Inexact Sciences

Thoughts on the place of science in an era of false conviction

Some recent articles, noted by a few of us in journals regularly monitored by HCR bloggers, provide real food for thought in our New World Order of alternate facts, fake news and truthiness.

In a recent number of the still intrepidly pay-wall-free Guardian,  development economist John Rapley summarizes his new book Twilight of the Money Gods. This summary is the best we in the colonies can do until this month’s UK publication of the full volume makes it to our shores. (Rapley, a true globalist, both an academic and a public intellectual experienced at teaching in several countries, is also a not infrequent Guardian contributor.)

Comes Rapley now to hammer home the point that research domains–his focus is economics–can ossify to the point that they become more like religions or belief systems, pace Mary Douglas’s classic work Purity and Danger, than anything resembling exact sciences. By abandoning humility to project rigor and group-think, they undermine their own credibility. Think about the following statements, then, and mentally substitute “academic medicine” for economics.

“… [academic] departments were increasingly hiring and promoting young economists who wanted to build pure models with little empirical relevance.”

One thinks, for example, about all the spurious metrics currently being applied to the assessment of “meaningful use” in electronic health records. Rapley goes on to elaborate and pose a partial solution. He notes that…

“…[w]hen the church retains its distance from power, and a modest expectation about what it can achieve, it can stir our minds to envision new possibilities and even new worlds. Once economists apply this kind of sceptical scientific method to a human realm in which ultimate reality may never be fully discernible, they will probably find themselves retreating from dogmatism in their claims.

By “power” one can read the unholy alliances with Big Money and managerialism oft-decried in HCR. By “retreating from dogmatism” one can read a renewal of alliances instead–well, let’s go with Rapley’s words: with “…social, demographic and anthropological work, and [the need] to work more closely with other disciplines.”

His solution, then, through such alliances, is the restoration of narrative to a central role for poo-bahs of some of the more overly sterile reaches of EBM, medical informatics, and decision analysis. He quotes the authors of the recent Phishing for Phools, for whom “storytelling is a ‘new variable’ for economics, since ‘the mental frames that underlie people’s decisions’ are shaped by the stories they tell themselves.”
Harvard cardiologist Lisa Rosenbaum, who’s produced some admirable and at times controversial writing for years in NEJM and elsewhere, has a new piece that appeared simultaneously with Rapley’s. She offers a way of refracting some of these same ideas through the lens of scientific medicine–or, more particularly, the crisis of trust by a “weary public” in the scientific process. Dr. Poses, in these e-pages of HCR, has frequently addressed this same issue of relativism where, to use Rosenbaum’s example, people (this includes people with major political power in today’s US of A) will be damagingly dubious about issues such as climate change. Yet at the same time we seem them devouring (so to speak) the claims of nutritional charlatans. Here I suppose she’s speaking mainly of the views of those who both fund and popularize medical science, and the way the traditional establishment of science has been dethroned or at least, by many, seriously questioned.

It’s a conundrum. The mandarins of science build their ivory tower and labor mightily in the effort of boundary maintenance (says Rapley); and yet they’ve lost ground (says Rosenbaum). “The fear of venturing into the fray,” she observes, “means that the public hears far more from science’s critics than its champions. This imbalance contributes to ‘science is broken’ narratives ranging from claims about the pervasiveness of medical error to the insistence that benefits of our treatments are always overhyped and their risks underplayed.”

Yet the prescriptions Rapley and Rosenbaum both offer seem rather similar: go back to telling the story. And here one can only agree most heartily. Telling the story works at two levels. At the level of domain knowledge, whether we’re talking about economic behavior, clinical decision making, or the interpretation of Big Data, we need more interdisciplinary efforts to connect the dots between physiological, psychological, social and economic processes. And, then, at the level of telling the story about science itself–something about which Rosenbaum herself is greatly concerned–individuals in all the domains of science and medicine need to “learn to tell stories that emphasize that what makes science right is the enduring capacity to admit we are wrong. Such is the slow, imperfect march of science.”

Advances Coming in Medical Science That Will Have a High Impact

There are a series of medical megatrends outlined in my book The Future of Medicine – Megatrends in Healthcare that will profoundly affect health care in the coming five to fifteen years and beyond. Some are due to the explosion of basic understandings of cellular and molecular biology. Others are related to advances in engineering and computer science. Here is a very brief overview.

