I’ve been asked to put up a page for questions pertinent to the site, but not directly related to any of the posts. This is it. I’ll try to answer questions that I have sufficient knowledge to hazard a response.
I’ve been asked to put up a page for questions pertinent to the site, but not directly related to any of the posts. This is it. I’ll try to answer questions that I have sufficient knowledge to hazard a response.
Osmotic Says:
July 26, 2009 at 2:51 pm
If you infuse Mannitol to a young healthy man(let’s say 26 years old at a dose sufficient enough to cause osmotic diuresis), what happens in the thin descending and ascending loop of Henle, what would be the osmolarity in the inner medullary interstitium, what happens to the 2Na+Cl-KATPase in the T.A.L, what happens to urea reabsortion in the medullary collecting duct and lastly, what happens to ADH levels in the serum.
Mannitol in amounts great enough to cause osmotic diuresis will cause blood hyperosmolality resulting in increased ADH release. If the osmotic diuresis lasts long enough the medullary concentration gradient will be washed out. Urea reabsorption in the medullary collecting duct is passive; it’s secondary to the hyperosmolality in the medulla and to the impermeability of the ascending limb and cortical collecting tubule to urea. Thus it would also be decreased. The activity of the 1Na-1K-2Cl transporter (which is what I assume was meant above) is dependent on active Na transport mediated by the Na-K-ATPase in the thick ascending limb. The former is on the apical membrane the latter on the basolateral. Activity at this nephron site is mainly mediated by Na delivery.
Thank you for the answer and for adding the questions section. ADH (which should be high in this case) will have an effect in the principal cells (by increasing the aquaporins in the luminal side of the cell), however ADH also increases the activity of 1Na-1K-2Cl, and increases urea permeability in the inner medullary collecting ducts. With your explanation it makes me think that the ADH effects in this hypotetical case is offset by the mechanisms that you described and that the effects of the ADH are modest to contribute to increase urea reabsortion as well as the effects on 1Na-1K-2Cl.
What measures should be adopted for a better healthcare plan in the US?
What do you think about Obama’s view on fixing this problem?
First ask why healthcare need reforming. The answer is that it costs too much. Then ask why it’s so expensive. It’s because there is no competition in medical care and because the payment is separated from the service. President Obama’s plan will do nothing to contain costs rather it will increase them. If we get a single payer system healthcare will be rationed by delay as it is in Canada and the UK.
Compare medical care to computers. Both rely on sophisticated new technology, yet medical care gets more expensive every year while computers get cheaper. Read my earlier posts on this subject to see more on this subject.
I love this idea of questions we all can read.
Do you know of any problems with genetically engineered foods?? Do they break down any differently. When I hear of corn resistant to herbicides it makes me wonder.
Just got back home – hence the delayed response. As far as I know there are no health problems associated with genetically modified foods.
NK
I got overwhelmed trying to learn about Medium-chain triglycerides. Am lost between hype and research minutia.
I wondered if you had any conclusions about them.
Operafilly
If you’re concerned about using medium chain triglycerides like coconut oil as an aid in weight loss you’re not likely to have any real success. Even if consuming them promotes weight loss (a big if), they’d have to constitute such a large fraction of total caloric intake that your diet would drive you mad. If I haven’t answered your concern please rephrase the question.
My main interest was more energy……
If your diet is nutritionally adequate there’s no variation that will increase energy or vigor. If one suffers from lethargy another cause other than diet should be sought.
A (unfortunately rare for decades) good night’s sleep has me bursting with energy. But some people seem to do great on just 4 hours……..So I wondered if I was missing something else……
My husband could get his 4 hours falling asleep in the bathtub (an English thing) then trudge thru the Namib Desert on foot and he walked very fast. Also lots of Cuban cigars and Barcardi 151. What a constitution…….He had the capacity to fall asleep just about anywhere. Do I envy that!!
Was there a Dr. Conquest with a manual of operations to produce comprachicos?? Or did Victor Hugo make it up? It even makes perverted sense when you think of cartoons with their distorted beings, today’s version of comprachicos. Then I wondered if Rigoletto was a comprachico.. That these were produced for the use and amusement of the aristocracy made more and more sense the more I thought about it. They hadn’t much else in the way of entertainment. And excess money seems sometimes to crave absurdities.
Hugo made it up.
