medicine
ddobbs | October 1, 2009
Last week the Times ran a story by Andrew Pollack, Benefit and Doubt in Vaccine Additive, that covered some of the ground I trod in my Slate story, "To Boost or Not to Boost: The United States' swine flu vaccines will leave millions worldwide unprotected. Pollack also had the room to explore something I lacked room for -- the fascinating history of adjuvants, and the strange mystery of how they work.
Like so many things that work in medicine, adjuvants were discovered more or less by accident -- and were in fact a "dirty little secret" in a fairly literal sense. As the Wikipedia entry…
oracknows | October 1, 2009
The endgame is in sight. At the end of this post is a list of questions for Bill Maher tomorrow (if the opportunity presents itself), the vast majority of which you, my readers, thought of.
Let's backtrack a minute.
A couple of months ago, I learned that an award named after Richard Dawkins was being given to someone who was so radically, unbelievably unworthy of such an honor, that I likened giving the Richard Dawkins Award to Bill Maher to giving a public health award to Jenny McCarthy. (In deference to Professor Dawkins, perhaps I'll now liken it to giving such an award to MMR anti-…
palmd | September 30, 2009I've been putting this off. Today I'm 203.5#. I feel into some bad habits this week.
I've found that routine is my friend. I have a few choices for breakfast at home, a few lunch and dinner choices at the hospital, and a few evening snack choices at home, all of which support my diet.
We had a very stressful week at Casa Pal, mostly due to friends' illnesses, and while I didn't "stress eat" as much as I might have (the donuts don't count, honey), I was thrown off my routine.
But I'm back on track and we'll see how things go.
palmd | September 30, 2009The state of Michigan is facing massive budget cuts which will further eviscerate the Medicaid program. If the legislature passes it's budget as planned, massive cuts to Medicaid will reduce federal matching funds further limiting access to health care for the state's many uninsured. It's not clear if there is a way out of this, other than a massive overhaul of the nation's health care system.
But lawmakers are looking for termporizing measures. One of these is to levy a tax on doctors. This is insane.
Medicaid pays pennies on the dollar so many physicians (my practice included) cannot…
oracknows | September 30, 2009I wil probably lose some respect from some of my readers by admitting this, but I've always had a bit of a soft spot for Dan Brown novels. I actually enjoyed The Da Vinci Code immensely as a jolly good read, as long as you're not too much of a stickler for anything resembling historical accuracy. Ditto Angels & Demons, although even I cringed at one of the most ham-handed bits of author foreshadowing every put into a highly popular novel. (Those of you who've read Angels & Demons no doubt know exactly what I'm talking about.) In fact, I'll probably eventually get a copy of Dan Brown's…
palmd | September 29, 2009Here's how this is going to work. Thanks to a reader, I have a case for you, which I'll present in parts. I will try to make the information accessible to both professionals and lay-people. I'll start with the barest of information and rather than guess what's going on right away, I'd like to see people organize their thoughts into broad categories based on the initial symptoms. One way to think about this is to think about what, anatomically, is in the area of question---in other words, what can go wrong there. Then, think of types of disease---vascular, anatomic, infectious, allergic,…
oracknows | September 29, 2009One of the most frustrating aspects of so-called "complementary and alternative medicine" is how much it's managed to bypass the scientific orientation of academic medical institutions and insinuate itself deeply into medical academia. Indeed, Dr. R. W. Donnell once quite aptly referred to this phenomenon, where wildly implausible claims with no science behind them somehow find truck in some of the oldest and most prestigious academic medical centers, as "quackademic medicine." Therapeutic touch, reiki, acupuncture, it doesn't matter. Somehow, much of medical academia seems to have forgotten…
ddobbs | September 29, 2009At Gene Expression, Razib casts a skeptical eye on a study of the neuroanatomical variability of religiosity.
The brain areas identified in this and the parallel fMRI studies are
not unique to processing religion [the study states], but play major roles in social
cognition. This implies that religious beliefs and behavior emerged not as sui generis evolutionary adaptations, but as an extension (some would say "by product") of social cognition and behavior.
May
be something to that, Razib says -- but it would be nice "get in on the
game of normal human variation in religious orientation
(as…
oracknows | September 28, 2009I promised last week in a post in which I described Bill Maher's latest pro-quackery remarks (this time, supporting cancer quackery), today is the day that I'm going to ask you, my readers, for some help. As I complained a while back, Bill Maher, who is anything but a rationalist or a booster of science (at least when it comes to medicine) is being awarded the Richard Dawkins Award by the Atheist Alliance International at its convention this weekend in Los Angeles.
As I said before, given that (1) the award lists "advocates increased scientific knowledge" as one of its criteria; (2) that…
palmd | September 28, 2009Dr. Jerome Groopman, whose writing I generally enjoy, put out a book a couple of years ago called How Doctors Think. It examined, well, how doctors think, how they think they think, and what the future holds for diagnosing disease. It's a good book, but with some faulty assumptions. I'm not the guy to write about how decisions are made---I don't know enough about the field, a field which needs much more research. But most doctors do not, as is sometimes posited, make diagnoses via algorithm. Nor are we slavishly bound to statistical likelihood, as the use of likelihood ratios and, er,…
j7uy5 | September 28, 2009The new drug is called iloperidone; the brand name in the USA
will be Fanapt. It is yet another antipsychotic that
blocks D2 and 5HT2 receptors. Although there is no universally
accepted way of classifying drugs into families, it will be referred to
as an atypical or second-generation
antipsychotic. This designation will indicate a loose kind of
similarity to risperidone, aripiperazole, ziprasidone, quetiapine,
olanzapine, clozapine, and paliperidone.
