palmd | January 24, 2010Tragedy can bring out the best and the worst in humanity. The Haitian earthquake has seen an outpouring money (the most needed type of aid) and other emergency aid. A few days ago I pondered what sort of quackery would emerge to fill a need that doesn't exist.
Homeopaths responded, of course, and while clean water is always needed, clean water that comes with a fairy tale is not.
Every person that lands in Haiti to provide "aid" also brings a mouth to feed and a cloaca to empty, so every body who goes better have a lot of value to deliver. That's why the arrival of Scientology…
palmd | January 20, 2010There has been much written about the doctor-patient relationship, and specifically how to best maintain a clinical distance while at the same time being empathic and compassionate. This is something individual doctors work on throughout their careers, but something else interests me here.
Most physicians derive enjoyment from helping people. Altruism (a topic way too complex for me to pretend to understand in depth) feels good both from the act itself and from the response one gets from the object of the altruism. This last bit has comes with potential pitfalls.
My job is to help people…
palmd | January 19, 2010I was traveling on the 14th, the official date of my first blogiversary at WCU, Sb edition. I started blogging in May of 2007 at the original WCU on Wordpress, then was invited to join the denialism blog here at Sb, and then decided to reclaim my brand.
It's been a helluva year, blogging-wise, and I like to thank you all for your traffic, your time, and your comments.
palmd | January 18, 2010I had the good fortune of spending a woefully-insufficient amount of time with author Rebecca Skloot at ScienceOnline10 last weekend. Rebecca has worked for the last decade on a remarkable book which is being released next month, but thanks to a quick hand on the keyboard, an active twitter account, and a glass of Merlot (don't ask) I have an advance copy. (I had already pre-ordered one, which I will likely give away in some sort of selfless act of tzedakah.)
The book is called The Immortal Life of Henrietta Lacks and documents one of the most important discoveries in modern biology and the…
palmd | January 18, 2010The current tragedy in Haiti may turn out to be one of the worst natural disasters (if not the worst) the Western Hemisphere has seen in the post-colonial era. Immediate deaths caused directly by trauma from the quake itself will likely number in the tens of thousands but we can be pretty sure that there's more horror to come. This is a tragedy which is going to continue for months---probably years---to come.
Science-based medicine has taught us much about how to mitigate disasters such as this one. Unfortunately, in Haiti medicine is only part of the problem; the long-standing political…
palmd | January 14, 2010The great Dr. Sandy Templeton once asked his pathology class, "Why do people go to the doctor?" People came up with all sorts of responses, but to each he gave his best British, "No, no, no, no!" Then he would tell us, "They come to the doctor because they don't feel well and they want you to make it better!"
So obvious. So simple. And yet, so complicated.
As physicians, we have a number of ways of helping patients, only some of which make the patient feel better. Primary and secondary prevention of disease don't necessarily make people feel better in the short run, so they can be…
palmd | January 13, 2010An inside source on Crisler's non-steroid-fueled "muscleboards.com" (which is now reg-protected) has fed me some classy stuff:
And someone told me he thinks PalMD is a child molestor. That is why he does not post his true name. A cursory look at what he has chosen to publish shows him to be a man of very low character, certainly capable of anything. Now, should we set up a blog to crucify him? ---Dr John Crisler
They then used their testosterone super-powers to find me real name (and to publish my office address):
Now THAT is the Peter we know.
You guys (all of you!) are GOOD!
The…
palmd | January 13, 2010Two recent posts raised some ethical questions about the practice of a very public doctor who has proclaimed himself (on the front page of his website) to be an expert on testosterone replacement therapy.
Leading TRT expert Dr. Crisler is now available for consultations, lectures, advanced physician training, conference hosting, interviews, and more.
Well, Dr Crisler was apparently not happy with my critique. He was kind enough to drop by and leave several comments explaining why, the first and longest I will reprint here. He has also sent me a great deal of traffic from his own message…
palmd | January 11, 2010Yesterday I wrote a piece expressing some concerns about a physician's practice featured in the news recently. Dr. John Crisler is a self-described anti-aging and men's health physician. A couple of my concerns regarded his prescribing practices and his possible practice of distance medicine.
From closer perusal of his site it would appear that he may not require the use of his pharmacy, but he does charge his patients to send prescriptions to pharmacies other than his own. It's not unreasonable to charge patients for the use of your time, but I feel very uncomfortable with what amounts to…
palmd | January 11, 2010The shamans of stupidity over at Huffington Post recently wrote a completely insane article whining about how unfair it is that science keeps winning. Orac did his usual best to illustrate how bizarre these folks are (and how wrong). But I also love the comments to the piece. They were an interesting mix of jaws hitting the floor in shock at the inanity, and "crank magnetism", as other idiots piled on science, which despite its successes must somehow bow to an alternative magical belief system. This comment was the best (broken down for your convenience):
Having been trained in the…
palmd | January 10, 2010An interesting discussion has been going on over at TerraSig. Abel used his expertise in pharmacology to help explain some of the nearly-inexplicable events that led to the injury of dozens and deaths of several participants in a sweat lodge ceremony. The investigation led to a Michigan physician who runs a "men's health" practice and pharmacy. The leader of the sweat lodge ceremony was apparently found to have prescription medications prescribed by and purchased from this doctor.
The medications were putatively for "anti-aging" and "low testosterone" treatments. It would clearly be…
palmd | January 8, 2010Next week, Val Jones and I are leading a discussion of professional ethics as they intersect with a professional's online life.
Each profession has its own set of ethics and draws its own lines but medicine is what I know best. I'd like to invite participants (or anyone, actually) to proffer ethical dilemmas related to having an online presence.
Some things to think about:
Some professionals bypass the issue by either staying off the internet or remaining anonymous/pseudonymous. To abandon the internet is like practicing abstinence for STD and pregnancy prevention. To stay offline without…
palmd | January 7, 2010As we mentioned earlier, Barbara Loe Fisher, founder of the infectious disease promotion group NVIC, is suing a bunch of people for "defaming" her.
Today she posted a piece at Age of Autism entitled, "2010 Needs A Fearless Conversation About Vaccination." She is suing a nationally-known vaccine expert, the reporter who interviewed him, and the magazine which ran the story about vaccination.
So much for fearless conversation.
palmd | January 7, 2010The following is a collaborative effort by PalMD, the usual author of this blog, and Ames Grawert, JD, a soon-to-be-sworn-in attorney working in New York City.
Proponents of science-based medicine have always had one major problem---human beings are natural scientists, but we are also very prone to cognitive mis-steps. When we follow the scientific method we have developed, we succeed very well in understanding and manipulating our environment. When we follow our instincts instead, we frequently fail to understand cause and effect. This is how people on the fringes of medicine and science…
palmd | January 6, 2010One of the best blogs out there, Terra Sigillata, seemed to have gone on a bit of a hiatus for a while, but Abel Pharmboy is back and better than ever.
His posts over the last 8 weeks or so are all must-reads. Go, read, discuss.
palmd | January 6, 2010It's hard to avoid news about the "obesity epidemic". Depending on who you talk to, obesity may be the number one killer of Americans or completely irrelevant to health. Alternative med boosters love to focus on obesity and other supposedly behavior-related illness. They use this to simultaneously blame the patient for their own ill-health, blame society for enabling them, and blame real doctors for not fixing it right.
The truth is that obesity is a real threat to health. The causes are protean. Societal problems, individual genetics, and politics can all contribute to obesity, as can…
palmd | January 4, 2010I'm giving two sessions at ScienceOnline10. The first, which I will be co-hosting with Dr. Val Jones, is entitled Privacy, ethics, and disasters: how being online as a doctor changes everything. I've given similar talks to physicians, but given that Val and I may be nearly the entire medical team at the conference, we'll probably let the conversation branch out significantly. If you're interested in the session, please go to the conference wiki and let us know what you're thinking. Val is a great public speaker and I have a set of points I'd like to hit on, but this is supposed to me more…
palmd | January 4, 2010I love it when friends read my blog. Maybe it's simple vanity, but I love being able to talk to people about what I'm writing. Readers who ask good questions (especially friends, because I trust their motives) help me reevaluate my message and my facts.
So an old friend sent me an email this weekend after reading a post, and it's a question deserving of careful examination. It goes to the mixed messages physicians give to patients even when we don't mean to.
I was anxious about vaccines and meted them out a little bit more slowly than is typical (only one or two at a time - just took…
palmd | January 3, 2010I don't know if Garrison Keillor is anti-semitic and I don't really care, but the question was raised by his Christmas editorial at Salon.com. After reading it last month I decided I had nothing to say about it. Who really cares what Garrison Keillor says, right?
This morning I was on my way to work and yesterday's Prairie Home Companion came on. I found my hand reaching for the dial to change the channel. Then I realized why I haven't been able to get this out of my head.
I've been listening to PHC for about 20 years. I always enjoyed the quirky humor and most of all the music. When I…