Is it usual to give aids medication to rape victims?? I just heard of an insurance company denying coverage for that. They said to wait 3 years. Is this medication so expensive?? Perhaps much cheaper in Mexico or Canada?? Would appreciate your comments.
I am not the right person to answer this question, but I can pose the additional questions that must be asked before yours can answered. First, I assume the rapist is not in custody. If he were he could be tested for sexually transmitted diseases and then the answer to you question would be obvious. Absent this information we’d have to know the likelihood of contracting HIV from a single exposure to an unknown sexual assailant. Then we’d have to know the risk-benefit ratio, ie what’s the incidence of side effects. Many women who were never going to an HIV infection would get side effects from treatment they didn’t need if we treated every rape victim with HIV prophylaxis. And we also have to take the victim’s wishes into account assuming she was properly informed of the risks vs the side effects. One must decide how many patients it’s reasonable to treat to prevent one case of HIV – a hundred, a thousand, a million? At some point you have to decide treatment is worse than observation.
So your question is not an easy one. An infectious disease specialist with good knowledge of epidemiology is a better source than I.
As usual you cover every angle of an issue. And even with studies it would still be a guess whether the person’s own immunity or the drugs prevented infection??
Is there any point in maintaining ‘long term care’ insurance when one becomes eligible for Medicare?? While I have some small understanding of car insurance, medical insurance is a mystery to me……like trying to nail jello……..
Medicare doesn’t cover long term care, ie nursing home care. If you have long term care insurance and you bought it when you were young it might make sense to keep it as your monthly premium may not be very high. Obviously, buying it when you reach Medicare eligibility will carry a higher premium. Also, the average survival of people who enter a nursing home is about two years. If you have sufficient resources it might be a better financial decision to pay the cost of long term care yourself reasoning that you likely won’t have to do it for long, but there’s always an outlier. People forget that the purpose of insurance is not to give you more than you pay in, but to smooth out payments so you don’t get hit with a sudden and very big bill. To see the government’s take on this click the link below.
http://www.medicare.gov/longTermCare/static/home.asp
Is it possible for vaccines (or additives to them) to produce sterility?? I heard the WHO uses vaccines for population control in South America, sub Sahara Africa, and the Phillipines. That Phillipines doctors were suspicious of a 5 shot series for tetanus from the WHO that produced sterility in millions of Phillipine women. Apparently the shots weren’t given to the men, another red flag.
Is this all BS? If not, why isn’t it available as an alternative to tubal ligations.
Operafilly
I have no direct information about this subject. A quick check showed no reliable medical site that suggested that common vaccines cause sterility.
From my myopic view prescription drugs seem vastly overused, often with dire consequences far worse than the problem they were supposed to help. I’d like your opinion.
Prescription drugs are overused as is much of medical care of any kind. Some wag, I can’t remember who, said that the desire to take medicine distinguishes man from the other species.
HCTZ is not longer of benefit when eGFR is <35, but Lasix still useful even in ESRD patients. The reason why the former is useless comes from the hypothesis that the reduction of number of working nephrons, and therefore less NaCl cotransporters available. The question is…. isn't that hypothesis should affect the same wat Lasix by having less Na-K 2Cl
Let me know if my question is clear and understandable
Actually, thiazide diuretics do work in patients with renal failure if the conditions are right. The reason they usually don’t work is that relatively little Na is reabsorbed at the thiazide sensitive portion of the nephron. In patients with chronic renal failure the fractional Na excretion is quite high so that any effect of thiazides is swamped. See the paper below for a demonstration how thiazides can work in renal failure and for a good discussion of the whole topic.
Coadministration of thiazides increases the efficacy of ioop diuretics even in patients with advanced renal failure
Excellent article
ESRD is an administrative term, now almost used as a quasi-scientific one… How did someone decided that a CrCl <15 qualifies for renal replacement therapy and not <13, or 12? How did they came up with this number?
15 ml/min (corrected for body surface area) is used as an indication for chronic dialysis in the absence of other signs or symptoms of renal failure (ie, uremia). The thinking is that below this level the likelihood of serious and life threatening events exponentially increases. Dialysis is commonly started above this value when clinically indicated. The number is arbitrary, 14 or 16 would work just as well.
Why isn’t micropuncture not longer utilized nowadays? Did it offer all what it had to?
There still questions that can be answered by micropuncture, just like there’s still good music to be written in C major. There’s just not much interest in the technique now because young investigators are more focused on molecular biology. Eventually everything will get sorted out.
