Doctors are often accused of being unfeeling technicians who treat their patients like cases of disease rather than people (think Dr. House). We were taught in medical school to remain detached, not get too close to patients, and not show our emotions. That attitude was epitomized in William Osler’s essay Aequanimitas. But doctors have feelings like anyone else, and no one is Spockishly rational. A patient might reasonably say “I don’t give a damn how my doctor feels as long as she gets me better,” but emotions affect everything we do, influencing clinical decisions and patient outcomes. This subject is investigated in a new book, What Doctors Feel: How Emotions Affect the Practice of Medicine, by Danielle Ofri, MD, PhD, an associate professor of medicine and an accomplished writer who has written extensively about her experiences in medicine.
She tells anecdotes from her training to give the reader a feel for what it was like to be in an extremely stressful situation with time pressure, conflicting duties, lack of sleep, life-or-death responsibilities, the highest expectations, and the impossibility of both getting everything done and doing each thing well. It reminded me of times in my own training when I desperately wanted to just somehow survive the day and not kill anyone. Medical residency can be almost as stressful as a war zone, and has its own PTSD victims, complete with flashbacks.
Part of the stress is being suddenly immersed in a new culture with its own tribal customs, slang, in-jokes, and a foreign language: “82WM w/PMH of CAD, CVA, MIx2, s/p 3V-CABG, c/o CP, SOB 2 wks PTA. BIBA s/p LOC. No F/C/N/V/D.” (more…)
I’m going to follow Mark Crislip’s example and recycle my presentation from The Amazing Meeting last week, not because I’m lazy or short on time (although I am both), but because I think the information is worth sharing with a larger audience.
We’ve all had screening tests and we’re all likely to have more of them, but there is a lot of misinformation and misunderstanding about what screening tests can and can’t do. Screening tests are done on populations of asymptomatic people and must be distinguished from diagnostic tests done on individual patients who have symptoms. Some tests are excellent for diagnostic purposes but are not appropriate for screening purposes.
We’re constantly being admonished to get tested for one thing or another. A typical example was a recent Dear Abby column. She got a letter from a woman who had been screened for kidney disease and learned that she had a mild decrease in kidney function. Abby was shocked to learn that 26 million Americans have chronic kidney disease, and she advised her readers to get their kidneys checked. This was terrible advice. It superficially seems like good advice, because if you have something wrong with your kidneys, you’d want to know about it, right? In fact, if there was anything wrong anywhere in your body, you’d want to know about it. By that logic, it might seem advisable to test everyone for everything. But that would be stupid. It would find lots of false positives, it would create anxiety by picking up harmless variants and anomalies that never would have caused problems, it would be expensive, and it would do more harm than good.
A correspondent asked for my opinion of a new book by journalist Jennifer Margulis that is apparently getting a lot of attention in some circles: The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line. I got a copy from the library and read it. It was a painful experience. One of the customer reviews on the Amazon website accurately sums up my own reaction:
There is a great need for an incisive look at all sides of modern maternity care in the United States, because — let’s face it — we all know it’s not perfect. This, however, is not that book.
The author is a strong advocate of home birth, water birth, midwives, “embracing the pain to make you stronger,” “parents know better than doctors,” natural = good, and very early potty training. She thinks bathing a newborn is harmful. She questions the need for well baby checkups: she thinks they are mainly a gimmick to sell vaccines. She questions the (science-based) practice of giving newborns vitamin K and prophylactic eye drops. She is against the use of chemicals in general. She reports that Johnson’s Baby Wash contains “a host of unpronounceable chemicals, some of which are known toxins…and carcinogens.” She doesn’t seem to have grasped the basic principle of toxicology that the poison is in the dose. She is against formula, which she says is killing babies, and against disposable diapers because they contain chemicals and petroleum and because they can cause your child to become infertile. Her only evidence for “infertility” is one study showing that disposable diapers raise scrotal temperatures. Indeed, plastic underpants are probably warm.
When I read that a new study had shown that antihistamines were harmful for patients with morning sickness, I cringed and thought “Here we go again.”
Hyperemesis gravidarum (HG) is a serious complication of pregnancy. Simple morning sickness is more common and less serious. When I started out in medicine, we routinely treated morning sickness with Bendectin. It was a safe and effective remedy, a combination of the antihistamine doxylamine and a B vitamin, pyridoxine. Unfortunately the manufacturer, Merrill Dow Pharmaceuticals, was bombarded with numerous lawsuits claiming that Bendectin caused birth defects. There was a clear scientific consensus that the evidence did not show that Bendectin caused birth defects and there was plentiful evidence of its safety. The lawyers prevailed over the science, and in 1983, Dow voluntarily took Bendectin off the market to avoid further litigation expenses. After the drug’s withdrawal, the rate of birth defects did not decrease, but the rate of hospitalization for hyperemesis gravidarum doubled. (more…)
Ever heard of George Augustus Scott? Probably not. Although he was once touted as “Man of the Century,” he was actually a charlatan who sold electric hairbrushes. (No, an electric hairbrush isn’t a device that will brush your hair for you; it’s a hairbrush that supposedly produces a “permanent electric current” to cure everything from baldness to headaches.) He went on to sell magnetic corsets, electric rings for rheumatism, and sarsaparilla, advertised as the “GREATEST MEDICAL DISCOVERY of the AGE.” (You probably haven’t heard about that greatest discovery either.)
He and his many comrades in crime are profiled in a new book, The Medical Electricians: Dr. Scott and his Victorian Cohorts in Quackery by Robert K. Waits. You will find more quacks in this book than in any duck pond. It provides historical insights and reminds us that there is nothing new under the sun; similar charlatans continue to sell similar quack devices today, facilitated by the Internet and other media.
