainscough, of course, is the "Wellness Warrior" who has advocated the Gerson Therapy for cancer treatment, followed the Gerson plan to treat her own cancer, and is now clearly moving toward death. She has "a big fungating tumour" in her left shoulder that has been bleeding "non-stop" from her armpit for "over 10 months" leaving her too weak to work, to make her own meals, or even do her own hair.

Ainscough's mother died from cancer while pursuing Gerson's without seeking conventional treatment. Nutrition-Curses-Cancer advocate/saleswoman Polly Noble died of cancer last may. Nutrition-Curses-Cancer advocate/saleswoman Belle Gibson's cancer has metastasized, and she has been given a terminal diagnosis. Pip Cornall of The Grace Gawler Institute for Integrated Cancer Solutions, Queensland, estimates "cancer ‘cure’ pied pipers, luring desperate patients to leap off the alt/med cliffs may be causing 4-8000 cancer deaths per year in Australia alone."

On 12/12/14 Ainscough announced on her blog that she had begun exploring conventional treatment options (as well as "natural medicine") and is working with a “non-judgmental” oncologist. She has not announced what new treatment plans, if any, she is pursuing or intends to pursue.

It seems most observers, including Orac, feel Ainscough is too attached to her woo to give it up entirely, but may we willing to go the "integrative oncology" route and begin chemotherapy, or possibly even consider amputation, as long as she can continue Gerson's and/or add other alt/med treatments.

So, say you're Ainscough's "non-judgmental' oncologist. Do you tell her:

1. You've been killing yourself with Gerson's. I want you to begin chemo now, and go on the hospital approved diet to keep up your strength. No more "natural" cures. They do not work. It would be unethical for me to let you continue with your diet, or adopt any other alt-med treatment.

2. I want you to begin chemo now. It's really the only chance you have. There's no medical science supporting any other treatment modality, so I can't actually endorse any of them ethically. However, if they make you feel for comfortable, I understand, and I won't object. You have to stop the coffee enemas, though. They'll mess up yor digestive tract with the chemo. We'll have to monitor your hydration, nutrition absorption, electrolytes and so on, so we'll probably have to modify some of you diet regimen a bit, more of this juice, less of that, supplement the supplements, but we'll keep it all plant based and organic as possible.

3. Obviously the Gerson's hasn't been working well enough by itself. That's too bad, but it happens. And when it does, well, it's very bad.... I... don't need to tell you that, I'm sure. I'm so sorry about your friends. There's a lot we don't know about cancer. We can't say for sure why some people get remissions and stay healthy, but others get better for a while and then everything comes back even worse. But we do know for sure that once it gets to this point, there isn't any kind of diet or natural treatment that can hold it back, much less make it go away. We have to add chemotherapy at least to push your body's healing power over the top. We have a few other things we try at the same time, but the chemo is absolutely essential. And frankly, as long as that tumor's been bleeding even the combined treatments with the chemo may not be enough, and we may have to operate. I know that sounds awful — it is awful but there's a light at the end of the tunnel. We have a support group for post-operative patients, and want you to meet some of those folks. You won't find a more positive, energetic, lively group anywhere, and they'll be the first to tell you there's nothing they can't do. Either way, some things are going to get worse before they get better. The chemo's no joy ride, so you're still going to feel sick for awhile. Maybe really sick. But that ends. And then you'll start to get well. And I know you'll be ahead of the curve because you know how to listen to your body, know the value of good nutrition. We'll do everything we can that might help your healing journey. For now, I'm going to suggest a few small diet changes, as there are some aspects of Gerson's that don't work alongside the chemo very well. You might sacrifice a small benefit here, but you'll gain a larger benefit there. We have an amazing natural food dietitian who specializes in this exact area: adjusting organic diets to maximize their healing effect in concert with chemotherapy. Get the whole choir singing in the same key. She does incredible recovery diet plans too, once you get to that stage. So can we get you started?

So #1 is unvarnished scientific medical Truth. #2 is a hedge. #3 is full of flat out lies. The questions are:
a) Which approach has the best chance of saving Jess Ainscough's life (or the lives of the thousands of other patients likely to die at the hands of pure 'non-integrative quacks)?
b) If Ainscough (or a similar patient) refuses conventional treatment after seeing you, and dies from her cancer in the near future, what's your moral defense of having told her anything but #3, that you would make not here on RI, but standing next to her grave among her family and friends?