Do you have 3 good questions, that you think micropuncture could give an answer that is not currently known?
I’d have to think about that for a while.
Do lasix alone (without any associated process going on) can cause hyponatremia? I heard a nephrologist saying so, and I thought he is wrong (unlike HCTZ that can)
Yes. All that’s required for hyponatremia to follow furosemide therapy is a relatively increased intake of solute free water.
In such situation, how can you blame Furosemide as the factor causing hyponatremia, in a patient with multiple comorbidities (not how can you not, but how can you?)
Appreciate the time you are taking answering this questions
Briefly, furosemide causes hyponatremia by decreasing free water excretion. The sequence of events is this: the salt and water loss induced by furosemide causes volume contraction. The contracted volume increases proximal tubular salt and water reabsorption (furosemide works in the thick ascending loop). Volume contraction stimulates release of antidiuretic hormone, which increases water absorption in the collecting tubule. The combination of increased proximal reabsorption and increased distal water reabsorption decreases the amount of water that can be excreted, ie dilutional capacity is reduced. If the patient’s water intake exceeds this reduced capacity hyponatremia results. This sequences of events also explains most cases of hyponatremia due to other clinical states.
I read your concise and good answer the same day that you published it, thank you. I have another question:
Some (is not the norm) clinical books (ICU) mention that 0.9 % saline can cause metabolic acidosis (hyperchloremic), and yes, I am aware of the mEq of this solution (chloride and Na) in relation to that from the serum (the former being 154 and higher).
What I have not seen clearly in any book is how hyperchloremia causes acidosis, I have been seeking to a good explanation at a tubular level
Thank you
I assume you are referring to “dilutional” metabolic acidosis. It’s a myth; it doesn’t happen. Two phenomena forbid it. The first is that the volume of distribution of bicarbonate in health is about equal to that of water. Thus changes in serum sodium, either up or down, have little effect of serum bicarbonate. Second is that the kidney excretes salt and water such that normal concentrations of electrolytes are maintained. If the kidney is asleep or dead injudicious administration of normal saline may result in hypernatremia and hyperchorlemia, but the patient will succumb to fluid overload before significant dilution of bicarbonate occurs. Hyperchloremia per se has no effect on acid-base status. It is often the result of acid-base perturbations, but not the cause.
Is “electromagnetic hypersensitivity” considered a legitimate diagnosis? I just heard it used to trigger a legal suit, forcing the neighbor to give up cell phones, wiring, etc., etc. Maybe if you spin this guy he points south, not north?? Of course, he was a medical student who couldn’t finish because of this malady……
The best evidence currently available fails to show any deleterious effects of exposure to the amount of electro-magnetic radiation encountered by the usual proximity to power lines or cell phones.
But definitely, HCTZ looses its antihypertensive effects (the paper did not show any effect in BP reduction). Therefore, the usefulness of HCTZ when GFR<35 seems to happen with coadminstration of a loop diuretic for natriuresis and can be useful in hypervolemic states like CHF exhacerbation.
Anyone have favorite operatic doctors???? Mine is Dulcamara..such a delightful character, and such wonderful patter music!!
What kind of camera do you use? any recommendations for a 500 – 600 budget? (nature, insects, small details)
Happy TGD
I use a Canon 40D SLR. For situations where it is not practical to take a SLR and several lenses with me I use a Canon S90. I always shoot in raw which allows greater flexibility after the shot has been taken. If you want a SLR, which is a must for serious photography, I’d go with this: http://www.amazon.com/Canon-T2i-Digital-3-0-Inch-18-55mm/dp/B0035FZJHQ/ref=sr_1_4?s=photo&ie=UTF8&qid=1290744303&sr=1-4
It’s a little above your price range, but a real bargain in terms of performance for the buck.
Thanks. What do you think about this one: http://www.amazon.com/s/?ie=UTF8&keywords=nikon+d3100&tag=googhydr-20&index=aps&hvadid=6344615471&ref=pd_sl_88ipljqsvk_e
Is the Nikon 3100
No comparison between your recommendation and the Nikon d3100. Nikon d3100 does not have a microphone jack, less megapixels, no bracketing options, etc. Thank you for your good suggestion.
Is there a book (photography) for a beginner that you would recommend to read (I am looking for something simple and easy too understand and advance from there, consider that my knowledge is very limited in the art of photography)
I would subscribe to Popular Photography. Over the course of a year or so they’ll cover just about anything you’d be interested in. They’re geared to photographers at all levels. Don’t worry at first about the more advanced articles – skip them for now. But they have a lot geared to beginners.
