A significant part of my job as a pediatric hospitalist involves caring for newborns. It is arguably the best thing that I get to do as a physician, even if I do at times prefer the increased intellectual stimulation of the ill hospitalized child. While seeing newborns, I am almost always surrounded by happy and appreciative parents, grandparents and whoever else is invited to meet and greet the new arrival because the babies are almost always healthy. In fact, and not that I really care (sniff, sniff), the parents of newborns are with rare exception the only caregivers that ever thank me at discharge.
Unfortunately, sometimes I am called upon to assist babies that are having difficulty transitioning into the outside world for a variety of reasons. These reasons can range from the fairly minor and transient to the catastrophic. And despite our advances in the understanding of neonatal pathophysiology and in medical technology, there remain newborn infants that cannot be saved or who have severe lifelong deficits caused by their illness or injury. This will likely always be the case, especially if unqualified professionals continue to involve themselves in either the delivery or the care of babies.
Over the course of 11 years of practice, and after having seen thousands of both perfectly healthy and severely ill newborns, I have acquired a skill set which allows for the recognition of a baby in trouble and the ability to respond appropriately. All pediatricians and family doctors strive to develop this, particularly if they see patients in the newborn nursery, although I imagine none, including myself, would claim to have perfected this “art”. Newborn medicine can be very challenging for many reasons, not the least of which is the significant overlap of the presenting signs and symptoms of many serious conditions, with even normal baby behavior sometimes mimicking potentially life-threatening pathology. (more…)
This is another post in the naturopathy versus science series, where a naturopath’s advice is assessed against the scientific literature.
When you think medicine, your first thought may be “physician”. But the practice of medicine today is a collaboration, as few health professionals, even physicians, can deliver health care completely independently. As a pharmacist I’ve worked closely with physicians, nurses, and other health professionals my entire career. Collaboration starts early, and the setting is usually the teaching or academic hospital, which is always crawling with students, interns, and residents from all professions. Teamwork and trust are essential. In order for different professions to work effectively together, there has to be a common foundation. For medicine, that foundation is science. From basic science principles through a common understanding of fields like biochemistry and physiology, health professionals all work from the same basic understanding about how the body works and what the principles of medicine actually are. If I give a recommendation to a physician or a nurse, I’m basing that assessment on an evidence base that we both rely on. It’s not “pharmacist evidence” versus “physician evidence”, it’s “medical evidence”. This is reality-based healthcare. (more…)
It’s an excellent business model. The only real infrastructure you need is a website, and you can have a custom site made for $5-10 thousand. Then you just have the monthly bandwidth charges. The rest is just e-marketing, which can be done for free, or the cost of some e-mails lists. After that, the money just comes rolling in.
The best part is that other people do all the actual work. All you have to do is charge them for publishing on your open-access online journal.
What you are selling is essentially scientific/academic fraud.
Unfortunately, this is a good business model, even though it is a terrible scientific model, and so it has proliferated. We may be living in the heyday of dubious open-access scientific journals.
The open-access format itself is not a bad one, and there are some very successful and respected open-access journals, such as the PLOS journals. The idea is that, instead of charging a subscription in order to gain access to published articles (in print or online), the articles are open-access, but authors pay a fee to have their work published.
This will be shorter than my usual book reviews and is something of an afterthought. I just finished writing a long article on “Food Myths” that Michael Shermer had asked me to write as a cover article for an upcoming issue of Skeptic magazine, and while researching the subject I read a book that someone had suggested to me (I’ve forgotten who you are, but thank you!). It occurred to me that since not everyone who reads SBM subscribes to Skeptic, it would be good to tell this audience about the book too.
(Note: if you subscribed, you could not only read my upcoming “Food Myths” article but also my regular SkepDoc column and my long article “On Miracles” in the next issue. And there’s lots of other great stuff in the magazine, including the Junior Skeptic section for your kids and grandkids. A digital subscription is available for only $14.99 and you can even get a trial issue for free, so you have no excuse not to check it out. End of commercial.)
The book is Diet Cults: The Surprising Fallacy at the Core of Nutrition Fads and a Guide to Healthy Eating for the Rest of Us, by Matt Fitzgerald, an endurance sport and nutrition writer. Not a doctor, but he understands science better than a lot of doctors who have written about diet and nutrition. His reasoning is persuasive and is supported by the scientific evidence. (more…)
Old bad studies: Fantastical autopsy results
I found the following quote at “Chiropractic care can treat more than just bad backs” (FYI. Chiropractic can’t):
Luse references a study published in The Medical Times authored by Dr. Henry Windsor [sic], M.D. that showcases the correlation of spinal health to overall wellness. Windsor dissected 75 human cadavers to investigate their causes of death. The study showed that 138 of the 139 diseases of the internal organs that were present were in connection to the misalignments of the vertebrae.
But I was intrigued. So I went to the video tape. Well, the PDF.
It is an interesting read by a physician who was looking for an association between curvature of the spine and visceral pathology.
He had 50 corpses, age unknown, that he dissected, looked at the spine for curvature and then looked for pathology in organs in the same distribution of sympathetic nervous system as the level of the spine curvature.
The Federal Funding Accountability and Transparency Act (FFATA) was signed on September 26, 2006. The intent is to empower every American with the ability to hold the government accountable for each spending decision. The end result is to reduce wasteful spending in the government. The FFATA legislation requires information on federal awards (federal financial assistance and expenditures) be made available to the public via a single, searchable website, which is www.USASpending.gov.
And what subject is more deserving of being held accountable by the American people than complementary/alternative/integrative medicine? After all, in what other area of government spending does scientific implausibility – indeed, even scientific impossibility – offer no impediment to spending millions of taxpayer dollars in research funds? We’ve complained about the NCCAM’s wasteful spending on pseudomedicine here on SBM several times: here, here, here and here, among others. As you shall see, the problem doesn’t stop at that particular $2.5 billion. (more…)
I just thought that I’d take the editor’s (and, speaking for Steve, the founder’s) prerogative to promote our own efforts. Regular readers of SBM are familiar with our message with respect to randomized clinical trials of highly implausible “complementary and alternative medicine” treatments, such as homeopathy or reiki. Well, believe it or not, Steve and I managed to get a commentary published in a very good journal in which we present the SBM viewpoint with respect to these trials. Even better, at least for now, you can read it too, because it doesn’t appear to be behind a paywall. (I’m at home as I write this, and I can read the whole thing on my wifi, no VPN needed.)
The article is entitled “Clinical trials of integrative medicine: testing whether magic works?” There’s also been a fair amount of news coverage on the article, and I’ve been frantically doing interviews over the last couple of days, including:
There are likely to be at least a couple more, given the interviews I’ve done; that is, unless editors reject the ideas.
In any case, Steve and I are interested in your comments. Trends in Molecular Medicine is good in that it published our article and it’s a pretty high impact review journal, but it doesn’t have a section for comments. So consider this your section for comments on our article.
Variations of the vitamin K molecule.
A small but increasing number of parents are refusing vitamin K injections for their newborns, an intervention recommended since 1961. This is yet another example of the difference between a science-based and philosophy-based approach to medicine. Science has given us the tool of knowledge, and in medicine that knowledge can have very practical applications.
The term “vitamin” was coined in 1912 by the Polish biochemist Kazimierz Funk. A vitamin is an organic nutrient that an organism requires in small amounts but cannot synthesize in adequate amounts and therefore must obtain from the diet. Knowledge of specific vitamins, their food source, and their biochemical activity in the body, has allowed medical scientists to cure many serious nutritional diseases, such as scurvy, rickets, and blindness.
The Vitamin K family are derivatives of 2-methyl-1,4-naphthoquinone, a fat-soluble molecule. It is a cofactor necessary for the formation of factors that function in blood clotting and in bone formation. The primary effect of vitamin K deficiency is therefore bleeding. Infants are at risk for vitamin K deficiency because this molecule does not cross the placenta well. Infants are therefore born relatively deficient in vitamin K. Further, breast milk contains little vitamin K (regardless of the mother’s diet) so infants are at risk for vitamin K deficiency until they start eating solid food at around 6 months (see Clay Jones’ post on the topic here). (more…)
Humans, like many other animals, crave the taste of salt. Animals frequent salt licks, humans have traded salt for equal weights of gold, and the word “salary” comes from the Roman soldier’s allowance for purchasing salt. Salt appears in our language in idioms like “worth its salt” and “salt of the earth.” Shakespeare’s play King Lear is a variant of a folktale where a daughter tells her father she loves him as much as meat loves salt. In a murder mystery I read years ago, a character listed the four food groups as sweet, salty, sticky, and chocolate.
It’s no fair: everything that tastes good turns out to be bad for us. We love the taste of salt, but dietary guidelines tell us we should all limit our sodium intake to less than 2.3 grams (2300 mg) a day to avoid high blood pressure and death from cardiovascular disease. And those who are over 51, African American, or who have high blood pressure, chronic kidney disease or diabetes should limit their intake even further, to 1500mg a day or less. (Note: the salt molecule consists of an atom of sodium and an atom of chloride; 40% of the weight is sodium, so 1500 mg of sodium equals 3750 mg of salt, roughly ¾ of a teaspoon. Over 75% of our salt is already in the food, not added from the salt shaker.) In 2010, the American Heart Association lowered its recommendations to 1500 mg a day for everyone. We thought that was good advice, but new evidence has muddied the waters. (more…)
EDITOR’s NOTE: There are three Addendums after this post, containing the complete text of e-mails.
EDITOR’s NOTE #2 (8/19/14 4:51 PM): There is one more Addendum, as Dr. Arguello has sent me another e-mail.
EDITOR’s NOTE #3 (8/20/14 7:18 PM): There is yet another Addendum, as Dr. Arguello is now complaining to my place of work.
EDITOR’s NOTE #4 (8/21/14 5:30 PM): And the beat goes on. See Dr. Arguello’s next e-mail.
The following post will be of a type that I like to refer to as “taking care of business.” That’s not to say that it won’t be, as my posts usually are, informative and entertaining, but it does say that I’m doing it instead of what I had originally had in mind because something came up. That something is a rather unhappy e-mail from the doctor about whom I wrote three weeks ago. It’s just an indication that, although it’s a great thing that this blog is becoming more and more prominent, it’s also a two-edged sword. People actually notice it when I (or other SBM bloggers) criticize them for dubious medicine. We see this in how Dr. Edward Tobinick has launched what I (and many others) consider to be a frivolous lawsuit against SBM founder Steve Novella over a post from 2013 clearly designed to silence criticism. It’s legal thuggery, pure and simple. That’s the bad end of the spectrum. I’ve been at the receiving end of similar retaliation that could have just as bad an impact on me personally as far as my career goes when antivaccine activists tried to get me fired from my job four years ago.
The more common (and far less agita-inducing) end of the spectrum consists of e-mails or letters of complaint. Sometimes they come from eminent radiologists who don’t like my criticism of their attacks on mammography studies. (Actually, truth be told, it is rarely eminent radiologists—or eminent physicians and scholars—who complain.) More commonly, it’s practitioners who object to how their treatments have been described. This time around, it’s a man named Dr. Frank Arguello, whose “atavistic chemotherapy” I criticized in one of my typical long posts that also explained why. Last week, I received this e-mail from Dr. Arguello: