Actually, there was a study that compared the joint problems of joggers and non joggers over decades. Surprisingly, the joggers had fewer problems.

The vast majority of people who don't immunize aren't doing it for religious reasons. There's a growing segment of 'educated' people who have 'researched' the issue and have decided that the risks outweigh the benefits.

Unfortunately there are 'professionals' within the health care system that spout this idiocy, including nurses and chiropractors.

You're misunderstanding me.

The reason children 'get pulled out of homes' in your example is not because the parents are religious, but because the state believes that harm is being done. The focus is on the act (or lack of action) by the parents, not on the fact that the parents are teaching religion to their child.

Dawkins is not advocating against the specific things that can lead to harm, but rather that religion itself is harmful and tantamount to abuse in and of itself. That is unreasonable.

I think a non religious environment can be potentially abusive too. So what?
OK, why?

I suspect you think I am saying that a non religious environment is conducive to abuse (compared to a religious one). I am not. I think any environment has a potential for abuse and the religion aspect is a non issue.

It's fine to look at a *specific* act or ideology and debate its merits. He is not. He is not saying 'potentially abusive', or 'more likely to be abusive'. He is saying that teaching a religious doctrine is child abuse. That is just not reasonable.

Saying that some religious teachings or philosophies are bad is no different than saying that some non religious philosophies are bad

I think a non religious environment can be potentially abusive too. So what?

There are plenty of non religious people who perpetrate atrocities. Would it be reasonable to paint Pol Pot or Stalin as model atheists?

And I quote,

"How did September the 11th change you? Well here's how it changed me. Let's all stopped being so damned respectful."

This is from the atheist's call to arms from Tedtalks 2002.

Now who's lying to promote their own agenda?

You honestly believe that religious people are all abusing their children? You think that concept is 'reasonable'? It's staggering that you got modded up.

I'm not saying that fundamentalists weren't responsible for the twin towers. I'm saying that painting them as representatives for all religion is offensive. But that is his intent after all...

He's said that people who teach their kids religion are child abusers.

He ends one of his lectures by saying how religious fundamentalists crashed into the twin towers, and therefore it's time to stop being so respectful of religion.

Those are pretty offensive comments to me...

Actually in many of his lectures he implies that religious people are less intelligent. He delights in in the studies that have shown this kind of correlation.

I mispelled it. It's actually Ovol.

I wish it were nonsense. There was a US case about a patient who had an acute spinal cord injury. There is a controversy about whether or not to give steroids in these cases to reduce swelling and decrease subsequent injury. So far the consensus is that it doesn't help. The ER attending physician therefore did not give steroids. The patient had a bad outcome. The ER attending was found guilty (not sure what the correct term is) because the prosecution found an expert witness who said that it might have helped.

The difficulty is in defining reasonable. It seems that some lawyers are very good at skewing this definition.

Most physicians practice 'defensive medicine'. That means they do things that are medically unnecessary, solely to protect themselves from frivolous lawsuits. Good medicine alone unfortunately won't protect you from malicious (or vulnerable and wounded) people, looking for someone to blame.

I can tell you a number of cases where the physician was found guilty and they did nothing wrong. The jury just didn't like how things turned out for the patient.

(Big fan of yours by the way!)

I'm comparing US emergency medicine guidelines with Canadian emergency guidelines. A lot of the US based CME will even directly admit in their lectures that their recommendation is based more on protecting against potential litigation.

I'm not criticizing defensive medicine either. 98% of my charting is done solely to protect myself in case of a law suit. Very little of it is clinically helpful.

I practice mostly in primary care, but I do ER work as well. Most of my EM CME is US based. My comment is not intended as a slam at all, just a realization that we practice medicine in different environments.

(and thanks to my EM training I picked up two subtle acute coronary syndromes recently that my partners missed. Direct admit from clinic to the ICU baby! Sometimes it pays to be aggressive)

I was referring specifically to acute (new onset) back pain. I'm not advocating never investigating back pain.

I think that medicine and physiology is still in its infancy relatively speaking. When I get someone in your situation, I tell them that the tests look normal. That it's good news because it rules out a lot of bad things, but it still doesn't explain the problem. There is a vast range of human experience that we just don't understand or have a good solution for.

There's no good answer to this. There aren't really EBM vs non EBM schools of medicine. The difference is the amount of time you spend keeping up, and how willing you are to change your practice. Newer docs tend to be more up to date than the older ones. EBM is very new phenomenon.

The other problems is that evidence is very often in the eye of the beholder. Many physicians lack the time and ability to evaluate evidence for themselves. They rely on drug reps (shudder) to get their 'evidence'.

Good evidence in medicine is hard to find. Once something is standard of care, it's hard to test it because ethically you can't not offer someone effective treatment to compare. The best studies are placebo controlled, double blind, randomized, controlled trials which are extremely expensive and often sponsored/biased by Big Pharma. Often there are even contradictory studies. A lot of the newest clinical care guidelines boil down to expert opinion.

I guess I do sometimes prescribe and perform treatments that have little evidence behind them. The problem is that the placebo effect is not necessarily statistically significant. Is it worth taking the gravol to have one less barf over the course of the illness? Maybe...

It's hard for me to recommend anything that has potential to harm, unless I firmly believe that the benefits outweigh the harms. That's the crux of the issue for me.

Many people I see take a number of medications, prescription and non that I may not even know about. There are potential dangerous interactions there that I don't/can't/won't know about. Even non dangerous side effects can be problematic. There is also the fact that medications cost money. I don't want people to waste their money on a treatment that is no better than placebo.

I do prescribe things that are of nebulous benefit, when people are desperate to try something, or to cling to their experience that it works.

It's just not my style to prescribe unnecessarily (in my opinion). If you see me for your cold. I will tell you to rest, take some advil or tylenol, suggest a decongestant and give you a note for work if you need it. If you see my partner, you will get a prescription for cough syrup (most do nothing), painkillers and decongestants. He also has a very low threshold for prescribing antibiotics. The net result is that his patients are extremely satisfied and his visits are quicker. My patients leave somewhat disappointed, often come back (I'm STILL sick!!!) and I have to spend a lot more time educating my patients. The patient populations self select over time and the pill poppers go to him, and the pill averse come to me.

I have considered it. I also consider the fact that every medicine I prescribe carries risks, even if those risks are low. If I don't know whether the risk outweigh the benefits, I don't prescribe, particularly for 'nuisance' illnesses.

I know many physicians who prescribe placebo treatments and tests. I have trouble doing this even though patients find it very satisfying. What I sometimes do instead is tell people what the evidence is and let them decide. I struggle with the ethics of prescribing a placebo.