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en:misc:talk-saine-novella-question01 [2013/06/05 13:32]
legatum
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62.65.168.3
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 ====== Novella-Saine Post-Debate Q & A ====== ====== Novella-Saine Post-Debate Q & A ======
  
 +Answered question from the [[en:​misc:​talk-saine-novella|Debate on Homeopathy]].
  
 **1- What do you consider to be the best clinical evidence supporting the efficacy of homeopathy for any indication? (March 28, 2013)** **1- What do you consider to be the best clinical evidence supporting the efficacy of homeopathy for any indication? (March 28, 2013)**
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 As this self-satisfactory level of evidence may not be satisfactory to everyone, I will now move closer to the central idea of your question. As this self-satisfactory level of evidence may not be satisfactory to everyone, I will now move closer to the central idea of your question.
 +
 +{{anchor:​homeopathy_clinical_evidence}}
  
 ===== What is the Best Clinical Evidence for Homeopathy? ===== ===== What is the Best Clinical Evidence for Homeopathy? =====
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 In conventional medicine, a great proportion of cases that show clear and sudden changes toward recovery during the course of very serious and/or stubborn diseases soon after initiation of treatment tend to indicate new directions in research and treatment, and establish new prognostic expectations. Despite the fact that the homeopathic literature is very rich in such cases, the scientific community as a whole has remained indifferent to homeopathy. In conventional medicine, a great proportion of cases that show clear and sudden changes toward recovery during the course of very serious and/or stubborn diseases soon after initiation of treatment tend to indicate new directions in research and treatment, and establish new prognostic expectations. Despite the fact that the homeopathic literature is very rich in such cases, the scientific community as a whole has remained indifferent to homeopathy.
  
-I will now illustrate the value of evidence provided by single case studies with a few examples in cases presenting with very serious acute diseases ( //e.g./, rabies, meningitis) and in a case with a stubborn, unremitting chronic disease (PD). The information they provide can’t be easily obtained through RCTs, partly because of the rarity of some these conditions (rabies), or the need for the long-term treatment (6 or more years) in order to be able to better appreciate the entire effectiveness scope of homeopathy.+I will now illustrate the value of evidence provided by single case studies with a few examples in cases presenting with very serious acute diseases ( //e.g.//, rabies, meningitis) and in a case with a stubborn, unremitting chronic disease (PD). The information they provide can’t be easily obtained through RCTs, partly because of the rarity of some these conditions (rabies), or the need for the long-term treatment (6 or more years) in order to be able to better appreciate the entire effectiveness scope of homeopathy.
  
