Sunday, August 26, 2007


It's racism! would be the Sharpton/Jackson explanation. Not really, says the study below. It turns out that blacks are only a tiny bit nore likely to have heart attacks than are whites of the same age but that blacks are much less likely to survive after the attack. "Demographic factors" (coming from rough areas where cocaine use is more prevalent?) and "prior functional status" (general poor health due to lifestyle?) were among the reasons why but the main reason is that black heart attacks are different to start with: "lower prevalence of ventricular fibrillation as the initial cardiac rhythm". Sadly for Sharpton/Jackson, inferior medical attention was not a factor

Explaining Racial Disparities in Incidence of and Survival from Out-of-Hospital Cardiac Arrest

By: S Galea et al.


A prospective observational study of 4,653 consecutive cases of out-of-hospital cardiac arrest (OOHCA) occurring in New York City from April 1, 2002, to March 31, 2003, was used to assess racial/ethnic differences in the incidence of OOHCA and 30-day survival after hospital discharge among OOHCA patients. The age-adjusted incidence of OOHCA per 10,000 adults was higher among Blacks than among persons in other racial/ethnic groups, and age-adjusted survival from OOHCA was higher among Whites compared with other groups.

In analyses restricted to 3,891 patients for whom complete data on all variables were available, the age-adjusted relative odds of survival from OOHCA among Blacks were 0.4 (95% confidence interval: 0.2, 0.7) as compared with Whites. A full multivariable model accounting for demographic factors, prior functional status, initial cardiac rhythm, and characteristics of the OOHCA event explained approximately 41 percent of the lower age-adjusted survival among Blacks. The lower prevalence of ventricular fibrillation as the initial cardiac rhythm among Blacks relative to Whites was the primary contributor. A combination of factors probably accounts for racial/ethnic disparities in OOHCA survival. Previously hypothesized factors such as delays in emergency medical service response or differences in the likelihood of receipt of cardiopulmonary resuscitation did not appear to be substantial contributors to these racial/ethnic disparities.

American Journal of Epidemiology 2007 166(5):534-543

Romancing Opiates

Post below lifted from Noodlefood. See the original for links

I just began reading Theodore Dalrymple's recent book Romancing Opiates. So far, it's excellent. Most surprising is the fact that -- contrary to all popular belief, fictional portrayals, and media reports -- the symptoms of physical withdrawal from heroin are extremely mild. The addict is not in any danger of dying whatsoever, as with serious alcohol withdrawal. He's not even in any real physical distress.

The distress that addicts do feel is based solely on their beliefs about the withdrawal of the drug: it's purely psychological. Studies have shown that addicts aren't able to tell whether they've been given morphine or placebo, such that symptoms like nervousness and restlessness came and went based on what they were told about the contents of their injection (28).

However, addicts are extremely adept at faking such distress in the hopes of wheedling a prescription from the often-gullible doctor. Most doctors accept the standard view that withdrawal from opiates is a terrible ordeal, despite substantial evidence to the contrary, such as the addicts displaying no great signs of distress when secretly watched by the doctor. So the doctors routinely prescribe the addict drugs like methadone.

In contrast, when the addict is confronted with a doctor like Dalrymple, who refuses such prescriptions and clearly explains his reasons why, some will not only cease their performance of distress, but even "smile and admit with a laugh that anyone who says that cold turkey is a terrible ordeal is lying and more than likely trying to bluff his way to a prescription" (25). Once that is done, other addicts in the ward don't even bother with the attempted deception.

In recent years, doctors have tried to alleviate the non-existent horror of opiate withdrawal by "ultra-short opiate detoxification." (If I recall correctly, this method was featured on House.) Basically, the addict is administered "an opiate antagonist, naloxone, under general anesthesia, followed by continued administration of naloxone for a further forty-eight hours. This [method] ... turns a trivial medical condition, namely 'natural' withdrawal from opiates, into a potentially fatal one, since quite a number of deaths are known to have occurred as a result of it, some clinics that use it having recorded as many as ten deaths" (29). Yikes!

The failure to consider the obvious implications of perceptual observations can have serious consequences in any area of life. In this case, that failure on the part of those in the business of addiction treatment means that a voluntary psychological dysfunction is treated with ineffective, counterproductive, and even life-threatening methods. Lovely, no?


Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.


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