palmd | November 21, 2009Opponents of science-based medicine like to accuse the rest of us of failing to be "holisitc", of failing to see the whole individual who comes to us for health care. I've argued many times that this is not only wrong, but that so-called alternative docs, by recommending unproven treatments and giving false hope are actually harming their patients. The new USPSTF mammogram recommendations are likely to fuel this debate as well as the one regarding health care reform and rationing. There's already been a great deal of debate new mammogram recommendations, most of it good. For a comprehensive…
palmd | November 19, 2009In November, the citizens of my home state approved a medical marijuana law. The very next day, I started getting calls from patients (often not may own) asking how they could get it. I'm not fan of draconian laws that imprison people for getting stoned, but when it comes to medical interventions (rather than legal ones) I have an informed opinion. The new law allows Michigan residents to grow weed for their own consumption if they have approval. The law does not allow doctors to prescribe marijuana, rather it allows them to certify that the patient has a condition designated by statue as…
palmd | November 19, 2009Basing medical practice on science helps us avoid the pitfalls of relying on our own reasoning and experience. If I want to start a patient on a new medicine, the individual characteristics of the patient are important (Is the drug meant for their condition? Will it interact with other drugs they are on? Are they allergic to it? Can they tolerate it?) but at least as important is how the drug performs when used on large numbers of people. This attenuates the large differences that can be seen among individuals, and allows us to predict how in general the drug will act.
One of the metrics…
palmd | November 18, 2009There are a couple of quotes circulating widely claiming that major players in flu vaccine development are "denouncing" the vaccine.
From (shudder!) mercola.com:
"Dr. Anthony Morris, a distinguished virologist and former Chief Vaccine Office at the U.S. Federal Drug Administration (FDA), states that "There is no evidence that any influenza vaccine thus far developed is effective in preventing or mitigating any attack of influenza" and that "The producers of these vaccines know they are worthless, but they go on selling them anyway."
And:
And in November 2007, the UK newspaper The Scotsman,…
palmd | November 18, 2009In a piece written for health reporters, journalist Jane Allen gives some useful advice about covering alternative medicine, but there are some gaps that are are hard for a non-medical professional to recognize (and frankly, for many medical professionals as well). She quite rightly urges skepticism, but when looking into ideologic and muddled topic of alternative medicine, skepticism needs to be turned up to "11". A major complaint that doctors have about health coverage is not the objectivity, earnestness, or research abilities of the reporter but the lack of some of the fundamental…
palmd | November 16, 2009Hat tip to the incomparable, contentious, pain-in-the-ass-who-we-are-all-better-for-having-around scienceblogs regular becca for pointing out this site (from google of course) that helps locate flu shots in your area (in my area, everyone is "temporarily out of stock"). While you're visiting, check out google's flu trends as well.
palmd | November 14, 2009An easy way to kill a debate on health care policy is to use the "R" word. We saw this early in the HCR debate with overheated talk of "death panels" and other nonsense. But we ignore the real issue of rationing at our own peril. Those of us who favor real HCR must embrace rationing, coopt it, show our opponents how it is inevitable.
Nowhere is the the Right more hypocritical than the issue of health care rationing (OK, maybe with sex stuff, but...). Everyone who studies American health care knows that we already ration; we just do it irrationally. Current rationing allocates resources…
palmd | November 13, 2009The resurgence of vaccine-preventable diseases is a fascinating, if unwanted, phenomenon. Pertussis, measles, and now mumps are cropping up after long periods of quiescence. Mumps has been generally very well-controlled since the adoption of wide-spread vaccination, with no nation-wide outbreaks, but there have been a number of regional outbreaks, most notably in 2006 and now again in 2009. Since the widespread use of two-dose vaccines, mumps cases in the US have dropped by more than 99%.
In an analysis of the 2006 outbreak the authors noted a three year periodicity to wide-spread mumps…
palmd | November 12, 2009There's a number of dangers in carrying an analogy too far. One situation may be analogous to another without being identical, or they may not in fact be analogous at all. Forgetting this principle can get you into a wee bit of trouble.
To formalize it a bit, just because you think "A" resembles "B", and "B" has property "P" does not mean that "A" also has property "P". It may be that "A" is not quite enough like "B" to share all of its properties.
But a weak analogy can't stop a weak but persistent mind. Dana Ullman, Hahnemann's cognitively-impaired bulldog, has given us a…
palmd | November 11, 2009In medicine, theater can go a long way. The seemingly simple acts of laying hands on a patient, leaning in to listen to them, and giving them instructions to follow can be therapeutic. Sometimes this is labelled as part of the so-called placebo effect, but whatever we call it, physicians (and priests) have been doing it for thousands of years. But how far should we push it? As medicine becomes more science-based, relying on actual evidence to guide practice, where does theater fit in?
