medicine
palmd | September 11, 2009In the current debate over health care, the Right is pissing me off. They are whining about a "government takeover" that will lead to rationing and death panels, but also about runaway costs. Guess what?
You can't have it both ways.
I just got off the phone with a Major Private Insurance Company. In order to save costs, certain tests must be pre-approved. In this case, I spent about twenty minutes on the phone, first with a clerk, then with a nurse (interspersed with a number of long hold periods). In the end, the study was approved. (I've never made such a call for a Medicare patient…
clock | September 10, 2009On Speaking of Medicine:
PLoS Medicine turns 5 years old on October 19th, 2009. To highlight the crucial importance of open access in medical publishing we're holding a competition to find the best medical paper published under an open-access license anywhere (not just in PLoS) since our launch.
Vote for your choice from the 6 competing papers, detailed below -- nominated and then shortlisted by our editorial board. Winners will be announced during Open-Access week (19-23rd October 2009). If you're interested in how we came up with this shortlist of top-quality open-access medicine papers,…
ddobbs | September 10, 2009
photo: Philip Todeldano for the New York Times
Part of any real healthcare reform will be improving practices in hospitals, and -- as Obama's proposed commission on comparative effectiveness would do -- identifying what works and what doesn't. Knowing what works and why people get better or not is vital to good medicine. But amid the talk on improving such knowledge as part of healthcare reform, a vital and fairly cheap way to generate some of it -- the autopsy -- is going ignored. This is too bad, as autopsies yield incredibly good information about the quality of both diagnosis and…
oracknows | September 10, 2009Dr. Robert Sears (a.k.a. "Dr. Bob), author of The Vaccine Book: Making the Right Decision for Your Child, is definitely antivaccine. His mouth may say, "No, I'm not antivaccine," but his actions say, "Yes, yes, yes!"
There, I finally said it. I've been flirting with saying it that bluntly for some time now, but have been tending to avoid it. I really didn't want to conclude this about "Dr. Bob," but, sadly, he's left me no choice. What else can I conclude from his actions over the last three months, when he's clearly solidly allied himself with the worst elements of the anti-vaccine movement…
palmd | September 9, 2009In the latest conversation about placebos, Steve Silberman got a number of things just right, including these converse statements:
Anthracyclines don't require an oncologist with a genial bedside manner to slow the growth of tumors.
...the placebo response has limits. It can ease the discomfort of chemotherapy, but it won't stop the growth of tumors.
Placebo, if it exists as a utile clinical entity (and I'm still not convinced) cannot cure cancer---but chemotherapy can, no matter what hand waving and chanting may or may not accompany it. This goes directly to the concept of "plausibility…
palmd | September 9, 2009I'm not gonna lie: the holiday weekend wasn't easy. Thankfully, I didn't lose ground---I'm still at 205#. But that puts me in a difficult position.
Obviously, my ratio of calories consumed to calories expended is still too high. I'm not doing great on the exercise---I just threw out my damned back again. Still, there's plenty of room for me to cut back on my intake, which is what I'm going to have to do.
See you next Wednesday.
oracknows | September 9, 2009What can one say about a woman who wrote books with titles such as The Cure For All Cancers, The Cure For All Advanced Cancers, The Cure for HIV and AIDS, The Cure For All Diseases, and, most recently, The Cure and Prevention of All Cancers (with bonus DVD)? A woman who stated that a liver fluke is the cause of all cancer and that she could cure all cancer by zapping the liver fluke with a device that looks as though it's constructed from spare parts purchased at Radio Shack? What can one say about a woman who can make a video like the one below?
In brief, what can one say about "Dr." Hulda…
grrlscientist | September 9, 2009tags: Obama, health care, AFL-CIO, Labor Day, politics, streaming video
This is a clip of President Barack Obama speaking at the annual AFL-CIO Labor Day Picnic. In this clip he is addressing the cynics and naysayers regarding healthcare reform.
If I am not mistaken, being poor, unemployed or homeless are felonies in the eyes of the GOP, so those Americans who dare commit such horrible crimes deserve nothing less than death.
oracknows | September 8, 2009I don't have much to add to this one, as it's a tragic tale. Shadowfax, a blogging ER doc, relates to us what happens when cancer patients rely on quackery like the Gerson protocol instead of scientific medicine:
This was a young woman, barely out of her teens, who presented with a tumor in her distal femur, by the knee. This was not a new diagnosis -- it had first been noted in January or so, and diagnosed as a Primary B-Cell Lymphoma. By now, the tumor was absolutely huge, and she came to the ER in agonizing pain. Her physical exam was just amazing. The poor thing's knee (or more…
oracknows | September 8, 2009Dr. Mark Hyman is famous as the "founder" of a form of woo known as "functional medicine." This new form of woo is...well, I'm not sure what it is, and neither are Wally Sampson (1, 2, 3, 4). Suffice it to say that it appears to be a serious grab bag of various forms of woo that, according to Dr. Hyman's website itself, involve environmental inputs, inflammation, hormones, gut & digestive health, detoxification, energy/mitochondria/oxidative stress, and, of course, "mind-body," whatever that means. No woo would be complete without mind-body, you know. Actually, no self-respecting woo…
oracknows | September 7, 2009Remember Daniel Hauser?
