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Wednesday, April 5, 2017

We do not do conventional wisdom here at the cave

I love it. In response to my post, "Here is what albuterol does and does not do," just one of the 125,000 plus people who viewed the article as of this writing complained about it. This person wrote the following:
"I'm not impressed. He does make a couple good points but, in looking further at his website, the author is rather smug and also has out-dated ideologies. I would not promote him as a reference.
I love it. I am a respiratory therapist. I have a job. I have to tackle these complicated issues from sort of a humorous angle, otherwise I would not be able to write about them. Keep in mind I have a wife and kids and don't want to lose my job. But at the same time, it's good that we educate each other.

I had one email about the subject. The person wrote:
I am getting some questions after sharing a post of yours. Do you have a citation or explanation why audible (without a stethoscope) wheezes are not brocho-spastic in nature?
My response was simple:
Ask your friends this question: Where is the evidence that a wheeze produced by airways that are 0.5-1 mm in diameter and buried deep inside your chest can be heard without the aid of a stethoscope?
It would be easy if I just went the conventional route and agreed with everything we are taught in respiratory therapy school. I could easily just say, "If it's ordered, it's needed."

Now, I know most people reading this now have been reading my blog long enough to know that I summarily reject conventional wisdom. Whatever it is, I go a different way. Because conventional wisdom does not result from thinking. Whatever it is, I go a different way.

This is because conventional wisdom does not result from critical thinking or analysis. Conventional wisdom is group think and a desire for sameness. Conventional wisdom is something where people who practice it seek comfort, trying to tell themselves things that they really don't know that make themselves feel better about things.

Conventional wisdom has also become a marker or a measurement for intelligence and perceptiveness inside the media, Washington, and even the medical profession. It's been that way for years. In fact, it's been that way since the beginning of civilization.

Here, I will give you one example, although you can just read any of my previous posts and find many more. Since the 1960s doctors have been under oxygenating people with COPD under the guise of the hypoxic drive theory. There has been no science showing that this is true. It was just one man, based on a study of 4 COPD patients, who postulated this theory in a presentation before a group of doctors. The hypoxic drive myth was born.

Save to say that not one study was ever done proving it. In fact, every time a respiratory therapist gives a breathing treatment with oxygen, he is essentially disproving the hypoxic drive theory. Yes, the hypoxic drive exists, but it is not blunted by too much oxygen. If your oxygen goes low enough, it will cause you to breathe. However, it is not blunted if you are a CO2 retainer. That is the myth.

So, then they come back at me. I mean, I know all the arguments. I have heard them all. People feel good about defending conventional wisdom. One argument, a famous one is: "Well, I have seen it. I have seen people with COPD stop breathing because of too much oxygen."

No, you have not. You have seen them stop breathing, or become lethargic, because of V/Q mismatching. They go into respiratory failure because they poop out. It doesn't matter if they are getting 21% or 100% oxygen. Chances it was just a coincidence that a person on oxygen became lethargic, as the logical response to hypoxia is to put a person on oxygen. So it only makes sense they fail after being put on oxygen.

However, the reason they fail has been the subject of perhaps one of the worse myths in respiratory therapy. I often wonder how many people with COPD died because of this myth -- because of intentional hypoxia due to a myth perceived as fact.

Another argument I get is: "Well, a consensus of doctors believe in it." So what. What does a consensus prove anyway? It proves nothing. A consensus is not science. Science means it either is or is not. You can have a consensus believe in global warming, for example, and you do have one. You have 99% of scientists (according to one poll anyway) believe in it. But that does not make it true.

A good way of defining "conventional wisdom" is by watching the crowds. Or, in the case of the medical profession, simply polling the people who take care of the patients. In our case, that's us -- respiratory therapists.  If you poll respiratory therapists, I bet a majority have observed that oxygenating COPD patients doesn't kill them. Sure it may drive up their CO2 somewhat, but it's not due to they hypoxic drive, it's due to the Haldane effect and V/Q mismatching. And I've been over all this before.

If you poll respiratory therapists, you'd learn what the wisdom is. You'd learn that most breathing treatments aren't needed. I'm convinced of this. And if you polled them, you'd find where the wisdom is. It's because most respiratory therapists think the same way. It's because most people are smart. They know what works and what doesn't. 

So, if most respiratory therapists think all of these are myths, then it has to be right. If so many people think the same, it has to be brilliant. 

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