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780.6

You can tell what a doctor does for a living by the ICD-9 codes they have memorized. There is an ICD-9 code for nearly every medical condition. Weightlessness is 994.9. Must be there for NASA, I have yet to see a weightless patient. Decapitation by guillotine is E978. There, I suppose, in case Marat returns from the dead. There is an ICD-9 code for the initial visit after being sucked into jet engine (V9733XA) and one for subsequent visits (V9733XD). Why do I suspect V9733XD has yet to be used?

780.6 is my personal favorite. Fever. All my patients have fever and 780.6 was certainly the first ICD-9 code I committed to memory. I have an endless interest in fever and after last Fridays post I thought I would toss in my two cents worth. I will remind my readers that I am an adult ID doctor (who I treat, not necessarily how I behave) and unless specifically mentioned, all that follows applies to those who can legally drink, vote and serve in the military.

98.6 F. It is not normal body temperature. Well it is. But it is not. 98.6 F as average body temperature is an enduring medical myth. (more…)

Posted in: Basic Science, Evolution, History, Science and Medicine

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Disingenuous: Deconstruction of a naturopathic white paper

Science is the Concept by which
we measure our reality
I don’t believe in magic
I don’t believe in I-ching…
I just believe in science…and that reality.

John Lennon. Sort of.

As regular readers of the blog are aware, I am science/reality based.  I think the physical and basic sciences provide an excellent understanding of reality at the level of human experience.  Physics, chemistry, biology, anatomy, biochemistry, physiology, evolution etc. provide a reliable and reproducible framework within which to understand health and disease.  My pesky science may not know everything about reality, but day to day it works well.

“There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy. – Hamlet (1.5.166-7).”  

Perhaps, but all the medical advances in my lifetime have been not yielded new science, just (amazing) variations and extensions of known processes.  I sometimes think the blog should have been called reality based medicine, but science is the tool by which we understand reality, and while the tool is constant, our understanding of reality is prone to changing.  An understanding of the rules of the universe combined with an awareness of the innumerable ways whereby we can fool ourselves into believing that those rules do not apply to us is part of what makes a science and reality based doctor.

We are often told of the need to keep an open mind, but I like to keep it open to reality.  Not that I do not like fantasy and magic, it is a common category for my reading.  I just finished Red Country by Joe Abercrombie, and while I love the world he has created, I would not want to apply the rules of that imaginary world to my patients.   Well, one exception.  As Logen Ninefingers  would say, “You have to realistic about these things.” Fictional worlds should be limited to the practice of art, not the practice of medicine.
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Posted in: Humor, Naturopathy, Politics and Regulation, Public Health, Science and Medicine

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Down the Virtual Rabbit Hole

The interwebs are more than a series of tubes, it has the power of endless distraction and tangents, a series of clickable rabbit holes that can drag you deeper and deeper into the alternative universes that are parallel with our own. One moment you can be on Science Based Medicine, grounded on the terra firma of reality, and then with a click of the mouse you can lose your way in the electronic warren.

It started as an advertisement on a skeptical website, perhaps SBM, perhaps not. The entrances to rabbit holes are Hogwartian in nature, never being in the same place twice. It is how I remember it.

Google serves up ads based on what their algorithm perceives as the content of the website. The algorithm lacks a certain, shall we say, nuance, and fails to understand that advertisements suggesting training in homeopathy or the promoting the practice of chiropractic may not have a close relationship to the content of Science Based Medicine. Still the ad did intrigue me, as it mentioned that the practitioner was Oregon’s only MD Acupuncturist. So I clicked. (more…)

Posted in: Energy Medicine, Herbs & Supplements, Humor

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Blonde Blood

Two scientists walk into a bar
The first one says “I’ll have some H2O.”
The second one says, “I’ll have some H2O too.”
Then he dies.

I have come to believe in my own version of The Secret.

The Secret describes the law of attraction as a natural law that determines the complete order of the universe and of our personal lives through the process of “like attracts like. The author claims that as we think and feel, a corresponding frequency is sent out into the universe that attracts back to us events and circumstances on that same frequency.

Obviously not true as I have yet to win Powerball. But a variant of the Secret is kind of creepy. As soon as I learn about a new concept, in medicine or life, I start to see it. All the time. Perhaps my learning a new concept causes it to spring forth like Athena. I would have said instantiate, but I got all sorts of grief when I used that word last time. For example, shortly after reading a review of infections in patients with Osler-Weber-Rendu,  I saw a case. Creepy. As I drive from hospital to hospital I listen to Audible books and it is equally creepy how often I see a word in my visual field that is identical to the word I am listening to. (more…)

Posted in: Science and Medicine

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The Light Fantastical

What would you do if your swimming pool was dirty?  Clean it of course.  But how?  Would you take out a few pails of water, treat the water in the buckets, then toss the water back into the pool and declare the pool clean?  And if it were the bathroom that needed cleaning, would you clean it by treating a few bucket fulls of water from the pool?  Seems an odd approach to me, but, metaphorically speaking, it is the approach used by ultraviolet (UV) and laser treatment of blood.

A weird bit medical therapy, I get the occasional ‘Hey Dr. Smartypants, what do you think of this treatment?’ email. UV blood irradiation is an odd treatment, with an peculiar history.

UV light does have many effects on tissues, as a trip to Hawaii can rapidly demonstrate to a pasty Oregonian. In my world UV is used to sterilize the environment and UV kills off everything from MRSA to C. difficile to tuberculosis.  We vent potentially microbially contaminated air to the outside in part to dilute any infection but more importantly  we know that most pathogens will die when exposed to solar UV light. Do not use UV light on people as a rule, since it causes tissue damage and we fret about injury to eyes and skin.

