Erroneous Concepts Research Articles

Incidence-based measures of birth, growth restriction, and death can free perinatal epidemiology from erroneous concepts of risk

Background Traditional perinatal epidemiology appears to embrace fallacious concepts of risk. The use of incorrect denominators for perinatal rates is commonplace both for straightforward indices such as the gestational age–specific labor induction rate and also for the more conceptually challenging indices such as the gestational age–specific neonatal mortality rate. As a consequence, perinatology is beset by several conondrums including the paradox of intersecting perinatal mortality curves. Proposition These traditions are ideally replaced by alternative concepts that may be derived a priori and measured using indices such as presented here: the incidence of birth (i.e., the gestational age–specific birth rate), the incidence of growth restriction (i.e., the gestational age–specific growth-restriction rate) and the incidence of death (i.e., the age–specific mortality rate). Results The incidence of birth, growth restriction, and death quantify the core phenomena in perinatology and reveal congruent and coherent patterns of occurrence. Conclusions These new indices can free perinatal epidemiology from erroneous concepts of risk and resolve the paradoxal phenomena that plague the perinatal domain. They also permit the development of a theoretical framework for obstetric intervention, which in recent years has been based exclusively on empirical evidence.

The changing epidemiology of GERD: geography and Helicobacter pylori.

Issues have arisen regarding H. pylori infection and GERD that have caused unnecessary confusion among practicing physicians. In the last century GERD became increasingly recognized in the West and it has become evident that the prevalence of GERD is now occurring in many previously underdeveloped countries. This review article fosters understanding of the issues by focusing on the esophageal acid load and the factors that control it. In particular, we discuss the effects of the change in the patterns of gastritis that have occurred naturally as well as after H. pylori eradication and correlate those changes with their effects on the esophageal acid load. We show how it is possible to separate gastroesophageal reflux from gastroesophageal reflux disease based on differences in esophageal acid load. We also describe how the practice of assessing gastroesophageal reflux based on the time the intraesophageal pH is less than 4 resulted in investigators systematically discarding data critical to understanding of the effect of their interventions on esophageal acid load. Testable hypotheses are presented to explain the interactions between H. pylori and GERD and between H. pylori and the changing epidemiology of GERD. We propose that the confusion regarding H. pylori and the changing epidemiology of GERD is based on the failure to critically examine the historical evidence in relation to the other H. pylori-related diseases as well as reliance on techniques that are either unable to measure, or systematically discard data critical for understanding effects of various interventions on the esophageal acid load. This has resulted in propagation of erroneous concepts regarding H. pylori and adenocarcinoma of the esophagus and has resulted in some patients being denied appropriate therapy.

Buried but not dead: resuscitating psychoanalysis in the twenty-first century.

This paper argues that psychoanalysis is not dead, but in the process of being revived in a more cogent and less erroneous form so it may thrive in the twentieth century. The weak adaptive position is seen as the key error in mainstream psychoanalytic theory. Erroneous concepts, like the primacy of inner fantasies and memories in emotional life and the role of so-called transferences in psychotherapy, have been derived from this base. Affording current psychoanalytic thinking a strong adaptive position that sees coping with environmental impingements as the primary task of the human emotion-processing mind sets straight many existing misconceptions. Revising psychoanalysis in light of a strong adaptive position brings it into line with the theory of evolution, the basic theory of biology. It also clarifies the nature of dreams and leads to the creation of a quantitative, mathematically based, formal science of psychoanalysis replete with laws and regularities. Also explored is the neglect of the emotion-processing mind and efforts to overshadow mental concepts with ideas about the brain from neuroscience. The dangers of this loss of mind are reviewed. The paper concludes with a discussion of the role played by existential death anxiety in the perpetuation of the errors rife in classical psychoanalytic thinking. Lessening our use of denial mechanisms in response to death anxieties is a key requisite for advancing psychodynamic theories in the next one hundred years.

Past and future of computer-assisted sleep analysis and drowsiness assessment.