These are the megatrends in medical care that are coming whether there is any change in health policy or not. First, expect that medical care will become much more custom-tailored to your personal needs. Genomics will allow you physician to select the most appropriate medication for you not just the one that on average works for most people. And he or she [more and more she since 50% of medical school graduates are now women] will also be able to select a drug that is less likely to cause a side effect as a result of you body’s reaction to it – all from knowing your genomic information. The surgeon will use your image such as a CT scan to program the simulator and practice the correct approach for your personal surgery. A vaccine may be made up specifically for you – a designer vaccine – to treat your specific cancer.

Second, expect that medicine will finally begin to focus more and more on prevention. . For example, genomics will allow your doctor to tell you at a young age if you personally are at high-risk for, say, heart disease and then prescribe a regimen of life style changes and medications selected specifically for you to reduce the risk. New vaccines will ward off serous infections and even many chronic debilitating diseases like Alzheimer’s.

Third, there will be major advances in repairing, restoring and replacing damaged and diseased organs and tissues. New surgical techniques will allow for remarkable repairs in a much less invasive manner; medical devices will allow the heart to beat regularly and stop the tremor and rigidity associated with Parkinson’s disease. And stem cells will allow for new tissues when old ones no longer function. Xenotransplantation – using an organ from an animal rather than a human – will be come available so that a person needing a heart or kidney will get it immediately and not need to wait and “hope” for someone else to die.

Medial information will be readily available no matter where you are. This will increase safety, convenience and improve medical care quality immensely.

Finally, care will become much safer as genomics adds to our knowledge of what drugs to prescribe, technologies such as simulators teach and demand competency and digitized medical information is readily available

These are the megatrends coming in medical care. They will occur and are coming in not that many years. Hopefully health care policy can advance as well and as fast, but that is much less certain.

For a video of these megattrends go here


Long-term Care Infection Prevention Training

The Infection Prevention Unit, within the Healthcare Associated Infections Program of the Colorado Department of Public Health and Environment, will be offering a FREE two-day infection prevention training event focused on reducing healthcare associated infections within the long-term care environment. 

This training is intended for a facility’s specified person (e.g., Staff Development Coordinator, ADON, DON) who is responsible for coordinating the infection control program.

To learn more about this training and to find out how to register, view the linked flyer.

If you have any questions, please contact Alana Cilwick (303.692.2727) or Injection Safety Coordinator at CDPHE.

Infection Prevention Training Flyer

Zoster / Shingles Vaccine – Is it Necessary?

I often get questions about the zoster or shingles vaccine known as ZOSTAVAX. Shingles or zoster is the painful skin condition that typically occurs in older patients and is caused by the chickenpox virus. If you’ve ever had chickenpox, then you are at risk for developing shingles later in life.

Typical symptoms initially include painful area for a few days which may be related to viral like symptoms of muscle aches, low grade fever, and malaise. The painful area usually is on one side of the body (unilateral) and along a dermatome, a nerve distribution root. The pain can be excruciating and often described as burning and intense. Patients often do not like any clothing to touch the area.

After the pain appears, a few days later a small rash of clear small blisters, known as vesicles, erupted and are typically grouped together on a base of redness. The rash appears on the exact same area of the pain.

The vesicles eventually scab over and over a period of a few weeks and resolve. The pain typically goes away as well but can take longer.

However, in some patients, the pain continues and can be irritating enough that it interferes with people’s lives. This condition is known as post-herpetic neuralgia (PHN) and is more common in individuals aged 60 and older and who have other chronic illnesses like diabetes.

This is why many patients are worried about shingles / zoster. A friend has suffered from PHN and has made sure everyone they know get the vaccine to decrease the risk of developing shingles and then potentially PHN.

So how good in the vaccine? Should you get it? How common is shingles?

It depends.

From the vaccine insert of ZOSTAVAX

The rate of getting zoster is WITHOUT the vaccine:
10.8 per 1000 people per year – aged 60 -69
11.4 per 1000 people per year – age 70-79
12.2 per 1000 people per year – age 80 and older.

This means about 1 percent of the population aged 60 and up will develop shingles annually.