He's the the 13-year-old boy with Hodgkin's lymphoma who underwent one course of chemotherapy and then decided he wanted to pursue "alternative therapy" based on fear of chemotherapy and because of the influence of the faux Native American religion that his mother had taken up with. Ultimately, after a judge ordered Daniel's parents to make sure that Daniel received the chemotherapy and radiation therapy he needed, Daniel and his mother Colleen went on the lam, but ultimately Daniel's mother decided to turn herself in. As a result, Daniel began live-saving chemotherapy…
oracknows | September 7, 2009If there's been a theme running through this blog, it's been the importance of science and critical thinking. The main focus of this emphasis on skepticism, of course, has been medicine, which makes sense, given that I'm a doctor and a cancer researcher, but I don't limit myself to just medicine. However, as part of my emphasis on science-based medicine (SBM) as being the best methodology to provide the best patient care that we can, besides the random quackery deconstructions,
I've tended to harp on two topics over the years. First, there's the subject of what Dr. R. W. has called "…
palmd | September 6, 2009Doug Bremner has a blog. That blog sucks.
Bremner is an apparently well-regarded psychiatrist, and takes a refreshing look at the influence of industry not just on pharmaceuticals but on the conduct of science itself. His outspoken views have led to attempts to squelch his academic freedoms. But his sometimes-heroic record does not excuse dangerous idiocy.
I can understand how wading into the shit pool that is conflict of interest can leave one cynical. But cynicism and suspicion turned up to "11" is no longer bravery---it's crankery. It's not his snarkiness that burns---it's his…
palmd | September 6, 2009Holiday weekends are supposed to be quiet around here. People head up north for the last long weekend of the summer, eat ripe cherries, melon, and peaches, go to street fairs. Apparently they also go to doctors. But I have a brief lull before the next onslaught of twisted ankles, hand-foot-mouth disease, flu, strep throat, chest pain, back pain, or whatever other common medical complaints walk in the door attached to a person.
There's a little cemetery up the street from me. This isn't New England, and old cemeteries aren't the norm, but this one look interesting from the car window. So…
palmd | September 4, 2009You really should be reading Zuska's pieces. As usual, she cuts through the crap to the meat of the issue. Go now and read.
palmd | September 4, 2009I'm finding my "diet" remarkably tolerable. I'm still losing weight, albeit slowly, and enjoying what I eat. And aside from the weight loss, I'm eating better---lots of fruits and veggies, fewer simple carbohydrates. But I'm also noticing things that I hadn't before. I'm noticing just how much everyone eats. Sure, it's not like it isn't obvious, when you see commercials for restaurant chains the the huge fat and sugar laden meals they serve. But just watching people out to eat or in the hospital cafeteria, seeing how they may eat an appetizer, main dish, sides, desert---meals that add up…
ddobbs | September 4, 2009
photo: U.S. Forest Service
Notables of the day:
John Hawks ponders the (bad) art of citing papers you've never read.
Clive Thompson ponders the new literacy spawned of engagement with many keyboards.
A poll on public education shows how much opinion depends on framing, context -- and who else thinks an idea is good. In this case, people liked the idea of merit pay more if told Obama likes it.
Mind Hacks works the placebo circuit.
And Effect Measure weighs in on the weird contrasts and (limited) parallels between swine flu and avian flu.
And for fun, fire lookout towers, from BLDGBLOG. You…
oracknows | September 4, 2009So-called "complementary and alternative medicine" (CAM) or, as it's now as frequently called, "integrative medicine" (IM) represents a hodge-podge of remedies that are mostly based on prescientific concepts about how the human body works and how disease attacks it. Homeopathy, through its concept of "like cures like" and law of contagion. The former in essence is a manifestation of the magical concept that "like produces like." Similarly, homeopathy's law of infinitesimals, in which serial dilutions to the point that there is unlikely to be a single molecule left of the substance thought to…
palmd | September 3, 2009If I read one more crappy article about placebos, something's gotta give, and it's gonna be my head or my desk. Wired magazine has a new article entitled, "Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why." Frequent readers of skeptical and medical blogs will spot the first problem: the insanely nonsensical claim that "placebos are getting better". This not only "begs the question," but actually betrays a fundamental misapprehension of the concept. I've written several times about the nature and ethical implications of placebos, but it's time for a serious…