 Many cases of clinical rabies in both animals and humans and experimental rabies have been reported to have fully recovered under homeopathic treatment. By clinical rabies, it is typically meant that an animal with an abnormal behavior, usually a stray dog, comes into a village located in an area in which rabies is known to be endemic, and, unprovoked, bites a number of animals and persons. Within a couple of weeks some of the bitten animals develop abnormal behaviors, are put in isolation, eventually develop the full unmistakable manifestations of furious rabies, and are killed. Some weeks later, one of the bitten persons develops general malaise with heightened redness, swelling and unusual sensation at the site of the bite, which are followed within a few days by spasms, especially when swallowing, hydrophobia,​ and convulsions. A physician, usually an allopath, is called in, who in turn calls in other colleagues as consultants. The spasms, hydrophobia and the convulsions become progressively more severe. From the history and the symptomatology,​ they all concur without any doubt in their minds that the patient has hydrophobia and is thus incurable. As a last resort they try various nostrums but in vain, and the patient is now in a state of almost constant convulsions and is on the verge of dying. Typically a priest, a distant family member or a friend suggests calling //in extremis// a homeopath, who is called in with great reluctance. This one comes, examines the patient, concurs with the diagnosis, and administers a homeopathic remedy. Within a short period of time, the spasms and convulsions begin to diminish in intensity, duration and frequency. The remedy is repeated as needed. The patient becomes more restful, falls into a deep and prolonged sleep, and eventually becomes capable of drinking without experiencing any spasms or convulsions. A convalescent period, typically of two to three weeks, follows with a progressive recuperation of strength, after which the patient seems completely recovered subjectively and objectively. Many cases of clinical rabies in both animals and humans and experimental rabies have been reported to have fully recovered under homeopathic treatment. By clinical rabies, it is typically meant that an animal with an abnormal behavior, usually a stray dog, comes into a village located in an area in which rabies is known to be endemic, and, unprovoked, bites a number of animals and persons. Within a couple of weeks some of the bitten animals develop abnormal behaviors, are put in isolation, eventually develop the full unmistakable manifestations of furious rabies, and are killed. Some weeks later, one of the bitten persons develops general malaise with heightened redness, swelling and unusual sensation at the site of the bite, which are followed within a few days by spasms, especially when swallowing, hydrophobia,​ and convulsions. A physician, usually an allopath, is called in, who in turn calls in other colleagues as consultants. The spasms, hydrophobia and the convulsions become progressively more severe. From the history and the symptomatology,​ they all concur without any doubt in their minds that the patient has hydrophobia and is thus incurable. As a last resort they try various nostrums but in vain, and the patient is now in a state of almost constant convulsions and is on the verge of dying. Typically a priest, a distant family member or a friend suggests calling //in extremis// a homeopath, who is called in with great reluctance. This one comes, examines the patient, concurs with the diagnosis, and administers a homeopathic remedy. Within a short period of time, the spasms and convulsions begin to diminish in intensity, duration and frequency. The remedy is repeated as needed. The patient becomes more restful, falls into a deep and prolonged sleep, and eventually becomes capable of drinking without experiencing any spasms or convulsions. A convalescent period, typically of two to three weeks, follows with a progressive recuperation of strength, after which the patient seems completely recovered subjectively and objectively.
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 The next day, Dr. Gonzalez returned to find the patient in a very happy, greeting mood when she saw him. After his departure on the previous day, she was given a third dose of the remedy and she had a similar fit as after the first two doses but shorter and with less desire to bite. Her state of terror progressively diminished during the rest of the day, and the night was calmer. She was able to sleep even though she kept being interrupted by jerking and frightful dreams. She continued to improve until the following morning (May 31), when around seven o’clock she went into a biting fit that lasted 45 minutes. The next day, Dr. Gonzalez returned to find the patient in a very happy, greeting mood when she saw him. After his departure on the previous day, she was given a third dose of the remedy and she had a similar fit as after the first two doses but shorter and with less desire to bite. Her state of terror progressively diminished during the rest of the day, and the night was calmer. She was able to sleep even though she kept being interrupted by jerking and frightful dreams. She continued to improve until the following morning (May 31), when around seven o’clock she went into a biting fit that lasted 45 minutes.
  
-Dr. Gonzalez was called and he found her in a state of constant restlessness,​ trying to escape, having great difficulty breathing and with titanic ​convulsions. Her limbs were now extremely cold. She was experiencing coldness ascending from her lower limbs to her mid-chest where it met a burning sensation that had now worsened and was extending to her throat. When this heat would extend to her head, she would choke until she would faint. Her jaw and lips were tight and her eyes were closed shut. She uttered frightening sound with inability to breathe, as if she had great chest pain. Her screams would get longer, as the fits would peak. During the fits, the muscles of her face would alternately contract and relax; she would then open her eyes, which were injected, shiny and fixed with an expression of furor but without being able to see. Her face was again inflamed.+Dr. Gonzalez was called and he found her in a state of constant restlessness,​ trying to escape, having great difficulty breathing and with tetanic ​convulsions. Her limbs were now extremely cold. She was experiencing coldness ascending from her lower limbs to her mid-chest where it met a burning sensation that had now worsened and was extending to her throat. When this heat would extend to her head, she would choke until she would faint. Her jaw and lips were tight and her eyes were closed shut. She uttered frightening sound with inability to breathe, as if she had great chest pain. Her screams would get longer, as the fits would peak. During the fits, the muscles of her face would alternately contract and relax; she would then open her eyes, which were injected, shiny and fixed with an expression of furor but without being able to see. Her face was again inflamed.
  
