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Cause of death? Junk science in court
The question being addressed in part of this essay is: how does an autopsy report list the cause of death as smoking? Or has one ever listed this as a cause? If so, how? How does one distinguish between a death allegedly caused by smoking from one caused by, for example, wearing perfume or breathing carbon tetrachloride, or doing too much outdoor barbecuing, or working for twenty years in a uranium mine, or living in a house with a basement (radon)? Just asking!
We are everywhere confronted with messages and statistics to the effect that smoking kills people, drinking too much wine kills, drinking some wine each day is healthier than drinking none at all. A propaganda arm of the Canadian Government, Participaction Canada (PC), used to spend millions of dollars in advertising to say how good it would be to go out for long walks. Isn't that stating the obvious? PC fails to mention the warning by dermatologists that taking long walks (longer than five minutes) in the sunlight can be harmful to your skin (melanoma) and your eyesight (cataracts). We are told that careless driving and frivolous jaywalking kills people. Fortunately, PC is now defunct. Have you ever wondered, though, what is listed on the autopsy report for these "victims"? In particular, have you ever wondered whether an autopsy report would ever list as the "cause of death" such things as "smoking", drinking too much wine, or jaywalking? I do not think so. Why not?
Although I do not have any medical qualifications, I will forge ahead anyway. In the USA, when a murderer is put to death by the state, guess what the cause of death is listed as. Would it be, for example, poisoned by injection, or electrocution? I have heard that autopsy reports usually or always list the cause of death as "homicide" -- homicide by the state. Maybe a lawyer can enlighten me as to why it is not called first-degree murder by the state instead.
We are moving into a realm here which at first glance may seem to be pedantic. Why worry about the cause of death? Well, for one thing, some people have the mentality that if there is something wrong in their lives, there must be some other party who is responsible. A woman develops breast cancer, and dies, despite the best treatment available. Does the distraught husband leave it at that and mourn for a while? No, not the type of person who believes that if there is anything untoward that has displeased him in his life, someone else must be responsible. Taking advantage of the fact that his wife had a silicone breast implant, he decides that the real cause of her death is not "just" cancer, as listed in the official autopsy, but deleterious effects of silicone from the breast implant, caused by the negligence of its manufacturer, Dow Corning, and leading to cancer, the final cause of death.
He and thousands of others, abetted by clever lawyers, reason as follows. Before the lady had a breast implant, she did not have cancer. She was diagnosed as having cancer after having the implant. Maybe the implant caused the cancer? But she did not develop just any kind of cancer -- it was breast cancer. Furthermore, she did not have just any kind of implant -- it was a breast implant, and it was made of silicone. Very suspicious, no? Is it, therefore, not obvious to common sense that the implant in the breast caused the cancer in the breast? Who made the implant? It was Dow Corning, with that suspicious substance, silicone. Silicone and Dow Corning must have caused the cancer! What other explanation could there be? Let's go to court and fight the evil company -- it has lots of money!
The defence lawyer for Dow could have argued in court as follows. Just because event A (the implant) occurs before event B (the diagnosis of cancer) does not necessarily mean that A caused B. Nor should one assume that because A involved the breast and not some other part of the body, as did B, that therefore A caused B. After all, it can be shown that most drug abusers who die of heart attacks have been drinkers of Coca-Cola. Most stamp collectors who die of heart attacks have also been drinkers of Coca-Cola. Does that imply that Coca-Cola causes heart attacks? Given that the common factor in Coca-Cola is water, could it be that it is the water that is causing the heart attacks? If the lawyer is clever, he might even ask in court some other questions, as follows:
(a) What is the cause of death on the autopsy report? I understand that it was "cancer", not "cancer caused by silicone". In fact, there has never been in all of history an autopsy that listed the cause of death as "cancer caused by silicone", has there?
(b) Did the lady smoke? Maybe smoking, not silicone, caused the cancer. After all, everyone "knows" that smoking causes cancer -- sometimes, not always.
