Like some fever induced nightmare, David Avocado Wolfe begins to materialize in your peripheral vision, cad in a bullshit Mexican poncho he is visible as long as you do not look directly at him.  He rubs his beads of peace slowly, like a rosary while he whispers softly in your ear, beckoning you to come with him to the sewers of natural news.

“They believe. And when you’re down here with me, you’ll believe, too…”

Do you know the risks of crossing a river with an average depth of four feet?
How could you not?

How did reading about medicine contribute to, or cause this minor existential crisis? Well, it didn’t, at least in the sense of things I know to be true and good and real, like relationships, dogs, spouses, caffeine, sunlight and many other things, still exist.  They still have value because I value them.

I wish for a simpler time, when I knew what I knew was the truth. It was not bliss, to be honest I am not sure I have ever experienced that, but there certainly is type solace that can be found in ignorance. Do I have  anhedonia? Maybe I should ask my doctor which pharmaceutical that performs as well as a placebo is right for me?  As an atheist, sometimes I long for the warm dull embrace that must come with being able to simply accept that faith is deeper than logic when the doubts start to creep in.

I never had that sort of faith in anything metaphysical; now find myself losing my faith in affairs related to medicine as well.

It all started simply enough. I wanted to trash alternative medicine. I wanted to bring the message that it is nothing more than magical thinking and placebo and bullshit. I wanted to bring the message that western medicine was the path, that it was somehow better. I wanted reassurance. There will be very little reassuring here.

Am I any better than Mary Baker Eddy? She has her book of bullshit and I have mine.
Which begs the question, is it significant? Easy to say objectively and mathematically, subjectively is harder. When the trial your dad was in for  stage IV melanoma was stopped early because the drug did not work, is it significant? Was it regression to the mean? I wish I had focused more on statistics than malt liquor and cheap weed twenty years ago in college. Was it really the cow brains and tree bark that saved him all those years ago? You can’t say yes and no at the same time.

Just because the odds are low, or astronomical does not mean it is impossible. 5% is still a decent chance. Arbitrary, but decent. One in a million sounds like good odds, unless you are the one.  The geologic record is littered with proof of this concept, extinctions occur with shocking regularity. 1 in 300 million sounds astronomical and unbelievable, until you realize you won that lottery when you competed with that many other packets of DNA. Surely the role of chance is not that important and the results can’t be due to it, then again 1 in 300 million is hard to believe. But here you are. Maybe the powerball retirement plan is not that crazy. What are the odds of hitting 1 in 300 million twice? 1 in 300 million.

I bought The Black swan and read it. I wanted to like it but something about the author’s style is off-putting. Perhaps I’m not smart enough to get it? It might be over my head. I’ll  buy his new book this winter. I will probably either not understand it or not like that one either.

At least I deadlift.

Like an adultering Christian the tenets of evidence based medicine are great when applied to others; to you? Not so much. But empirical data and an n=1 should count for something, right? If you side with EBM you give up the medication, but the lab results do not lie, do they?  Maybe the endocrinology world should revisit the fact that some rivers are 4 feet deep and some rivers have an average depth of 4 feet? Maybe it is the placebo effect?

Tens of thousands of idiots read natural news and believe acupuncture works as well as opioids in the ER because the authors were disingenuous, if not worse when the  gloss over the role of rescue opioids being double that in the control arm.  At some level everything is going to affect something. Even nothing (the concept or in a vacuum) can be effected by something. Sometimes, late at night when the insomnia is especially bad I read about physics and quantum vacuum particles, occasionally this leads to my anxiety about the false vacuum state creeping in. At least it will be over at the speed of light, which is much faster than the human nervous system can process.

This, of course, does not help the insomnia.

My friends tell me acupuncture works well for insomnia.

The new study reads “sooner is better” and talks about how the CPC scores get progressively worse the longer providers wait to administer epinephrine in cardiac arrest. Charts show this, their data has confidence intervals and their conclusions leave no ambiguity. Finally we are getting some answers: “Early EPI administration within 19 minutes after emergency medical service call independently improved the neurological outcome compared with late EPI (24-29 minutes) administration in patients with out-of-hospital cardiac arrest.” Get that shit on board early, son!

But, something is not right here, just at the edge of your perception, like the splinter you only notice when you brush up against it. Then it is apparent, although not without the paranoia that comes with it.
Is everyone this fucking stupid? How could they not see it? You know that you might be slightly smarter than average but you are not really smart, how has no one mentioned it? Are you missing something here? The results don’t mean shit when the one sentence is re-read. The best the epi did was as good as not giving epi in the first place. A treatment that we have always have given is at best as good as nothing when we give it early, when we give it after 19 minutes, it is literally worse than nothing?

But…they will not care; they will cite this in the guidelines and the distilled, dumbed down versions, the picture books (literally) that will be handed out to the masses. Like some Bizzaro-Superman we cannot stop until we prove that it is worse than doing nothing. You have become a practitioner of alternative medicine, administered q3 minutes.
In the books they do not read this study will become citation 243 or maybe 362 or maybe just citation number 2.

A shit study will go in to the guidelines to be turned in to a picture book and your colleagues will argue with you and show you a picture of the picture book….or worse they will show you a picture of their magical picture book that has the picture books picture in it.

Always follow your local picture book.

This was a stream of consciousnesses that I put out in about 20 minutes one night after working on a presentation about evidence based medicine. This is what happens in my brain with too much caffeine in me and not enough sleep.

I am still considering David Avocado Wolfe’s offer.

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