Misconceptions about oxygen by alternative medicine practitioners

An article called “Simple ‘4-7-8? breathing trick can induce sleep in 60 seconds” claims that this trick can get you to go to sleep within 60 seconds. All you have to do is the following:

? Exhale completely through your mouth, making a whoosh sound.
? Close your mouth and inhale quietly through your nose to a mental count of four.
? Hold your breath for a count of seven.
? Exhale completely through your mouth, making a whoosh sound to a count of eight.
? This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths

An integrative medicine expert, Dr. Andrew Weil, said it works because it allows the lungs to become fully charged with air, allowing more oxygen into the body, which promotes a state of calm.

“Promotes a state of calm” is nonsense. Let’s concentrate on the science. Does it allow more oxygen into the body? Ich dont think so.

The air we breathe contains about 21% oxygen. Nearly all oxygen in the blood is carried by hemoglobin. No matter how many deep breaths you take, you cannot get the oxygen saturation of hemoglobin (normally > 92%, closer to 98% in healthy people) above 100%. This is explained in more detail in a previous post of mine about why athletes don’t benefit from breathing pure oxygen after exertion.

This simple trick would be hard to remember but might work through the power of suggestion. It doesn’t cost anything, and unless you hyperventilate and pass out (but youll be in bed anyway), it is harmless.

The next misconception about oxygen is neither inexpensive nor harmless.

Two naturopathic “doctors” have been accused of injecting a woman with oxygen or perhaps purified water that had been taken from an Octozone machine. The oxygen was supposed to destroy any pathogens in the woman’s blood. In the process of trying to kill the pathogens, the injection killed the patient who paid $500 for the treatment.

The naturopathic duo left town and were at large for several months before eventually being caught and charged with homicide.

An autopsy found her death was due to an air embolism.

According to a recent review of the subject, “Traditionally, it has been estimated that more than 5 mL/kg of air displaced into the intravenous space is required for significant injury (shock or cardiac arrest) to occur. However, complications have been reported with as little as 20 mL of air (the length of an unprimed IV infusion tubing) that was injected intravenously.”

Pure water should never be injected IV either because it causes blood cells to die from hemolysis.

How about we just take our oxygen the old-fashioned way—normal breaths and never intravenously?

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Variation is not causation

I made a rookie mistake in statistics of the “correlation is causation” genre by confusing variation for causation in the recent JAMA Surgery paper referred to in my last post. I contacted Dr. Timothy M. Pawlik, the lead author of the Johns Hopkins study, who said the following:

"The model is explaining and attributing variation in readmission and not attributing readmission itself to the different domains. The model suggested that only 2.8% of the variation in readmissions was attributable to surgeons. This is different than saying that only 2.8% were the fault of surgeons. A more accurate interpretation would be that only 2.8% of the variation seen in readmissions was attributable to provider level factors. The majority of the variation in readmission was due to patient factors."

He added that some of the 82.8% variation in readmissions attributable (note: attributable doesn’t mean it’s the patient’s fault) to the patient could be modified by better medically managing patients comorbidities or not operating on some of these patients.

That readmissions can be explained by a single domain or a single person is simplistic. Dr. Pawliks clarification confirms my original concern that attributing differences in patient outcomes solely to differences in technical quality of surgeons is probably inaccurate, statistically speaking.

Variation is not causation but variation is still a call to action. Regardless of who is to blame for unfavorable outcomes, surgery is a team sport. The incision is just as important as the community care. In this regard, I am certain that ProPublica and I are on the same side. Let’s work together so that we see the whole story behind the numbers.

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Appendicitis and shared decision making

Staying with the current theme of appendicitis on my blog, here is a summary of recent developments. A JAMA Surgery Viewpoint suggested that because of the findings of a Finnish randomized trial, surgeons now should give patients with appendicitis a choice between an appendectomy or treatment with antibiotics.

The paper acknowledged my criticisms of the Finnish study which found that simple appendicitis could be treated successfully with antibiotics in almost 75% of patients.

I respect the authors of the JAMA Surgery article and am happy they referenced the blog post noting my concerns about that Finnish trial: the trial compared antibiotics to open appendectomy—an operation with more complications than the more commonly performed laparoscopic appendectomy; the antibiotic used in the Finnish trial is not a first line choice in the United States; patients were followed for only one year.

The JAMA surgery paper answered three questions I posed in a previous post. One, the Viewpoint authors consider antibiotic therapy for appendicitis mainstream. Two, surgeons must assume that patients might opt for antibiotics despite at least a 25-30% chance of suffering a recurrence of appendicitis. Three, an informed consent discussion now should include a mention of antibiotics as an option.