The development of computerized sleep analysis has been very much technology-driven by both mathematical tools and available hardware but, additionally and unfortunately, by the almost-30-year-old standard used for manual sleep stage scoring of paper recordings. There are no technical restrictions in terms of computing power, storage space, and costs anymore. However, the standards of visual sleep stage scoring have proven insufficient and ambiguous, and their utilization evidently provides misleading and erroneous information. The low temporal resolution provided by the one-page epoch, the crude division of the sleep processes into a few discrete stages, and the total ignorance of spatial information are the major drawbacks. It is meaningless to try to improve the computerised systems if the algorithms are based on erroneous concepts. Instead, the focus should be changed to studies dealing with the identification and modelling of true biological sleep-related processes. This work cannot be performed without the successful application of computerized methods, some of which have been used in related fields but have not yet been applied to sleep studies. It is extremely important that basic findings are confirmed with a wide variety of methods in several laboratories. The use of predetermined, fixed criteria for methods, waveforms, and states too early is scientifically erroneous and hazardous. Instead standards should describe the minimum requirements for the recording and analysis of the signals in terms of sampling rate, dynamic range, linearity, and documentation of the methods used. With the development of better technology, these standards ought to be constantly reevaluated and modified. The development toward more open commercial digital systems, including standardized programming methods and data formats, would have great positive impact to the field. These trends have long been established in many other fields of industry.

Syndrome de Capgras: Perspectives ouvertes par la neuropsychologie cognitive

To examine the way in which certain concepts regarding the physiopathology of Capgras' syndrome (1) have been tested neuropsychologically. Data consist of approximately 30 studies selected for their relevance to the cerebral stages of face processing in patients with schizophrenia, patients with Capgras' syndrome and normal subjects. Study of this work shows: a) that with respect to patients, authors have focused on the stage of treatment corresponding to the facial recognition phase per se; b) but that it is also possible to study the phase corresponding to knowledge and beliefs relative to individuals and to evaluate the existence of the cleavage proposed by numerous psychodynamicians. Views from the field of neuropsychology, like those from the field of psychodynamics, can therefore be tested. By offering a means of developing testable predictions in experimental protocols, cognitive neuropsychology methods will, in short, make it possible to reject erroneous concepts and demonstrate accurate ones. Limited here to the example of Capgras' syndrome, we advocate that the same methods be applied to Capgras' syndrome as to each symptom of schizophrenia.

Erroneous concepts behind the New Austrian tunnelling method : K. Kovari, Tunnels & Tunnelling, 26(11), 1994, pp 38–42

The New Austrian Tunnelling Method (NATM) represents in the words of one of its main authors, L. Muller, a 'structure of thought'. It is shown here that this structure rests not on an established theoretical foundation but rather on two fundamental misconceptions. The first concerns the definition of the NATM itself, according to whose concept the rock mass (ground) becomes part of the support structure. Upon closer examination, this concept is revealed to be unfounded because the ground inevitably becomes part of the support structure in any tunnel independently of the selected method of construction. The second error lies in the claim that the NATM theory can optimise the design of the tunnel lining following the so-called Fenner-Packer ground reaction curve. The reason such misconceptions flourished is that the NATM operates with ambiguous or undefined terms, making it difficult to prove through logical argument that it is incorrect.

Current role of cerebral angiography in the diagnosis of cerebrovascular diseases.

The role of cerebral angiography in the diagnosis of cerebrovascular disease is currently being questioned because of the increasing availability of MR angiography. The purpose of this essay is to place the use of cerebral angiography in perspective in light of these new developments. In patients with atherosclerotic cerebrovascular disease, MR angiography can almost entirely supplant cerebral angiography as a screening procedure in the evaluation of the carotid bifurcation. However, detection of "pseudoocclusion" still requires cerebral angiography for accurate diagnosis. Atherosclerotic stenosis or occlusion of the major intracranial vessels at the base of the brain can be detected with MR angiography, but not as accurately as with cerebral angiography. Furthermore, for detection of more distal occlusions, cerebral angiography is still needed. A number of erroneous concepts about the risks and value of cerebral angiography have prevented its optimal use for patients with cerebrovascular disease. These myths can be countered by applying several rules to optimize the use of cerebral angiography. Subarachnoid hemorrhage is best evaluated with CT followed by detailed cerebral angiography, although MR angiography can be used as a screening test for aneurysms 3 mm or larger. Cerebral angiography is still necessary to confirm the diagnosis of cerebrovascular malformations, although MR angiography is a useful screening test. Cerebral angiography is required for the definitive diagnosis of arteritis, arterial dissection, or fibromuscular dysplasia.

The Risk of Redefining Rationing

<h3>To the Editor.</h3> —I respond to a problem in the article by Drs Hadorn and Brook on definition of terms and "The Health Care Resource Allocation Debate."¹Hadorn and Brook state that the "use of the word rationing has clearly transcended its original meaning." I agree that clear definition of terms is necessary for discussion participants. I disagree with altering the meaning of clearly defined terms, particularly when misconceptions are perpetuated. The authors first review some erroneous concepts about rationing and give examples of inappropriate use of the word rationing such as "deliberate curtailment" and "rationing through inconvenience." They then redefine<i>rationing</i>as "toleration of inequitable access to beneficial services" with the modification "withholding of care duly deemed necessary." The remainder of the article answers some of the necessary questions about who they think should be given the authority to make the subjective decisions on equity, benefit, and necessity.