 In her state of unconsciousness,​ she would convulsively open her mouth followed by the desire to bite anything she could find. After three minutes of intense furor, she would slowly calm down but would continue to moan but less loudly. The same remedy was again given and was repeated every three hours. She was better by the evening when Dr. Gonzalez decided to test her by making a new preparation of the remedy in water before her. This provoked a fit but of a lesser intensity as compared to the previous days when she was trying to escape at the sound or sight of water. In her state of unconsciousness,​ she would convulsively open her mouth followed by the desire to bite anything she could find. After three minutes of intense furor, she would slowly calm down but would continue to moan but less loudly. The same remedy was again given and was repeated every three hours. She was better by the evening when Dr. Gonzalez decided to test her by making a new preparation of the remedy in water before her. This provoked a fit but of a lesser intensity as compared to the previous days when she was trying to escape at the sound or sight of water.
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   - The prophylactic approach would have to be started all over again but this time by producing rabies with less severe introduction of the rabies virus than by the intracerebral,​ intraocular or intralingual/​intralabial way, as it is a well-known fact that rabies occurs more frequently, more rapidly and more severely the closer to the brain is the introduction of the virus. ​   - The prophylactic approach would have to be started all over again but this time by producing rabies with less severe introduction of the rabies virus than by the intracerebral,​ intraocular or intralingual/​intralabial way, as it is a well-known fact that rabies occurs more frequently, more rapidly and more severely the closer to the brain is the introduction of the virus. ​
-  - As for the treatment of fully developed rabid animals, even if only in its early phase of experiments,​ the 35 cured dogs provided the//​absolute proof// that rabies //can no longer be// considered an incurable disease and this because of homeopathy. [(E. Plantureux. Recherche sur le traitement de la rage et de diverses maladies par l’homoeopathie. //​Homoeopathie Française//​ 1950; 37: 217-226.)] ​+  - As for the treatment of fully developed rabid animals, even if only in its early phase of experiments,​ the 35 cured dogs provided the //absolute proof// that rabies //can no longer be// considered an incurable disease and this because of homeopathy. [(E. Plantureux. Recherche sur le traitement de la rage et de diverses maladies par l’homoeopathie. //​Homoeopathie Française//​ 1950; 37: 217-226.)] ​
  
 These experimental findings are consistent with the clinical data, and provide greater strength to the evidence of the curability of rabid animals and humans by homeopathy. These experimental findings are consistent with the clinical data, and provide greater strength to the evidence of the curability of rabid animals and humans by homeopathy.
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 Late on the evening of Tuesday November 3, 1987, I received a phone call from a nurse who was asking if homeopathy could help an AIDS patient imminently dying in the ICU of the Toronto General Hospital. Late on the evening of Tuesday November 3, 1987, I received a phone call from a nurse who was asking if homeopathy could help an AIDS patient imminently dying in the ICU of the Toronto General Hospital.
  
-This 37-year-old man began experiencing a full relapse of pneumoncystic ​carinii pneumonia two days after having been released from two weeks of hospitalization. After another two weeks of IV antibiotics,​ he developed acute cryptococcal meningitis, a very insidious and often fatal form of meningitis. Two antifungal drugs, flucytosine was given orally and amphotericin B was given IV, both in increasing doses, as he was not responding.+This 37-year-old man began experiencing a full relapse of pneumocystic ​carinii pneumonia two days after having been released from two weeks of hospitalization. After another two weeks of IV antibiotics,​ he developed acute cryptococcal meningitis, a very insidious and often fatal form of meningitis. Two antifungal drugs, flucytosine was given orally and amphotericin B was given IV, both in increasing doses, as he was not responding.
  