Not that I can't think of other scenarios where a doctor's lie would save someone's life. Would save my life. It wouldn't be an alt-med lie for me, as I don't buy that stuff. But I am 100% with zebra on this: if you would not tell me a lie to save my life, I do not want you to be my doctor. Hell, if you would not tell me a lie to save my life, I do not want you practicing medicine at all.

Update regarding this:

* Rockman et al. is paywalled at Elsevier even though it’s open-access (PDF). They’ve received a nastygram.

It wasn't actually nasty at all, but as detailed as a report of a paper that somebody (prima facie) paid to make open-access being paywalled all the same required.

The reply (explaining how I could use a credit card to obtain the paper that I already have) strongly suggests that Elsevier's fundamental attitude is in fact that of other such not-public-utilities as AT&T and Comcast broadband.*

So, could somebody with institutional access confirm that http://dx.doi.org/10.1016/j.vaccine.2014.03.032 (in the printing of which they openly scorn Crossref's Very Technical Rules of Etiquette) still bears on its first page the following slug?

© 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license....

* Never to be confused with the true villain, as James Coburn the new "Publisher" of Science and an affiliated "Chef" gravely whine.

Anderson must be off the hook on this one, but I've circled back to #17.

The foot of the first page reads:

http://dx.doi.org/10.1016/j.vaccine.2014.03.032
0264-410X/ © 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/)

Well, screw that, it's not called Gold OA for nothing.

sadmar,

Is Kreblozen paranoid about TCM in med schools in clinics? Yes, he is.

I have offered evidence that TCM and other CAM is being taught in medical schools, that it is mostly being taught by CAM practitioners, and that only a small minority of courses emphasize "a scientific approach to the evaluation of CAM effectiveness". Yet my concern about this is delusional?

To score valid points, you would need to address a proposition more along these lines: “if telling a patient the truth won’t get that individual to undergo proper treatment, [you] should tell them something other than the truth, so long as you believe there’s a good chance the specific thing you tell that person will lead to adoption of an appropriate standard of care.’

That isn’t the proposition zebra’s offered however, is it?

Instead he’s argued “If telling a patient the truth (antibiotics aren’t effective in cases of viral infection) won’t get that individual to forego that improper treatment, we should tell them something other than the truth so long as there’s a good chance the falsehood we tell them will lead to them adopting a different improper treatment (ginger tea).”

“if telling a patient the truth won’t get that individual to undergo proper treatment, [you] should tell them something other than the truth, so long as you believe there’s a good chance the specific thing you tell that person will lead to adoption of an appropriate standard of care.’

If that were the proposition, my question back would be: in what context do we find this behavior acceptable? If, say, a politician, car salesman, or teacher were to use this tactic, would we praise or revile said person for that (once the truth was known)?

The only context I can think of offhand where that's acceptable is parents talking to their children where stories are used to get desired behavior. A parent might say, for example, "Santa Claus can't come until you go to sleep" to encourage a small child to go to bed at a reasonable hour on Christmas Eve. In reality, of course, the two events are independent but it serves both the parent and the child well to get a good night's sleep before Christmas day.

However, if a politician were to tell other than the truth to get a policy implemented, we would expect that not to be looked at fondly as a childhood tale.

Doctors dealing with adults are not the same thing as parents dealing with children.

If that were the proposition, my question back would be: in what context do we find this behavior acceptable?

Somehow i doubt that zebra would argue it would be ethical for an oncologist to lie to his patient. minimizing the risks and inflating the efficacy of chemo and radiation therapy. i f doing so would likely cause a patient to agree to undergo treatment.

But who knows? Maybe he would.

zebra did say he'd want his doctor to lie in order to save his life, so ...

But would he hold the doctor unaccountable if he suffered an adverse consequence that his doctor had told him wasn't a risk associated with the treatment--for example if after his doctor assured him statins would reduce his high cholesterol levels and were completely risk free but he went on to develop necrotizing myopathy?

Somehow I don't think his response would be "Since you lied to me to get me to undergo standard of care it's all good" rather than "You'll be hearing from my attorney".

Kreb:
"I have offered evidence [snip] Yet my concern about [TCM in med schools and clinics] is delusional?"
No. I specifically said it was understandable under the circumstances — employing 'paranoid' in the colloquial sense rather than a clinical one —and I specifically said I considered it no more 'weird' than any number of opinions i may hold — of which I did not provide examples as they would be OT and for, uhh, space considerations.

