medicine
palmd | April 15, 2009First, I'd like to thank everyone who participated in the naturopaty primary care challenge. It was far more successful than I could have hoped. A number of naturopaths and their supporters responded, most of them quite rationally. It takes guts to walk into the fire.
It also takes fanaticism.
I have always rather assumed that most naturopaths and other "alternative" healers are, on the whole, motivated by good. After reading all the comments, I still hold that assumption---most "alternative" healers probably mean well. That does not, however, divorce them from an ethical…
oracknows | April 15, 2009There's an old saying, so old that it's devolved into cliché: Be careful what you wish for; you just might get it. I'm sure the vast majority of my readers, if not every last one of them, have heard this saying before. Certainly, it has a lot of truth to it. Sometimes it even applies to blogging. The most recent example that comes to mind occurred yesterday, when a commenter named David M. taunted me (or so he thought):
I know you all like to pick on actresses, college students and parents with sick kids, but how about taking a look at the column by Dr. Bernadine Healy on U.S. News. She used…
ksharpe | April 14, 2009Originally posted by Scicurious
On April 8, 2009, at 12:02 AM
As I'm sure everyone knows by now, Sci LOVES getting books in the mail. Even if I paid for them, I still love seeing them show up in a box. Even better is when I pick them out of a store and get to cuddle them on the way home. So you can imagine how happy Sci was to see this show up at the door:
I've always wanted a specialized psychiatric dictionary, almost as bad as I've wanted a specialized pharmacologic dictionary. It's a good thing to have handy, and is an even cooler thing to get in the mail. So Sci pranced around…
palmd | April 14, 2009So naturopaths want to be licensed to practice "primary care". I've come down pretty hard on this idea, but one of my colleagues is asking me to reconsider for some pretty good reasons.
If we license them as PCPs, then they must be held to the same standards as MDs, meaning they must provide insurers including medicare with PQRI data on quality measures and outcomes, and they must buy malpractice insurance (and lots of it). I have a feeling that as when they have bad outcomes and are found to not be following the standard of care, the trial lawyers can make a few more boat payments.
oracknows | April 14, 2009Remember the Jenny McCarthy Body Count website that I mentioned last month? Basically, it's a website that uses CDC reports and other sources of information to estimate the number of cases of and deaths from vaccine-preventable diseases in the U.S. since Jenny McCarthy started her antivaccine crusade back in late summer 2007. The site points out that it is not blaming Jenny McCarthy for all this disease and death but that she should bear at least part of the blame for them because she has become the public face of the radical antivaccine movement. That's something I've been saying for a while…
oracknows | April 14, 2009Recently, there's been a movement afoot among purveyors of that special brand of "natural" woo known as naturopathy to convince various legislatures and regulatory bodies that they not only are capable of serving as primary care physicians but that they should be allowed to do so. My first impression was laughter--that is, until I realized that the naturopaths are serious. For example, in New York, naturopaths, spearheaded by the New York Association of Naturopathic Physicians, are lobbying to be given the power to prescribe medications. Never mind that, despite their claims to the contrary,…
palmd | April 13, 2009Yesterday I issued a challenge to naturopathic physicians to justify why they should be considered competent primary care physicians. The best and most comprehensive answer received so far is the one from "Mona". Here is my analysis.
Her response, while not entirely "wrong", shows a frightening level of chaotic thinking and unsophistication.
As a naturopathic physician graduated from National College of Naturopathic Medicine in 1988, and having done a year's residency there in Family Practice I am happy to answer your relatively easy question. I see many diabetic patients who come with…
palmd | April 13, 2009One of the common themes in biology and medicine is the feeling that somehow there must be more. Creationist cults simply know that life must be more than matter, and mind-body dualists (which includes most alternative medicine advocates) are certain that humans are more than an "ugly bag of mostly water" (sorry for the geek reference). If you can stick with me here, I'll explain to you a bit of the history surrounding this fallacy.
Most of us intuitively feel that we are both a body and a person. In every day life, it makes a certain operational sense to think of our "mind" as being…
oracknows | April 13, 2009Nearly two weeks ago, P.Z. Myers mentioned a story that would normally have provoked a post by me. Specifically, the U.S. Conference of Catholic Bishops had issued a warning against the use of reiki as being unscientific, unproven, and, worse, "dangerous to Christian spiritual health." Unfortunately, this story came out right before Autism Awareness Month and the all out spring offensive by antivaccinationists fronted by Jenny McCarthy, along with all the nonsense that entails, and my attention rapidly got sidetracked. The reason I've come back to it is that I recently learned that defenders…
palmd | April 11, 2009Yesterday's piece about naturopathy lead to a nice conversation, but I realized we're missing something. We don't actually have a naturopath to defend the profession.