I disagree with the Viewpoint authors’ assertion that antibiotics are as safe and effective as surgery for treating appendicitis. Based on one flawed study, antibiotic therapy cannot yet compare to the many years of excellent results of laparoscopic appendectomy.

Here are some other problems.

Let’s talk about shared decision-making. After hearing all the options, some patients will want to guide their own care. However, most patients would rather not. A 2011 Journal of Medical Ethics study of over 8000 patients found that 97% “of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor.”

What about the medicolegal implications of antibiotic therapy for appendicitis? Right now, the “standard of care” for appendicitis is appendectomy. Suppose a surgeon, in the interest of shared decision-making, explains the Finnish study to a patient and neglects to mention that it only involved patients with simple appendicitis. Or suppose that patient’s CT scan is read as simple appendicitis but is not accurate, and the patient actually had complicated appendicitis that went on to perforate despite antibiotic therapy.

If that patient becomes septic and requires a laparotomy and suffers a subsequent wound infection and massive hernia or dies, who is going to be held responsible for not recommending an appendectomy? Certainly not the patient.

In the era of shared decision-making and patient autonomy, maybe patients should be required to carry malpractice insurance so they can sue themselves if the decisions they make turn out badly.

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Medicine like air travel once was fun

A Wall Street Journal blog about a reunion of employees of American Airlines lamented the good old days of air travel. Heres an excerpt:

"They came together to celebrate the days when flight attendants in white gloves hustled to serve you, gate agents doled out upgrades and arranged seating so families could be together, and managers worked flights with the single mission of ensuring excellent customer service."

The employees told tales of the fun they had and the camaraderie they shared. The passengers had fun too.

One retiree said of todays airline employees, "They dont look like they are having any fun at all."

Certainly the same can be said of todays passengers.

Im usually not a fan of the airline-medicine analogy, but Im going to make an exception here.

Back in the day, those of us in medicine had fun too. Dont get me wrong. It wasnt at the expense of the patients.

We always approached our patients with a proper attitude of respect. But it was OK to enjoy those encounters and also the fellowship of colleagues. We helped each other out, and we did it with spirit and camaraderie.

Not anymore.

All we read about now is how doctors are burned out, stressed, depressed. We battle with electronic records, hospital administrators, clipboard carriers, third-party payers, the government and just about everyone else.

What happened to the fun? Its all about the money.

David Shaywitz in Forbes: "The view from the front lines suggests that hospitals and care delivery systems are obsessing like never before on doing whatever they possibly can to maximize their revenue. They are consumed, utterly consumed, by this objective."

He added: "Many (I’d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago. Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative “quality” metrics that rarely capture the complexity, or essence, of the patient experience."

I believe what Shaywitz said is true. Can anything be done or is it hopeless?

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Problem with my blog I need your help

I have a big problem.

For the last 10 days, Twitter has been blocking me from tweeting any links to my blog.

This is the message I get whenever I try to send a tweet with "skepticalscalpel.blogspot.com" in it.

I have tried to contact Twitter through @twitter and @support four times and have received no reply, nor have they replied to numerous ticket requests through the Twitter Help Center.

I discovered a site called virustotal.com which compiles reports from 63 different programs that detect viruses, worms, trojans, and malware.

Originally a site called BitDefender claimed my site was malicious. The next day, BitDefender declared my site was clean, but AutoShun, which previously had no problem with my site, said it was malicious. The following day, AutoShun said my site was unrated and Clean MX said "malicious." But the day after, AutoShun went back to calling it malicious and Clean MX said my blog was clean. At no time, did more than one of the 63 detection programs identify my blogsite is being malicious.

You would think that if my blog contained any suspicious programs, more than one of the 63 virus detection organizations would have come up with a positive result on the same day.

None of the programs saying my blog was malicious gave me any clue as to what part of my site was supposedly creating the problem.

I attempted to get some help from Blogger, which hosts my blog. Although one person on a forum responded with some advice, it wasnt enough for me to solve the problem.

My blog is averaging 1600 page views per day. Not one person has contacted me to complain that I am harboring viruses or any other malicious software. That is because, to the best of my knowledge, no such malicious software exists on my blog.

Maybe it would help if you would go to the results section of the virustotal website and cast your vote in favor of my site as not being malicious. In the upper right-hand corner of the site you will see this cartoon.



 Please click on the green face to support my blog.

Meanwhile, I have discovered an interesting workaround which enables me to tweet links to my blog, but visitors to the site will still be blocked by Twitter from tweeting links.

If you consider yourself computer-savvy, maybe you can figure out how I did it. If you think you know the answer, please submit a comment.

I also would welcome any comments or suggestions that could help to resolve my problem. If anyone knows a way to contact a human at Twitter, please let me know.

Thanks.

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