Your 'evidence' does not provide adequate support for your assertions by a long shot, but that is hardly a sign of 'delusion' — unless we expand the definition of 'delusion' to include confirmation bias, in which case we're all delusional and the word becomes useless. And beyond that, it's an issue for a different post.
_____
MOB asked In what context we might find telling someone something other than the Truth acceptable if it leads to positive outcomes for the recipient? If a politician, car salesman, or teacher were to use this tactic, would that be ethical?
Fair question.
Too easy.
The POTUS announces troops will be withdrawn from the MidEast as their mission has been successful and stability has been achieved.
The used car salesman steers a customer away from a known lemon the manager has placed on the lot, putting the customer into a good car by framing some other problem with the lemon in a way that doesn't undermine his credibility by revealing the lot sells junkers. (When I worked in sales, I routinely did things like this.)
The teacher hangs up the phone and tells the 2nd grade class to run to the coat closet and hide as part of a school game to see which classroom can make itself look the most empty, and once they're inside gunshots ring out in the hall.

"Doctors dealing with adults are not the same thing as parents dealing with children."
You could have fooled me. While two of the above examples are flat lies, I posed the question as not-the-whole-Truth. I illustrated this with the short story of Guy's inquiry about acupuncture, in which his doctor does not make a single false statement. The used cat salesman also does not need to lie, merely emphasize other valid negatives of the lemon, and other valid benefits of the good car.

As I observed, doctors frequently decline to tell the whole truth about illnesses and even some procedures, sometimes for good cause to the patient, sometimes not-good-cause to the patient but necessary for the practice to avoid exposure to litigation, or meet requirements of insurance mandates.

A patient with a GSW to the stomach is wheeled into the ER. He is panicked, and asks "Doc! How bad is it?" The doctor replies, "Relax. You're going to be fine. I'm going to give you something for the pain, and make you sleepy, so we can get you fixed up OK?"
On the other hand, I have yet to hear an MD say, "I'm giving you a prescription for widgetelene, which is actually a piss poor substitute for nuvomaxalene — which would probably really fix you up, but it's not in the formulary, and costs a shit ton of money I know you don't have. Tough tuchus; here's the scrip, pay the desk on the way out."
And do I really have to mention how often doctors say "I/we don't know." which is literally true as they don't KNOW, in order to conceal negative probabilistic assessments from patients?

"If, say, a politician, car salesman, or teacher were to use this tactic, would we praise or revile said person for that?"
What "we"? Praise or revile on what basis? Vox Populi, Vox Moralitas?

Would it be ethical for an oncologist to lie to his patient. minimizing the risks and inflating the efficacy of chemo and radiation therapy. if doing so would likely cause a patient to agree to undergo treatment?

This is why I am not an ethicist. It might be 'unethical' for an oncologist to do that. If the patient will likely die as a consequence of refusing treatment, I would argue it would be immoral for the oncologist NOT to do that. (I do not speak for zebra, of course)

But would he hold the doctor unaccountable if he suffered an adverse consequence that his doctor had told him wasn’t a risk associated with the treatment? Somehow I don’t think his response would be “Since you lied to me to get me to undergo standard of care it’s all good” rather than “You’ll be hearing from my attorney”.

False dilemma, and straw-man. The question addressed "minimizing risks" which you have inflated into "told wasn't a risk" — the introduction of an affirmatively false statement, and thus a clear ethical violation. Presumably, a doctor might hear from an attorney if a complication resulted from a risk the physician simply neglected to mention, however I doubt a plantif would be likely to meet the legal burden of proof in court. Moreover, in any actual adjudication, the patient's prognosis without treatment would be extremely relevant, as would the specifics of any mischaracterizations of risk or efficacy involved, e.g. how any mischaracterization addressed the patient's reluctance to undergo chemo and radiation. Since I have no idea what necrotizing myopathy is even after Googling it, i doubt worries about it would keep me out of chemo, nor do I know or care anything about statins. So if I developed necrotizing myopathy from statins, perhaps I would contact an attorney. But that would be malpractice, as the physician's non-disclosure would have had nothing to do with insuring I received proper standard of care.

And by introducing lawyers and litigation into the discussion I thank you for taking ethics off the table, and putting the money on, validating my argument earlier in this comment.

