As I have mentioned in the past, almost all of my practice is inpatient medicine, doing infectious disease consults in acute care hospitals. I only spend three hours a week in the outpatient clinic, so I have a skewed perception of medicine and disease. The patients I see are sick, really sick, often trying to die and are a complicated collection of abnormal labs and deranged physiology.
I remember finishing residency thinking that a potassium of 2.8, a hemoglobin of 9.8 or a bilirubin of 4.5 wasn’t all that bad, losing track of normal physiology amongst all the medical pathology. I never did lose track of normal vital signs (VS): pulse, respiration, blood pressure and temperature. Like trying to be the fifth Beatle, over the years other values have vied to become the fifth vital sign: pain level or O2 saturation, but none have the importance of the fab four. I can live without pain*, but I can’t live long if the other vital signs are abnormal for extended periods of time. Watching the vital signs return to normal is often an important variable that signifies the patient is improving. (more…)
Our last look at the Council on Chiropractic Education (CCE), about 18 months ago, found the CCE deeply embroiled in a heated dispute among various chiropractic factions over new accreditation standards for chiropractic colleges. Today we offer an update on that situation.
Update: the CCE is deeply embroiled in a heated dispute among various chiropractic factions over new accreditation standards for chiropractic colleges.
As you may recall, the CCE, which accredits chiropractic colleges in the U.S., stood accused of removing the subluxation from its standards for accreditation, so that chiropractic students would no longer be required to learn how to “detect” and “correct” the putative vertebral subluxation. Of course, the chiropractic subluxation doesn’t exist, but we’ll get to that in a minute. This brouhaha was raised by the more traditional wing of the chiropractic community, called “straights,” whose practice (and livelihood) is based on convincing patients that their spines need “adjustments” to remove these subluxations under the threat of ill health should they be left unattended. The straights were also upset at the move by another faction of chiropractic seeking to rebrand chiropractors as primary care physicians who diagnose and treat a wide variety of diseases and conditions.
In 2011 the Swiss government completed an official examination of homeopathy, as part of its consideration of whether or not insurance companies should be made to cover homeopathic treatment. Their report, which concluded homeopathy is effective and should be covered, was published in English in February 2012. Not surprisingly, homeopathy promoters, like Dana Ullman writing for the Huffington Post, were quick to proclaim the virtues of the Swiss report and tout it as evidence for the effectiveness of homeopathy. Recently, however, a more critical review of the Swiss report has been published, revealing the report to be biased and scientifically suspect.
Ullman begins his crowing about the Swiss report with this dubious statement:
The Swiss government has a long and widely-respected history of neutrality, and therefore, reports from this government on controversial subjects need to be taken more seriously than other reports from countries that are more strongly influenced by present economic and political constituencies.
Political neutrality is not equivalent to being scientifically unbiased. Ullman, and other homeopaths, however, are keen to prefer the Swiss report over other government reports. This is because in 2010 the UK government performed their own systematic review of homeopathy – Evidence Check 2: Homeopathy. In their report they concluded that homeopathy is essentially witchcraft – that it does not work, its underlying principles are scientifically invalid and tantamount to magic, that it should not be covered by the national health service, and that it is not even worth any further research. Ullman strangely does not mention this report directly in his article.
What should you do if you feel tired? Taking a nap isn’t always possible. The ever-inventive capitalist marketplace has come up with another option.
5-hour Energy is a flavored energy drink sold as 2 oz “shots.” It was invented by Innovation Ventures in 2004. It is intended to counteract the afternoon slump, to increase alertness and energy, to help you stay sharp, improve attention, leave grogginess behind and sail through your day.
According to the label, its ingredients are:
- Niacin 30 mg — 150% of the RDA
- Vitamin B6 40 mg — 2000% of the RDA
- Folic acid 400 mg — 100% of the RDA
- Vitamin B12 500 mcg — 8333% of the RDA
- Energy blend: taurine, glucuronic acid, malic acid, N-acetyl L tyrosine, L-phenylalanine, caffeine, and citicoline. Total amount of blend: 1870 mg. The caffeine content is not specified on the label, but it is supposedly comparable to a cup of the leading premium coffee.
It contains only 4 calories, with no sugar.
Anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that “my ignorance is just as good as your knowledge.”
The first principle is that you must not fool yourself – and you are the easiest person to fool.
Richard P. Feynman
What would we do without it? It’s become so necessary, so pervasive, so utterly all-enveloping that it’s hard to imagine a world without it. Given how much it pervades everything these days, it’s easy to forget that it wasn’t that long ago that the Internet was primarily the domain of universities and large research groups. Indeed, the Internet hasn’t really been widely and easily available to the average citizen for very long at all. Go back 20 years, and most people didn’t have it. For example, Netscape Navigator, the popular browser that made the Internet accessible, wasn’t released until 1994. Amazon.com, an online store I can’t imagine living without now, didn’t sell its first book until 1995, and I didn’t discover it until 1996 or 1997. Google, that ubiquitous search engine that everyone uses, wasn’t incorporated until 1998. Now, less than 14 years after Google was incorporated most people have the Internet in their pockets with them in the form of mobile devices that have computing power undreamed-of in the 1990s and can access the Internet at speeds that increasingly blur the line between landline access and mobile computing. It’s been an amazingly fast social and technological revolution, and we don’t yet know where it will take us, but we do know that it’s not going away. If anything, the Internet will continue to become more and more pervasive.