The rate of getting zoster is with the vaccine
3.9 per 1000 people per year – aged 60 -69
6.7 per 1000 people per year – age 70-79
9.9 per 1000 people per year – age 80 and older.

Note the decrease of those developing shingles age 60 to 69, but that the vaccine’s ability to prevent shingles diminishes. This isn’t due to the vaccine per se, but the immune system’s ability to mount a response. As we get older, the immune system is less effective.

As a result the vaccine effectiveness is as follows:

Effectiveness of Zoster vaccine is
64% for pt aged 60-69
41% pt age 70-79, and
18% for those 80 and older.

Also from the package insert although the vaccine did decrease the rate of PHN due to decreasing cases of shingles, other complications of shingles like zoster around the eye, pain, and scarring from the rash were unchanged.

ZOSTAVAX is only indicated for people 60 years and older. Some patients cannot get the vaccine so check with your doctor.

It is covered under Medicare Part D.

More at the CDC website.

Cyathostemma micranthum (A.DC.) J. Sincl.(Norn Maeo)

Medicinal Plants in Thailand.

Cyathostemma micranthum (A. DC.) J. Sincl


Thai name: Norn Maeo

Climber; young branches rusty-brown-tomentose. Leaf simple, alternate, oblong-lanceo­late, 2-3.5 cm wide, 6-14 cm long. Inflorescence in terminal or axillary, 2-5-flowered cyme; corolla greenish-yellow, tomentose. Fruit aggregate, globose, turned yellow when ripe.

Roof: grind with small amount of water and topically apply for insect bites.

By: Medicinal Plants in Thailand
Volume 2

AyurGold for Healthy Blood

What triggers heart attacks?