As I had noted in #603 how often replies in these threads amount to ‘selective attention / logic chopping’ in which "the core of an argument gets ignored to pick at some supporting component," I thank you for the confirming evidence there as well.

Your inattention to the questions about Ainscough speak much louder then the rhetorical clay pigeons in #613-#617. I hope you're not trying that hard. I do basically like you guys when all is said and done, because I think you care about people and don't want them to get hurt by quacks. If you're going too be effective in that, you're gonna have to do better. I'm just being a sparring partner here. When you get into the ring, the other guy is going to be really trying to hurt you — well, not YOU, but your ability to help the people that need your help. Try to pick up your game, OK?

@Narad:

Not actually an Einstein quote, for future reference.

"Quotes are often misattributed on the Internet." -- Abraham Lincoln

@herr doktor bimler:
‘Neutrosophy’ may be hilarious, but it reminds me of paraconsistent logic, which is actually an interesting thing.

@Denice Walter

I am always surprised just how many people have admitted having perfect scores on this test or that and IQs in the highest 1%- either they pad results or I’ve been exceedingly fortunate to have met so many.

It would be one in every hundred people you meet if you were sampling randomly. That's a lot o people. OTOH, it's going to be even higher than that if you tend to hang out in places that intelligent people like to be.

@zebra

As I’ve said, I have given this topic little thought prior to encountering it here, so I had no idea about what goes on with naturopaths. But it appears to be a problem with local regulation, allowing them to practice beyond their training.

It's not so much allowing them to practice beyond their training as it is that their training is actually harmful.

The question addressed “minimizing risks” which you have inflated into “told wasn’t a risk” — the introduction of an affirmatively false statement, and thus a clear ethical violation.

Uhh...no, that isn't the question being addressed--at least as you defined it yourself in he post I was responding to. You instead identified the question being discussed as whether ""If telling a patient the truth won’t get that individual to undergo proper treatment, [you] should tell them something other than the truth, so long as you believe there’s a good chance the specific thing you tell that person will lead to adoption of an appropriate standard of care" was ethically valid.

Remember?

JGC:

What I don't need to remember, as it's on the page above, is comment #617 by one 'JGC':

Somehow i doubt that zebra would argue it would be ethical for an oncologist to lie to his patient. minimizing the risks and inflating the efficacy of chemo and radiation therapy. if doing so would likely cause a patient to agree to undergo treatment.

So, it looks to me you've just dug yourself a deeper hole without attempting to make any kind of point, other than perhaps some ad hominem shot at my reading comprehension. Which is off-the-chart compared to yours — (not saying much there, I guess).

@ jts & @Denice

"i am always surprised just how many people have admitted having perfect scores on this test or that"

Not being a stats person: Would this also be affected by how many different tests there are, providing multiple opportunities for people to get a result they could brag about. E.g.on my UG boards, my SAT score was nothing to write home about, but my ACT was in the 99.9% percentile. So if you had a random sample of 100, probability would be a single 99% in the group if they all took the same test and only that test. But would it not go up, if they could take multiple different tests?

In the case of 'IQ' we would have to be talking some kind of apples-to-apples Stanford-Binet taken as an adult, right? There seem to be lots of other 'instruments' out there, Including different tests of varying complexity one can find online. All of the ones I've seen, even from seemingly more 'legit' sites, seem designed to flatter the test taker. They usually tell me I'm smarter than Stephen Hawking but not quite as bright as Jimmy Woods. WhatI think is I'm just smart enough not to think IQ tests have that much relevance. :-)

I suspect it's like 80 percent of people "admitting" to being above-average drivers: not only are the people who do well on a given test more likely to talk about it, but nobody is checking in that kind of conversation. I could say I got a perfect score on the SATs, and you might believe me; I could equally well say I got a mediocre score on the SATs but got into college anyhow, which people also might believe.

sadmar,

I checked back to see if you had made any more carefully crafted and erudite comments and I see you have. I feel my task is done here, in providing some bit more for you to work with.

With respect to your advice to me-- look, you have these last few comments from the Minions that call into question your positive evaluation. You do all this work to produce a *very clear* (and compelling) argument, and they fire off sloppy, repetitive, silliness.

It is a game with which I am all too familiar, although I don't know if it has an internet name. The idea is to wear you down until you respond in an equally sloppy manner, so they can 'win', and make some triumphant noise, and forget all the previous humiliation you have dished out. Too boring for me.

At one point I thought you and I could engage in some little debate where we took your position

"at least this will help in the maturation of the med students thinking and in discourse with patients"

as the 'Weak Hypothesis',

and my

"hey wait a minute, given all the problems with standard medicine (USA), maybe we could make use of people's inclinations to 'belief' to get some concrete improvement in the system metrics"

as the 'Strong Hypothesis'.

But on reflection and reading your recent comments, I don't think I would make a very effective sparring partner for you, and since this isn't my fight, I'm content with stirring things up a bit when I encounter it in the future.

Au revoir, not goodbye. I'm hoping I will find some real disagreement with something you say in the future.

sadmar -

The POTUS announces troops will be withdrawn from the MidEast as their mission has been successful and stability has been achieved.

When stability has shown NOT to be achieved, the words are thrown back at the president, used as the basis for an investigative committee, and are endlessly parsed by commentators for Mother Jones. Yes, politicians use methods other than the truth continually. Is that ethical?

The used car salesman steers a customer away from a known lemon the manager has placed on the lot, putting the customer into a good car by framing some other problem with the lemon in a way that doesn’t undermine his credibility by revealing the lot sells junkers. (When I worked in sales, I routinely did things like this.)

This is a very odd example. If the car is a junker, and the salesman points out an actual problem with it to steer someone away from an unsatisfactory experience, that is not "other than the truth".

You follow that up with "The used cat [sic] salesman also does not need to lie, merely emphasize other valid negatives of the lemon, and other valid benefits of the good car." Why do you use the word "other" twice in that sentence? Other than what? I get that you might think that the lemoncity of the bad car is such an overwhelming tidbit of information that you might actually want to lead off with that, or at least mention it if the customer become insistent. But when discussing the "good" car is the most important thing to say is "hey, it's not a lemon!"?

Are you thinking, perhaps, that the salesman might use trivial details as the most important comparison points? Something like "That yellow car has pinstripes, but you wouldn't like that. This black car has the boy pissing on the Chevy logo sticker - hilarious!" to avoid talking about the lemon, sorry, elephant in the lemon, sorry, sorry, room? Have we descended into a John Cleese sketch?

The teacher hangs up the phone and tells the 2nd grade class to run to the coat closet and hide as part of a school game to see which classroom can make itself look the most empty, and once they’re inside gunshots ring out in the hall.

And you're back to an adult acting in loco parentis with children, which was my original example of a case where we consider it acceptable.

sadmar

As I observed, doctors frequently decline to tell the whole truth about illnesses and even some procedures, sometimes for good cause to the patient, sometimes not-good-cause to the patient but necessary for the practice to avoid exposure to litigation, or meet requirements of insurance mandates.

That's likely true. Fictional examples of that spring to mind (The Bells of St. Mary's, starring Ingrid Bergman and Bing Crosby, or countless episodes of any doctor show on TV). You see it in the news often enough, though typically when the doctor is being sued for malpractice, being accused of bilking Medicare, or losing his/her/its license.

Regarding your example of Guy (I prefer to think of him as Bugsy, but that's just me) and the acupuncture referral - your claim that the doctor never lies is along the same lines as Mrs. Lovett's protestation in Sweeney Todd.

“If, say, a politician, car salesman, or teacher were to use this tactic, would we praise or revile said person for that?”
What “we”? Praise or revile on what basis? Vox Populi, Vox Moralitas?

I thought it was clear based on context - "we" refers to people reading this comment stream. The basis would be on the "politician, car salesman, or teacher's" behavior with regard to this particular tactic and not, say, on their church attendance or stable home life.

zebra,

You do all this work to produce a *very clear* (and compelling) argument, and they fire off sloppy, repetitive, silliness.

I am unable to discern any clear and compelling arguments that you or sadmar have made in this thread.

First you expressed disbelief that CAM is being taught to medical students, "Sorry, I must have missed the part where they were going to teach about the efficacy of [Rhino horn] in medical school. And require ‘practices’ to dispense it".

