master slave morality

Consider living in a world of imbeciles. They subsist but barely. A superior intellectual individual enters this world and manipulates it such that he no longer spends the majority of his time subsisting. In fact he organizes some of these imbeciles and builds wealth, only for himself but does increase (accidently) wealth for those he has used. In the sum of all things, some imbeciles have a better world wealth wise. We know this superman increased his lot proportionately more than those who helped, but if he was never born the wealth would not have been created.Do they have a better world morally? The imbeciles wonder why their life is so hard while the superman's is not. Jealousy is assured leading to hate, envy and folksy tales of why this superman is immoral. If we replace "superior intelligence" with some other factor x, is this not our world?

God is dead

Kant=morality is proportional to religion, hence when God goes so does our society's morals. Dostoevsky= If there is no God, everything is permitted. This is a huge slam to atheists. Do morals come solely from the pavlovian promises of eternal life and eternal damnation? Nietzsche= since man made god and the belief in god has led to some great virtues of man, cannot we invent something else that supercedes god in w/c we can believe? To eliminate god we must eliminate grammar ie god and religion is ingrained in our institutions whether we like it or not. We stand on the shoulders of giants, and if we stood on those shoulders our path is somewhat pre-determined. I say nonsense.

However, it is different from the VAL-HEFT and CHARM studies, which also examined the combination of an ACE inhibitor with an ARB {2,3}. The latter two trials showed an added benefit from the combination therapy, but they examined different patient populations (congestive heart failure) and their design did not stress an increase in the dose of ACE inhibitor to a maximum, which could account for the differences in their results. Questions also remain about the benefits of ACE inhibitor-ARB combination therapy in patients with established chronic kidney disease, given the benefits described in earlier (albeit much smaller) clinical trials and about the role of novel renin-inhibitor aliskiren. References: {1} Anderson et al., Am Heart J 2008, 155:706-711 [PMID:18371480]; {2} Krum et al., Eur J Heart Fail 2004, 6:937-945 [PMID:15556056]; {3} Pfeffer et al., Lancet 2003, 362:759-766 [PMID:13678868]. Trial registration: NCT00153101.

This study concludes that the angiotensin-receptor blocker (ARB) telmisartan was equivalent to the ACE inhibitor ramipril in preventing cardiovascular events in high-risk patients with vascular disease or diabetes mellitus. The combination of telmisartan and ramipril offered no advantage over maximally dosed ramipril and was associated with higher risk of adverse events. The authors examined the non-inferiority of therapy with telmisartan compared to maximally dosed ramipril and to combination therapy of telmisartan plus ramipril in high-risk patients with established cardiovascular disease or diabetes mellitus with end-organ damage (but normal serum creatinine). The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) study was a randomized, controlled, double-blind trial. There was no difference in the three groups in incidence of primary outcome. Patients in the telmisartan group had a lower incidence of cough and angioedema, but a higher incidence of hypotension compared to patients on ramipril. The incidence of syncope was identical in these two groups. Patients in the combination arm had a higher incidence of hypotension, syncope and renal dysfunction compared to patients in the ramipril arm. Another interesting finding was the fact that ACE inhibitor-ARB combination therapy did not result in better outcomes compared to ramipril therapy alone, in spite of better blood pressure (BP) control seen in patients treated with the combination regimen (2.4/1.4mmHg lower BP in the combination arm). One potential explanation for this is the higher incidence of adverse effects such as hypotension and renal complications seen with combination therapy, which might have offset the benefits of better blood pressure reduction. The conclusion here, regarding combination therapy with ACE inhibitors plus ARBs, is similar to the VALIANT trial which examined the combination of full dose captopril plus valsartan {1}.

low carb/starvation ketosis vs diabetic ketoacidosis