Electricity and magnetism sounded exciting to Victorian ears, but their properties were poorly understood. Great hopes were raised for medical applications. The opinions of experts varied. Priestly reported experiments from Italy and Germany in 1747-8 showing that a patient who held a vial of medicine while being electrified would get the same benefit as if he took the medicine by mouth. Benjamin Franklin, on the other hand, was persuaded that these reports were not true. (more…)
We are not alone. Walt Whitman didn’t know how right he was when he said, “I contain multitudes.” The microbes on and in our bodies outnumber our own cells 10:1. Perhaps that creeps you out. Perhaps that makes you curious to know just who all these billions of creatures are that are using your body for a home and a transportation device.
For just $89 you can learn what’s in your gut, nose, mouth, skin, genitals…or sample anything!
The offer comes from uBiome, a “citizen science startup” that has scientific goals somewhere down the line, but for the moment is happy to just provide a personal service, to sequence your microbiome and tell you how you compare to others. The current utility of this offering is questionable. It’s just not ready for prime time. (more…)
Skin tags (acrochordon) are benign growths, often raised on a pedicle with a tiny stem. 46% of the population has one or more of them. They are usually ignored, but some people think they are ugly and want to get rid of them, and sometimes the lesions rub on clothing and become irritated. Never fear! Tag Away is here!
I saw it advertised on TV. They said it is “not available in stores.” But they only meant their special TV offer is not available in stores. You can buy Tag Away on Amazon.com, at Walgreens, at Walmart, and elsewhere. Tag Away is an all-natural product that promises to remove unsightly skin tags painlessly. It comes in a 15 cc bottle and is applied with a cotton swab 3 times daily for 3-8 weeks. One website claims:
One of the secrets of this product’s amazing success rate is Thuka [sic] Occidentalis, which is world-renowned for its ability to eradicate even the largest, most unsightly skin tags.
That’s not true. It doesn’t have an amazing success rate, it’s not world-renowned, and there’s no evidence that it can actually remove skin tags of any size. (more…)
Osteoarthritis is the “wear and tear” kind of arthritis that many of us develop as we get older. Cartilage becomes less resilient with age, collagen can degenerate, and inflammation and new bone outgrowths (osteophytes) can occur. This leads to pain, crepitus (Rice Krispie type crackling noises with movement), swelling and fluid accumulation in the joints (effusion), and can severely limit activity for some patients.
Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound. Previously we have covered a number of CAM options on this blog, including glucosamine, acupuncture, and several others. The American Academy of Orthopaedic Surgeons (AAOS) has just issued a 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery. A 13 page summary is available online. They have done the heavy lifting for us, reviewing all the available scientific studies for evidence of effectiveness. Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.) (more…)
Note: Lest you think that SBM is becoming “turtles all the way down,” let me apologize for the duplication and explain that I had already written this right before I read Mark Crislip’s Turtle Agony article on Friday. My focus is different, and turtles were only a small part of my article, so I decided to leave the turtles in. If you prefer to avoid a turtle overdose, you can just skip the Turtlepuncture section and go on to the Motion Style Acupuncture section. They are clearly labeled for your convenience.
The “science” of acupuncture trudges ever onward without really getting anywhere. New developments include a report of turtlepuncture and a study about treating low back pain with a new kind of “motion style” acupuncture using passive or active movement while the needles are in place. I found the first amusing and the second unconvincing.
A group of Ridley sea turtles were rescued after being stranded during a cold spell that left them hypothermic and unable to function. In addition to the usual rescue and rehabilitation efforts, two of the turtles, Dexter and Fletcher Moon, were treated with acupuncture. It was intended to “decrease inflammation and swelling on their front flippers, restore a full range of motion on those limbs and help the animals regain their appetites.” It allegedly worked: their appetite and the use of their limbs improved. But without any controlled observations, this is only an anecdotal report and means very little. They might have recovered just as well without the treatment, for all we know.
In a former life, when I was an Air Force doctor, one of my duties was to give “Healthy Heart” briefings with a script furnished by Air Force experts. It covered the scientific consensus of the time (the early 80s) about diet. It recommended a low fat diet, restricted cholesterol and saturated fat, and demonized tropical oils like palm oil and coconut oil. (Trans fats weren’t yet on the agenda.)
Times have changed. Today we are more lenient about cholesterol in the diet, less concerned about total fat and saturated fat, and more concerned about trans fats. While many major health organizations still discourage its use, coconut oil has not only been rehabilitated in the public mind, but all kinds of health benefits are being claimed for it.
The fats in coconut oil
Coconut oil is high in saturated fats; it contains more saturated fatty acids than any other non-hydrogenated oil. It is stable and has a long shelf life. It is used in movie theaters to pop popcorn and in South Asian cuisine for dishes like curries. A hydrogenated version of coconut oil is an ingredient in non-dairy creamers. Much of the research done on coconut oil studied hydrogenated or partially hydrogenated forms. According to an article in the New York Times:
Partial hydrogenation creates dreaded trans fats. It also destroys many of the good essential fatty acids, antioxidants and other positive components present in virgin coconut oil. And while it’s true that most of the fats in virgin coconut oil are saturated, opinions are changing on whether saturated fats are the arterial villains they were made out to be. “I think we in the nutrition field are beginning to say that saturated fats are not so bad, and the evidence that said they were is not so strong,” Dr. Brenna said.
Coconut oil contains lauric acid, which raises both HDL and LDL cholesterol levels. This may improve the cholesterol profile, although there are concerns that it may promote atherosclerosis by other means. Virgin coconut oil contains medium-chain triglycerides, which are not as risky as some other saturated fats.