Sudden stress — whether it’s from anger, a heat wave, or getting out of bed — can be the final “insult” that sets off a heart attack, stroke, or cardiac arrest.
Heart attacks, strokes, and cardiac arrests seem like they come out of the blue, but most don’t. They usually appear after cholesterol-rich plaque has festered for decades in arteries nourishing the heart and brain. So what makes one happen at a particular time? A trigger.
Researchers have identified about two dozen of these. They’re a diverse crew, ranging from anger and earthquakes to simply waking up in the morning. The ongoing search for triggers is generating ways to prevent potentially deadly cardiovascular events.
Some triggers cause a sudden surge in blood pressure. Some make the heart beat faster and harder. Others encourage the formation of blood clots, constrict blood vessels, or cause bursts of inflammation. Any of these changes can set in motion processes that culminate in the sudden formation of a blood clot (leading to a heart attack or ischemic stroke), a tear in a blood vessel (leading to a hemorrhagic stroke), or a wild heart rhythm (leading to sudden cardiac arrest).
One pathway common to many triggers is activation of the sympathetic nervous system, which is responsible for the body’s fight-or-flight response. The stress hormones it sends into the bloodstream can be hard on the heart and on vulnerable atherosclerotic plaque.
The more important triggers include:
Waking from sleep. Long before you wake up, your body prepares for a new day by trickling stress hormones into the bloodstream. They signal small blood vessels to constrict, make your heart beat faster, and begin boosting your blood pressure from its sleep-time low. This activity ensures adequate blood flow through your blood vessels by the time you are ready to get out of bed. It’s no coincidence that cardiovascular problems peak between 6 a.m. and noon. The slight dehydration that occurs during sleep may contribute to this early morning peak, as may the overnight fade in protection from blood pressure drugs and other heart medicines.
Heavy physical exertion. Shoveling snow, lifting heavy objects, running, and other types of strenuous physical activity can trigger heart attacks, strokes, and cardiac arrests. Don’t take this as a reason to stop exercising. In fact, the opposite is true — exertion is much less likely to cause trouble in people who exercise regularly than in those who don’t.
Anger. A furious argument or gut-churning anger can provoke a heart attack, stroke, or cardiac arrest. In two large studies, a bout of anger increased the chances of having a heart attack between ninefold and 14-fold over a two-hour period following the anger-provoking event. A study presented at last year’s American Heart Association meeting showed that anger often preceded shocks from implanted cardioverter-defibrillators, pacemaker-like devices used to halt potentially deadly, fast or chaotic heart rhythms.
Natural disasters and war. Heart attacks and cardiac arrests spiked abruptly on the day of the early-morning earthquake in Northridge, Calif., in 1994. Israeli researchers saw spikes in heart attacks during the first week of Iraqi missile attacks in 1991, while New Jersey researchers found a 49% increase in heart attacks within a 50-mile radius of the World Trade Center immediately after the attacks on Sept. 11, 2001.
Weather. Severe heat waves, such as the ones that struck Europe in 2003 or the Midwest in 1995, increase heart-related deaths. Cold weather triggers cardiovascular problems, too — in the United States, deaths from heart disease peak in December and January.
Air pollution. Breathing air full of tiny particles from car, bus, and truck tailpipes and fuel-burning factories or electricity generators is a trigger for heart attack and stroke.
Infections. Pneumonia, the flu, and upper respiratory infections are potent triggers for stroke and heart attack. Urinary tract infections have also been linked to strokes.
Sexual activity. Sexual activity briefly raises heart attack risk. Sex with a new partner in an unfamiliar setting increases the risk more than sex with a familiar partner in a familiar setting.
Overeating. A heavy meal, especially one that is chock-full of saturated fat or carbohydrates, can raise the risk of having a heart attack by temporarily making blood more likely to clot, interfering with blood vessels’ ability to relax and contract, or increasing the heart rate and release of stress hormones.
Other triggers. These include grief, lack of sleep, mental and work-related stress, the use of cocaine and other “recreational” drugs, holidays, and sporting events (like the World Cup) if your team loses.
Silencing triggers
With triggers lurking everywhere, waiting to assail you even before you wake up, what’s a person to do? Relax, for one thing. The vast majority of people, including those with cardiovascular disease, get out of bed in the morning, shovel snow, make love, get angry, and suffer through the flu just fine.
Still, it’s scary to hear that something like sexual activity doubles your risk. But keep in mind that the chance of having a heart attack, stroke, or cardiac arrest in any particular hour or during a particular activity is very low, on the order of one in a million. So sex increases the absolute risk from one in a million to two in a million. In other words, not that much. What’s more, the risks are averages, and so are lower for people without cardiovascular disease and higher for those with it.
That said, there are ways to inactivate these triggers.
Lower your absolute risk. The more flexible your arteries and the less plaque they contain, the lower your chances of having a heart attack, stroke, or cardiac arrest. Exercise, not smoking, eating a heart-healthy diet, and controlling your blood pressure, cholesterol, blood sugar, and weight go a long way to warding off all cardiovascular problems.
Blunt specific triggers. The more you exercise, the less likely you are to have a heart attack while exercising or shoveling snow. If you are prone to stress, anger, or anxiety, learning to manage these emotions can nip these triggers in the bud. Get vaccinated against pneumonia and get a yearly flu shot. In the morning, give yourself a few extra minutes to wake up and get out of bed.
Avoid some triggers. If you’ve already had a heart attack or stroke, or are at high risk for one, avoiding some triggers may minimize your risk. Hire a teenager to shovel your walk. Wash your hands often, especially if you’ve been around someone with a cold or other respiratory infection. Walk away from confrontations. Try not to indulge in rich, high-calorie meals. Stay indoors where it’s cool during a heat wave or on days when air pollution is high.
Stick with your medications. Many of the standard medications taken for cardiovascular disease prevent or interrupt triggered pathways. Aspirin makes it more difficult for blood clots to form. Beta blockers calm the activity of the sympathetic nervous system. Statins stabilize plaque, making it less likely to rupture. If you take one or more medications to control your blood pressure, make sure they last long enough to do their job through the night and into the early morning.
This description of triggers is meant to empower you, not frighten you. Knowing the things that can set off a heart attack, stroke, or cardiac arrest can help you avoid them or blunt their power. Being aware of possible triggers can also help you respond faster if they do, indeed, set off a heart attack or stroke. The faster you act, the better off you’ll be.

Bowling Games An Effective Weight Loss Exercise

Bowling is 1 from the game titles that offer a great deal of enjoyable as well as for this cause most people uncover it soothing to perform this sport. It’s very demandingdemanding to function straight hrsseveral hours throughoutthroughout mondays to fridays for this reason you require to alleviate your self from tension throughoutthroughout weekends. 1 method of carrying out this really is by taking part in bowling throughoutthroughout your working day off. Not only will it offer enjoyable but additionally assist you in shedding excess weight.