 100 mg of prednisone was added to counteract the severe adverse effects of these two antifungal drugs, which the patient experienced as severe headaches, nausea, vomiting, cramps, spasms, chills, fever, photophobia and general weakness. 100 mg of prednisone was added to counteract the severe adverse effects of these two antifungal drugs, which the patient experienced as severe headaches, nausea, vomiting, cramps, spasms, chills, fever, photophobia and general weakness.
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 It is ironic that any intervention in conventional medicine demonstrating a fraction of the ranges of effectiveness reported for homeopathy would attract limitless attention, and would turn the research world around particularly if there were great financial incentives for the medical-industrial complex. On the other hand, homeopathy is continually and automatically being dismissed in people minds since a huge negative prejudice was stamped on it in the 1830s, which was actually based on completely false premises and flawed evidence. Ever since generation after generation of skeptics have been repeating the same arguments without ever taking the time to look at the original facts. Homeopathy had to be a sham, as like magic its reported results were too good to be true. It is ironic that any intervention in conventional medicine demonstrating a fraction of the ranges of effectiveness reported for homeopathy would attract limitless attention, and would turn the research world around particularly if there were great financial incentives for the medical-industrial complex. On the other hand, homeopathy is continually and automatically being dismissed in people minds since a huge negative prejudice was stamped on it in the 1830s, which was actually based on completely false premises and flawed evidence. Ever since generation after generation of skeptics have been repeating the same arguments without ever taking the time to look at the original facts. Homeopathy had to be a sham, as like magic its reported results were too good to be true.
  
-Medical historian Michael Dean explored the rejection of homeopathy by some of the most prominent skeptics in the first half of the nineteen-century. He wrote, “The rejection of homeopathy by the medical establishment has been portrayed as a watershed in medical history because it is deemed to have been based on evidence rather than prejudice: homeopathy was given a fair trial, especially by the pre-eminent Paris School, and was found wanting. This belief forms the basis of an influential thesis that the development of modern scientific medicine, as a unified discipline, can be date to that rejection in the 1830s and 1840s.”+Medical historian Michael Dean explored the rejection of homeopathy by some of the most prominent skeptics in the first half of the nineteen-century. He wrote, “The rejection of homeopathy by the medical establishment has been portrayed as a watershed in medical history because it is deemed to have been based on evidence rather than prejudice: homeopathy was given a fair trial, especially by the pre-eminent Paris School, and was found wanting. This belief forms the basis of an influential thesis that the development of modern scientific medicine, as a unified discipline, can be dated to that rejection in the 1830s and 1840s.”
  
 However, Dean dared asking some very pertinent questions regarding this early rejection, as true scientists should do, which are, “How valid was the trial evidence used by sceptics such as the French Académie de Médecine (1835) and Holmes (1842) in their rejection of the claims of homeopathy? Was their use of evidence biased in any way?” However, Dean dared asking some very pertinent questions regarding this early rejection, as true scientists should do, which are, “How valid was the trial evidence used by sceptics such as the French Académie de Médecine (1835) and Holmes (1842) in their rejection of the claims of homeopathy? Was their use of evidence biased in any way?”
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 The main finding of this research is that results obtained by homeopathy during epidemics reveal a very important and clear constancy, //which is a very low mortality rate//. This constancy remains, regardless of the physician, time, place or type of epidemical disease, including diseases carrying a very high mortality rate, such as cholera, smallpox, diphtheria, typhoid fever, yellow fever and pneumonia. The main finding of this research is that results obtained by homeopathy during epidemics reveal a very important and clear constancy, //which is a very low mortality rate//. This constancy remains, regardless of the physician, time, place or type of epidemical disease, including diseases carrying a very high mortality rate, such as cholera, smallpox, diphtheria, typhoid fever, yellow fever and pneumonia.
  
-Since society values the savingn ​of life more highly than any other outcome, most of these reports give accounts of rates of recovery versus mortality, and should therefore warrant great attention from academia, governments and health authorities,​ and be followed with strong recommendations. [(Gordon H. Guyatt, et al. Rating quality of evidence and strength of recommendations:​ GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. //British Medical Journal// 2008; 336 (7650): 924-926.)]+Since society values the saving ​of life more highly than any other outcome, most of these reports give accounts of rates of recovery versus mortality, and should therefore warrant great attention from academia, governments and health authorities,​ and be followed with strong recommendations. [(Gordon H. Guyatt, et al. Rating quality of evidence and strength of recommendations:​ GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. //British Medical Journal// 2008; 336 (7650): 924-926.)]
  
