palmd | June 28, 2010Over a quarter century ago, a young woman was admitted to a New York hospital with fever and agitation. She never walked out. Libby Zion died while under the care of he primary care doctor and two medical residents. The exact cause of death was never identified, but the case led to a forced examination of medical residents' work hours. This was driven largely by Zion's father who felt that his daughter had been killed by inexperienced, poorly supervised, and overworked resident physicians.
"You don't need kindergarten," he wrote in a New York Times op-ed piece, "to know that a resident…
palmd | June 28, 2010I frequently read about the latest medical and scientific "breakthroughs" in the mainstream media, and in modern media such as sciencedaily.com. One commonality is lack of citations. If I'm lucky, they may cite the source journal or meeting. If I'm really, really lucky, they may even give a general date (e.g., "JAMA in June"). But I never see an actual citation. That would be one simple way to improve science journalism. A standard citation would give readers the tools to evaluate the primary source. In science, we consider that pretty important.
palmd | June 27, 2010Author Chris Mooney has a provocative piece up at the Washington Post today. He argues that scientists are misunderstanding the dynamics of science-policy debates. Because, he argues, ideology often trumps scientific fact in the minds of the public, we (scientists) need to work harder to engage the public to win their hearts before we win their minds (please forgive me, Chris, if I didn't get this quite spot on).
While I appreciate Chris's general point---that we can't just "fact" people into submission---I think some of his arguments beg for a more critical analysis. Point one,…
palmd | June 24, 2010When you walk into a good coffee shop, you can smell it. It's a smell nothing like the smell of the old, sour coffee sitting in a carafe at the office. It's the smell of dark, dark beans, cracked open, releasing complex odors of fruit and of heat. And as much as I enjoy sitting in a coffee shop reading and writing, I don't get much time for that these days. But I can bring it home.
I love opening a new bag of beans. They have that shine to them, a shine that is lost very quickly. And when you pour those fresh beans with their volatile sheen into the grinder, they jostle and release just…
palmd | June 24, 2010Medicare is the government health care program for the elderly. For internists such as me, Medicare patients make up around half our practice. Because of historical budget tools, every year Congress goes through the motion of watching our reimbursement cut, and quickly fixing it. It's a terrible system. As a small business, my costs are pretty much fixed: rent, employee pay, health insurance, supplies, etc. Every year, a Medicare pay cut goes into effect, and then our checks are held while Congress puts together a temporary fix.
This year, the pay cut is 21%. That means that I will…
palmd | June 23, 2010When it comes to medical blogging, no one has been as consistently good, fresh, and snarky as Orac. Respectful Insolence sets the standard for all other medical blogs, and though Orac may not be a media star like some other med bloggers, his writing has had a significant impact on some important medical issues such as vaccination. The fact that he is often the target of vicious attacks by anti-vaccination activists and other quacks and wackos shows just how good a job he is doing.
Though he has been criticized for being a bit loquacious, his thoroughness is one of the traits that makes…
palmd | June 21, 2010I'm looking forward to having some time to read this summer. I've planned a total of two weeks away from work, and if all goes well, I'll get some time to plow through a few good reads. My first trip away will be my usual gig as a camp doctor in Ontario. Last year I brought up The Great Influenza by John Barry, which was ironic, given I landed at flu central. My second week off will be up in northern Michigan. Here's my list, which is heavily biased in subject matter (I'm far too lazy to give a three-source bookstore link, so you'll have to google them):
Breakthrough: Elizabeth Hughes,…
palmd | June 20, 2010I visited a physician this week as a patient. The details of the meeting are in the TMI category, but the long a short of it was he gave me advice that the altmed folks wouldn't believe. Surrounded by the most advanced diagnostic technology, armed with a nearly infinite pharmacopoeia, he made a single recommendation: stop caffeine.
Stop caffeine. Ugh. He said, "Stopping caffeine often solves the problem you're having. You know, it's a drug. You don't need it. It's like speed. Stop it, and I'll see you in a month."
Caffeine is my friend. In college I always wrote my papers in one,…
palmd | June 16, 2010I've been teaching internal medicine for a number of years now. The practice of internal medicine falls into two broad categories; inpatient medicine, and outpatient medicine. Because of certain historical imperatives, internal medicine training is heavily biased toward inpatient education, and these days, inpatients are sick. To qualify for hospital care a patient must be receiving care that cannot be given outside the hospital; they must meet criteria for intensity of service and severity of illness. Ask any old-timer doc and they will tell you that hospitalized patients are much sicker…
palmd | June 15, 2010My wife is an accomplished professional. She loves her profession, and she's damned good at it. But she is officially "unemployed", and it kills her every time she has to put that down on a form. So how is it that she came to be unemployed?
When we met, MrsPal and I were both working full time---more than full time, actually. I'd have to say she was actually working quite a bit harder than I was. After we were engaged, an opportunity arose for her to cut back on her grueling schedule, but to do it she would have to quit her job entirely. For a variety of reasons, that is what she chose…
palmd | June 14, 2010One of the questions addressed in this space is, "what makes a particular condition susceptible to quackery?" Some of the common features we've seen over time are:
Diverse and protean symptoms: fatigue, "brain fog", diffuse pain, and other vague symptoms are often used as diagnostic criteria for controversial entities such as morgellons and chronic Lyme disease.
Lack of diagnostic certainty: there are no definitive tests to make the diagnosis of chronic Lyme disease or morgellons (or fibromyalgia for that matter) making objective diagnosis difficult.
Children affected: autism affects…
palmd | June 9, 2010I was catching up again on my favorite periodical (Morbidity and Mortality Weekly Report---the Dengue Fever story is Awe.Some.) I came across the official recommendations for Gardasil for males. Gardasil is the vaccine produced by Merck that can protect women against infection by four strains of human papilloma virus (HPV). The vaccine has been shown to prevent genital warts and pre-cancerous lesions caused by the virus. The vaccine, in conjunction with Pap tests, has the potential to significantly reduce the incidence of cervical cancer.
Of course, HPV infections do not arise…
palmd | June 8, 2010As we ramped up for the H1N1 influenza pandemic last year, one of the worries expressed by the public and by the alternative medicine establishment was Guillain Barre Syndrome (GBS). As explained by neurologist Steven Novella, GBS is a serious auto-immune neurologic disease that causes weakness. It is often preceded by a relatively mild upper respiratory or gastrointestinal illness. In 1976, when a novel swine flu appeared and spread quickly through a military reservation in the U.S. This was a pattern seen in the 1918 pandemic, and the government moved to stem a potential serious…
palmd | June 7, 2010I'm not sure what to write about this, but I feel a need to write something. There has been an interesting and infuriating discussion going on at Jason and Zuska's blogs.
Jason, whose posts on learning and cognition rock, started the discussion with an examination of a small amount of scientific literature on pornography. He's young, so he might not be aware of the extensive literature going back at least 25 years, including writings of Dworkin, MacKinnon, and many others. There's a lot of it, some of which I've read, but not for a very long time.
He starts by wading into a deep swamp…
palmd | June 3, 2010Joe Mercola's website has always been a "target-rich environment" for quack hunters. His rants against vaccines, his incorrect flu information, his support of homeopathy, and just about everything else at his website comes free of evidence and full of unfounded assertions (as well as some seriously side-splitting giggles).
But his latest post up at---where else?---the Huffington Post is patently dangerous. It is entitled, "Why You Shouldn't Drink Pasteurized Milk". If he had gone into the high caloric content of milk, the possible uses of alternative sources of calcium and other nutrients…
palmd | June 2, 2010
Not an opium poppy
I took this picture a couple of days ago. This poppy popped up as a volunteer in my front bed. It's about four feet tall and the flower is about 5 cm in diameter. It's not an opium poppy, but it could pass, and I've been looking for an excuse to use the picture.
Opium derivatives---and later, synthetic opioids---have probably been used for millennia for the relief of pain. Given human biology, they've probably been abused for just as long. Opiate use disorders are a daily fact for primary care physicians; the use of these drugs has become more and more common for…
palmd | May 31, 2010According to my family's recollection, none of our relatives has died fighting for the United States. My grandmother was from a small town in what is now Belarus and most people in the family were born, lived, and died there. One of her brothers, though, did something remarkable. If family memories are correct, he left town and went to the Sorbonne in Paris. After being there a short while, the Great War broke out, and he joined the French army to fight for his new home. He was killed, and my father and two of his cousins are named for him (in an Anglicized way).
I am in the first…
palmd | May 31, 2010I'm off to watch my daughter march in some sort of neo-fascist parade (Daisy scouts) and then off to the hospital, but first some quick housekeeping issues:
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palmd | May 28, 2010As summer approaches and people spend more time outdoors, many parts of the country will start to see cases of Lyme disease. It is carried by deer ticks and is especially common in the Northeast. Tick bites often go unnoticed, but the rash of Lyme disease is pretty characteristic and occurs in about 70-80% of those who are infected.
Erythema migrans, the typical rash of Lyme disease. Source.
It's easily cured with antibiotics, but if untreated can have significant complications, such as arthritis, and various neurologic problems. As most of my readers know, there is also a movement…
palmd | May 26, 2010As my regular readers know, I'm not a big fan of our current health care system. Our bloated, industry-driven system manages to deliver less effective care at a higher cost than most other industrialized nations. The system is Byzantine, unnavigable, and dangerous, and is kept that way in the name of the Holy Market. But health care can benefit from practices that are decidedly un-capitalist, at least in the Milton Friendman or Ron Paul sense.
Like aviation, health care must apply risky and expensive practices to large numbers of people in dangerous situations. This process is made safer by…