I’m an eastern european physician, not very familiar with the american reimbursement to doctors, and confusing at times to me, since in some countries private medicine works (apparently) different. In the US, seems that physicians have little control on what they receive for a service, depending on third parties and needing to hire people to collect their money (which do not make sense to me if you work in the private sector).
I read what is below and caught my attention, and I would like a simple explanation of the consequences and real meaning to a person that understands little of this:
On December 9, the U.S. House of Representatives passed H.R. 4994, thus averting a 25% Medicare reimbursement reduction scheduled for January 1, 2011, and providing twelve month’s worth of relief from Medicare payment cuts. The Senate passed the bill by unanimous voice vote on December 8. President Obama, who previously urged Congress to pass the legislation, is expected to sign the bill immediately, and he urged Congress to provide a long-term solution to the problem in the coming year.
Thank you for sharing your knowledge to the public
Lazlo
There is no simple explanation for the American system of payment for medical care. Half of it is paid by the government through a series of programs the most prominent of which are Medicare and Medicaid. About half is paid for by private insurance. The numbers add up to more than 100% because many people are covered by both Medicare and private insurance. The large number of people without insurance includes non-citizens, those who move in and out of insurance pools, and the chronically uninsured. The last group still get medical care; it’s provided by public hospitals and clinics and by teaching hospitals and clinics. There is no competition in this system because rates are set by the government and by insurance companies. Private providers spend billions of dollars figuring how to get the most out of the system which becomes more costly every year.
Give up trying to understand all this. I’ve thought about every day for 40 years and still don’t understand it.
From the physiologic point of view, what do you think about this?
http://www.asn-online.org/press/files/ASNPositionStatementofUSDietaryGuidelines.pdf
This is an important issue. I’ll respond with a full post on the home page.
Have you seen a case of gentamycin nephrotoxicity that lead to the need of hemodialysis? I am trying to find case report on this, but all what i found is reversible acute kidney injury, hypomagnesemia, hypokalemia, etc.
Yours is a hard question to answer. Patients who get acute renal failure after receiving gentamicin often have other causes of renal injury; so it’s not always easy to isolate the culprit. Patients who get ARF that is due solely to the antibiotic typically get non-oliguric (or high output) renal failure and thus usually don’t need dialysis. Without looking at patient records, I can’t think of a case that did.
I would like to know your opinion about the american education. Below is an interesting article
http://blogs.independent.co.uk/2011/05/04/from-america-with-caution-avoid-our-higher-education-mistakes/
I didn’t think much of the article. When somebody concludes “Don’t let the American philosophy of valuing money above all else get to you, too” they generally want to spend more of someone else’s money on something they think is a public good. The writer seems to understand very little about how American education is actually funded. The reason it’s so expensive is not because of market forces, but rather because the government has distorted the education market through subsidized student loans. Absent this subsidy a college education would be much cheaper. Higher education is the only sector of the American economy which has inflated its costs at the same rate as medical care. This author also doesn’t mention public colleges which are much cheaper than their private counterparts.
We also have too many colleges and universities; many, if not most, are second rate or worse. They “educate” students who are in no real need of higher education save as a ticket of admission to a job or profession. For example, there no reason for a medical student to go to college prior to medical school. Studying Shakespeare or Verdi doesn’t make you a better surgeon. In fact there’s no reason to pursue a liberal education other than a desire to do so. All arguments in support of such an educational experience based on utility fail.
I realize that our system will continue until we run out of money (which is likely not far off) when it will collapse under its bloated weight. Even our best colleges seem to teach their students very little. It is, however, a nice way to spend four years. As far as the Brits go, if they think a college education is valuable it’s valuable mainly (or exclusively) to those who receive it; they should stop whining and pay for it as should their American equivalents.
I have always been convinced that those 4 college years are just a waste of time and money. In most countries you pick your professional career after highschool, and go directly to law school, medical school, etc, without majors and minors in between. In most parts of the world (Europe, Americas, Asia), if you go to a good high school, you should have a solid foundation in grammar, math, chemistry, physics, and this assignments or modules are not part of the curriculum in a university, unless is related to the profession that you choose, whereas here, a significant portion of these assignments are taught in college. At what point in the american history it was decided that having college to become a physician or lawyer, was better than just without it?
“In most parts of the world (Europe, Americas, Asia), if you go to a good high school, you should have a solid foundation in grammar, math, chemistry, physics,”
My ‘high school’ had excessive jocks “teaching” these subjects they knew nothing about. My history and math classes were nothing but sports. I was lucky to find a self teaching algebra manual put out by the US Navy. It was fantastic, no need of a teacher at all!!!I
If i am right, back in the 90’s it was considered that hgb targets >13 gr/dl may be beneficial, then it was changed to 10-12, now it is just recommended to be given if <10 gr/dl.
Too many things to analyze from these changes in opinion.
http://www.nytimes.com/2011/06/25/health/policy/25drug.html?_r=1&partner=rss&emc=rss
I haven’t seen the data on which the FDA based its new recommendations. I would like to get a chance to closely examine it to see how soundly based the advisory is.
Once I remember telling you that medical journals are full of editors that do not review well what it is published (and that there is a’lot of benevolence if the author is “well known”) or that a’lot of them may have some financial reward, I remember you telling me that you doubt that this could happen in most journals. EPO is an example for this. Ajay Singh, the guy in Harvard has a’lot of publications on ESA, he also creates guidelines for KDOQI on this regard. His publictions are full of conflict of interests. Please read what it is below, it is also interesting good Dr Kurtzman:
Spine Journal Takes Aim at Infuse Research
Doctors who received millions of dollars from Medtronic systematically failed to reveal serious complications linked to the company’s lucrative back surgery product, Infuse, in 13 papers they co-authored for medical journals over the course of nearly a decade, according to a scathing new review.
The analysis is part of an unprecedented event in medicine: The entire issue of a medical journal devoted to a scientific and financial expose of a product, the practices of the company that markets it, and the financially conflicted doctors who tested and promoted it.
Blame also is heaped on the lax oversight of the Food and Drug Administration and failures by editors and reviewers of medical journals.
The main analysis, which was led by editors of the Spine Journal, found a systematic failure to report serious complications with Infuse, bone morphogenetic protein-2 or BMP-2, which is used in spinal fusion surgery. The researchers found complication rates that were 10 to 50 times greater than the estimated complication rates revealed in the medical literature.
The 13 papers reviewed in the Spine Journal were co-authored by doctors who received a median of at least $12 million to $16 million per study from Medtronic, the journal reported.
In each study, those conflicts of interest were either not reported or were unclear, the article said.
The analyses in the current issue of the Spine Journal come close on the heels of studies linking Infuse to retrograde ejaculation, a cause of infertility. The Spine Journal editors published those studies late last month.
“A Whole Journal … ”
“A whole journal devoted to a product, I’ve never seen this before,” said Jeffrey Fischgrund, MD, editor-in-chief of the Journal of the American Academy of Orthopaedic Surgeons and a spine surgeon at William Beaumont Hospital in Royal Oak, Mich.
“This is really extraordinary,” said Marcia Angell, MD, the former editor of the New England Journal of Medicine. “I’ve never seen a journal publish an issue devoted to debunking a popular treatment, and, by implication, the authors of the studies that promote the treatment.”
The studies co-authored by the Medtronic-associated doctors indicated there were no complications related to Infuse when it was known that the product was linked to several serious problems. The complications and adverse events range from excess cancers and serious inflammatory reactions to fertility problems caused by retrograde ejaculation and radiating leg pain.
“We find ourselves at a precarious intersection of professionalism, morality, and public safety,” a Spine Journal editorial accompanying the study said. “We work under a burden of suspicion that new technology research and publication is simply a “broken system”‘ as currently practiced.”
In an interview with the Journal Sentinel/MedPage Today, Medtronic officials said they now are looking into the issue of whether published articles failed to properly report various complications linked to Infuse.
“We are very serious about this,” said Richard Kuntz, Medtronic’s senior vice president and chief scientific, clinical and regulatory officer. “We will do a full analysis of these papers.”
Kuntz and Christopher O’Connell, an executive vice president who oversees the Medtronic division that includes Infuse, also said they will provide a full accounting of royalties and other payments to doctors who authored Infuse papers.
In a prepared statement, Medtronic chairman and CEO Omar Ishrak said he strongly believes in the safety of Infuse as it is described in data submitted to the FDA and is summarized on the product’s label.
