Don’t Get Mad, Get Even!

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My 11th grade history once told my class that we have an illusion of power when it comes to our government. He said “You all will follow my instructions because I am the teacher, and I have the illusion of power. But there are 30 strong individuals in front of me, and you could easily ignore or overtake me at any moment. But you don’t, because you think I control you or you are too afraid of the consequences.”

Consult A Doctor, Inc. Names Retail Clinic Pioneer, Douglas Smith, M.D. as Chief Medical Officer

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Douglas Smith, MD, the medical founder of Minute Clinic, joins Consult A Doctor, Inc. as Chief Medical Officer; calls Consult A Doctor “the next evolution in medical care delivery, increasing access and lowering costs.”

Miami, FL (PRWEB) April 13, 2010 -- Consult A Doctor, Inc. announced today that Douglas Smith, board-certified family practice physician and pioneer of retail medical clinics, has joined as its Chief Medical Officer. Consult A Doctor is a nationwide telemedicine service provider of 24/7 access to physician consultations by phone and online.

“We are thrilled to have Dr. Smith on our team. He brings years of experience and a deep understanding of the delivery of quality care in an accessible and affordable way with new disruptive business models,” said Wolf Shlagman, CEO. Mr. Shlagman added, “He will help to expand our telemedicine service offerings with specialist consultations, lab services and telemonitoring in addition to leveraging our online software platform for use by health plan providers and their own physician networks.”

Consult A Doctor’s telemedicine services reduce health care costs for all payers by providing members with convenient efficient access to medically equivalent care in a lower-cost setting, reducing unnecessary doctor and ER visits by up to 80%.

In 1999, Douglas Smith, M.D. and his partners formed the idea of a retail health care model: convenient clinic locations staffed by physician-supervised nurse practitioners who could focus treatment to common family medical conditions. They set out to offer the same top-quality care expected from a primary doctor's office, urgent care center or emergency room, but made quick and affordable. CVS acquired Minute Clinic for over $200 million in 2005. Today, Minute Clinic operates over 500 clinics in 25 states.

“I joined Consult A Doctor because it was apparent that there was a great synergy between the utilization of evidence-based medical care, technology and patient knowledge allowing more of the care that can be delivered by telephone and online. Consult A Doctor’s platform allows more complete medical offerings than the others that I have looked at,” Dr. Smith said.

“I believe that consumers have become educated regarding the availability of alternative methods of accessing lower cost, high quality care and Consult A Doctor is well positioned to address many current and future problems facing the American health system, bringing disruptive change in the way medical care gets accessed and delivered.” said Dr. Smith.
About Consult A Doctor, Inc.

Consult A Doctor partners with health insurance companies, self-insured groups, third-party administrators, brokers and others to offer convenient 24/7 access to doctor consultations by phone and online to their members and customers. Its proprietary nationwide network of U.S.-based physicians provides specific answers to medical questions and advice regarding non-emergency, routine medical conditions. All Consult A Doctor physicians are carefully screened, credentialed and have malpractice insurance coverage. They discuss symptoms, recommend treatment options, diagnose many minor conditions, and can prescribe medication when appropriate. Consult A Doctor’s telemedicine service reduces healthcare cost for all payers by providing members with convenient efficient access to medically equivalent care in a lower-cost setting, and considerably reduce unnecessary doctor, ER and urgent care visits.

For more information about Consult A Doctor – call 888-688-DOCTOR (888-688-3628) or visit http://www.consultadoctor.com

Homeopathy – Failing Randomized Controlled Trials Since 1835

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I’m sad to say that this is the last day of World Homeopathy Awareness Week.  We’ve tried to give homeopathy its due honor, providing it the attention its practitioners clearly desire, while continuing to cover pertinent news in the world of homeopathy and providing a somewhat more sober, rational discussion of it on our homeopathy reference page.

Of course, most of this has not been news in the literal sense of the word.  There hasn’t been anything truly new in homeopathy since its invention (no, not discovery; discovery implies that something actually exists to be found) by Hahnemann in 1796.

Well, perhaps that’s not quite fair.  As our knowledge of reality (medicine, pharmacology, chemistry, physics, etc) has steadily improved, homeopathy’s plausibility has dwindled to the point of being indistinguishable from the roundest of numbers (0).  And I suppose the recent contortions of logic, abuses of legitimate science, and pure magical thinking put forth to protect homeopathy from the relentless assault of science are far more impressive than that laid out by Hahnemann.  So that’s news of a sort.

There’s also homeopathy’s long and rich tradition of abject failure in randomized controlled trials to consider.  The overwhelming mountain of evidence showing homeopathy to have no effect beyond placebo is impressive and definitive.  That’s data Hahnemann didn’t have, so that’s news too.

Each of these properly conducted studies and analyses demonstrates the scientific method’s utility to help us understand reality and protect us from our own delusions, but frankly, at this point they are about as exciting and useful as proving that the sun will rise in the east tomorrow morning.  News?  Not so much.

Nuremberg’s Less Famous Trial

I found myself wondering how far back this trail of negative trials goes; how long we’ve been having the identical argument.  Pubmed’s earliest mention of homeopathy was in 1906, and the first RCT I found in its database was in 1980.  However, the oldest double-blind RCT of which I found record was conducted in 1835 in Nuremberg, Bavaria, and subsequently described in an editorial in 2006 entitled “Inventing the randomized double-blind trial: The Nuremberg salt test of 1835.” Though the trial has its flaws, it was of sufficient quality to satisfy my historical curiosity with a thoroughly depressing answer: 175 years.

The local physicians and public health officials of Nuremberg held an understandably dim view of homeopathy, and as it gained popularity in Nuremburg they became more vocal, and more public, in their opposition:

Von Hoven accused homeopathy of lacking any scientific foundation. He suggested that homeopathic drugs were not real medicines at all and alleged homeopathic cures were either due to dietetic regimens and the healing powers of nature, or showed the power of belief. He called for an objective, comparative assessment by impartial experts. If, as he expected, homeopathic treatment proved ineffective, the government would need to take drastic measures to protect the lives of deceived patients.”

Sounds familiar, doesn’t it?  Nuremburg’s resident homeopath Karl Prue’s defense should as well:

[Prue] pointed out that even children, lunatics and animals had been successfully cured. Based on Hahnemann’s assertions, he challenged Wahrhold/von Hoven to try the effects of a C30 dilution of salt on himself. The odds were 10 to 1, he claimed, that his opponent would experience some extraordinary sensations as a result – and these were nothing compared to the much stronger effects on the sick.”

Eventually a trial was designed and agreed upon by both parties to test the effect of a 30C dilution of salt.  The trial design was surprisingly good, as it was:

  • Randomized: participants had an equal chance of being in either the control or experimental group
  • Controlled: participants not given the experimental therapy were given an indistinguishable and inert placebo
  • Blinded: participants didn’t know if they received the homeopathic dilution or placebo
  • Double-blinded: the experimenters didn’t know which participants received the homeopathic dilution or placebo, as the placebo and homeopathic dilution were prepared and the vials containing them randomized and coded by people independent from the experimenters.
  • Well Powered: the trial contained enough participants so that if, as Prue claimed “the odds were 10 to 1… to experience some extraordinary sensations” that it could detect a difference between the two groups.
  • Transparent: The design, hypothesis, methods and outcomes were agreed upon beforehand and explained in detail to all participants, conducted publicly (in a literal Pub in fact; these people were full of good ideas), results were published quickly, and any deviation from protocol was acknowledged.

Of the 54 people they managed to enroll, 50 completed the study three weeks later by reporting what, if any, “extraordinary sensations” they had experienced following ingestion of their vial.  5 people reported sensations in the homeopathic group, 3 in the control, which was statistically insignificant.  Homeopathy had failed the first of many RCTs.

I am not putting this trial forward as the final (though perhaps it could be considered one of the first) nail in homeopathy’s coffin.  The trial design had areas of potential bias, most notably that the symptoms which qualified as “extraordinary” are not well defined (though a glance at the homeopathic proving of “Natrum Muriaticum” or “table salt” provides some insight into this particular problem), and the fact that it relied upon participants to honestly report all symptoms; a hostile or imperceptive set of participants could easily confound the study.  Nevertheless, on the whole it was solidly designed and executed, particularly when one considers that this is one of the first double-blind, randomized controlled trials ever documented.

Time To Move On

Here we are in 2010, 175 years after the first of legion negative RCTs of homeopathy, yet it persists with the same tired old arguments.  Is there anything to gain from investing more time, money, resources, and ignoring the highly dubious ethics of subjecting human subjects to a trial that has no hope of benefiting them or humanity, just to prove one more time that homeopathy is an utter failure?  No, and here’s why.

I look at the current debate surrounding homeopathy, and I see three primary groups.  The first accepts the last two centuries of scientific progress and evidence and concludes that homeopathy is a delusion unworthy of further study.  They don’t need another trial.

