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Sunday, October 24, 2010

We must all be receptive to change

Opinion is opinion, yet facts are facts. You can debate an opinion, yet you can't debate facts. Opinions may change. Facts never change. That seems simple enough. Right?

A theory is an opinion. A hypothesis is an educated guess. Still, a fact is a fact, and that cannot and will not change.


Opinion: The earth is made of green cheese.

Fact: Upon landing on the moon, Jack Armstrong confirmed the moon was not made of cheese, but of sand and rock just like the earth.

Opinion: Global warming is real.

Fact: The jury is still out, so debate away.

Opinion: Giving epinephrine at a code might help restart the heart

Fact: There is no evidence epinephrine will restart the heart.

Opinion: A high amount of oxygen (say 100%) with positive pressure breaths might instigate a baby to take its first breath.

Fact: After extensive studies on the subject, scientists now believe positive pressure breaths alone will instigate a baby to take its first breath, and oxygen is actually detrimental even to term babies and should not be used.

Opinion: Reverse facing car seats are good for babies, but stupid for a 2-year-old child.

Fact: Study after study has proven that reverse facing car seats are the safest way to secure a child into a car.

Opinion: If you give a COPD retainer who is in no respiratory distress oxygen he will stop breathing. This is called the hypoxic drive theory.

Fact: The hypoxic drive theory as applied by many physicians is a myth, and the evidence proves it.

Opinion: All Conservatives are liars.

Fact: To say all conservatives are liars is a generalization made by some liberals. Some conservatives probably are liars.

Opinion: All liberals are liars

Fact: Once again: a generalization.

Opinion: Conservatives are stupid

Fact: Many conservatives have well thought out opinions based on facts based on their goals for the country. I've had many intelligent discussions with my conservative friends.

Opinion: Liberals are stupid

Fact: Many liberals have well thought out opinions based on facts that support their goals for the country. I've had many intelligent discussions with my liberal friends.

Opinion: The best way to give breaths to a non-breathing neonate is with an AMBU-bag.

Fact: The AMBU-bag has been linked to hyline membrane disease and barotrauma, and the Neopuff is now the recommended mode of ventilation of neonates.

Opinion: Bronchodilators treat pneunonia and pulmonary edema.

Fact: Bronchodilators do not treat inflammation in the alveoli and do not rid the lungs of unwanted fluid caused by a failing heart.

Another term to throw into this discussion is dogma. What is dogma? According to, it's "a settled or established opinion, belief, or principle."

I believe it was Socrates way back in Ancient Greece who was sentenced to death by a trial of his own peers because he dared question members of higher rank in society that they claimed to know what they really did not know.

Yet, from time to time, new evidence comes forward to prove our opinions either right or wrong. Yet we humans have a natural instinct to defend our old views, or the views we simply made up based on feelings. Yet, in fact, we have a natural tendency to be dogmatic.

Science, if scientists do their job, should never be wrong so long as the scientific process is used. A theory is devised and it must be observed as opinion. Yet we all know that some theories are considered fact by many, i.e. global warming, hypoxic drive theory. While others treat a theory as a theory.

Yet, once a person, or an group of people (say, the National Medical Association for example) decides that a theory is indeed a fact (the hypoxic drive theory for example), the view becomes dogmatic and it's nearly impossible (if not completely impossible) to get it's members to change and accept new fact.

I was faced with this problem today. In fact, I'm faced with it every day when doctors order bronchodilator breathing treatments for non bronchospasm disorders. Yet today I was teaching a neonatal resuscitation class, and some doctors winced when I said, "New evidence suggests we not use 100% oxygen anymore. It's hazardous even to newborns."

One doctor said, "Well, at least that's what the book says."

That was his opinion. He could be right, but the evidence is not actually pointing in his favor. Still, if he so chooses, he may give a newborn 100% oxygen. Yet, if he were taking care of MY baby, I certainly wouldn't want him doing so.

Yet since most people are ignorant of medicine, and leave it up to their well respected physician to make the right decision, you can see where dogma might cause a problem. We trust and believe the experts thinking they are doing what is right, or telling us to do what is right and best.

So what if the so called "experts" are wrong?

Some doctors, however, were more than open to this new theory, and have noted they will be more leery with oxygenating babies in the future.

The same happened when I mentioned about the Neopuff. One doctor said, "I'm not using that thing! You can't even tell if you're giving breaths."

"You can use your stethoscope," I said.

"I just feel better bagging," he said.

"Well that's fine," I said. And it is fine. Although, once again, the facts obtained from recent studies don't point in his direction. Still, a study is just a study.

The hypoxic drive theory. Well, I've discussed this recently with our medical director, and there's no budging there. I provided him with article after article, and he stands firm on his dogmatic view.

I also discussed global warming with him. I told him that I am neither a believer nor a disbeliever, as the facts are not all in yet. "After all," I said, "it is just a theory. I certainly wouldn't ignore it. I certainly would want to try to come up with better ways of running cars and heating homes. But I see no point in ruining the economy with regulation after regulation based on a theory."

"Bla bla bla bla!" He got all upset with me. No, actually, he was pretty cool. Yet he was not going to give up his belief that global warming is a fact. It is a fact. Period. No way to talk him out of it. No fact. No opinion. Period.

That's fine. Maybe he's right. Yet that's the kind of view I think is scary, and is the exact reason we have such a partisan divide now in Washington. That's exactly the reason we have some doctors not oxygenating some patients who need oxygen. That's exactly why we have a partisan Obamacare.

It's also why some kid somewhere will develop cancer in about 20 years because he was bagged with 100% oxygen. Yet no one will know he was bagged with 100% oxygen, because that fact will be forgotten, and the medical records destroyed long ago.

All I ask is that people be open minded. We all have our dogmatic views, and we all have our opinions, yet we should all be open to change. We should all do our research, and, as new evidence comes in, we ought to think better and do better.

As a wise person once said: "We do the best we can with the wisdom of today, and as we learn better we do better."

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