Factors Why Bowling Might Be Regarded as as like a Component of the Excess weight Reduction Plan

Taking part in the sport of bowling will need you to definitely transfer a great deal of physique muscle tissue. While you presently know, bodily action that entails a great deal of muscle mass motion adds a great deal in burning energy inside your physique. With this cause, you won’t just obtain the physical exercise that the physique needs but additionally assist you remain in form.

This can also preserve the energy of the arm joints, back again and legs that is very essential if you’re more than fifty many years outdated. Should you dislike heading towards the health club and perform some workout routinesexercises simply because it had been dull, bowling is 1 from the game titles that you could appreciate and also at the identical time provide your physique the physical exercise it needs.

Various GroupsClasses of Excess weight Manage that may be AccomplishedAccomplished Via Bowling

Mild Muscle mass FirmingFirming: Inside a bowling sport, you’ll require to stroll, bend your physique, swing your arm, and allow free from the ball. These physique actionsactions will assist you tone your muscle tissue. Bending and swinging your arm every single time you attempt to strike the bowling hooks using the bowling ball is great for the muscle tissue, tendons and ligaments. It will likewise enhance your bloodstream flow that will assist you decrease the danger of battling from the coronary heart assault.

Gentle Body fatBody body fat Burning: Gentle body fatbody body fat burning also entail stretching, flexing and swinging. These steps will burn up fats inside your physique that is important for excess weight reduction. This only signifies that if you’re taking part in bowling frequently you’re also shedding your excess weight inside a normal foundation. You may also lengthen your excess weight reduction physical exercise by parking your vehiclevehicle considerably in the bowling alley and stroll the right path into it. You may also make use of the stairs ratherrather of utilizing the elevator.

These are the advantages that bowling offers particularly if you’re trying to shed your excess weight. Aside from that, it’s a enjoyable action, with out a question.

The Importance Of Walking As Shared By The Personal Trainer Agoura Hills

Some of the biggest companies in the United States have headquarters in Agoura Hills – a city that’s situated in the Los Angeles County of California. Of these companies are the Bank of America, IBM, Teradyne, and many more.

Statistically, the average time that a worker would consume when going to work in Agoura Hills is half an hour, and of all the workers in Agoura Hills, only ten percent of them admitted that they walk on their way to the office each day.

A personal trainer Agoura Hills would like to stress the importance of walking to somehow encourage people in Agoura Hills to walk each morning to work.

Weight Loss

The greatest benefit of walking going to work is weight loss. The personal trainer Agoura Hills stated that walking at least 40 minutes each day can help you to shed off all the excess pounds in your body. Walking is a great way to shed off the weight in your hips and legs, abdomen as well as all throughout your body. The amount of weight that you can lose will pretty much depend on your pace as well as your intensity.

Disease Prevention

If you take time to walk on your way to work daily, you could avoid getting sick especially with those illnesses that are related to the heart. The increase of high blood pressure can also be prevented as well as diabetes.

If you take time to walk on your way to work daily, you could avoid getting sick especially with those illnesses that are related to the heart. The increase of high blood pressure can also be prevented as well as diabetes.

Furthermore, walking regularly can help to boost up the healthy cholesterol levels in your body and the personal trainer Agoura Hills added that walking can also help to strengthen your bones which is important for you to be able to exercise well and of course, to prevent bone deficiency as well.

Studies show that walking can help to improve one’s mood and prevent anxiety and depression. Above all, walking regularly can also help to relieve stress. If you walk regularly on your way to work, you will be able to concentrate more on your tasks and therefore, you could be more productive.

The greatest benefit of walking going to work is weight loss. The personal trainer Agoura Hills stated that walking at least 40 minutes each day can help you to shed off all the excess pounds in your body. Walking is a great way to shed off the weight in your hips and legs, abdomen as well as all throughout your body. The amount of weight that you can lose will pretty much depend on your pace as well as your intensity.

As you can see, there are definitely lots of benefits that you could get if you choose to walk on your way to work instead of driving your car. You might be actually helping to save the environment as well because this helps to lessen the pollution.