It turns out that there is a Wikipedia page for
href="http://en.wikipedia.org/wiki/Iloperidone">iloperidone.
It is not one of the…
oracknows | September 27, 2009Khhaaaaaannnn!
I mean, Arriiiaaaaannaaa!
Ever since its very inception, I've been--shall we say?--less than enthusiastic about the Huffington Post's medical blogging. Indeed, the level of anti-vaccine rhetoric there from the very beginning, back in 2005, astounded me. If anything, HuffPo's record has gotten even worse over the last four years, be it Deepak Chopra, or, in 2009, the addition of a variety of quacks to its roster, not to mention a brain-blisteringly stupid anti-vaccine rant by Fire Marshal Bill--I mean Jim Carrey--the promotion of "functional medicine" quackery by Mark Hyman, "…
palmd | September 27, 2009Warning: this post has a long, boring prologue. Proceed at your own risk.
I am an expert in the prevention and treatment of adult diseases. That's what I do from well before the sun rises until well after it sets every day of every week. To become an expert and retain this status is not a simple task. After college I completed four years of medical school, three years of residency in my specialty, and chose to become "board-certified". There are doctors who are not board certified in their specialties, and there's nothing nefarious about that---all that is required to practice medicine…
oracknows | September 27, 2009I didn't know that Bill Maher used Twitter, but I do now:
The original Tweet is here.
Gee, given their similar comments about flu shots being "for idiots," you don't think that Bill Maher and Doug Bremner are the same person, do you? Maybe they were separated at birth! In any case, perhaps we should see how many of us can be blocked by Maher by telling him that if you call people who get their flu shots idiots, you're the real idiot.
Here's a hint, Bill. If crackpots like those at Age of Autism love your stand on vaccines, you've gone down the same road as the Gardasil crackpots you…
palmd | September 25, 2009The stupid truly burns brightly in this one. Dana Ullman, known to readers of Respectful Insolence, Science-based Medicine, and this blog as Hahnemann's cognitively impaired bulldog, has started blogging at the Huffington Post. It's certainly an appropriate venue for his brand of cult medicine belief, but that doesn't make it any less painful. His inaugural piece, entitled The Wisdom of Symptoms: Respecting the Body's Intelligence betrays a stunning level of ignorance of basic human biology.
I have good and bad news about the human body: it is neither wise nor foolish, good nor evil, nor is…
j7uy5 | September 25, 2009Practitioners are warned that it is astonishingly easy to make dosing
errors with the oral suspension of Tamiflu (oseltamivir).
This is a product that is mostly given to kids, although it
could be used for adults who have difficulty swallowing, or for anyone
if there is a shortage of the capsules.
The reason: usually, doctors write prescriptions for liquid medications
by specifying the number of milliliters, or sometimes teaspoons, to
administer. But the dispenser that comes with the product is
marked in milligrams, not milliliters.
This came to attention when a doctor got a…
oracknows | September 25, 2009There once was a time not so long ago--oh, say, four our five years--when the anti-vaccine fringe was looked upon as what it was: a fringe group, a bunch of quacks and quack advocates, all in essence one big conspiracy theory movement, in which vaccines are the One True Cause of Autism. At the time, there were two basic flavors of this movement, the American and the British variety. The British variety began back in the 1990s, fueled by Andrew Wakefield's pseudoscience, lack of ethics, bad science, and even potentially data falsification for his original 1998 Lancet study that claimed to have…
palmd | September 24, 2009I'm not a psychiatrist, and I won't guess what motivates someone like Doug Bremner. On his blog, he posted a picture showing the head of a cancer surgeon/researcher/blogger pasted onto a large beast. A little man is doing something to the beast.
An armchair psychiatrist might make silly suppositions based on the image of a little man bent over toward what looks like the genitalia of a large beast, but also like a little man eviscerating the beast with a big tool (which is not part of the little man...he's just holding it). But images probably don't mean anything anyway.
Bremner is a…
palmd | September 24, 2009It's like this: science requires a tolerance of failure. If your shiny, happy hypothesis fails to stand up to rigorous scrutiny, you drop it and move on. If instead of a true, disposable hypothesis, you have a fixed belief that will not change based on the data, you are delusional. Boosters of alternative medicine prefer the term "maverick" to "lunatic" but in the two are often the same.
It is nearly impossible to get someone to abandon a belief in alternative medicine, no matter how strong the evidence against it. Study after study has failed to validate homeopathy as anything other…
palmd | September 24, 2009So the weight loss continues at a slow but steady pace. The exercise has been not so good; I was doing fine until I re-injured my back. Now it's just an excuse.
I've started getting up early to get PalKid to kindergarten. I suppose I could get up just a bit earlier and ride the bike. I'm not looking at exercise as a weight loss tool, but as a way to regain good health.
My morning meal is generally a high fiber cereal, oatmeal, or a bagel. Earlier I was doing eggs, but I got tired of the extra time and effort. The key to the cereal is a small serving size. I do OK until lunch and…