You see, if, for example, you are curious what your primary care physician might recommend to you, you can go to the American College of Physicians website, or the US Preventative Services Task Force to get an idea of what the standard of care and evidence is for screening, prevention, and treatment. What isn't clear to me is what a naturopathic primary care provider has to offer.
Here's my question, and I encourage any and…
jstemwedel | April 11, 2009One arena in which members of the public seem to understand their interest in good and unbiased scientific research is drug testing. Yet a significant portion of the research on new drugs and their use in treating patients is funded by drug manufacturers -- parties that have an interest in more than just generating objective results to scientific questions. Given how much money goes to fund scientific research in which the public has a profound interest, how can we tell which reports of scientific research findings are biased?
This is the question taken up by Bruce M. Psaty in a Commentary…
oracknows | April 11, 2009Readers may have noticed that we've had a minor antivaccine troll infestation in a couple of previous posts. It's no big deal of course, hardly worth my attention--except for one thing. That one thing is that a certain member of the antivaccine propaganda blog Age of Autism, for which no evidence that vaccines are not associated with autism is strong enough to penetrate its collective Borg-like hivemind and no study suggesting that vaccines are associated with autism is too execrable not to trumpet to the high heavens as "vindication" that the antivaccine cult is correct, arrived to tell us…
palmd | April 10, 2009I'm a primary care physician. What I, other internists, pediatricians, and family medicine docs do is prevent and treat common diseases. When we get to diseases that require more specialized care, we refer to our specialist colleagues. There is a movement afoot to broaden the role of naturopaths to make them primary care doctors. The big difference between naturopaths and real primary care physicians (PCPs) is that naturopaths haven't gone to medical school, completed a post-graduate residency program, and taken their specialty boards. Why is this important? If a naturopath wants to be…
oracknows | April 10, 2009
If there's one concept that seems to cross many "disciplines" of woo (a.k.a. "alternative medicine," a.k.a. "complementary and alternative medicine," a.k.a. CAM) is the concept of some sort of "life force" or "life energy." It is true that life does depend upon the utilization of energy, specifically chemical energy. That's what biologists and biochemists mean when they talk about life energy, but that's not what woo-meisters mean by "life energy." Rather, what woo-meisters mean by "life energy" can best be described as some sort of magical mystery energy field that means the difference…
oracknows | April 9, 2009Whatever you think of President Obama's economic stimulus package, there's one thing that I, at least, am happy to learn about it:
Vice President Joe Biden announced today that the Obama Administration will make $2.3 billion available for crucial health and human services programs that help to provide care for children and prevent disease. States will receive $2 billion in Recovery Act funding to support child care for working families. The administration also plans to make $300 million in vaccines and grants available to ensure more underserved Americans receive the vaccines they need…
purepedantry | April 8, 2009Neurological diseases can be strange in that they often have additional personality effects. If someone gets a cold, they sneeze a bunch but are basically the same person they were before the cold. In contrast, meningitis can include mental status and personality changes in its early stages -- including irritability and sleepiness. When a disease involves the brain, it can change who we are in addition to making us sick.
In this vein, I found this paper in the journal Brain particularly interesting. Abe et al. report that Parkinson's patients tell fewer lies than controls in a task where…
jstemwedel | April 8, 2009The Independent reports that drug giant Pfizer has agreed to pay a $75 million settlement nine years after Nigerian parents whose children died in a drug trial brought legal action against the company.
It's the details of that drug trial that are of interest here:
In 1996, the company needed a human trial for what it hoped would be a pharmaceutical "blockbuster", a broad spectrum antibiotic that could be taken in tablet form. The US-based company sent a team of its doctors into the Nigerian slum city of Kano in the midst of an appaling meningitis epidemic to perform what it calls a "…
razib | April 8, 2009I only know about Phenylketonuria (PKU) because it is an elementary example of an autosomal recessive disease. Newborns are routinely tested, because those with PKU may develop mental retardation on a normal diet. That's about all I knew, but this from Wikipedia:
If PKU is diagnosed early enough, an affected newborn can grow up with normal brain development, but only by eating a special diet low in phenylalanine for the rest of his or her life. This requires severely restricting or eliminating foods high in phenylalanine, such as meat, chicken, fish, nuts, cheese, legumes and other dairy…
palmd | April 8, 2009The Times is reporting that health care workers actively assisted in the torture of CIA detainees overseas. This, as you might imagine, sickens me.
Many of us have seen movies or read spy novels where a doctor stands by as someone is tortured, monitoring their condition and telling the interrogator when they need to back off. It turns out this really happens.
I don't have that much to say about this that isn't obvious, i.e., it's never acceptable for health care workers (HCWs) to participate in activities designed to cause their patients intentional discomfort or injury. That's a no-…