In my last post I link to a newspaper article featuring a young man who tragically died of hypoxia after inhaling pure nitrous oxide. The article emphasises that this was a consequence of substance abuse. However there is another situation where theoretically exactly the same situation could arise in what is perceived as a much more harmless practice.
Helium balloons are widely bought both for adults and children. How many people, including children, have opened the balloon and inhaled the gas to produce an amusing squeaky voice? There's no oxygen in them either.
DZ is fond of browsing in old bookshops. In particular he likes medical textbooks from the 1920s and 30s, and autobiographies of doctors who worked at the time. It's fascinating to read about some of the things we used to do to people.
For example. I found an old textbook of anaesthesia, in which was described the "nitrous oxide jactitation technique" of starting anaesthesia.
Apparently what you did was this. You put a mask on the patient's face and administered 100% nitrous oxide. That is, no oxygen. None at all. Unsurprisingly, in a very short time the patient became blue, and unconscious. The anaesthetist (who at that time was likely to be the surgeon's houseman) continued to administer 100% nitrous oxide until the patient exhibited a phenomenon known at the time as "jactitation". What is known today as a hypoxic fit! The houseman would only then switch in oxygen, and ether, and all was well. Apparently.
It sort of puts in perspective the panic you see in today's anaesthetists when the saturation drops below 90%.
I've mentioned this technique to a number of anaesthetists and only one (older generation) had ever heard of it. He assures me that the technique was still used, mainly by dentists, right into the 1960s.
The practice now seems to be making something of a comeback. You'd think wouldn't you that if people were going to sell N2O for recreational purposes that it might be a good idea to put some O2 in. Just 20% would do
DZ very rarely buys fast food. But once in a while he finds himself hungry enough to eat a raw scabby cat with the fur on, and finds no alternative. And so recently he found himself in a Burger King where he he enjoyed this exchange with a young lady behind the counter.
DZ. “Burger & chips please.”
YL. “You mean fries? That’ll be £6.50 please. You wanna drink wi’that?”
DZ. “No thank you.”
YL. “It’s cheaper with a drink.”
DZ “Really? OK then I’ll have a diet coke please.”
YL. “OK that’ll be £6.80 please.”
DZ. “ …………………ummmmmm,………I thought you said it would be cheaper with a drink?
YL. “Yes thats right it’s cheaper with a drink.”
DZ. “But £6.80 is more than £6.50.”
YL. “ Uh.??”
DZ. “If it’s £6.50 without a drink, and £6.80 with a drink then it’s not cheaper with a drink. Is it?”
YL. “That’s right. It’s cheaper with a drink.”
DZ. “No it isn’t! £6.80 is not cheaper than £6.50……………..Is it?”
At this point there was obviously some inner intellectual turmoil within the girl and a long period of silence. Then she called over her supervisor.
YL. “This customer ordered a drink, and now he says he don’t wannit”
We all know that finding beds for emergencies can be a problem. And that part of the problem is that many elderly patients occupy beds when they no longer need hospital care, but there is nowhere to send them. Nursing home beds seem to be in short supply too. But I had no idea how desperate the shortage of nursing home beds actually was till I saw this.
In his time DZ, in common with just about all hospital specialists, has done a little research. My own feeling is that the insistence that some research appearing on a CV is an absolute necessity for career progression is misplaced. Forcing the disinterested to do research can only produce poor quality research, and dilute resources, starving those who really want to do it, and produce good quality stuff.
But that's not what I'm going to explore today.
Imagine for a moment DZ does a research project. He collects the measured data and does the analysis. And gets results entirely unexpected and counter intuitive. His natural reaction is to doubt the data. So what does he do? Does he, doubting his results, submit what he actually found, or does he throw it in the bin and start again? Either would be acceptable ethically. But there's a third option. What if he looks at the data, and alters it, so that it supports his preconceptions? What if he tweaks the data here and there so that the results are completely altered to conform with what he expected to find?
In medicine that would rightly be called "falsification" or "fraud". If found out my paper, if published, would be redacted and my reputation destroyed. I might well lose my job, and have to answer to the GMC. And quite right too. Research fraud is a serious matter.
The point of research is to observe nature. The data you collect is sacrosanct. If you find you've made an error you can discard it, but you can't just alter it. Your measurements should be inviolable, whether you like them or not.
Altering your data is just not acceptable or excusable. Even worse is when you admit the fraud and try and sanitise it by calling your falsifications "adjustments". Present your data, like it or not unadjusted. Don't piss down my back and tell me it's raining.