This image is in the public domain and thus free of any copyright restrictions. As a matter of courtesy the CDC requests that the content provider be credited and notified in any public or private usage of this image. Taken from the Wikimedia Commons.
Thirty plus years in medicine has given me some perspective as has infectious diseases (ID). One of the almost TNTC cool things about ID is that infections, unlike the diseases of modernity, have been plaguing humans since before we were humans.
There is a sense, a usually unvoiced assumption, on the part of many people that we are supposed to be healthy, that our default mode is good health and that with the proper diet and attitude we could obtain the health that was ours before the fall.
I think not. I see no perfection in any human, except maybe my wife who would achieve perfection if only she liked beer and steak.
We are a hodgepodge of anatomic and physiologic compromises that allowed us to spread across the world. But if you like to read history, you realize that most of the time we died like flies from infections, trauma and other medical problems. The variations that allowed us to survive malaria or tuberculosis led to sickle crises and the metabolic syndrome. Even with evolution no good mutation ever goes unpunished. (more…)
I remain curious as to why people use, and continue to use, useless pseudo-medicines. I read the literature, but I find the papers unsatisfactory. They seem incomplete, and I suspect there are as many reasons people choose a pseudo-medicine as those use them.
There are numerous surveys on what SCAMs people use. Designing and offering these surveys to every possible medical condition is a growth industry: the old, the young, cancer patients, AIDS patients. All need be asked which SCAM they use. It seems to be a ready way to get a quick entry in your CV, but which SCAM is used does not speak to the why a particular SCAM is being used. Why try acupunctures, say, instead of reflexology?
There are numerous reasons suggested for why people partake of SCAMS as a general concept: dissatisfaction with standard medical care is a common one but is not always supported in the literature. Gullibility, ignorance, and stupidity are often credited, none of them are particularly valid. Dr. Novella covered the topic in 2012. There is some data to suggest that which SCAM and why is a moving target, changing over time. (more…)
Summertime and the living is easy. I am in Sunriver, Oregon for the week and I though, hilariously, that I would have plenty of time to write a post. Between the hiking, the biking, the golf, the food and the beer, there has been little time to sit in from of a keyboard. There may be no better place to spend a week if you like the outdoors, but they do not have internet on the hike around Paulia Lake. So while a caramel banana cake bakes for a dinner tonight, I have an hour or so churn out a post. Do not expect much.
One person’s ethics is another’s belly laugh, but in medicine ethics are formalized. The basic principles in the US are
- Respect for autonomy – the patient has the right to refuse or choose their treatment (Voluntas aegroti suprema lex)
- Beneficence – a practitioner should act in the best interest of the patient (salus aegroti suprema lex)
- Non-maleficence – “first, do no harm” (primum non nocere)
- Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
These are guidelines, not mandated, but if you get an ethics consult in my institutions the above concepts are the framework within which the consult will be completed.
Patients can only be autonomous if they are given accurate, truthful information with which to make a decision about their treatments. You can’t lie to patients, but we all know how you phrase an idea can subtly alter the response. Do you say an 80% success rate or a 20% failure rate? I tend to say both. And not everyone can handle the unvarnished, blunt truth. Part of the art of medicine is trying to tell each patient the truth, the whole truth and nothing but the truth in a manner palatable for the individual patient. It is not easy and I am certain I do not always do a good job. (more…)
I suspect there is more published about traditional Chinese medicine than any other SCAM. Here are some of the recent curiosities of TCM.
The little girls laughed about the germs, because they didn’t believe in them; but they believed about the disease, because they’d seen that happen. Spirits caused it, everyone knew that. Spirits and bad luck. Jack had not said the right prayers.
– Oryx and Crake
I long ago gave up on the idea that there are a finite number of pseudo-medical treatments. Anything a human can imagine will probably be used as a SCAM intervention. I remain amazed at the permutations that occur in the pseudo-medical world, not unlike the mix and match bioforms in Oryx and Crake.
Not everyone knows basic anatomy and physiology that allows for understanding of disease. Instead, people often rely on metaphor and magic for their understanding, especially in the world of pseudo-medicine. Sympathetic magic lies at the heart of many SCAMs. (more…)
I knew that Jann was thinking of writing about reiki and fraud, but did not know the details of her most excellent discussion from yesterday until I had finished my penultimate draft for today. Think of them as a match set, two perspectives on the same elephant.
Fraud: a person or thing intended to deceive others, typically by unjustifiably claiming or being credited with accomplishments or qualities.
There are numerous activities that one human will offer another in exchange for money that are completely divorced from reality.
Astrology. Total bunkum.
There is no force, known or unknown, that could possibly affect us here on Earth the way astrologers claim. Known forces weaken too fast, letting one source utterly dominate (the Moon for gravity, the Sun for electromagnetism). An unknown force would allow asteroids and extrasolar planets to totally overwhelm the nearby planets…
Study after study has shown that claims and predictions made by astrologers have no merit. They are indistinguishable from chance, which means astrologers cannot claim to have some ability to predict your life’s path.