-Hierarchies of evidence of EBM have not been developed with the perspective of integrating such massive amounts of evidence, as the allopathic literature prior to WWII is relatively poor in valuable therapeutic interventions. Aside from a small number of trials, such as the ones of Lind’s with citrus in sailors with scurvy (1747), and Louis’ with bleeding and expectancy in patients with pneumonia (1828), there are not many astounding //​therapeutic//​ trials that are worth recounting, or whose therapeutic interventions would have any clinical significance today. However, //this is not at all the case with homeopathy//,​ whose literature overflows with all types of very meaningful case studies, trials and outcome reports that remain as pertinent today as when there were first published. Results obtained by homeopathy don’t really lose any of their value with the passing of time, and are like all facts as relevant as if they had occurred today.+Hierarchies of evidence of EBM have not been developed with the perspective of integrating such massive amounts of evidence, as the allopathic literature prior to WWII is relatively poor in valuable therapeutic interventions. Aside from a small number of trials, such as the ones of Lind’s with citrus in sailors with scurvy (1747), and Louis’ with bleeding and expectancy in patients with pneumonia (1828), there are not many astounding //​therapeutic//​ trials that are worth recounting, or whose therapeutic interventions would have any clinical significance today. However, //this is not at all the case with homeopathy//,​ whose literature overflows with all types of very meaningful case studies, trials and outcome reports that remain as pertinent today as when they were first published. Results obtained by homeopathy don’t really lose any of their value with the passing of time, and are like all facts as relevant as if they had occurred today.
  
 Also, in the hierarchies of EBM, expert opinion tends to be the least valued. This is understandable,​ as expert opinion, with rare exceptions (//e.g.//, incurability of rabid persons (except outside homeopathy)),​ tends to greatly change from one expert to another, and from one era to another. No one will contest this to be true within conventional medicine, but it is actually not at all the case in homeopathy, as Hahnemann had so well explained the perennial relevance of the principles and practice of homeopathy, “Homeopathy is a perfectly simple system of medicine, remaining always fixed in its principles as in its practice.” Also, in the hierarchies of EBM, expert opinion tends to be the least valued. This is understandable,​ as expert opinion, with rare exceptions (//e.g.//, incurability of rabid persons (except outside homeopathy)),​ tends to greatly change from one expert to another, and from one era to another. No one will contest this to be true within conventional medicine, but it is actually not at all the case in homeopathy, as Hahnemann had so well explained the perennial relevance of the principles and practice of homeopathy, “Homeopathy is a perfectly simple system of medicine, remaining always fixed in its principles as in its practice.”
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 Incidentally,​ it is a strange fact how detractors of homeopathy rely so much on expert opinion when they recognize it to be the least valuable level of evidence. From earlier time until now, professed experts on homeopathy, whom skeptics have relied on, have been found to be shams and/or the evidence they advanced against homeopathy have been shown to be flawed, like we have seen above with the French Academy of Medicine, Holmes, Shang et al., the //Lancet// editors, Edzard Ernst, etc. Incidentally,​ it is a strange fact how detractors of homeopathy rely so much on expert opinion when they recognize it to be the least valuable level of evidence. From earlier time until now, professed experts on homeopathy, whom skeptics have relied on, have been found to be shams and/or the evidence they advanced against homeopathy have been shown to be flawed, like we have seen above with the French Academy of Medicine, Holmes, Shang et al., the //Lancet// editors, Edzard Ernst, etc.
 +
 +{{anchor:​homeopathy_statistics}}
  
