Medical school clinical training
A new law in Missouri will allow medical school graduates who have not completed a residency to practice in underserved areas. They will be able to call themselves “doctor” but will be licensed as “assistant physicians” with significant limitations on their practice. (The first link is to Senate Bill 716, the bill that was passed and signed by the governor. It covers several subjects, so you will need to skip to page 8 to find the portion we’re discussing.)
The Missouri State Medical Association supports the new law and helped draft the original bill. It is designed to address the state’s critical need for primary care physicians – 40% of Missouri’s population lives in underserved areas but only 25% of the state’s physicians practice there, according to a 2009 survey. Underserved areas have high poverty rates, high infant mortality, large senior populations and fewer primary care physicians per capita. (more…)
The Hollywood Reporter recently published what is mostly an exposé on privileged Hollywood parents who have elected to delay, limit, or avoid altogether immunizing their children. The most common headline coming out of this article is that some LA communities have vaccination rates at third-world levels, such as South Sudan. The issues raises many questions pertinent to the promotion of science-based medicine – what leads an otherwise well-educated individual with financial security to make decisions that actually put their own children (and others) at risk?
We have often observed at SBM that the anti-vaccine movement is likely to experience a serious backlash once epidemics of vaccine-preventable diseases start to emerge. I think we are seeing the beginning of this prediction coming true. Vaccines are partly the victim of their own success. The diseases they prevent, such as polio, measles, whooping cough, and others, are now uncommon. Modern parents have the privilege of not fearing these diseases because the vaccination program has reduced them to sporadic cases. Therefore, when pseudoscientists or ideologues stoke fears against vaccines, the fear of the diseases they prevent is not there as a balancing force.
That may be changing, however. The CDC reports:
During 2012, 48,277 cases of pertussis were reported to CDC, including 20 pertussis-related deaths. This was the most reported cases since 1955. The majority of deaths occurred among infants younger than 3 months of age.
From January 1-August 16, 2014, 17,325 cases of pertussis have been reported to CDC by 50 states and Washington, D.C.; this represents a 30% increase compared with the same time period in 2013.
This cover picture is scientifically inaccurate. See explanation below.
José Jarimba believes that our bodies are physically molded into an asymmetric form by our mothers’ sleeping positions during pregnancy, that this has lifelong adverse impacts on health, and that shoe inserts can eliminate pain and other health problems by realigning the body. This is a silly untested hypothesis by a single individual. As such, it would be too minor to merit mention on SBM; but it is worth analyzing as a teaching opportunity. Jarimba attempts to bypass the scientific process; he provides a prime example of self-deception, confirmation bias, scientific ignorance, and the “Unpersuadables” I recently wrote about.
Much of alternative medicine originated with a “lone genius” who had an epiphany, thought he had discovered something no one had ever noticed before, extrapolated from a single observation to construct an elaborate theory that promised to explain all or most human ills, and began treating patients without any attempt to test his hypotheses using the scientific method. Some of them were uneducated laymen, others were scientifically trained medical doctors who should have known better. I wrote about one of them here, Dr. Batmanghelid, inventor of the Water Cure, who attributed a great variety of illnesses to dehydration after he thought he had cured a prisoner’s peptic ulcer disease by giving him a glass of water. Similar paths were followed by many others. Hahnemann invented homeopathy after he thought a malaria remedy gave him symptoms of malaria. Palmer invented chiropractic after he thought he had restored a man’s hearing by repositioning an out-of-place bone in his back. Nogier invented ear acupuncture after he imagined that the external ear looked sort of like a fetus. Shapiro invented EMDR after she noticed during a walk in a park that moving her eyes seemed to reduce the stress of disturbing memories. Bach invented Bach flower remedies after a walk in the country revealed his intuitive psychic connection to various plants. Jose Jarimba follows in their footsteps. (more…)
I don’t recall if I’ve mentioned this before, but I will be speaking at Skepticon in November. (Holy crap, that’s just over two months away. I’d better get my talk ready. It’ll be about the central dogma of alternative medicine. Or some such medically-related topic.) In any case, now’s crunch time, the time of year when Skepticon’s fundraising needs to go into high gear, given that the bills are coming due for the conference.
So give. Give until it hurts. Or buy swag. Or both. And if you’re planning on going, register now instead of later. You’ll be glad you did.
I’ve been a big Star Trek fan ever since I first discovered reruns of the original Star Trek episodes in the 1970s, having been too young (but not by much!) to have caught the show during its original 1966-1969 run. True, my interest waxed and waned through the years—for instance, I loved Star Trek: The Next Generation, while Star Trek: Enterprise and Star Trek: Voyager pretty much left me cold—but even now I still find myself liking the rebooted movie series. In the original series, my favorite characters tended to alternate between Spock, the Vulcan first officer and science officer on the Enterprise, and Dr. Leonard “Bones” McCoy, the ship’s chief medical officer. I sometimes wonder if my love of these two characters had anything to do with my becoming a doctor and researcher myself. It probably did.
One aspect of all the Trek shows that always interested me was its portrayal of medicine in the 23rd and 24th centuries. After all, what doctor wouldn’t like to have a device like the tricorder that he could wave over the patient and come up with an instant diagnosis and course of treatment? Who knew, of course, that nearly 50 years after the first Trek episode first aired, we would have technology that makes the communicators on the original series (TOS, for those Trek non-fans) look primitive and large by comparison and that we’d be well on the way to developing devices that can do some of what tricorders did on the show. Throughout all the shows and movies, the medical technology of a few hundred years in the future is portrayed as vastly superior to what we have now, with 20th century medicine at times denigrated by “Bones” McCoy and other Star Fleet medical personnel as barbaric quackery.