The second believes in homeopathy in spite of the gargantuan volume of evidence; further evidence will do nothing to change their minds.  They don’t need another trial.

The final group is comprised of people who are unaware of the nature of homeopathy or the evidence that already exists.  This final group requires exposure and education; they require World Homeopathy Awareness Week (SBM edition).  They don’t need another trial.


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Study: Insurance Companies Invest in Fast Food – CBS News

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CBC.ca
Study: Insurance Companies Invest in Fast Food
CBS News
The Harvard Medical School's Dr. Wesley Boyd, an author of the study, finds it ironic that these firms would invest nearly $2 billion in companies that sell ...
Study: Insurance companies hold billions in fast food stockCNN
Harvard Docs to Insurance Companies: Drop the Big MacsWall Street Journal (blog)
New study reveals health, life insurers' $1.8 billion stake in fast foodMedill Reports: Chicago
Psychology Today (blog) -MedPage Today -newjerseynewsroom.com
all 35 news articles »

Eggs keep coming!

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Hello Puffins - Mediterranean Gull introducing itself to the locals
(by Mark Breaks)
Pair bonding Kittiwakes (by Mark Breaks)
Chiffchaff's on the move
Thursday 15th April comments:
The (reasonably) fine weather continued although with a slight chill in the air as the light wind was moving in from the north (which was bringing volcanic ash from Iceland apparently!). The breeding seabirds continued to come and go, with Shags well settled, Guillemots laying eggs but the real stars; the Puffins, continued to remain elusive (on occasions). However the major discovery of the day was the first Ringed Plover eggs of the year, on the beach on Inner Farne. The number of Sandwich Terns in the evening roost continues to increase daily (as shown below) and the first Arctic Tern will only be days away.
Sandwich Tern roost counts on the Farnes in April:
3rd – 6
4th – 26
6th – 75
10th – 94
13th – 128
14th - 131

Interestingly, the Mediterranean Gulls remain including at least one second-summer bird lingering in the large Black-headed Gull colony. Otherwise it’s quiet on the migration front with just a smattering of passerines.

The dangers of opponents of science-based medicine

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Michael Specter, author of Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives, on the danger of science denial:

Given that more than half of the video is devoted to discussing vaccine denialism, supplements, and HIV/AIDS denialism, I think Spector’s talk is quite appropriate for this blog. Perhaps the best quote in Specter’s entire speech is this: “When you start down the road where belief in magic replaces evidence and science, you end up in a place where you don’t want to be.”

Unfortunately, for more and more of the population, it seems, when it comes to vaccines and “alternative” medicine that’s exactly where they’re going. They don’t want to be there, but unfortunately they won’t realize it until there there. They might not even realize it even then.

Unfortunately, society will.


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Stunning, Deserted Corralito Beach on Espiritu Santu Island, La Paz, Mexico

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La Paz, Mexico is a land of stunning contrasts, where reddish limestone cliffs soar above crystalline turquoise seas and golden sunsets burnish deserts dotted with sentinel-like cardon cactus, elephant trees and thorny chollas. Nowhere is this beauty more astonishing than Espiritu Santo Island, a protected nature preserve at the northern tip of the Bay of La Paz in Baja California’s Sea of Cortez.

Corralito Beach on Espiritu Santo Island near La Paz, Mexico

On this island paradise, where cliffs meet sea and sky meets desert, astonishingly beautiful beaches have formed. Some of the better known include Punta Lupona, Playa Dispense, Playa San Gabriel, Ensenada de Pescadores, Candelero, Playa Ballena, Mesteno, and Playa Partido, but I was destined for a lesser known cove that the locals call Corralito Beach. I hopped out of the boat into thigh-high water, waded to shore, and climbed to the upper edge of the beach. As the boat vanished into the distance I surveyed my surroundings. Not a soul was to be seen and the only evidence of civilization was a flimsy shelter on a distant spit of sand, used occasionally by fishermen who camp on the island.

Rocky arms wrapped around the precious cove; on the left, a volcanic massif glittered in shades of black and red, while a limb of cactus-strewn desert jutted on the right. Between the two swept an exquisite white beach of powdery sand unmarred by footprints other than my own. Beyond the blinding white sand stretched the most gorgeous turquoise sea I have ever seen, with a coral reef within easy swimming distance.

