health
palmd | February 2, 2009I gotta admit that I just don't get it. Perhaps it's my overly narrow world-view, or perhaps it's my lack of imagination, but I really don't get it. Let me explain.
I've got this horrid pain in my back and leg. It's searing, aching, gnawing. My foot is numb, but still hurts. It tingles, feels heavy, and it's weak. Sometimes it feels like electricity is jumping through it, sometimes like little worms are crawling in it. Being a curious person, I look for ways to explain this.
I'm sure this horrid crawling feeling could be explained thusly:
Perhaps there are actual worms crawling…
gregladen | January 30, 2009A paper coming out in the next issue of the journal Clinical Infectious Diseases addresses the question of the link between vaccines and autism. This new review article examines three hypotheses linking vaccines to autism:
(1) the combination measlesâmumpsârubella vaccine causes autism by damaging the intestinal lining, which allows the entrance of encephalopathic proteins;
(2) thimerosal, an ethylmercuryâcontaining preservative in some vaccines, is toxic to the central nervous system; and
(3) the simultaneous administration of multiple vaccines overwhelms or weakens the immune system.
The…
palmd | January 29, 2009It started a few weeks ago---a dull ache in my lower back, more on the right, worse with sitting for prolonged periods of time. I did my usual stretches, although not as much as I should have. The pain waxed and waned, until a few days ago, when the pain escalated suddenly, preventing me from standing up straight, and making even a trip to the bathroom an unwelcome adventure. Two nights ago, I lay in bed awake, pillows wedged at strategic points, hoping to find some comfort, any comfort.
And then all hell broke loose. My back spasms loosened up a bit last night, so I got a few essential…
palmd | January 28, 2009It's hard to hide severe back pain. When I stand up, I look like a question mark. The visibility of the problem, combined with the general goodness of my fellow human beings, leads to lots of unsolicited advice. Folks have given me great advice (take some NSAIDs, stretch, and don't lay in bed) and some questionable advice (go to the chiropractor, get some acupuncture). My colleagues and I have written a lot about acupuncture. It's sort of a "gateway CAM", in that it has a patina of plausibility. But the evidence of its efficacy has pointed toward it being an elaborate placebo.
To help…
gregladen | January 26, 2009A strain of drug-resistant staph identified in pigs in the Netherlands five years ago, which accounts for nearly one third of all staph in humans there, has been found in the U.S. for the first time, according to a new study.
Seventy percent of 209 pigs and nine of 14 workers on seven linked farms in Iowa and Illinois were found to be carrying the ST398 strain of methicillin-resistant Staphylococcus aureus (MRSA).
The study marks the first time researchers have tested for the strain in the U.S., so there's no way yet to tell when or how it arrived or how widespread it may be, says Tara Smith…
palmd | January 26, 2009Morning report is a daily conference for medical residents. It is done differently at different institutions, but normally a case is presented, often by the post-call team, and discussed by the senior residents and an attending physician. Today's case will be the first in an occasional series. --PalMD
Case:
Mrs. M is an 89 year old woman who resides in a nursing home who was admitted with confusion and lethargy. She has a past medical history significant for stroke, coronary artery disease, depression in the distant past, and no history of dementia. She has lost significant weight over…
palmd | January 26, 2009It's true that words matter, and that we who practice real medicine have often let cult medicine practitioners get the linguistic high ground. We've let them get away with calling non-science-based practices "alternative" and "complementary", without really asking, "alternative to what?" or "does it really "complement, or just distract?" We've often ignored language, and when we don't, we are accused of being pedantic, of focusing on "rhetoric" rather than "real" issues. Language is powerful. There is no such thing as "it's just a word".
Language is even more important in the fight…
gregladen | January 26, 2009In an astonishing demonstration of the evils of Marketing in a Research University Context, the University of Leicester today announced that an upcoming research project would find a link between coffee consumption by pregnant women and leukemia to develop later in their offspring.
This is a statement made by scientists involved in the Research That Has Not Yet Been Done:
Although there's no evidence at all of a link between caffeine and cancer, we're putting two and two together and saying: caffeine can induce these changes and it has been shown that these changes are elevated in leukaemia…
palmd | January 25, 2009Sometimes I feel like I'm pounding my head against a wall. I've been wondering why the issue of so-called conscience clauses just won't die, why otherwise intelligent people can't just agree with me just don't get it.
Quick review: some health care professionals wish to be able to deny patients certain types of care, and want to be protected by law for imposing their own morals on others, in violation of basic medical ethics and human dignity (as you can see, I don't have a strong opinion about this one).
Ethical behavior is difficult. It requires empathy---but in a very particular sense…
palmd | January 24, 2009...or so goes the refrain of the addict. I was going to put up a more substantive, well-researched post, but I wanted to give you a few weekend thoughts to chew on.
I deal with addictions a lot, but the most common and deadly one is tobacco. Tobacco is responsible for millions of serious illness and deaths every year in the U.S., all of which are preventable. But, like other substance use disorders, we don't really know how to talk about tobacco addiction (which is more properly "nicotine addiction"). There is no doubt that nicotine is powerfully addictive, and the health and social…
palmd | January 24, 2009I don't have a lot of experience with small hospitals. My medical school's hospital was about two square blocks of buildings, all of them attached, ranging in age from 100 years to 10 years. The were connected by irregular bridges and linked (ex)-fire escapes, and by miles of dim tunnels.
During my residency, the campus covered several square blocks, with buildings linked by more airy bridges (a la Minneapolis) and "secret" tunnels that you could find if you just knew where to look---although getting lost underground was the rule.
My current hospital is---by number of admissions---one of…
palmd | January 22, 2009I've written quite a bit of the need for good health reporting, and I've had the good fortune to talk to some terrific reporters. But bad reporters are easy to come by, which is kind of sad, especially since jobs are getting scarce.
When this article came across my browser, something looked familiar. The Stamford (CT) Advocate has shown up on my blog before. The last time, it was an article about a naturopath preying on immigrants. When I saw a new story pop up, I was sure it would be the same reporter. The article is locked in the archives, so it took some searching, but I eventually…
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…
omnibrain | January 20, 2009It seems that a brilliant doctor in the UK has come up with an amazing piece of machinery and convinced a famous author to wear it in order to stave off the onset of Alzheimer's disease. Here's the machinery... looks like a mind control device or something - too bad It's not going to work.
According to the news article about this amazing technology:
The prototype anti-dementia helmet, which must be worn for ten minutes each day, was designed by British GP Dr Gordon Dougal.
It works by directing intense bursts of infrared light into the brain to stimulate the growth of brain cells.
Low-level…
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…
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…
palmd | January 14, 2009Hope, of all ills that men endure,
The only cheap and universal cure.
---Abraham Cowley, The Mistress. For Hope. c. 1647
I was visiting my friend in the hospital the other day. She had a port put in under the skin of her chest for chemotherapy. The whole story is unfair. She's a terrific person, with a great husband and an adorable son. She's also doing remarkably well. But that's not today's story.
Another friend wondered if maybe she should recommend a macrobiotic diet or something, anything, to help stop this stupid disease. Now, you…