Through a Glass, Darkly

Aiming to undermine the terra firma of organization theory, Sandelands and Drazin's paper 'On the Language of Organization Theory' at first sight provides a potentially important case of foundational criticism. On closer scrutiny, serious flaws become apparent. The authors' general notion of science proves to be far too narrow excluding, per definition, alternative methodological perspectives such as the idiographic one. Their recommendation that organizational research be confined to perceptions of individual actions emerges as mistaken on meta- scientific grounds, and unrealistic in practice. According to a central idea in the paper, the concepts of organization and environment are 'hypostasized', and so are fallacious. Yet, while misunderstanding the meaning of hypostasization, Sandelands and Drazin themselves make ample use of the supposedly erroneous concepts. Finally, the theories of natural selection and strategic choice are squeezed by force into an analytical dichotomy taken from linguistic philosophy, with the result that the authors confuse achievement and process aspects. In actual fact, however, the theories involve both aspects, as do theories of decision processes.

Medical Management of Idiopathic (Bell’s) Palsy

Experience with treating more than 400 cases of Antoni's palsy, the findings of autoimmune reaction, and recent gadolinium-enhanced magnetic resonance imaging reports in "idiopathic" Bell's palsy verify the hypothesis that the disease results from a viral geniculate ganglionitis. The diagnosis no longer needs to be one of exclusion. We now are capable of establishing a positive diagnosis, permitting the clinician to initiate treatment with corticosteroids and acyclovir confidently. Facial nerve compression and electrotherapy are not advised. It is suggested that the term idiopathic Bell's palsy be replaced with Antoni's palsy as the first step in changing erroneous concepts of the past.

Theoretical Aspects of Enzymes in Diagnosis: Why Do Serum Enzymes Change in Hepatic, Myocardial, and Other Diseases?

The pathophysiological mechanisms of leakage, synthesis, and decreased removal of enzyme from blood all play a role in explaining why serum enzymes increase in disease. This presentation has focused on increased synthesis as an important and perhaps major source of increased serum enzymes. The second key point has to do with the reference standard. There is tremendous sophistication in the field addressed to the numerator, that is, biochemical units. The natural tendency is to focus attention on what we want to know in the numerator, the enzyme changes in the tissue. In so doing, however, we tend to ignore the changes of the reference standard in the denominator, which influence the final result as much as the numerator. The following recommendations are made: uniformity, enzyme activities referable to morphological units, and basic biological significance. Total organ per gram initial body weight is recommended as the optimal reference standard whenever possible. If this were done, perhaps we could then resolve the dilemma of the poor understanding of why serum enzymes change in disease. We would, thereby, be better equipped to bring the major part of biochemical pathology out of its infancy as described by Farber.

Common chromatography misconception

Students often have erroneous concepts concerning the separation process on a gas chromatography column. An escalator-in-a-mall analogy helps students gain more accurate conceptions.

Three-locus haplotype interactions in the analysis of linkage disequilibrium.

We have shown that the application of Piazza's formula for the estimation of the "three-locus interaction delta" should not be used for that purpose. In addition, the method of Porta & McHugh, for the demonstration of haplotype interaction in associations between HLA and disease, leads to completely erroneous conclusions. Other methods of calculation that have been used to analyse haplotype interactions also appear to be based on erroneous concepts. We suggest that nothing more than the estimation of heterogeneity in simple 2 X 2 contingency tables should be used for the analysis of linkage disequilibria. This principle is applied to the HLA-A, -B and -C haplotype frequency tables of Baur & Danilovs. For the greater part of the HLA-B alleles, three-locus haplotype frequencies can be explained from the A, B and the B, C disequilibria, without any further haplotype interactions. The predominant exceptions in that respect are haplotypes containing the B44 allele, which has been shown to contain two subgroups and therefore, we are not justified to conclude that this exceptional behaviour of haplotypes with B44 should be attributed to three-locus haplotype interactions.

Common Misconceptions About Oral Pharyngeal Structure and Function

Many of the concepts about oral pharyngeal structure and function which were acceptable in the past are now totally unacceptable. Although advances have been made, some clinicians continue to use information based on erroneous concepts in making management decisions. There are many reasons for considering these issues. Among them are: (a) the need for more reliable decisions about adequacy of the speech mechanism, and (b) the need for more adequate training.