The view from Corralito Beach on Espiritu Santo Island

I spent the better part of an hour snorkeling the reef before splaying on the beach to soak up some rays while enjoying a delicious box lunch. I was sad when the boat returned to pick me up, but happy to learn that camping is possible with a permit. Someday I will return with cooler, tent and sleeping bag and stay until I have had my fill of the amazing serenity at Corralito Beach.

Photo Credit: Barbara Weibel
Article by Barbara Weibel of Hole In The Donut Travels

Even quirky Republican Ron Paul ties Obama in 2012 match-up

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by James Fryar

It has been said often, that anyone in the US can aspire to be president. Today’s Rasmussen Poll is a clear indication that this is in fact the case.

Pit maverick Republican Congressman Ron Paul against President Obama in a hypothetical 2012 election match-up, and the race is – virtually dead even.

A new Rasmussen Reports national telephone survey of likely voters finds.

Obama with 42% support and Paul with 41% of the vote. Eleven percent (11%) prefer some other candidate, and six percent (6%) are undecided.

While I tend to find Paul a quirky character, I find myself more often in agreement with him than against. Apart from his weaknesses in foreign policy, mainly in the area of defense I tend to find him pretty sound. It’s a pity he seems to follow the leftist garbage line that the US is somehow an ‘empire’.

The poll though has him well within any margin of error. I doubt he could maintain the momentum in a real election with the rough and tumble of politics, but it must be a very disquieting time for Democrats when one of the most unlikely guys in Congress can be a threat to them.

It seems clear that if the Republicans can put up a genuinely fiscally conservative socially tolerant libertarian Republican in 2012, Obama is a goner. The slogan, “A second term for Jimmy Carter” will have been realized.

Editor's Note - Jim Fryar is a true Blue Collar Republican. He's an oil rig worker in south central Australia. He's also a member of the Australia Libertarian Society. His blog is Real World Libertarian. He covers the International Libertarian movement.

Even more praise for Rand Paul’s Pro-Defense libertarian stance

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From Eric Dondero:

Reason Magazine (print issue) currently has a front page spread on Rand Paul and his US Senate race in Kentucky. In an on-line version, Reason points out Paul's differences with his famous father on foreign policy and defense issues.

(I am quoted in the magazine article, as well as noted in the on-line version.)

Reason Foundation, Opposing Views "The Son Also Rises; Ron Paul's Son, Rand Paul, Makes Big Impression":

What set Ron Paul apart from most Republicans, though, was his passionate opposition to the Iraq war and to the GOP’s interventionist foreign policy. Here Rand Paul is careful to tailor his arguments in ways that appeal to more conventional conservatives. The only section of his campaign website that deals at length with the war appears under the heading “National Defense.”

"Defending our Country is the most important function of the federal government," Paul says on his website. “When we are threatened, it is the obligation of our representatives to unleash the full arsenal of power that is granted by and derived from free men and women.”

Says Rand Paul campaign manager David Adams: "What people are seeing is that despite what our opponent says, Rand is actually very strong on national defense. He believes in doing what it takes to keep the American people safe and secure."

This careful messaging has helped Rand win the mainstream conservative support that eluded his father’s Republican presidential campaign. The biggest example is the endorsement of former Alaska governor and 2008 GOP vice presidential nominee Sarah Palin, who said she was "proud to support great grassroots candidates like Dr. Paul..." has helped him appeal to Republicans who wanted to read his father out of the party in 2008, such as Erick Erickson of the activist conservative blog RedState.

The libertarian Republican activist Eric Dondero, a disgruntled former staffer of the elder Paul who contemplated a primary challenge against him, praises Rand Paul as a “pro-defense libertarian.” At the same time, dovish Ludwig von Mises Institute President Lew Rockwell is politely supportive—though not effusive—on his website, despite regarding much of the Republican primary electorate to which Rand must appeal as "red-state fascists."

Tea Party favorite Rand Paul wins Jim Bunning’s backing

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No to Bailouts, No to Government Takeover of our Economy, No to Wasteful Spending

The headline in USAToday:

Jim Bunning endorses Tea Party favorite to replace him

The Statement from Senator Bunning's office:

In the United States Senate, Kentuckians need a strong, principled conservative to stand up to the liberals and establishment politicians that run Washington. Kentucky needs a conservative who will say no to bailouts, stop the government takeover of our economy, end wasteful spending, and bring down our national debt. And Kentucky's families need a conservative who believes in traditional values and the rights of the unborn. In 2010, there is only one such conservative running for the United States Senate -- Dr. Rand Paul.