(c) Has there ever been a shred of evidence that silicone causes cancer -- even, for example, when giving overdoses of 1,000 times "too much" in mice -- or even in humans, for that matter? Our expert witnesses, all twenty of them, are unanimous in confirming that there is not the slightest shred of evidence that silicone causes cancer -- or that it even, in theory, could cause cancer. It is inert.
(d) How much alcohol did the lady drink?
(e) Did the lady go for long walks in which sunlight fell upon the upper chest? We all know that sunlight can cause cancer. Maybe that's what killed her. After all, dermatologists recommend that one should not be out in the sun for more than five minutes per day. We can show that she often went for walks for as much as 30 minutes, prompted to do so by organizations such as Participaction Canada!
(f) What kinds of foods did she eat? Did she eat lots of whole-grain cereals? Maybe they caused the cancer.
With up to a hundred new lawsuits being filed each day against Dow, each for more than one million dollars, Dow needs to win this suit.
The verdict in court? Dow is found guilty, even though there is not the slightest bit of evidence that the implants caused cancer, or any other problem whatever. The potential liabilities are so large (a billion dollars or more) that Dow must, by law, file for bankruptcy protection. Here was junk science operating at its very worst!
One must even question whether the term 'cause' or the concept of 'cause and effect' have the same meanings in the realms of jurisprudence and science. For an excellent introduction to this subject, and aspects of arguments pertaining thereto, see Causation: law vs science. It will explain why, although the aim of science is to strive for 'truth', the aim of law is to strive for 'fairness'. Decisions in a particular case under those two realms are not always the same!
For additional commentary, see the following.
The Decade of 'Junk Science' (Commentary): http://www.cato.org/dailys/05-10-99.html The Cato Institute. Among the worst examples is breast implant litigation, which has become one of the great legal deluges in history, with thousands of women filing suit. An entire industry essentially collapsed as a result; Dow Corning was forced to file for bankruptcy protection. . . . Since then a score of serious, peer-reviewed studies conducted by researchers at such institutions as Harvard University, Johns Hopkins University, the Mayo Clinic, and the University of Michigan, among others, have found an insubstantial to nonexistent connection between silicone implants and disease. Moreover, one report concluded that as a group women who had received implants were not at higher risk to a variety of health problems.
The Excesses of Liability Lawsuits: http://www.cato.org/dailys/11-22-96.html by Doug Bandow, a Senior Fellow at the Cato Institute. . . .
Distinguishing between correlation and causation has become increasingly difficult for the American legal system. Although by the early 1990's silicone breast implants had been on the market for some 30 years without evidence of harm, some implant recipients believed that their health problems were the result of the procedure. A number of lawsuits resulted, attended by bad publicity
Never one to lose an opportunity to expand his own authority, the ever-political David Kessler of the FDA then ordered implants off the market in 1992. True, he acknowledged, evidence of harm was lacking, but so what? In his view, the burden of proof rested on the manufacturers. And women certainly didn't have the right to choose to voluntarily accept even a small risk, a philosophy which would put into doubt "the whole rationale for the agency." The result of his decision, not surprisingly, was hysteria by women who'd received the implants (who can blame them?) and a deluge of lawsuits, more than 21,000 so far.
The result was a financial cornucopia for trial attorneys. They don't win an of their cases—roughly eight out of 10 verdicts have gone for the defense. But they don't have to. The mere prospect of huge damages in multibillion dollar class actions encourages settlements. And the massive potential liability has destroyed the silicone breast implant industry. Dow Corning has filed for bankruptcy; companies have even become wary of selling other silicone-based products, like cardiac pacemaker wires and artificial joints. Dr. Marcia Angell, executive editor of the New England Journal of Medicine, and author of the new book, "Science on Trial," points out that "Under these conditions, a large number of very important medical products may become scarce or even unavailable."
People who've been injured by the negligence of others deserve redress. But that doesn't justify the use of liability lawsuits as search-and-loot missions directed at the deepest pocket around, irrespective of fault. The courtrooms certainly shouldn't be what they are increasingly becoming today— legal lotteries, where neither injury nor fault needs be shown.