Beta adrenergic blocking drugs

Although the beta-adrenoceptor blocking drugs were initially used in the treatment of angina pectoris, arrhythmias and phaeochromocytoma, other uses have been found which were not originally predicted from an understanding of the pharmacology of these agents. The major and first such use has been to lower blood pressure in hypertension, which now represents a major indication for the use of these drugs. Their use has subsequently been explored in thyrotoxicosis, anxiety states, schizophrenia, drug addiction withdrawal syndromes, migraine, obstruction of the outflow tract of the heart and glaucoma. The widest experience has been gained with propranolol and clinical responses that have been demonstrated for this drug usually also occur with the newer beta-adrenoceptor blocking drugs. Beta adrenergic blocking drugs may possess other properties namely intrinsic sympathomimetic action, membrane stabilizing action and cardioselectivity (Frishman, 1979). These properties have been used as a basis for classification of the agents (Table 1) (Fitzgerald, 1972, Prichard, 1978). There is usually little change in blood pressure after acute administration of beta blocking agents at rest, but the rise of blood pressure on exercise (Shinebourne, Fleming and Hamer, 1967; Thadani et al., 1973) or the overshoot after the Valsalva manoeuvre (Prichard and Gillam, 1966), is markedly reduced. The initial report of the hypotensive effect of beta adrenoceptor blocking drugs appeared in 1964 (Prichard, 1964) and the use of propranolol in hypertension was described later the same year (Prichard and Gilliam, 1964). After some initial delay the value of beta adrenoceptor blocking drugs in hypertension has become widely accepted (Simpson, 1974). The slow acceptance of beta blocking drugs may have been because beta receptor antagonists inhibit the force of cardiac contraction which was considered undesirable and was also associated with untoward reactions in acutely ill patients. The increase in peripheral resistance, also seemed disadvantageous. Moreover the anti-hypertensive effect had not been described in animals and the mechanism of this action was unknown. A further reason was the use of inadequate doses and the full hypotensive effect was often delayed. Early investigators tended to fix doses at sub-optimal levels despite original reports (Prichard and Gillam, 1964, 1966) emphasizing the importance of variable dosage regimes. The misgivings about dosage arose from erroneous concepts of complete betaadrenoceptor blockade where a relatively small dose, of propranolol had been observed to block the effect of a dose of isoprenaline which had previously given a maximal tachycardia. Considerably larger doses were needed to produce maximum inhibition of exercise induced tachycardia or even the supine or standing resting heart rate (Boakes et al., 1973). It is these larger doses that are often needed to give an adequate antihypertensive effect. It was also believed that large doses had a 'direct depressing action' ('quinidine-like effect', 'membrane action' local anaesthetic effect) on the heart. A membrane action is

Vascular hemodynamics: deep rooted misconceptions misnomers.

Erroneous concepts about vascular hemodynamics are widespread, notably as regards the effect of gravity on blood flow. Vascular pressure at any point is equal to the sum of two pressures of entirely different origins: (1) pressure caused by the pumping action of the heart ('cardiodynamic' pressure which is vital for circulation) and (2) pressure due to gravity acting on the blood ('gravitational' or hydrostatic pressure which plays no direct role in blood flow). Gravity neither helps nor hinders circulation because of the U tube or siphon principle. The gravitational energy of the column of blood in arteries is balanced exactly by the gravitational energy of the column in veins and vice versa. Thus, contrary to common belief, gravity does not hinder blood flow to the head in the upright position, nor does it hinder venous return from the dependent parts of the body. For this reason, in Poiseuille's equation, perfusion pressure should exclude gravitational pressure. Postural effects on circulation result from the distension vessels (particulary veins) subsequent to changes in gravitational pressure of blood.

Spectral distributions of microwave bursts

The lack of open literature publication of the distributional properties of the cm-λ spectra of solar microwave bursts has lead to some erroneous concepts of the typical characteristics of these spectra. To provide more accurate information, this paper sets forth various distributions of the peak flux density spectra of large numbers of bursts, based on observations of the Sagamore Hill Radio Observatory at nine discrete frequencies between 245 and 35000 MHz over the years 1968–1971. As a foundation for the distribution studies, the basic spectral classification system is outlined. The majority of burst spectra were found to contain a cm-λ component having a single spectral maximum in the 1400 to 35000 MHz range; such spectra are designated C type. A study of the correlation of the spectral maximum frequency fmax of the cm component and the photospheric magnetic field strength of the associated region shows a tendency for greater correlation at higher fmax for stronger magnetic sssfields. A study of the correlation for C type spectra between fmax and the quasi-cutoff frequency fqc on the low-frequency side shows that for bursts of moderate peak flux density (50–500 sfu) fqc is well correlated with fmax; a good fit to the relation fmax=Afqc is found with A =3.4. The possible attenuating mechanisms responsible for the spectral shaping of the cm component are discussed.