When I provided evidence that CAM (just as fantasy-based as rhino horn) really is being taught in medical schools sadmar claimed his experience of teaching tells him that CAM isn't really being taught, it is just being used as a teaching opportunity. I then provided evidence that the great majority of CAM courses are being taught by CAM practitioners, that few of the courses "emphasized a scientific approach to the evaluation of CAM effectiveness" and even evidence that at least one school of integrative medicine dispenses homeopathic medicines, yet sadmar has dismissed this evidence with:

Your ‘evidence’ does not provide adequate support for your assertions by a long shot,

Why the scare quotes around 'evidence'? I suppose citation of scientific papers is what you describe as "sloppy, repetitive, silliness".

It is a game with which I am all too familiar, although I don’t know if it has an internet name. The idea is to wear you down until you respond in an equally sloppy manner, so they can ‘win’, and make some triumphant noise, and forget all the previous humiliation you have dished out. Too boring for me.

Anyone who cares can review this thread to see this is precisely the game you have been playing here. What humiliation have you "dished out here", precisely?

There's sadmar's ‘Weak Hypothesis’:

“at least this will help in the maturation of the med students thinking and in discourse with patients”

This appears to be based on some kind of homeopathic principle: use CAM practitioners to teach medical students absolute nonsense, and somehow they will realize it is nonsense and this will improve their performance. "Clear and compelling"?

And there's your ‘Strong Hypothesis’:

“hey wait a minute, given all the problems with standard medicine (USA), maybe we could make use of people’s inclinations to ‘belief’ to get some concrete improvement in the system metrics”

As far as I can see, this hypothesis is that the best way to address erroneous beliefs about medicine, such as that antibiotics are effective against viral infections, is not to educate people about the science involved, such as the difference between viral and bacterial infections, as we are doing in the UK as I described above. Instead it is to teach medical students bogus diagnostic techniques and pre-scientific systems of belief based on imaginary energy channels and the healing effects of magic water in the hope that these nonsensical models will be more persuasive to patients than scientific evidence.

Your explanation of how this translates into delivery of better healthcare was based on a "metaphorical example" of 'ginger tea'. We are supposed to believe a doctor will do better dissuading a patient from demanding non-indicated antibiotics by suggesting the patient drink some 'ginger tea' instead, than by providing science-based advice.

You don't appear to have explained why you think "people's inclinations" are more amenable to belief in pre-scientific BS than in what the scientific evidence tells us, or why the former is more likely to result in beneficial outcomes than the latter.

This is your idea of a "very clear (and compelling) argument", of a "Strong Hypothesis"? Perhaps I have been blinded by your superior reasoning skills, but I am left deeply unimpressed.

Meph:
In loco parentis gets us somewhere in the discussion. In the thread about Cassandra C. I argued the State had a moral obligation to intervene —regardless — of her age, based on her apparent lack of competence to make life-and-death decisions for herself apart from the influence of her woo-besotted mother. It's not much of a stretch from there to a physician manipulating a patient into a life-saving treatment. You (MOB, sbm advocates) cannot have it both ways. If Jess Ainscough refuses chemo and opts to continue Gerson's in the face of a fungating tumor bleeding into her armpit for 10 months, based on some truly dippy new-age spirituality, and in the wake of 3 associates losing their lives under like conditions, she would be acting, per skepticism, far outside the bounds of reason. I would argue (seriously) that her irrationality amounts to incompetence to control her own medical affairs. If it moral for the State to physically force Cassandra into chemo, it's certainly moral for an oncologist to fib about the value of an 'integrative' approach to get her into chemo.

Likewise, in the scenarios I can imagine in which I would want a physician to lie to save my life, I would be under some kind of stress or misunderstanding tat would render me incompetent to make a wise decision for myself.

A true story of a moment when a medical professional placed me in harm by telling me the whole truth: As I was running to second in a low-level rec-league slow pitch game, asshole 2nd baseman decides to get macho as I'm in the way of his relay throw to first on a DP ball, so with full wind up he delivers the ball into my eye from about a foot and half away. I'm in hellatious pain my eye closes up, they call an ambulance. Shortly after we pull away from the fields, the EMT carefully pulls back my lid, and looks at my eye. He says, "You have a hyphema. Blood is filling up your eye. Try not to move around so much, or you could lose your sight." Well what do think happens when you tell a 30-ish filmmaker in shock from a blow to the head that knocked him off his feet he might go blind if he moves too much? I sent into serious hyperventilation, gasping for breath so badly I was jerking around all over the back of the ambulance. Dude should have told me ANYTHING but the actual truth to get me to calm down and be still for the ride to the ER.
............
I'd go with Bugsy (I'm probably missing an allusion), but lets split the dif and call him 'Buggy'. Cleese would be quite a flattering compliment. One ascends to Cleese. Not there yet. Excuse me if repitition has not clarified, but by 'other-than-the-truth" I mean 'less-than-a-lie-of-comission" — not "full disclosure" ('lie' of omission), or 'spin' ('lie' of emphasis). So yes, it is "other than the truth" if salesman doesn't tell Buggy the used Accord he's enamored with has a micro-crack in the block from the last of the many times it's blown a head gasket, and pushes Buggy towards the Camry by saying a bunch minor smack on the Honda. And if that's OK, as you seem to suggest it is, you can't have it both ways. Really, a doctor can't save Buggy's life by the same methods a salesman can use to save Buggy the cost of a replacement engine?