Junk Science Cases on a Scientific Edge: http://www.sepp.org/controv/junksci.html Copyright 1998 THE FINANCIAL TIMES (UK), August 18, 1998. It is usual in civil litigation for the losing side to say they have settled because they could not afford to fight on, even though they would have won. Such claims are usually greeted with a healthy scepticism by the public, but Dow Corning's $3.2bn (2bn pounds) settlement of the breast implant litigation really was done on that basis.
The case was an alarming victory for so-called "junk science" - a mish-mash of speculative theories and poor statistics - and for US plaintiff tort litigators. . . .
At first sight it seems impossible that anyone would pay billions of dollars to get shot of a case. But bear in mind that there were 170,000 plaintiffs, the maximum award for an individual will be $150,000 and many will receive only a token $750. The only ones who really made any money out of the case were the plaintiffs' lawyers, whose 25 per cent contingency fee comes to $800m.
Risk Reviews vol. 3: http://www.fplc.edu/riskrevs/rv3.htm#gal Peter W. Huber, Gallileo's Revenge: Junk Science in the Courtroom (Basic Books 1991). Gallileo's Revenge is the latest in a series of Huber's articles and books critical of the U.S. tort system.1 In it, his basic criticism is that the rules of evidence, as applied by technically illiterate judges, permit the testimony of greedy, dishonest and incompetent expert witnesses to pull the wool over the eyes of ignorant and gullible citizens who happen to be chosen for jury duty. For support, he offers up a series of verdicts that many people have had difficulty accepting and presents evidence on the other side so as to make those decisions appear to be mindless.
No reasonable person would expect juries always to be "right." As discussed in an earlier issue of Risk, the jury system is not perfect, but it is the best we have thus far been able to devise.2 Even Huber does not seem to contemplate replacing juries with, e.g., panels of scientists. Rather, based on his carefully selected and anecdotal evidence, he proposes reform of rules designed to keep irrelevant, immaterial and inflammatory evidence away from juries.
SLEIGHTS OF SILICONE: http://www.time.com/time/magazine/1997/dom/970901/law.sleights_of_s.html THE LEGAL WRANGLING OVER BREAST IMPLANTS MAY TEST THE ABILITY OF SCIENCE TO STAND UP IN COURT. TIME Law, SEPT. 1, 1997 VOL. 150 NO. 9.
Open Directory - Society Issues Environment Opposing Views Junk Science: http://dmoz.org/Society/Issues/Environment/Opposing_Views/Junk_Science/ Has links to several junk science sites.
Now, what could be the next target of our wrath? Aha! Big tobacco! Tally ho! Let us scrounge the Net some more before making additional comments. Some intersting facts and logical conundrums are in store.
Forces International Homepage: http://www.forces.org/index.htm
FORCES is an international organization providing support and guidance for the Pro-Choice consumer. We are campaigning against irrational bans, and misinformation effecting consumers' right to choose.
ALL consumers are confronted with "politically correct" advocates that attempt to "control" our lifestyles. They try to control the food we eat, the music we hear, the books we read, the habits and pastimes we enjoy; in other words, "Our Lifestyles". FORCES will respond with equal vigor and support whenever consumers' freedoms to choose their lifestyles are under attack. . . .
See also: We're All Sick and Government Must Heal Us.
Let us return to this seemingly simple term cause of death. What does it mean? To get more of a grasp on this concept I turn to the Net, and find the following:
Leading causes of premature death -- Washington state, 1990-98, and Actual causes of death: http://www.doh.wa.gov/Publicat/2000_News/00-02b.htm A table of rankings, not actual numbers.
Now we are presented with a tabulation of deaths by cause, but with two refinements of the term cause of death: leading cause, and actual cause. These terms are not rigorously defined. The leading cause is the cause listed on the death certificate. Instances include Cancer, Heart disease, Unintentional injuries, Suicide, Liver disease, Stroke, Diabetes, Chronic Obstructive Pulmonary Disease (COPD), and Human Immunodeficiency Virus (HIV). It is stated in conjunction with the table that the listed actual causes of death do not account for all deaths in those aged under 65. There are additional determinants not listed here, such as poverty, genetics, and toxic and microbial agents. Those actual causes listed in the table include Tobacco use, Poor diet, Lack of physical activity, Alcohol abuse, Firearms, Unsafe sexual behavior, Motor vehicles, and Lack of preventive medical care.