Back in the 1930’s a physician named Knott had two patients, one with a brain abscess and one with sepsis, who he evidently cured by irradiating the patients’ blood and returning it to them.*  His rationale was since cutaneous TB can be cured by UV light (the discovery resulted in the 1903 Nobel Prize in medicine and physiology), perhaps other infections would be amenable to the therapy as well (1). (more…)

Posted in: Science and Medicine

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More Boosting

Topics, as I noted a fortnight ago in my uniquely misspelled and ungrammatical way, never die**. Or even fade away. There are popular ideas that persist in the world that have little to do with reality. In the reality based world of medicine there are concepts that refuse to die. Atelectasis causing fever or the need to ‘double cover’ Pseudomonas. Neither are true, yet every year medical students tell me that is what they have been taught. It is said the only way new ideas take hold is for those that hold the old ideas to die off. So maybe 50 years from now those medical myths will be gone.

Popular culture also its myths. Take the immune system. Please. It is not a bicep that can be made stronger with a little exercise. It is a complex network of cells and proteins. There are antibodies (IgG (with five subtypes, IgM, IgA, IgE),the complement pathway, polymorphonuclear cells, monocytes, lymphocytes in a profusion that rivals beetles. God, I think, has an inordinate fondness for lymphocytes. There is the Toll system, the cytokines and lymphokines, the non-specific defenses like cilia and mannose binding lectin and on and on and on.

I have a journeyman’s understanding of the immune system, what is needed to understand why a given patient has an infection, although there is little I can do to reverse the immunologic defects: abnormal antibodies from Waldenström’s or low mannose binding lectin levels from liver disease are not amenable to clinical intervention. (more…)

Posted in: Herbs & Supplements, Humor, Science and Medicine, Vaccines

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I Never Meta Analysis I Really Like

David Gorski recently pointed out that Science Based Medicine is going on five years. Amazing. That there would be so much to write about day after day comes as a surprise to me. Somehow I vaguely thought that ‘controversies’ would be resolved. Pick a SCAM, contrast the SCAM with reality as best we understand it, and, once the SCAM was found wanting, it would be abandoned. Why would rational, thoughtful people persist in the pursuit of irrational behavior, contradicted by the universe?

Ha. More the fool me. I would never have guessed that these SCAMs are harder to kill than Dracula (at least one version of Dracula). Stake them and back they come*.

I have tried to avoid repeating repeating information found in prior posts by myself and others, in part because I am lazy and in part because, well, I have said it before. Just look it up. I have come to realize (all too slowly) that each blog entry should be  self contained and that much of the old material is lost in the corn maze (an punning homophone) that is WordPress. Reading my second favorite computer reinforces the realization that each post often needs to be an island universe, complete in itself.

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Posted in: Acupuncture, Science and Medicine, Traditional Chinese Medicine

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Protect Yourself

Flu season is upon us. If there is such a thing as flu season. H1N1 started at the furthest point in time you could get from the traditional start of the flu season. It is an interesting question as to whether global warming will alter the flu season, as it has the RSV season. Classically influenza is a fall/winter disease and fall started today.

It is perhaps worthwhile to review what is known about influenza. (more…)

Posted in: Science and Medicine, Vaccines

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Guiding Lights

This is, I admit, a content free post. July and August are the sunny days here in the great Pacific Northwest, and rather than spend time in front of the computer, I am outside with the kids. To compound matters, I was on call the labor day weekend (I usually write the first draft the weekend before the posts are due) and was very busy. I am finishing this early on Thursday on an airplane to Vegas. My wife and I are taking our first non-child containing vacation in 19 years while my youngest is on a 4 day school trip. Wander the strip, see a show and enjoy the desert heat as a couple and not a family.

I have not had the time to spend researching a topic, so instead I thought I would ramble on about 2.5 topics that have been on my mind. Writing helps to focus my thoughts. Even though I often have residents on service, I still write daily notes as the act of putting thoughts into words is the best way to clarity thoughts. Next week the kids are back at school and I am sure the rains will start up and I will again have time to go into full research mode. In the meantime feel free to ignore this post.

There is nothing to see here. Move along. (more…)

Posted in: Science and Medicine

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Low Level Lasers: N-Rays in action.

I do not want to get all angsty and omphaloskeptic, but I have been thinking more of late about the purpose of the blog and my role in it.  Blogs,and the people who write them,  are ephemeral.  It takes a unique personality and commitment to churn out these essays and commit them to the ether.  Especially since Michelson and Morley.

I have never given much thought as to who our readers are, at least as a composite.  I read most of the comments on every entry and have certainly developed a mental picture of some of our regular commenters, although I suspect I probably do not have even the gender correct most of the time.  The commenters represent a tiny fraction of the regular readers and an even smaller fraction of occasional readers.  It occurs to me I haven’t a clue who the real audience of this blog is.

I write  first for my own education and entertainment, then for the slightly bored and overwhelmed medicine resident, since that is who I spend most of my time educating at work.  Someone educated with an understanding of basic medicine but has more important things on their mind than a need for a detailed understanding of why homeopathy is complete nonsense.  I doubt the majority of my readers are health care workers and I suspect  continuing medical education is not a major part of the blog.

I never considered SBM to be a consumer protection group, but this week my wife showed me a half page advertisement in the local paper, and I realized that not only was the advertisement a good topic for blogging, but consumer protection is a fundamental result of this blog.  There really is no site on the interweb that looks at both SCAM and real medicine with quite the same skeptical eye.  Here is the headline:

A Special Wellness Report

New Medicine Based On An 88- Year Old Theory By Albert Einstein Can Help Almost Everyone Who Is Sick Or Injured! (more…)

Posted in: Basic Science, Energy Medicine, Health Fraud, Science and Medicine, Science and the Media

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