However, critics say the problem has been a lack of transparency and reporting of serious complications in medical articles written by doctors, often at medical schools, with financial ties to the company, not FDA or product labeling data. Practicing surgeons and the patients learn about the safety and effectiveness largely from the published literature, they say.
“Integrity and patient safety are my highest priorities,” Ishrak added. “While the Spine Journal articles raise questions about researchers’ conclusions in their peer-reviewed literature, the articles do not raise questions about the data Medtronic submitted to the FDA in the approval process or the information available to the physicians today through the instructions for use brochure attached to each product sold.”
News Stories Prompt Action
Stories in the Journal Sentinel and MedPage Today about financial conflicts involving Infuse and a small group of surgeons from around the country who tested and promoted it were, in part, responsible for the Spine Journal review, said Eugene Carragee, MD, editor-in-chief of the journal and lead author of the main review article and editorial.
Beginning in late 2009, the Journal Sentinel and MedPage Today began running separate investigative reports about Infuse and a core of doctors with financial ties to Medtronic. In early 2010, the two news organizations began a partnership and continued reports that also focused on the FDA approval of Infuse. The stories raised questions about complications and extensive off-label use of the product as well as whether doctors with financial ties to Medtronic got better results in the pivotal clinical trial of Infuse than doctors in the trial who did not have financial conflicts.
Several of the stories involved Thomas Zdeblick, MD, a prominent orthopedic surgeon at the University of Wisconsin School of Medicine and Public Health. Zdeblick, who has received more than $23 million in royalties and other payments from Medtronic since 2002, was involved in the clinical trial of Infuse and also co-authored papers about the product.
Two Infuse papers co-authored by Zdeblick were published in the Journal of Spinal Disorders & Techniques where Zdeblick has been editor-in-chief since 2002.
Neither of those papers linked Infuse to a complication that causes sterility in men, though that information was known to the authors.
None of Zdeblick’s royalties are for Infuse, though he has received royalties for a product that is used with Infuse. Zdeblick declined to comment for this story.
At about the same time that the Journal Sentinel and MedPage Today started a joint investigation of Infuse, editors at Spine Journal began receiving complaints from doctors around the country who were pointing out contradictions between papers published by doctors with financial ties to Medtronic and other data involving Infuse complications.
By August of last year, the problem had become so pronounced that it was brought up at a meeting of Spine Journal board members, said Carragee, a spinal surgeon at Stanford University.
That same month, the Journal Sentinel and MedPage Today ran an investigative report about the conflicts of interest among doctors in the original Infuse clinical trial along with a story about the growing number of complications with the product.
Those stories, as well as stories in other publications, are cited in both the Spine Journal review article and main editorial.
Citing news articles based on the Milwaukee Journal Sentinel/MedPage Today investigation, a U.S. Senate committee earlier this month launched an investigation into reports that doctors with financial ties to Medtronic were aware of serious complications with a lucrative spine surgery product yet failed to reveal those problems in medical journal articles.
I remember you telling me that you doubt that this could happen in most journals….“A whole journal devoted to a product, I’ve never seen this before,” said Jeffrey Fischgrund, MD, editor-in-chief of the Journal of the American Academy of Orthopaedic Surgeons and a spine surgeon at William Beaumont Hospital in Royal Oak, Mich. “This is really extraordinary,” said Marcia Angell, MD, the former editor of the New England Journal of Medicine. “I’ve never seen a journal publish an issue devoted to debunking a popular treatment, and, by implication, the authors of the studies that promote the treatment.”
What I said sill stands.
“CEO Omar Ishrak said he strongly believes in the safety of Infuse…”
An attitude more suitable to religion???
It had to be that evident to become obvious, i think we are little suspicious when some results have significant conflict of interest, and yet we make them guidelines or truths
I was quite disallusioned with American science when I heard Dr. F. Stare (head of dept of nutrition at Harvard) declare that refined white sugar was the most healthful food you could eat because it is so PURE!!!!!!!!!! Total whore to the refined food interests….and seemingly proud of it!!!!!! He repeated this nonsense on 60 minutes…..
It is human nature operafilly, is not the american science per se, that is why it is easier to believe in a man than in an institution or the state. Where there is money, there are lies..
*****Where there is money, there are lies..****
Also, where there is irrational (or religious) zeal, there are lies…….worse than the $$ motivation as its impervious to logic.
I lived in one foreign country where scientific standards were quite stringent. Pride seemed more motivation than money there.
Operafilly
How and who discovered the antidiuretic hormone?