It is significant that there are not listed any entries for such specific causes of death as lung cancer caused by smoking, breast cancer caused by silicone implants, liver cancer caused by smoking, liver cancer caused by carbon tetrachloride, and many others. I doubt whether an autopsy could conclude that a death was caused by lung cancer from smoking as opposed to lung cancer caused by breathing some other pollutant. In short, how can it be said that a specific person died from lung cancer caused by smoking rather than by some other pollutant, unless one is prepared to say that every single case of lung cancer is caused by smoking, and not by anything else, even as a contributing factor? A major source of air pollution in Los Angeles is smoke from outdoor barbecuing. Who should we sue for that? Barbecue makers? The gas company? The electric company? The charcoal briquette company? The makers of propane tanks? The delivery company that delivered the gas barbecue? The company that installed the barbecue? The makers of barbecue lighters, matches, and cigarette lighters? Maybe all of them?
Although it is known that those who smoke are at increased risk of getting cancer, how can it be said that, for a specific person, the fact that one smoked before one got cancer means that smoking caused the cancer? It is known that those who smoke have a decreased chance of getting Alzheimer disease. It is also known that the more coffee one drinks, the lower is the chance of getting Alzheimer disease. Does this mean that smoking more and drinking more coffee therefore is the cause of the reduced incidence of Alzheimer disease? Not necessarily. It might mean, instead, that those who are predisposed to undertake smoking more and drinking more coffee are those people who are predisposed to not getting that disease. In a sense, it is almost like saying that not getting Alzheimer disease in later life is the "cause" of drinking more coffee earlier in life -- something in the future "causing" something in the past to happen! There is a common linkage which should also imply that those who take up gambling and car racing should also have less chance of developing the disease. That common factor is the level of a common neurotransmitter in the brain -- dopamine. We are back to the question of whether A causes B just because A occurred before B did. One must be careful in the scientific world of ascribing effect to cause. In the courtroom, however, anything goes, it would seem! Should we let jurists or legislators determine whether the constant pi should be 3.14159265358979 . . . , or else, exactly 3.1, just for convenience? It almost happened!
The following is a very interesting essay which addresses the fundamental question of what is meant by statements such as smoking causes cancer.
Smoking does not cause lung cancer, WHO 1999 statistics. Editorial from the Journal of Theoretics: http://www.journaloftheoretics.com/Editorials/Editorial%201-4.html By: James P. Siepmann, MD. . . .
Based upon what the media and anti-tobacco organizations say, one would think that if you smoke, you get lung cancer (a 100% correlation). You would at least expect a 50+% occurrence before someone used the word "cause."
Would you believe that the real number is < 10% (see Appendix A)? Yes, a US white male (USWM) cigarette smoker has an 8% lifetime chance of dying from lung cancer but the USWM nonsmoker also has a 1% chance of dying from lung cancer (see Appendix A). In fact, the data used is biased in the way they are collected and the actual risk for a smoker is probably less. . . .
You don't see this type of information being reported, and we hear things like, "if you smoke you will die" but when we actually look at the data, lung cancer accounts for only 2% of the annual deaths worldwide and only 3% in the US.** . . .
The process of developing cancer is complex and multifactorial. It involves genetics, the immune system, cellular irritation, DNA alteration, dose and duration of exposure, and much more. Some of the known risk factors include genetics4,5,6, asbestos exposure7, sex8, HIV status9, vitamin deficiency10, diet11,12,13, pollution14 , shipbuilding15 and even just plain old being lazy.16 When some of these factors are combined they can have a synergistic effect17, but none of these risk factors are directly and independently responsible for "causing" lung cancer!
Take a look in any dictionary and you will find something like, "anything producing an effect or result."18 At what level of occurrence would you feel comfortable saying that X "causes" Y. For myself and most scientists, we would require Y to occur at least 50% of the time. Yet the media would have you believe that X causes Y when it actually occurs less than 10% of the time.
As ludicrous as that is, the medical and lay press is littered with such pabulum and gobbley-guk. Even as web literate physician, it took me over 50 hours of internet time to find enough raw data to write this article. I went through thousands of abstracts and numerous articles, to only find two articles that even questioned the degree of correlation between smoking and lung cancer (British lung cancer rates do not correlating to smoking rates)19,20 and another two articles which questioned the link between second hand smoke (passive smoking) and lung cancer.21,22 Everywhere I looked the information was hidden in terms like "odds ratio," "relative risk," or "annualized mortality rate," of which most doctors probably could not accurately define and interpret them all let along someone outside the medical profession. The public relies on the media to interpret this morass of data but instead they given politically correct and biased views.
. . . We must embrace Theoretics as a discipline as it strives to bring objectivity and logic back into science. . . . Unfortunately, most scientists have never taken a course in logic and I'm sure that English class was not their favorite. Theoretics is a field of science which focuses on the use of logic and appropriate language in order to develop scientifically credible theories and ideas which will then have experimental implications. As someone whom I respect says, "Words mean things." Let us use language and logic appropriately in our research and the way that we communicate information.
* * * * *
The Untold Facts of Smoking (Yes, there is bias in science)
or
"I feel like the Fox Network" (a bastion of truth in a sea of liberalism)
1. USWM smokers have a lifetime relative risk of dying from lung cancer of only 8 (not the 20 or more that is based on an annual death rate and therefore virtually useless).
2. No study has ever shown that casual cigar smoker (<5 cigars/wk, not inhaled) has an increased incidence of lung cancer.
3. Lung cancer is not in even in the top 5 causes of death, it is only #9.**
4. All cancers combined account for only 13% of all annual deaths and lung cancer only 2%.**
5. Occasional cigarette use (<1 pk/wk) has never been shown to be a risk factor in lung cancer.
6. Certain types of pollution are more dangerous than second hand smoke.
7. Second hand smoke has never been shown to be a causative factor in lung cancer.
8. A WHO study did not show that passive (second hand) smoke statistically increased the risk of getting lung cancer.
9. No study has shown that second hand smoke exposure during childhood increases their risk of getting lung cancer.
10. In one study they couldn't even cause lung cancer in mice after exposing them to cigarette smoke for a long time.
11. If everyone in the world stopped smoking 50 years ago, the premature death rate would still be well over 80% of what it is today.1 (But I thought that smoking was the major cause of preventable death...hmmm.)
This site has a link to Journal of Theoretics. See below.
Journal of Theoretics - a peer reviewed science journal: http://www.journaloftheoretics.com/second-index.html Science without theory, is Science without direction. A Nonprofit Scientific Peer-Reviewed Internet Journal.
NetDoctor.co.uk - Facts about Lung Cancer: http://www.netdoctor.co.uk/diseases/facts/lungcancer.htm How is lung cancer diagnosed?
The above references and an extensive search of the Net still does not answer the fundamental question. How can it be concluded that a person died from smoking, rather than for example a combination of smoking and breathing carbon tetrachloride? There may be a good answer, but I suspect that there is not, especially based on the Smoking does not cause lung cancer article above.
One reason for wanting to know this answer precisely, is that relatives of people who die from lung cancer are quick to blame cigarette smoking (even for non-smokers), and engage a lawyer to sue the nearest tobacco company. From the above, it appears that lung cancer is not caused by one specific pollutant or process. I think that such lawsuits are ridiculous, whether undertaken by individuals or by governments. I will probably add more here.
The following is from a private e-mail that I sent to someone on 19 Mar 01.