A confluence of events and media led me to want to explore a couple of questions. First, which procedures that we consider state-of-the-art science-based medicine will be considered “barbaric” 50 or 100 years from now? Second, is the contempt expressed for the medicine of the past (e.g., by “Bones” McCoy) justified? These are questions that I’ll explore a bit with the help of the Star Trek universe, a recent new cable television drama series, and a couple of articles that appeared on medical sites as a result of the premier of that series.
We dentists are an evil group of sociopaths. When we’re not trying to kill you or give you chronic diseases such as multiple sclerosis with our toxic mercury saturated fillings, we are advocating for the placement of rat poison/industrial waste (i.e. fluoride) in your water supply by our governmental overlords. What is up with us?
The problem is, we’re failing miserably. Even after more than 150 years of placing silver amalgam restorations in our patients, thereby saving untold numbers of teeth, reducing pain and suffering, and improving chewing ability for millions upon millions of people, there is still no evidence worth a damn that shows any correlation or causative effects for any known disease or condition. And with fluoride, after adjusting fluoride levels in municipal water supplies throughout the U.S. and in many places world wide for over sixty years, after adding fluoride to toothpastes and mouthwashes, and giving fluoride treatments to patients in our offices, the only nefarious result we have obtained is the significant reduction of dental decay with its concomitant savings of billions of health care dollars and untold pain and suffering for our patients. Man, we can’t do anything right.
Now, with the help of the American Academy of Pediatrics (AAP), there’s a new strategy.
Science is under attack, and not just from anti-vaccine celebrities and parents with degrees from Google University. Scientific illiteracy is being woven into the very fabric of our society through legislative assault. If you dismiss this as alarmist hyperbole, you haven’t been paying close enough attention.
Every day thousands of pediatric health care providers throughout the country provide safety advice to patients and their parents during routine health maintenance visits. As part of this important routine we ask a series of standard questions to assess the safety of our patients’ environment. Some of these questions are easy and straightforward, and some are more personal and potentially awkward for patients and their parents, including questions pertaining to sexual practices and preferences and psychosocial history. An important series of questions focuses on potential hazards in the home, such as how toxins and medicines are stored, how pools are secured against curious toddlers, and whether there are guns in the home and how they are stored and secured. Parents are usually appreciative of the advice we provide, and thankful for our concern and attention to these issues. Occasionally patients or parents are taken aback by some of these questions, and very rarely they prefer not to answer them (in my 20 years in practice, I can recall only one time this has occurred). We ask these questions because accidental injuries and deaths are common occurrences in the pediatric population, and there is good evidence that patients tend to follow the advice we provide our patients. (more…)
“Safe and natural.” It’s a marketing phrase attached to dietary supplements that’s often accepted as self-evident. The marketing works. Supplements have a strong health halo. But evidence suggests that this reputation may be undeserved. Not only are there continued questions about whether most supplements have any health benefits whatsoever, there is also evidence that they can be harmful. We can’t even be confident that what’s on the label is actually in the bottle. Just two days ago I was notified of another long list of supplements and remedies that the FDA had identified that were contaminated with prescription drugs. These warnings about products sold as supplements appear regularly. Some time ago I asked, “What’s in your supplement?“, and noted that contamination and poor product quality standards continue to raise questions about whether supplements can be used safely at all, because the harms, when they occur, can be catastrophic. No matter how you feel about their efficacy, we can probably all agree no consumer should lose an organ from taking a health supplement. But it can happen. (more…)
That there is an “autism epidemic” is taken as a given by those who feel autism has a dominant environmental cause. The Age of Autism blog, for example, bills itself as a, “Daily Web Newspaper of the Autism Epidemic.” The term “epidemic” also implies an environmental factor, such as an infection.
The epidemiology of autism and autism spectrum disorder (ASD) has never supported the conclusion that there is an autism epidemic. There is no doubt that the number of autism diagnoses has increased in the last two decades, but the evidence strongly suggests this increase in an artifact of how autism diagnoses are made, and not representative of a true increase.
Adding to this data, a newly published study looks at autism and ASD prevalence worldwide: “The epidemiology and global burden of autism spectrum disorders“. They found:
In 2010 there were an estimated 52 million cases of ASDs, equating to a prevalence of 7.6 per 1000 or one in 132 persons. After accounting for methodological variations, there was no clear evidence of a change in prevalence for autistic disorder or other ASDs between 1990 and 2010. Worldwide, there was little regional variation in the prevalence of ASDs.
Thirty years in Moukden
A mythology has grown up around traditional Chinese medicine (TCM). The ancient wisdom of the inscrutable Orient supposedly helped patients in ways that modern science-based medicine fails to understand or appreciate. A typical claim found on the Internet: “The ancient beliefs and practice of traditional Chinese medicine have been healing people for thousands of years.”
As Steven Novella has said, “TCM is a pre-scientific superstitious view of biology and illness, similar to the humoral theory of Galen, or the notions of any pre-scientific culture”. TCM really hasn’t been doing a creditable job of healing people for thousands of years. A book that was brought to my attention by one of our readers (thank you!) provides a unique insight into what Chinese medicine was really like circa 1900. I wish everyone who believes in ancient Chinese medical wisdom would read the chapter on Chinese medicine in this book. It provides a much-needed reality check. (more…)