The personal trainer Agoura Hills suggested that you start at a slow pace on the very first week and then eventually raise your pace on the following week and so on. Also, make sure that you wear light clothes and comfortable shoes when walking your way to work and you can just change to your office attire after you reach your office premises. If you want further assistance, call a personal trainer Agoura Hills who can give you more advices when it comes to walking.

Joining A Yoga Therapy Calgary Program

By Jeannie Chapman

People that have recently suffered from an injury are often overwhelmed with all that is required for full recovery. Working through any aches and pains that may be present is much more complicated to consider than most people realize as it often involves the need to ensure that specific programs and forms of guidance are available to bring life back to full functionality. When joining a yoga therapy Calgary program consumers are given the chance to make sure their relief efforts are managed in a safe and healthy manner.

Yoga techniques have become a popular alternative offered to patients in lieu of participating in physical therapy training. People are often focused on this alternative as they are offered the chance to focus on the entirety of their health as opposed to simply dealing with their injury. The selections made from available programs generally require quite a bit of planning.

Consumers in Calgary that are considering this particular option have a multitude of programs to sort through. Many consumers are unfamiliar with all that should be considered when being assured their recovery is managed in the healthiest manner possible. Paying attention to several ideas is quite useful in making the right joining decision.

Doctor recommendations are some of the most helpful forms of insight for patients that are focused on this option. Most people actually find that they are encouraged to use this process to work through their aches and injuries while also having the chance to lose weight and benefit from mental well being increases in the process. Using any recommendations from a doctor also helps consolidate all options in a more confident manner.

Reviews that are posted from current and former members are also quite useful to consider when making this decision. Reviews are typically helpful in allowing consumers the chance to understand what is actually offered from the program from the direct viewpoint of people that are versed in how it helped them recover from their issues. Paying attention to the best rated programs is useful in feeling more confident about the decision that is made.

Enrollment requirements are essential to consider as well. Many programs require consumers to be of a certain age and health level to ensure participation is completed in a safe and healthy manner. Specific kinds of injuries and sources of pain are known to have their own courses which can also be helpful to hone in on.

Convenience should also be carefully focused on when trying to determine which program is right for them. Many people that are suffering from an injury are also required to deal with limited mobility and increased strains on their time which is why they focus on the most readily accessed and extended time frame programs available to them. The most convenient solutions are helpful in avoiding unnecessary difficulties with the entire recuperation process.

When choosing a yoga therapy Calgary program consumers are additionally interested in their price. Many consumers discover that this form of recuperation is not covered with any insurance policies they maintain which create the need for self funding. People are typically focused on the lowest cost options for the most convenience to save as much money as possible.

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Discover How Whiplash Pain Sufferers Get Relief With South Anchorage Chiropractic Office

By Kenya File

Whiplash is quite common, and anything which can cause you to jerk your neck suddenly such as an accident or sports injury can be the cause. While it might seem to be simple, correcting the problem can present difficulties. Patients frequently end up visiting several doctors without being able to find lasting relief, so knowing where to go for the best results is vital..

Fortunately, Anchorage neck pain sufferers can get rapid relief by visiting a local chiropractor. Whether the neck pains are due to whiplash or has other causes, chiropractic is usually effective in dealing with the problem. As other approaches usually prove ineffective or offer only temporary relief, it deserves to be your first choice therapy for this condition.

Nowadays, there is an answer for virtually every medical problem. Depending on what the cause of the condition is, you should be able to find an approach which will produce great results. It is acknowledged that chiropractic is often the most effective option for pain or conditions involving the spine, quickly providing amazing relief.

You will soon know if chiropractic is the best solution, as the results are usually very quick. Simply applying the right technique usually produces rapid improvement. This does not always happen, but in most cases immediate relief is a sign that you have found the right answer to your problem.

When dealing with neck pain, an adjustment may frequently be required. Nowadays, low impact adjustments permit greater control and increased safety when correcting the alignment of your spine. Your chiropractic will be able to determine which combination of techniques is likely to prove most effective in each individual case.

Anyone living in Anchorage who is having problems with neck pains would do well to visit a local chiropractor. Modern techniques will be used to identify the precise cause of your symptoms. Whichever methods which are most suitable for dealing with the problem will then be applied, and you will usually experience amazing relief.

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