Many of the specific issues that the Governor and the Legislature asked the Commission to review have festered because the [California] Acupuncture Board has often acted as a venue for promoting the profession rather than regulating the profession.
– Little Hoover Commission, Regulation of Acupuncture: A Complementary Therapy Framework: September 2004, page 63.
On March 12, 2012, during a brief Sunset Review hearing, the California Senate Committee on Business, Professions and Economic Development asked the California Acupuncture Board (the Board) to respond to a set of harsh criticisms.
It is not the first time that the dysfunctional Board — which falls under the Department of Consumer Affairs — is being scrutinized by the legislator. The Board has a long history of operating in an inefficient manner, misreading its governing statutes, and potentially endangering the public by refusing to promulgate regulations concerning the sterilization of acupuncture needles or the wear of medical gloves by practitioners.
In the past, members and affiliates have even been investigated for taking bribes and selling licensing exam answers. The Board was replaced several times in order to clean up the quasi-anarchic and corrupt practice of acupuncture and Oriental medicine in California.
This time, the Senate Committee listed 10 major issues in a Background Paper, which is a worthwhile read for those interested in the regulation of acupuncture. The Senate expressed serious concerns about many administrative, educational, licensing, enforcement, consumer protection and budgetary matters. In response, the Board Chair and Executive Director offered little explanation. The Board now must respond to the Background Paper in specifics.
As a group blog, Science-Based Medicine brings a variety of perspectives to issues of science in medicine. However we align around a few core principles which define what science-based medicine is, and how it should be practiced. One principle we emphasize is the importance of subjecting the evaluation of all health interventions and treatments to a single, science-based standard. One of the biggest successes of the alternative medicine industry, worldwide, has been the embedding of different regulatory standards for the evaluation and approval of so-called “non-drug” products such as supplements, herbal products, and non-scientific treatment systems like homeopathy or traditional Chinese medicine (TCM). The implications cannot be overstated: this different and lower standard is now so firmly entrenched in most health systems that few seem to question its rationale, or consider the consequences. As a practicing pharmacist I spent the first decade of my career working within this regulatory framework without ever stepping back to question why we regulate some products differently. I started reading, took the red pill, and here I am today. (more…)
I wrote previously about bee venom therapy (BVT), also called apitherapy or bee sting therapy, as an emerging “alternative” therapy. Both use and research into BVT continue, providing an excellent example of the many things that are wrong with the CAM movement.
A recent Reuters article on the topic is also an excellent example of the frequent complete failure of the mainstream media in dealing with such topics. The articles discusses a Filipino bee keeper who decided to practice medicine based upon his personal anecdotal experience. Joel Magsaysay suffered a stroke and right-sided weakness. He attributes his recovery from the stroke partly to bee stings.
He admits he is not a physician and has no medical or scientific background. He has concluded that BVT works based upon anecdote along. He seems to be unaware of the unreliability of individual anecdotes in stroke recovery. Most patients will improve following a stroke. There are also two kinds of recovery, including neurological recovery from brain plasticity.
A few months ago I wrote about Fabrizio Benedetti’s research on the neurobiology of the placebo response, and a discussion about placebos and ethics ensued in the comments. Now Dr. Benedetti has written about that issue in a “Perspective” article in the journal World Psychiatry, “The placebo response: science versus ethics and the vulnerability of the patient.”
We have learned that verbal suggestions can activate neurotransmitters and modulate pain perceptions, and positive expectations can activate endogenous opioid and cannabinoid systems. A complex mental activity has objective effects on body physiology. Words and drugs can activate the same mechanisms. Drugs are less effective without therapeutic rituals. We are delving deep into human foibles and vulnerable traits at the center of human interactions. What implications do these insights into mind-body interactions have for patient care?
A couple of months ago, a reader sent me an article that really disturbed me. In fact, I had originally been planning to write about it not long after I received it. It is, as you might imagine given my specialty and what disturbs me the most wehen I encounter quackery, a story of a cancer patient. Worse, it’s the story of a cancer patient in my neck of the woods. True, it’s not in the same country, but my cancer center is only around two or three miles from the Detroit River and the Canadian border; so it’s plenty close enough. Too close, in fact. Reading the story, in fact, I realized that it features a form of cancer quackery that, as far as my searches have been able to tell me, we haven’t covered before here at SBM, which alone makes it worth taking on, even though the story is two months old. The “cure” is called Cantron, and it is deeply rooted right here in my metropolitan area. Not only that, its siren song and false promises are attracting patients from across the boarder in Canada. Bernie Mulligan is one such patient: