medicine
palmd | January 22, 2009This is just for kicks, and requires a little work. I recently became aware of a dreadful article that I'd love to share with you, but then I thought, "my readers are pretty damned smart; let's see what they have to say first."
The article in question, "External Qi of Yan Xin Qigong differentially regulates the Akt and extracellular signal-regulated kinase pathways and is cytotoxic to cancer cells but not to normal cells" just seems ripe for feeding into the dewooificator. Now, the full text is behind a paywall, and it wouldn't do for me to share my full text copy with you. I certainly can…
oracknows | January 22, 2009Being involved in clinical research makes me aware of the ethical quandaries that can arise. Fortunately for me, for the most part my studies are straightforward and don't provoke much in the way of angst over whether what I am doing is ethical or whether I'm approaching a line I shouldn't approach or crossing a line I shouldn't cross. However, there's lots of research that flirts with the unethical and sometimes even crosses the line. Institutional review boards are there to oversee the ethics of clinical trials and protect the human subjects who participate in them, but they don't always…
oracknows | January 21, 2009Regular readers here know that one of the themes of this blog is both a lament over the infiltration of quackademic medicine and a call to arms to fight it with science- and evidence-based medicine. However, to achieve this end, it won't be enough for middle-aged farts like myself to take up the banner. We need to influence the next generation of doctors. In order to provide our patients with the best care, we need to inculcate the knowledge of science and how to apply it to medical questions into the next generation. In short, we need to win over residents and medical students.
Medical…
ddobbs | January 21, 2009
My brother, who started his medical career as a pulmonary tech at a naval hospital and is now the medical director for the National Disaster Medical System -- a system that draws heavily on medical personnel normally employed outside government -- sent me this account of his Inauguration Day, which he spent overseeing the NDMS care of the vast crowd on the Mall.
Allen's job that day, for which he spent months preparing, was to be ready for anything from stubbed toes and headaches to widespread medical disasters of the sort best not pondered (except by disaster relief people). The day…
palmd | January 21, 2009I'm one of those wacky idealists for whom January 20th was a great day. But with those high hopes, I have some fairly high expectations of our new president, one of the first of which is to repeal the Church Amendment, an HHS directive allowing health care providers to abandon proper ethics without consequence.
I've done quite a bit of blogviating about so-called conscience clauses, the rules that would allow health care providers to deny patients care not because it is outside the standard of care but because it bothers the personal beliefs of the provider. In case my previous writings…
palmd | January 21, 2009Nearly a year ago, a young girl was killed by her parents. She was dying of diabetic ketoacidosis, and her parents provided only prayer. They weren't living on some compound under the thrall of some cult leader. They weren't living in a third-world country far from modern medical care. They were living in the middle of Wisconsin, and had access to any care they might need, but while their child suffered, the parents did the equivalent of nothing. This type of situation has been done to death, but since the parents are about to go on trial, let's review the responsibilities of the state…
palmd | January 21, 2009Jake over at Pure Pedantry has a post up about eCards used to warn of sexually transmitted infections (STIs), and while the idea is certainly humorous, it's probably a really good idea. The story has popped up a few times in the last several months, most recently in the New York Times. The basic idea is this: you hook up with someone, find out you have and STI, and then email them anonymously through a third party service to let them know they've been exposed and need to get checked out. These third party services usually provide health care links as well.
Anonymous internet hook-ups…
oracknows | January 21, 2009I got home from work rather late last night; so for once I'll spare you my typical Orac-ian level of logorrhea today. Yes, I know how much the ravening hordes of my fans thirst for every bit of wisdom that flows from my keyboard to Seed Magazine's servers and from there to the world, but fear not. I didn't say I wouldn't quench that thirst. I just won't be taking as long as usual. Maybe a couple of quickies instead of the epic post.
My vastly inflated sense of self-importance, bloated beyond all reasonable sense of scale, aside, if there's one thing I've taken an interest in and written about…
oracknows | January 20, 2009I never thought I'd finally see the day, but George W. Bush is no longer President of the United States, and Barack Obama is. I have to say, I've paid attention to Presidential Inaugurations since 1981, and I can't recall one greeted with as much excitement, hope, and expectation. All around my university, in my medical center, and even in my cancer center, auditoriums were set up and the oath of office and inaugural speeches televised on the big screens there. At my cancer center, the auditorium was packed. Our cancer center director was there, as was most of the center leadership and many…
palmd | January 20, 2009Make no little plans; they have no power to stir men's blood.
---Daniel Burnham
The last eight years have seen subtle and not-so subtle predations on the practice of medicine. Will the new administration be able to promote the kind of change we need? Let's review some of the challenges facing the Obama administration.
Ethical apocalypse
Bush's evisceration of the Constitution of the United States has affected health care professionals. For example, the military has likely always used psychologists to assist with interrogations, but the last eight years has seen a huge increase in the…
oracknows | January 20, 2009About a year ago, I discussed an article by Dr. Atul Gawande describing a quality improvement initiative that appeared to have been stalled by the Office for Human Research Protections and its apparent tendency to apply human subjects research protection rules to initiatives that are not exactly research using human subjects. The problem appeared to be an excessively legalistic and a "CYA" attitude more than a genuine concern for protecting human subjects. At the time, I was more concerned with the ethical and policy implications of the story rather than the actual research itself. After all…
palmd | January 19, 2009You've probably read about the current Salmonella outbreak. It's a fine example of what can happen when food is produced and distributed on an industrial scale---even one small contamination event can spread widely in the food supply, and there isn't much of a system in place to follow the trail of contaminants. Others have covered the public health implications of this outbreak, so I'd like to examine some other facts that make this outbreak disturbing.
Salmonella likes non-human animals
Some species of Salmonella cause typhoid fever. Typhoid fever, a nasty epidemic disease of humans, is…
palmd | January 19, 2009I can't say enough about ScienceOnline09, and about how useful meetings like this can be. When you toss a bunch of smart people from various disciplines together, add a little ethanol, and shake vigorously, you get some interesting results.
I had the chance to chat a bit with Dave Munger (hi Dave, hi Greta---great to meet you guys!) who put together researchblogging.org, an aggregator of blog posts on peer-reviewed research. It's a great tool. Let's say you want to blog about a cool journal article. You can shoot over to researchblogging.org, generate a citation, and place a badge on…
oracknows | January 19, 2009I almost feel sorry for homeopathy Jeremy Sherr. Almost. You see, he is busily learning a lesson that HIV/AIDS denialist Celia Farber learned a couple of weeks ago, namely that, unlike the fictional nation of Oceania in George Orwell's Nineteen Eighty-Four, memory holes do not work very well in the Internet age.
I'll backtrack a bit and explain. Last week, several readers sent me reports about a homeopath named Jeremy Sherr, who apparently in November went to Tanzania in Africa and has been busted by the skeptical blogosphere for proposing on his blog Jeremy's Journal from Africa completely…
palmd | January 17, 2009OK, in all the recent chaos, I finally got PalCast # 5 out. It touches on some wide-ranging issues: the screwed up US health care system, pooled risk, hospitalists, and the ethics of being a doctor-blogger.
Reference
Andrew B. Bindman, Arpita Chattopadhyay, and Glenna M. Auerback
Interruptions in Medicaid Coverage and Risk for Hospitalization for Ambulatory Care-Sensitive Conditions. Annals of Intern Medicine, Dec 2008; 149: 854 - 860.
oracknows | January 16, 2009I hate to see this. I really do.
I really hate it to see people who think they're doing a good thing, who think they're raising money for a worthy charity, totally clueless that what they are doing is supporting the rankest pseudoscience and quackery. Here's an example from my hometown of Detroit. It's a story about a woman who's going to raise money for what she thinks is autism awareness and research at the North American International Auto Show in Detroit this coming week:
When it comes to dressing for the North American International Auto Show Charity Preview, attendee Val McFarland is…
palmd | January 16, 2009Remember those pesky conscience laws the Bush administration is trying to ram into our collective orifaces on their way out the door? No?
Let me remind you.
You see, the theocrats who are on their way out on Tuesday want to step up enforcement of the so-called Church Amendment, which protect health care providers (defined broadly) from the consequences of their own malpractice. With Church in place, your doctor (if she receives federal funds) can refuse to tell you about or prescribe birth control (as one example). Of course, she can do that anyway, but the Church Amendments protect her…
oracknows | January 16, 2009I hate to finish up the week on a bit of a downer, but unfortunately this week I really wasn't in the mood to do justice to Your Friday Dose of Woo, even though I have at least a couple of potential targets--I mean subjects--to cover for my (hopefully) fun little Friday exercise. I was gearing up to try anyway, when I saw something in my e-mail that saddened me greatly. (More on that in a moment.) I even thought of trying to pull off a post on a peer-reviewed article, even though it was pretty late when I got home. However, due to the careful reading and examination of data required, those…
terrasig | January 15, 2009Let me just start off this post by thanking Mark and Chris Hoofnagle for inviting PalMD to join them at denialism blog. Through Orac, I had followed Pal at his White Coat Underground and was delighted when the Hoof-gents invited PalMD to a bigger forum in their ScienceBlogs digs.
PalMD has now metamorphosized with his old blog now on ScienceBlogs. Congratulations, friend!
My Mom, a retired nurse, will understand completely when I say that PalMD is the kind of doc I once thought I could be (and Mom, you've got to put this guy in your bookmarks!).
Many speak of Pal's criticism of…
oracknows | January 15, 2009P.Z. Myers turned me on to a phenomenal proposal at Change.gov, the website of President-Elect Barack Obama's transition team:
Defund the National Center for Complementary and Alternative Medicine:
Here's a way to increase the available funding to NIH without increasing the NIH budget: halt funding to NCCAM, the National Center for Complementary and Alternative Medicine. This Center was created not by scientists, who never thought it was a good idea, but by Congress, and specifically by just two Congressmen in the 1990's who believed in particular "alternative" (but scientifically dubious)…