 ===== Statistical Analysis of the Epidemiological Evidence ===== ===== Statistical Analysis of the Epidemiological Evidence =====
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 First, we find that among 146,237 patients under PAA there were 35,698 reported deaths for an average mortality rate of 24.4%.[(Willis A. Dewey. Editorials. Pneumonia and its treatment. //Medical Century// 1912; 19: 250-253.)] [(Henri de Bonneval. //​Considérations sur l’homoeopathie.//​ (Bordeaux: Imprimerie Adrien Bousin, 1881), 19-22.)] [(Krüger-Hansen. Ueber das Heilverfahren bei Pneumonien. //​Medicinischer Argos// 1842; 4: 341-361.)] [(J. Greenwood, R. H. Candy. The fatality of fractures of the lower extremity and of lobar pneumonia of hospital mortality rates, 1751-1901. //Journal of the Royal Statistical Society// 1911; 74: 363-405.)] [(William Osler. The mortality of pneumonia. //​University Medical Magazine// 1888; 1: 77-82.)] [(Samuel Henry Dickson. //Essay on Pneumonia.//​ In //Studies in Pathology and Therapeutics//​. New York: William Hood & Co., 1867.)] [(O. Sturges, S. Coupland. //The Natural History and Relations of Pneumonia//​. 2<​sup>​nd</​sup>​ edition. London: Smith, Elder & Co., 1890.)] [(William Osler. //The Principles and Practice of Medicine.// 8th ed. New York and London: D. Appleton and Company, 1912.)] [(Russell L Cecil, Horace S. Baldwin, Nils P. Larsen. Lobar pneumonia: A clinical and bacteriological study of two thousands typed cases. //Archives of Internal Medicine// 1927; 40: 253-280.)] First, we find that among 146,237 patients under PAA there were 35,698 reported deaths for an average mortality rate of 24.4%.[(Willis A. Dewey. Editorials. Pneumonia and its treatment. //Medical Century// 1912; 19: 250-253.)] [(Henri de Bonneval. //​Considérations sur l’homoeopathie.//​ (Bordeaux: Imprimerie Adrien Bousin, 1881), 19-22.)] [(Krüger-Hansen. Ueber das Heilverfahren bei Pneumonien. //​Medicinischer Argos// 1842; 4: 341-361.)] [(J. Greenwood, R. H. Candy. The fatality of fractures of the lower extremity and of lobar pneumonia of hospital mortality rates, 1751-1901. //Journal of the Royal Statistical Society// 1911; 74: 363-405.)] [(William Osler. The mortality of pneumonia. //​University Medical Magazine// 1888; 1: 77-82.)] [(Samuel Henry Dickson. //Essay on Pneumonia.//​ In //Studies in Pathology and Therapeutics//​. New York: William Hood & Co., 1867.)] [(O. Sturges, S. Coupland. //The Natural History and Relations of Pneumonia//​. 2<​sup>​nd</​sup>​ edition. London: Smith, Elder & Co., 1890.)] [(William Osler. //The Principles and Practice of Medicine.// 8th ed. New York and London: D. Appleton and Company, 1912.)] [(Russell L Cecil, Horace S. Baldwin, Nils P. Larsen. Lobar pneumonia: A clinical and bacteriological study of two thousands typed cases. //Archives of Internal Medicine// 1927; 40: 253-280.)]
  
-| **Allopathic Treatment** | Cases | **Deaths** | **Mortality (percent)** |+| **Allopathic Treatment** | **Cases** | **Deaths** | **Mortality (percent)** |
 | Dr. Brouillard, Paris[(#​72)] | 152 | 18 | 11.8 | | Dr. Brouillard, Paris[(#​72)] | 152 | 18 | 11.8 |
 | Dr. Louis, Paris[(#​72)] | 107 | 32 | 29.9 | | Dr. Louis, Paris[(#​72)] | 107 | 32 | 29.9 |
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 | **Treatment** | **Number of patients** | **Number of recoveries** | **Survival Rate** | **Number of deaths** | **Mortality Rate** | | **Treatment** | **Number of patients** | **Number of recoveries** | **Survival Rate** | **Number of deaths** | **Mortality Rate** |
-**Homeopathy** **25,216** **24,360** **96.6** **866** **3.4** +| Homeopathy | 25,216 | 24,360 | 96.6 | 866 | 3.4 | 
-**PAA** **146,237** **110,539** **75.8** **35,698** **24.4** +| PAA | 146,237 | 110,539 | 75.8 | 35,698 | 24.4 | 
-**CC** **C (limited to CAP)** **33,148** **28,607** **86.3** **4,541** **13.7** |+CCC (limited to CAP) | 33,148 | 28,607 | 86.3 | 4,541 | 13.7 |
  
 Statistics from these outcomes show that: Statistics from these outcomes show that:
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 ===== Pneumonia during the 1918-1920 Influenza Pandemic ===== ===== Pneumonia during the 1918-1920 Influenza Pandemic =====
  
-The second part of the answer to Dr. Steven Novella’s first question will follow in June.+The second part of the answer to Dr. Steven Novella’s first question ​[[talk-saine-novella-question01-part02|will follow in June]].
en/misc/talk-saine-novella-question01.1370439171.txt.gz · Last modified: 2013/06/05 13:32 by legatum