I cram for TAM, and, combined with other commitments, not the least of which is that it is finally sunny and warm in Portland, after a year that has resembled All the Summer in a Day, which leads to a relatively short post. There are just so many hours in a day and if possible those days need to be spent in the sun.
In my first year in practice I was sitting on a nursing station writing a note when a patient started howling in pain. Further investigation revealed that the patient had a chronic, open surgical wound and the (old) surgeon had ordered sugar poured into the wound as part of wound care. The cafeteria mistakenly sent up salt, and a metaphor became reality. It did pique my interest in both sugar and honey for wound care, an area where you have to be careful not to fall prey to all the errors in CAM thinking: a reliance on anecdotes, using suboptimal studies as evidence, mistaking a gobbet of basic science as a meaningful clinical application, and not realizing the warping effect of confirmation bias.
That being said, I have suggested honey and sugar for years for patients, and many patients with prior refractory wounds had healing. And what are the three most dangerous words in medicine? In my experience. I have recommended honey less in the era of the wound vac, but there are not an insignificant number of people with insufficient financial resources who cannot afford even simple wound care supplies. Many of the ointments, creams and special bandages for wound care costs too much. Patients also like honey as it is natural (people do love to fall for the naturalistic fallacy) and inexpensive, and I always tell patients that the data is iffy, but not stupid. (more…)