Pathophysiology of cestode infections: Effect of Hymenolepis diminuta on oxygen tensions, pH and gastrointestinal function

Studies on the normal and parasitized rat intestine were used to investigate the effect of the tapeworm, Hymenolepis diminuta, on in vivo intestinal lumenal oxygen tensions, acid-base balance and mucosal absorption and accumulation of fluid and glucose. The lumenal bulk aqueous phase is considerable, well mixed and aerobic with an oxygen tension of 40–50 mm Hg. Neither the unstirred layers adjacent to the brush border membrane nor the area adjacent to the mucosa (“paramucosal lumen”) are significant barriers to the diffusion of oxygen from the blood to the intestinal lumen. In the uninfected distal ileum and colon anoxic conditions may occur in the central lumen, but, in the parasitized intestine fluid absorption is reduced and anoxic conditions do not occur. Increased H + ion concentration in the parasitized intestine plays a role in increasing the availability of oxygen to intestinal helminths. Concomitant with the lower pH, the pCO 2 in the lumen of the parasitized intestine was twice as high as that found in normal animals. The total CO 2 in the parasitized intestine steadily decreased over a 3-h perfusion period, while in the normal intestine the total CO 2 content increased after an initial fall during the first 30 min of perfusion. When the worms were removed, the ability of the intestine to restore normal acid-base balance was restored. Glucose and fluid absorption in both the infected and uninfected intestine were reduced by an increase in H + ion concentration; both parameters were lower in the parasitized intestine than in the normal animals. Low pH increased fluid and glucose transport by H. diminuta. While the dry weights of both the parasitized and uninfected total small intestine and of the intestinal mucosa were the same, the wet weights were considerably different, indicating defective fluid balance in the infected intestine. Accumulation of glucose by the parasitized mucosa was greater than in control animals and decreased with an increase in H + ion concentration. The glucose transport system in the parasitized gut was therefore affected at two levels, one at the brush border, where transport into the mucosa was decreased by lowering the pH, and secondly at the level of the basal and lateral membranes, where transport out of the mucosal tissue into the circulatory system was also reduced. The above results are discussed in terms of current widely accepted but erroneous concepts relating to the intestinal ‘microcosm’.

DRUG ABUSE, ALCOHOL AND MARIHUANA PROBLEMS ERRORS, COSTS AND CONCEPTS

Erroneous concepts underlying confusion and apparent contradictions about drug use are detailed. Decisions on the control of perceived drug problems are discussed in terms of social cost-social benefit accounting, thresholds of acceptable use for the individual and the community, and community goals. Current treatment inadequacies are said to stem from the “disease-concept” of “alcoholism”, “addiction” or “dependency”. Alcohol, illicit drugs, cigarettes and prescribed drugs are all considered, but the arguments against any measures which might increase the use of marihuana are presented in a comprehensive manner. The errors are listed under: (1) emotional approach; (2) failure to appreciate the complexity of drug effects; (3) assuming linearity of dose- response; (4) false definitions and categorization; (5) perception of distribution of drug use; (6) multiple versus single drug use; (7) incorrect evaluation. The arguments against legalizing or using marihuana are listed under: (1) adverse effects; (2) driving hazards; (3) multiple drug use; (4) incorrect evaluation; (5) consumer culture; (6) alcohol and marihuana; (7) example to children; (8) rights of the less-privileged; (9) prejudiced assessments; (10) community testing; (11) legal control difficulties; (12) social group alienation problems; (13) regard for the law and (14) social goals.

Philosophical Trends as a Subject of Research: The Problem of Laws of the History of Philosophy

The history of philosophical thought has often been compared to a comedy of errors, and is one of the most important dimensions of the intellectual history of mankind. Quests for a correct view of the world and tragic mistakes, the polarization of philosophy into mutually exclusive trends, which is sometimes thought of as a permanent scandal in philosophy — these are not merely the searchings and sufferings of individual thinkers. This is the intellectual odyssey of mankind, and those to whom it appears a farce apparently interpret the tragic only as the idols of the theater. But the fact is that antinomies, crises, retracing of steps, the discarding of real truths in favor of erroneous concepts long since refuted but stubbornly taken as true — are these things characteristic of philosophy alone? Philosophy is the intellectual image of mankind, and the contradictions of its development are of no small importance to the intellectual biography of humanity.