Finally, an explanation for the mindsets of our favorite green doomsayers: Al Gore, Prince Charles, Jim Hansen, Bill McKibben, David Roberts, and Joe Romm

At 4:59 PM on 24 June, RoHa tries the time-tested “Nyah-Nyah!-You’re-Another!” rejoinder with:

And while we are trying to treat and innoculate their pathology, they will be trying to treat and innoculate what they see as our pathology. They are just as convinced of our irrationality, and just as vehement about it, as you are.

To which the proper response is Number 4 of the Laws of the House of God:

THE PATIENT IS THE ONE WITH THE DISEASE.

When dealing with megalomaniacs (particularly charismatic types) suffering their delusions, the scrupulous diagnostician keeps conscious of fact that the subject with whom he’s dealing is dysfunctional by virtue of an idiosyncratic mental disconnection from verifiable objective reality.
Regardless of which peculiar fixation is at the focus of the disordered mentation demonstrated by the person in need of evaluation, the clinician must simply remember that there is no supported evidence for the fantasies the patient is yammering about.
There is no equivalence between the skeptical position (on the crippled conjecture that arose in the late ’70s regarding atmospheric carbon dioxide’s “greenhouse gas” effect as a significant potential cause of anthropogenic global warming) and las warmistas‘ yelpings and squealings about either effect or causation.
No evidence supports the alarmists’ intrinsically untenable proposition.
This is why the AGW charlatans have corrupted and otherwise “cooked” global surface atmospheric temperature data sets, why they have cherry-picked proxy paleoclimatic temperature markers, why they have lied in their presentations of what they claimed to have been their own observational data, and why they have generally deviated from the standards of scientific methodology in their fabricated simulacra of “research.”
But that’s the deliberately duplicitous fraudsters. How do we consider the gulled and cullied majority of the Watermelon whackjobs, who actually believe in this Cargo Cult Science crap?
Well, hell. What other word do we use to describe people who claim (with ostensible honesty) that something is happening (or has happened) when the notion is not only friggin’ ridiculous but there’s also no evidence for that something’s existence?
Nothing but “delusional” and its synonyms comes to mind, right?
What a psychopath says about his perceptions are of value only to the extent that it serves to delineate the extent and nature of his psychopathology.
Beyond that scope, they reflect nothing reliable about the nature of the real world.

At 8:40 PM on 25 June, in a masterly display of totally friggin’ irrelevant pointless argumentum ad hominem, Khwarizmi responds to my concerns as a primary care physician anent the management of mental health concerns in the general patient population with:

The greatest serial killer known was a doctor – Dr. Shipman.

Just what the hell has this to do with anything under discussion here?
And, of course, whether or not any question of mine allegedly “fails to parse,” note please that this incontinent sphincter uses that irrelevant and unsupported batpuckey assertion as an excuse to evade answering the question.
The Kwarizmi goes off on a truly wonderful dung-flinging excursion to assert (again, without support) the following:

A General Practitioner only has to get 50 percent of questions on an exam correct, and they graduate. The job of a GP is to point people to the relevant specialist. An estimated half a million Americans were killed by Vioxx. That’s modern “medicine” for you.

Has that first sentence any relation to fact? Has this Kwarizmi character any idea of the education and training undergone by a Family Physician presently entering practice in these United States? Yeah, I’m a GP, but contrary to this oaf’s abject idiocy about what FP and GP guys do, we’re not simply triage officers. Especially with the onset of “managed care” several decades ago, we’re counted upon to handle the routine screening and continuing care of most of the patient population, from neonates to nonagenarians. There simply aren’t enough “relevant specialists” for us to turf out every patient who comes in the door.
Besides, of course, there’s the fact that once a gall bladder patient’s had her cholecystectomy, and the guy with benign prostatic hypertrophy has recovered satisfactorily from his TURP and the lady with the herniated L5 nucleus pulposus has responded tolerably to a percutaneous diskectomy, all of these people are still going to need expectant evaluation and maintenance treatment for chronic dysfunctions like essential hypertension, hyperlipidemia, hyperglycemia, atheromatous peripheral, coronary, and CNS vascular disease, various kinds of skin cancer, infections, digestive disorders, alcoholism, allergies, disorders of mood and mentation, et-interminable-cetera to which the human organism is heir by way of genetic predisposition, environmental pathogens, diet, indolence, stress, aging, and other factors either unavoidable or lifestyle-induced.
Does this Kwarizmi putz expect that every patient is supposed to be bouncing from cardiologist to endocrinologist to pulmonologist to general surgeon to orthopedic surgeon to surgeon urologist to psychiatrist as a matter of routine for the address of multitudinous conditions which have been satisfactorily stabilized or are not in need of particular “relevant specialists'” focused expertise?
Just how the hell does Kwarizmi explain the reason for medical and surgical specialization in the first place? All other things being equal, these guys tend to get good in their peculiar areas of expertise by concentrating their attention and efforts therein. Sure, a thoracic surgeon can evaluate a school-age child for Osgood–Schlatter disease, but he hasn’t seen many cases of the condition, hasn’t got a physiatrist’s handle on optimum treatment or prognosis, isn’t as qualified as an orthopedic surgeon is to make a decision about surgical intervention, and generally has better things to do with his time than to follow up with the family of such a youngster in the long course of remediative treatment and prevention of exacerbation and recurrence.
That gets left – by all those “relevant specialists” – to us lowly “Local M.D.” (LMD) types, the primary care grunts.
In parts of “flyover country,” access to secondary- and tertiary-care “relevant specialists” requires road trips of three to four hours, if a patient can get an appointment at all. A helluva lot of these “relevant specialists” have brief office hours maybe two or three days a week, at most.
They’re not available in the office forty or fifty hours a week, or rounding on chronically ill elderly and disabled patients as a matter of routine at every extended care facility (“nursing home”) in the county, or pulling a 12-hour shift in the community hospital’s Emergency Department once or twice a month when the Medical Staff office phones to say that they need somebody to fill in.
And – oh, joy! – us primary care guys are supposed to be responsible for the fact that the manufacturer of Vioxx (rofecoxib, Roche) actively and duplicitously suppressed safety data reporting on adverse cardiovascular and cerebrovascular events in their Phase III clinical investigations (emphasis on the VIGOR trial reported in The New England Journal of Medicine, 1998) despite warnings from guys like cardiologist Eric Topol and one of the FDA’s own epidemiologists – David Graham – so that news of the risks associated with this and other COX-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) didn’t get out to us until 2004.
Merck – like all the rest of Big Pharma looking for the main chance back in the ’90s – wanted Vioxx to be a “blockbuster” prescription drug that could be written to treat chronic mild to moderate osteoarthritis pain (as well as for other indications) occurring in a broad range of patients, and because they suppressed that safety data there was no way that physicians in active practice could reliably calculate even the roughest sort of risk/benefit ratio.
And that’s supposed to have been our fault? Anybody else want to pummel this Khwarizmi ignoramus until he’s got some other kind of excuse for his drooling idiocy?
(Ditto on this inspissated impaction’s whining about how the FDA kept tryptophan not produced by the culprit manufacturing process to which I’d referred – supported by the links I’d provided above – off the U.S. market in a glorious spasm of bureaucratic FUD until 2002 in spite of the fact that there was zero evidence to support a surmise that this amino acid itself was in any way causative of eosinophilia-myalgia syndrome. That was not a decision made by those of us in the practice of medicine, goddamnit.)
The Big Pharma “suits” certainly deserve to come in for a slagging, and they do. Not so curiously, however, that criticism doesn’t tend much to come from Kwarizmi‘s beloved “relevant specialists” because these guys – being tracked as high prescribers in their “relevant” therapeutic categories – are the doctors who are wined and dined and brought into lucrative relationships with the manufacturers as clinical investigators and medical education activities’ faculty members and consultants and promotional speakers and “opinion leaders” and all the rest of that nice stuff involving fancy dining and luxury hotel accommodations and big fat checks.
Us lowly primary care generalists? Jeez, but since the last revision of the PhRMA Code, we can’t even get cheap ballpoint pens or a calendar for the front desk anymore.
Gotta love earnest cement-heads like this Khwarizmi klutz, don’tcha? Proof that willful ignorance doesn’t prevent a deserving dolt from sticking his head up to get it whacked with a two-by-four.