Although 48% of Americans think astrology is a science, as best I can tell astrology is not part of the curriculum at any astronomy division or program. Astronomers know it is bunkum and avoid it . (more…)
There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. JAMA
Just just because there are flaws in aircraft design that doesn’t mean flying carpets exist. Ben Goldacre
Wiser heads than I have commented on “Invitation to a Dialogue: Alternative Therapies” in The New York Times. So why add my two cents? Partly because The New York Times wanted brief responses and I don’t do brief. Partly because I write for me; nothing focuses the mind like putting electrons to LCD, except, perhaps, a hanging. Partly we do need a dialog, just not of the kind suggested by the writer. And partly, life has been so busy of late I needed a topic that required no research. (more…)
There are two topics about which I know a fair amount. The first is Infectious Disease. I am expert in ID, Board Certified and certified bored, by the ABIM. The other, although to a lesser extent, is SCAMs.
When I read the literature on these topics, I do so with extensive knowledge and, in the case of ID, 30 years of clinical experience. The extensive knowledge, and, one hopes, understanding, has led me to read meta-analyses with a grain of salt substitute. They average meta-analysis and systematic review is good for gaining a general understanding of the topic within, as well as, and here is the key phrase, the limitations of the included studies.
And like all the published literature, when writing a meta-analysis, those with an axe to grind will grind it. Even, or perhaps especially, the Cochrane reviews.
Just because something is labelled as a systematic review does not mean it is any good. We have to be just as vigilant now as ever. Even a review with a Cochrane label does not make its true. Four out of 12 Cochrane reviews on acupuncture were wrong. Caveat lector rules, OK? (more…)
There are many forms of Traditional Chinese Medicine (TCM), and many have the same underlying theory: they stimulate non-existent acupuncture points to alter the flow of non-existent qi. For each form of TCM there are many variations on a theme. There are, for example, a half-dozen styles of acupuncture and multiple forms of cupping all trying to move the qi. That qi is an untameable beast, hard to corral into a proper gate even by the best acupoint wrangler.
There is, fortunately, yet another way, moxibustion, to alter that most intractable mysterious life energy.
Moxibustion is the burning of mugwort over acupoints.
What is mugwort? I resist the urge to make a Harry Potter pun about where Muggles go to school. No wait, I just did. Sorry. You know the old saying: yield to temptation, it may not pass you way again. Mugwort is a member of the daisy family, related to ragweed and, like ragweed, a common cause of hay fever. It is also used in food and was used in beer before hops was discovered.
Always start with an excuse. I have been ill for the last 10 days. I suspect I picked up an infection from the woman I slept with in Vegas.* I normally go through the day at warp 5 (I do not want to destroy space-time), but this illness has reduced my mental functioning in the evening to one-half impulse at best, with thoughts moving at the speed of a cold Oregon slug. So bear with me.
There can be an odd popularity to medicine. I see this in antibiotics usage. When a patient is admitted to the ICU with sepsis, while awaiting cultures you try and kill all the likely bacteria that may be trying to kill the patient. At any given time most doctors can only remember two antibiotics and the current popular duo is vancomycin and pipericillin/tazobactam. It is a reasonable choice, one of many combinations that would treat most patients with sepsis. I am not certain how this combination became so popular, although I have been told that the pipericillin/tazobactam reps have been very active at the Universities with medical students and residents. As the adage goes, “Give me a student until he is seven and I will give you the doctor.”
There are also popular trends in alternative medicine as well. Every now and then there is a flurry of mentions on the interwebs suggesting that a pseudo-medicine has become all the rage. Or maybe it is just the echo chamber that is the interwebs.
This week it is Oil Pulling Might Be The Next Big Thing — Or Not and What is cupping? Lena Dunham the latest celeb to try the ancient Chinese remedy for pain relief. (more…)
A comment from the blog:
Every single time – bar none – I have had a conversation with someone about CAM and its modalities, they are absolutely astonished when I explain to them what the modality really is. One story I love telling comes from my friend in the year behind me. His parents are professional chemists and he came home one day and saw his mother had a bottle of homeopathic medicine. He asked why and she gave the typical non-committal response of “well, I thought it may help and I saw it on the shelf at the pharmacy.” He explained what homeopathy actually is and they were absolutely dumbfounded. They are well aware of Avogadro’s number, after all. People generally don’t study what the CAM in question actually is – merely the fluff PR garbage that gets touted around and without direct and clear demonstration of harm, give it a pass as a result. After all, the business of real medicine is time consuming and difficult enough.
Participating in activities that have a permanent record gives one the fortunate, or unfortunate, opportunity to revisit the past and see just how you worked early in a career. (more…)