One argument is that since this difficult-to-quantify intervention can clearly do something, we should…
palmd | November 10, 2009According to a Pew survey, 61% of Americans are getting health information online. The internet is now the third leading resource for health information after doctors and family/friends. At a recent session hosted by USC Annenberg School for Communication and Journalism, I learned this and many other things while chatting with journalists and other bloggers. It turns out (and I don't have the data in my hands yet) that some of the "sub-trends" are pretty interesting. For example, moms and other women seem to prefer facebook to other social networking sites. I've noticed this anecdotally…
palmd | November 9, 2009I had a nice dinner last night with a group of medical bloggers and journalists (I don't recommend the scallops). One journalist, a veteran of many years, asked me, "is your goal to convince people, or are you preaching to the choir?"
It's a simple question, one that I probably should ask myself daily but don't. Rather than extracting an answer from my behind, I decided to think about it for a while.
The answer, I think, is both and neither. It's hard to judge given that the percentage of readers who comment is low, but the question wasn't "are your readers convinced", but "do you intend…
palmd | November 7, 2009I'm told that mathematicians and physicists get a lot of mail from folks with "big discoveries". These discoveries are often of the "Einstein was wrong and I figured out the Theory of Everything" variety. Many of us refer to these folks as "cranks", a catch-all, derogatory term for people who, through their own arrogance and ignorance, think they have, despite little education or work, disproved ideas that have taken lifetimes to assemble.
Enter the anti-vaccination cranks. Immunoprophylaxis---the manipulation of the immune system to prevent disease---is centuries old, and over those…
palmd | November 5, 2009Some were surprised to read that after a pro basketball player swatted a bat out of the air, he had to have rabies vaccinations.
This is not a surprise to many medical folks who have had to give rabies prophylaxis after bat exposures. Most of the few human rabies cases in the U.S. are transmitted by bats, although raccoons are more often diagnosed with the disease. Because rabies is fairly easy to transmit and nearly always fatal to humans, we are very aggressive about prevention. Rabid wild animals can have unusually aggressive behavior and can transmit rabies to humans and to their…
palmd | November 4, 2009No matter how you feel about incarceration, it's a dangerous business. Inmates have high rates of serious transmissible diseases which aren't turned into the warden when they are released. Around 2.5 million people are held in American correctional facilities. HIV rates for imprisoned men 1.6% and for women is 2.4% (compared to about 0.4% among Americans as a whole). About 4.5% of inmates reported sexual victimization. Of the facilities that provide hepatitis B vaccination, 65% target "high risk" groups only. Tuberculosis rates are also very high. This is just a sampling of the horrifying…
palmd | November 4, 2009As I've written before, the placebo effect is a rather messy phenomenon. It usually refers to the difference in outcomes in a study that are not due to the intervention but to multiple other variables associated with being in a study. More colloquially, "placebo" often means a positive effect seen from the administration of a biologically inert substance. There's a bit of a buzz brewing about a recent brief communication in Science. The report used fMRI to look for physiologic correlates to pain responses that were attenuated by an inert substance. (For the purposes of this discussion, I'…
palmd | November 3, 2009
Thank you for polluting my in box with a hateful, lie-filled chain letter. It took me all of ten seconds on the internet to find the truth behind your lie and thereby discover what a tool you are. I'm sure it would have seemed natural to you that because we share an ethnic identity I would give you a pass on this one---I won't. My wife and I are not raising our daughter in a household of hatred, but of love. She will learn to love and respect everyone, and even to reach out to those, who like you, may not at first seem deserving of such a precious gift.
My daughter is surrounded by…
palmd | November 3, 2009The mainstream media is finally catching on to a disturbing story--the insertion of faith-healing and other non-scientific practices into health care reform. Health bloggers have been on this story for a while, showing us that Senate Bill 1679 currently contains language that would require support for faith healing practices:
The essential benefits provided for in subparagraph (A) shall include a requirement that there be non-discrimination in health care in a manner that, with respect to an individual who is eligible for medical or surgical care under a qualified health plan offered through…
palmd | November 2, 2009One of my dear readers just left the internet equivalent of a flaming bag of turd on my bloggy doorstep:
Everybody should read this article by Dr. Russell Blaylock http://articles.mercola.com/sites/articles/archive/2009/11/03/What-We-H…
These are the facts folks, all information is derived from Center for Disease Control and Prevention, the National Institutes of Health, the National Institutes of Allergy and Infectious Diseases and the New England Journal of Medicine.
Whenever stamping out the flaming bag of poo, it's wise to remember ones shoes may become sullied. Still, how can I…
palmd | November 2, 2009This is not a normal flu season (if you hadn't heard). Normally, summer sees a return of flu cases to a low baseline, but not this year---this year we saw a bump in cases around April, with a consistent trickle of cases throughout the summer, and significant outbreaks at summer camps and military bases. And now, from that "higher low point" we are seeing an early, rapid rise in flu cases. Some of this is likely attributable to an increase in reporting---people are worried and going to the doctor for illnesses that they would normally ignore. But that isn't likely to be the bulk of reported…