'Political ethics' is more of an oxymoron that 'business ethics'. The POTUS get's grief from somebody no matter what he does. (And for troop withdrawal, it wouldn't be MJ complaining, try O'Reilly or Hannity). IRL, pols come up with excuses for doing things the public wants, but which they can't be truthful about for political reasons, so they lie, knowing the public will be happy with the outcome and it will blow over.

When an examplar is clearly offered to explicate a general abstract point, It's sophistry to pick at details of the examplar not germance to the general point. Fine, their physics grad students and the prof. comes up with a ruse to get them to lock themselves in a lab closet. When I was grad school, I played ultimate with a bunch of guys from physics, all of whom wound up lucky enough to have not been in the wrong time when another grad student disgruntled over a grade went through the building killing both pre-chosen targets and anyone who got in his way.

See, IRL these things raen't abstractions: That's my teammate who's just wiggy enough to fly off the handle and do something stupid if he knows there's a guy in the hall with a Bushmaster. That's my cousin who's going to be shipped out to Fallujah, and so on. Fu¢k your 'Ethics' if that means i have to bury one of my friends.
...........
" Why do you use the word “other” twice in that sentence?"
Inept proof-reading.
..........
"I thought it was clear based on context – “we” refers to people reading this comment stream." Nope, that locution is usually an abstract referent to a social whole. But the 'what we' was a referent to the individuals who would benefit from the action and their loved ones; 'basis' meaning action (as I assumed that specified) but value standard. The pol, of course, will be both praised and reviled. I would have thought it clear I wasn't referring to the thread readers by the reference to Vox Populi...

Truth: I was actually going to write that all out and clarify it in the OP, but i didn't because it was already too long.

Kreb:

"Your ‘evidence’ does not provide adequate support for your assertions by a long shot,"
Why the scare quotes around ‘evidence’?

They're not "scare quotes". I think you've read enough of my comments to know my use of single-quotes is a kind of idiosyncratic practice used for all sorts of things. I picked it up from my Day who put quote marks around every word he wrote that seemed to reference some common usage. ( e.g. he would have written — reference some "common usage").

I noted my assertion about your evidence was unsupported in my comment, and that i will flesh out the claim when I can get to it. So lets wait until then to argue it further. Maybe enjoy some of the weekend.
........
Personal question (answer strictly optional): My memory may be foggy, but I have the impression you've been more combative on this issue than you've been in other threads. Is there something about the topic — 'integrative' medicine — that's especially 'triggering' for you? I would prefer a more 'civil' vibe, which isn't to tone troll you, but to say I'd want to avoid sticking rhetorical needles in anyone's soft spots.
........
I do wonder about the culture of that med/sci pedagogy based on memorization and regurgitation (as I recall you put it) vs. the culture of my academic training (which is 'arts/humanities' but not nec. every discipline or program therein). Basically, we'd have a colloquium every week where some debatable issue wound up on the floor, and we'd have at each other in vigorous argument — then go to the pub for grub, liquids and social chat, then maybe head to somebody's kitchen for silly 5/10/25 poker games...

zebra:
I wish you'd stick around. I think we might have debate. I'm guessing my take on your "Strong Hypothesis" is sort of 'you're in the ballpark, but a bit off track; dial back this a little, go more into that' blah, blah blah.

There's no law here that says the minions have to agree or even reply, nor we to them. There are other fairly folks who participate somewhat less often, and haven't been active in this thread, who have more 'moderate' takes (quotes as I don't know if that's the right word...) and might or might not be interested.

