THE AMERICAN JOURNAL OF MEDICINE SEES PARALLELS BETWEEN THE GLOBAL WARMING SCARE AND PAST MEDICAL FIASCOS

Editorial by Joseph S. Alpert MD (Robert S. and Irene P. Flinn Professor of Medicine and Head, Department of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz)

My medical school classmate, Michael Crichton, argues strongly in favor of skepticism in his most recent novel, State of Fear. Crichton applies the lessons we learned together at the Harvard Medical School: "Think critically and carefully review the literature before deciding on a course of action." Today, some 35 years later, we call this principle "evidence-based medicine," but the truth at its core remains the same.

In Crichton's novel, the bad guys turn out to be ecoterrorists, and the good guys are government security agents with an extensive knowledge of the environmental scientific literature (cited in footnotes in the text). This book is more a Socratic dialogue than a novel. It calls into question the conventional wisdom that human activity is producing global warming with potentially catastrophic environmental results. Until I read State of Fear, I, too, thought that global warming was a proven, accepted fact. After reading Crichton's novel, I am much less sure of what I now call the hypothesis of global warming.

Crichton has convinced me that in other areas of science, just as in medicine, it is critical to maintain a skeptical attitude toward so-called "conventional wisdom." What everybody knows may turn out to be false. Crichton cites the example of eugenics that was widely accepted by scientists in the years leading up to the Second World War. Following the war and with the revelation of the hideous crimes perpetrated in Nazi Germany in the name of eugenics, the field lost its followers and is now just a footnote in the history of biological science.

Crichton suggests in State of Fear that the hypothesis of global warming may experience a similar fate in the future. Of course, medicine has also had many experiences that resemble the eugenics fiasco.

For example, we recently went through the premature ventricular contraction (PVC) debacle. As a resident and a cardiology fellow, I was taught by master clinicians and clinical investigators that patients who had PVCs following a myocardial infarction were at increased risk for sudden death. Moreover, I was instructed that such patients should be treated with antiarrhythmic drugs such as quinidine in order to eradicate the PVCs. Although some retrospective analyses questioned whether quinidine therapy really saved lives, most practicing cardiologists accepted the "PVC hypothesis" and treated patients liberally with antiarrhythmic agents. In the late 1980s and early 1990s, the National Institutes of Health sponsored a large, multicentered, randomized and double-blind trial, the Cardiac Arrhythmia Suppression Trial (CAST) in order to test whether PVC suppression really benefited patients with ventricular ectopy following a myocardial infarction. To everyone's surprise, PVC suppression with antiarrhythmic drugs actually was associated with a higher rate of sudden death or cardiac arrest than occurred in the placebo group. The publication of this trial led to a dramatic decrease in the use of antiarrhythmic drugs. The PVC hypothesis had been disproved!

The experience with the CAST trial is not unique. Many other examples of medical "common knowledge," so-called pearls, taught for decades and even generations, have been shown to be false. For example, each of the following pearls taught to me as a student or house officer has now been shown to be untrue: Don't give nitrates to patients with acute myocardial infarction; don't use beta blockers in patients with heart failure; tight control of glucose in diabetic patients is not beneficial; peptic ulcer disease is the result of stress; ST segment elevation myocardial infarction is always transmural in nature, and so on.

Clearly, today's internist and subspecialist need to be constantly reviewing the literature with a skeptical eye. What is allegedly true and useful today may be shown to be worthless tomorrow. The take-home message from this editorial is "remember Socrates and remain skeptical!"

(Excerpt from "The American Journal of Medicine". Volume 118, Issue 8, August 2005, Page 807)

The Doi (permanent) address for the above article is here




Marked Decline in Atmospheric Carbon Dioxide Concentrations During the Paleogene

Points of interest from the paper abstracted below: CO2 levels were much higher than today and recovered -- so if present day levels are too high in some sense they could easily drop again; We are not in a runaway state; This all falls under natural climate variation.

(By: Mark Pagani,1 James C. Zachos,2 Katherine H. Freeman,3 Brett Tipple,1 Stephen Bohaty2 . 1 Department of Geology and Geophysics, Yale University, 210 Whitney Avenue, New Haven, CT 06511, USA; 2 Earth Sciences Department, University of California, 1156 High Street, Santa Cruz, CA 95064, USA; 3 Department of Geosciences, Pennsylvania State University, University Park, PA 16802, USA.)