I had mentioned the interview with Dr Brian Goldman on CBC Radio 1 (91.5 FM) this am. It took place at about 6:42 this morning, and lasted only about 5 min. The gist of it is that the news is not as bad as might have been feared. First, the bad news. Dr. Goldman confirmed that a doctor in Canada recently issued a statement that he would not be giving a specific kind of medical procedure to smokers who did not promise to quit smoking. That particular procedure involves replacing bone with a template around which, and within which, new bone or attachments of living flesh to bone should grow after the operation. For those who continue to smoke, the growth of new blood vessels, etc., that is necessary for the operation to be successful in the long run is not usually sufficient. Amputation is then called for. Dr Goldman feels that, in this type of case, the doctor might be justified in not wanting to do that procedure, based on scientific evidence that it will not usually succeed for a smoker.
It does not solve the ethical problem, though, because there are many other kinds of cases in which operations are performed in which it is known that the chance of success is, say, less than 1%. Should the doctor have the choice of not doing it? What about the Hippocratic oath? In Australia and NZ, the situation is more serious. There, some doctors have threatened to not do some other kinds of operations -- for example, on the lungs of smokers who refuse to quit, and on the livers of those who do not promise to quit drinking. What would come next? Should we not do operations on traffic victims who were not wearing seat belts, or on hockey players or boxers?
How about musicians -- and not just the Beastie Boys? They form a high-risk group for hearing loss and carpal tunnel syndrome in the wrists. Several major rock musicians are almost totally deaf by the age of 25. One of the highest-risk professions for hearing loss is being a classical violinist. The noise levels in a classical orchestra are almost at the threshold of pain, or being ten feet away from a jackhammer. In fact, there is a special clinic or hospital in Hamilton that deals with such cases. Should we refuse to do ear operations on violinists unless they promise to stop living dangerously? What occupation is next? Maybe one of the most dangerous -- farming? I might follow up and see what one of Canada's leading medical ethicists has to say about this: Margaret Sommerville, a Prof. at McGill. We met her once at a medical communications conference that my wife was involved with.
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Why measure blood pressure in only one arm, not both?
I had what I, at least, thought was a new idea this morning. I had been up all night working on my Web pages, had finished breakfast, and was very tired. As I drifted off to sleep, I had a sudden thought -- and I cannot remember (in the afternoon of 12 Mar 01) what triggered it. If I can recall what triggered that idea, I will add it here later.
My initial thought was this. Why do doctors measure blood pressure in only one arm, not both? In fact, why don't they measure it at, for example, the ankles as well -- or around the chest, for that matter? My thought proceeded as follows. If one has a system, such as in the present case, a network of veins and arteries with blood flowing and pulsating through it, if one can measure the value of one property (blood pressure) of it at a given point (such as the left arm), should we assume that the value of that property would be the same at another point (the right arm) in the system? If one were dealing with a static system in which there is no flow and there are no pulses (a dead person), one should expect that the pressure should be the same at all points in the system that are at an equal altitude. That is elementary static hydraulics of plumbing systems!
The next stage of the thought process was as follows. If the arteries at the positions in the left and right arms are not of equal diameter, it occurred to me that one would not expect that the measured pressures would be the same -- because, for a given rate of fluid flow of a given volume of fluid per second through a pipe, the larger the diameter of the pipe, the lower would be the observed pressure. (Upon later reflection, I thought of the additional possibility that, even if the diameters at those points were the same, there might be differences in nearby parts of the system that might give rise to unequal pressures.) The next step was a very general thought. If one expects that a property of a system can have different values at different points in the system, would there not be useful additional information about the system that could be gained by measuring the value of that property at more than just one point in the system? I would certainly expect that there could be -- although, with my limited knowledge of anatomy, it was not obvious to me that the extra information would necessarily be of useful significance in practice.
The next step was simple. Although this idea was new to me, it might have been thought of fifty years ago for all I know. Furthermore, even if there were a difference in pressures that could be observed, perhaps it would not be large enough to be of any diagnostic advantage in practice.
The next step? Check out the Web. Perhaps the question has been already asked and answered years ago. Here are some results.
MedicineNet
- High blood pressure, readings different two arms: http://www.aboutarthritis.com/script/main/Ques.asp?li=ART&QaKey=8360 Ask
The Experts!
Question Regarding:
High blood pressure, readings different two arms.
Viewers Question: What is the importance of a bilateral blood pressure reading of 146/98 in left arm and 122/96 in the right arm? Both arms positioned the same and within 2 minutes of each other. Both readings are repeatable.
Doctors Answer: The editors of MedicineNet can think of two possible common explanations for blood pressure readings different in the two arms.
Differences in blood pressure reading can be caused by any process that would lead to narrowing of the large blood vessels supplying the arms (for example, atherosclerotic narrowing of one of the subclavian arteries, the arteries that supply blood to the arms). Atherosclerosis is a process whereby cholesterol plaques accumulate on the inner lining of arteries, causing thickening of artery walls and narrowing of the arteries. The arm receiving blood from the narrowed artery will have a lower blood pressure reading.
Irregular heart rhythms (such as ATRIAL FIBRILLATION, and frequent premature ventricular contractions) can generate heart contractions with different degrees of forcefulness (hence different blood pressures). If blood pressure readings are obtained from different arms during different rhythms, the readings can differ.
For further explanation of irregular and abnormal rhythms, please visit MedicineNet's PALPITATIONS site. (See site below.) The viewer is encouraged to discuss the findings with the doctor to exclude other possibilities.
MedicineNet.com - Diseases & Conditions - Palpitations: http://www.medicinenet.com/script/main/art.asp?li=MNI&ArticleKey=437 Has much detail, well done. It also has the following statement, which I consider to be mistaken: "What is the normal heartbeat? The normal resting adult heart beats regularly at an average rate of 60 times per minute."
I take issue with the word "regularly". There is ample evidence that a healthy heart does not beat at a regular rate, but at an irregular rate which exhibits chaotic noise and fractal structure. See The myth that a healthy heart beats regularly for several papers justifying my statement.
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Dr Blood Pressure -- how to measure blood pressure: http://www.drbloodpressure.com/05-mesurer.shtml Good diagrams!
Human Physiology lab #5 -- Blood Pressure, heart function, electrocardiography: http://www.willamette.edu/~stas/physiology/labs/lab5/ Raises many good questions!
UCI Press Release UCI blood-pressure study challenges earlier findings: http://www.communications.uci.edu/00releases/029ap00.html
From the above results, it appears that the main question of whether measured pressures would be different has been answered -- and in the affirmative. However, the subsidiary question has not been answered -- namely, why are not such differential measurements used as part of standard practice? I shall pursue this question further -- both on the Net, and with my physician.
The myth that a healthy heart beats regularly
It seems that it has been accepted wisdom that the beats of a healthy heart are regular. I cite the following in support of that statement: MedicineNet.com - Diseases & Conditions - Palpitations.
This appears to me to be untrue, but still widely accepted. In contrast, see Nonlinear Dynamics for Clinicians, which includes the following statement:
"Note that according to classical physiological paradigms based on homeostasis, neuroautonomic control systems should be designed to damp out noise and settle down to a constant equilibrium-like state. However, the healthy heartbeat displays highly complex, apparently unpredictable fluctuations even under steady-state conditions. In contrast, the heart rate pattern from the subject with heart failure shows slow, periodic oscillations that correlate with Cheyne-Stokes breathing. . . . "
Not only is the heartbeat of a healthy heart irregular, it displays irregularities that can be mathematically analyzed and considered in the context of nonlinear dynamics, chaos theory, and fractal geometry. See heart for additional supporting papers, including images of ECG recordings of healthy and unhealthy hearts, in the context of those disciplines. In contrast, it is unhealthy hearts that show the highest degree of regular periodicity.
This insight and current research in that context has been made possible only with the development of complexity and chaos theory and fractal geometry over the past twenty years. That development would not have been possible without the availability of very fast computers. See my extensive set of links at Fractals and Iterated Function Systems (IFS).
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You can e-mail me at waynerp@sympatico.ca