I doubt we'd be singing harmony on one hand, nor sparring on the other. I'm not sure what you meant by "not my fight." If the fight is sparring with the minions, that's not my fight either, it's just what I wind up doing to support the fight i actually care about on these particular grounds. So if whatever IS you fight has to do with health. life. death. medicine, science, rationality etc. there's a place for it here. Orac's not a forum Nazi or anything. There's also Science Based Medicine blog, which covers some of the same ground and re-publishes some of Orac's posts. The regulars there are a different group, with only some overlap, and I find it more collegial, fwiw.

cheers: s.

sadmar

In loco parentis gets us somewhere in the discussion. In the thread about Cassandra C. I argued the State had a moral obligation to intervene —regardless — of her age, based on her apparent lack of competence to make life-and-death decisions for herself apart from the influence of her woo-besotted mother. It’s not much of a stretch from there to a physician manipulating a patient into a life-saving treatment.

Actually, I disagree with the premise. The argument you express is that if someones makes a choice the State believes is not in that person's best interests, that is sufficient grounds to show the person is incompetent to make that choice. The law does not say that, fortunately, as it could apply to almost any situation in life.

If your doctor believes you are not acting in your own best interests, he/she/it should certainly try to encourage you to do otherwise. But manipulate?

it’s certainly moral for an oncologist to fib about the value of an ‘integrative’ approach to get her into chemo.

Perhaps you missed that particular discussion (and perhaps you, like zebra, are speaking metaphorically). In the case of Ms. Ainscough, the most likely approach to save her life, as I understand it, is a rather extreme amputation. Chemotherapy has been used; perhaps there's another chemotherapy approach that could be tried, I could not say. Can you think of a combination of organic vegan lifestyle, meditation, and massage that would make the loss of an arm more palatable?

Shortly after we pull away from the fields, the EMT carefully pulls back my lid, and looks at my eye. He says, “You have a hyphema. Blood is filling up your eye. Try not to move around so much, or you could lose your sight.” Well what do think happens when you tell a 30-ish filmmaker in shock from a blow to the head that knocked him off his feet he might go blind if he moves too much? I sent into serious hyperventilation, gasping for breath so badly I was jerking around all over the back of the ambulance. Dude should have told me ANYTHING but the actual truth to get me to calm down and be still for the ride to the ER.

I don't know if what the EMT told you was sufficiently sensitive. He wanted to stress that you shouldn't move around; you panicked and did exactly what he told you not to do. I'm happy you didn't lose your eye, but what could he have said that would have kept you from moving around without making you panic? Anything too mild, you'd have been constantly trying to sit up or rub your eye.

Excuse me if repitition has not clarified, but by ‘other-than-the-truth” I mean ‘less-than-a-lie-of-comission” — not “full disclosure” (‘lie’ of omission), or ‘spin’ (‘lie’ of emphasis).

I have never once argued that the full, unretouched truth must be used at all times. Spin has its place. When someone about to give you an injection says, "you'll feel some pressure", that is clearly spin. When someone says, "this may sting a little" when about to re-set your broken nose, that is spin.

So yes, it is “other than the truth” if salesman doesn’t tell Buggy the used Accord he’s enamored with has a micro-crack in the block from the last of the many times it’s blown a head gasket, and pushes Buggy towards the Camry by saying a bunch minor smack on the Honda.

A more laudable approach would be to say "that Honda needs a new block; unless you're willing to put in that kind of time and expense, I'd suggest the Camry." I agree with you that using "minor smack" to steer the sale is dishonest - and intended to say so in my example of pinstripes vs. decal. As such, I can't see that it's acceptable.

When an examplar is clearly offered to explicate a general abstract point, It’s sophistry to pick at details of the examplar not germance to the general point.

Fair enough - except the details actually mattered in your example (perhaps it was a bad example). The ways you deal with 8 year olds and 20 year olds are different; they react differently, their ability to understand is different. You couldn't tell a class of second graders "there's a man with a gun coming down the hall, let's all please hide in the closet" and expect a rational, if perhaps fearful, response and compliance. I would also not expect a professor to need a ruse to get his more-or-less adult students out of danger. The professor may say "there's a problem, please come with me quickly and I'll explain later", which is by no means a ruse.

50 comments and three days after I posed my question to zebra (yet again), he shows up but fails to address the points raised, ending with a flounce. I do hope he'll come back and "dish out" some humiliation by showing us his concrete calculations that I asked for in comment #577.