The relation between the partial pressure of atmospheric carbon dioxide (pCO2) and Paleogene climate is poorly resolved. We used stable carbon isotopic values of di-unsaturated alkenones extracted from deep sea cores to reconstruct pCO2 fromthe middle Eocene to the late Oligocene (around 45 to 25 million years ago). Our results demonstrate that pCO2 ranged between 1000 to 1500 parts per million by volume in the middle to late Eocene, then decreased in several steps during the Oligocene, and reached modern levels by the latest Oligocene. The fall in pCO2 likely allowed for a critical expansion of ice sheets on Antarctica and promoted conditions that forced the onset of terrestrial C4 photosynthesis.

Abstract above from Science Express





ASBESTOS: A BETTER WAY

Asbestos litigation is a continuing crisis. Thousands of truly impaired asbestos victims are deprived of just compensation through the courts because their legitimate claims must compete with those of the unimpaired.

At the same time, hundreds of firms face the imminent threat of bankruptcy at the hands of a predatory trial bar with all the economic calamities that inevitably result -- lost jobs, a depleted source of settlements and destruction of the retirement pensions of ten of thousands of employees.

The current system is irrational and unfair. The problem is compounded by an elite class of trial lawyers who have turned asbestos litigation into an entrepreneurial pursuit. Worse still, the hundreds of millions of dollars siphoned by the trial bar are unavailable to compensate suffering asbestos victims.

For the past several years, Congress has tried to address this crisis with legislation to replace the current litigation system with an asbestos trust fund. Funded by defendant companies and insurers, the trust fund model would set up medical criteria for determining eligibility as well as compensation based on impairment. In exchange, asbestos claims would be theoretically removed from the tort system and ineligible for compensation from other sources of funding (such as the U.S. treasury). But things haven't worked out that way.

Instead, the trust fund model is proving to be a political and policy mess. The fund's size has skyrocketed, now up to a $140 billion, with provisions in the bill ensuring that will go higher.

The medical criteria provisions (standards that determine eligibility for compensation) permit unimpaired individuals -- even those with conditions unrelated to asbestos exposure -- to stake a claim on trust fund dollars.

Other problems are the compensation amounts and the potential future taxpayer liability if the new $140 billion asbestos tax doesn't provide enough revenue for the trust fund. The fund will get bigger and the medical criteria less stringent. And, again, truly impaired victims of asbestos exposure and their families will be left empty-handed.

The Senate's trust-fund champion, Sen. Arlen Specter, Pennsylvania Republican, confirms the difficulties of creating a workable trust fund. Many of Mr. Specter's recent public comments on asbestos reform, such as his March 1 op-ed article in these pages, focus on the legislative battle and his closed-door efforts to divide the asbestos pie between businesses, victims and attorneys.

Unfortunately, this approach does not address the asbestos crisis in the context of our limited government principles and belief in the rule of law.

Indeed, Mr. Specter seems to sense a lessening of Republican support for creating a trust fund and its necessary taxes and is now turning to Democrats in order to get the bill passed.

On Feb. 25, Mr. Specter told the Wall Street Journal: "I'm very close to getting sponsorship by Democrats. Part of the chess game is that if you get Democrats on certain key issues, you may lose Republicans, so it is a balancing act."

That's hardly a prescription for good public policy, but it shouldn't come as a complete surprise. Mr. Specter clearly does not agree with the Senate majority on broader tort reform. Indeed, just last month he was the only Republican to vote for an amendment that would have gutted the Class Action Fairness Act -- a key Republican priority to limit junk lawsuits. And in the 108th Congress, Senate Democrat Leader Tom Daschle. co-authored Mr. Specter's Asbestos Trust Fund bill.

Fortunately, there is another way. Reasonable and effective asbestos litigation reforms have been proposed or enacted in several states. The most notable example was the enactment last year of a medical criteria law in Ohio -- to ensure a day in court for those who most deserve to have their claims heard and to be awarded compensation.

Additional provisions in medical criteria reforms can further help curb litigation abuses, limit costs and rationalize the court system. And what has worked in Ohio and elsewhere can be translated into legislation Congress may find more palatable politically and less likely to break the bank.

The Senate should shelve the Specter-Daschle Trust Fund asbestos reform and move a medical criteria bill that delivers just compensation to asbestos victims and their families.

Source

***************************************

Many people would like to be kind to others so Leftists exploit that with their nonsense about equality. Most people want a clean, green environment so Greenies exploit that by inventing all sorts of far-fetched threats to the environment. But for both, the real motive is to promote themselves as wiser and better than everyone else, truth regardless.

Global warming has taken the place of Communism as an absurdity that "liberals" will defend to the death regardless of the evidence showing its folly. Evidence never has mattered to real Leftists

Comments? Email me here. My Home Page is here or here. For times when blogger.com is playing up, there are mirrors of this site here and here.

*****************************************