I write this post with a great deal of trepidation. The last time I perused the Medical Voices website I found nine questions that needed answering. So I answered them. One of the consequences of that blog entry was the promise that Medical Voices was poised to “tear my arguments to shreds.” Tear to shreds! Such a painful metaphor.
They specified that the shred tearing would be accomplished during a live debate, rather than a written response. While Dr. Gorski gave excellent reasons why such a debate is counterproductive, I am disinclined for more practical reasons. I am a slow thinker and a lousy debater and have never, ever, won a debate at home. If I cannot win pitted against my wife, what chance would I have against the combined might of the doctors and scientists at Medical Voices? My fragile psyche could not withstand the onslaught.
Still, there is much iron pyrite to be mined at Medical Voices and it may provide me for at least a years worth of entries. Please forgive me if I seem nervous or distracted. I have a Sword of Damocles hanging over my head and it may fall at any time. My writings may, without warning, be torn to pieces by the razor sharp logical sword of Medical Voices. Or maybe not. It is my understanding that Medical Voices will only answer with a debate, so maybe I am safe from total ego destruction.
This month, as I perused Medical Voices, I found it difficult to choose an article. So much opportunity and I have limited time to write. I finally decided on Why the New Mumps Outbreak Puts You At Risk by Robert J. Rowen, MD.
Carlyle said “a lie cannot live.” It shows that he did not know how to tell them.
— Mark Twain
There is an infamous hoax from last century called The Protocols of the (Learned) Elders of Zion, an anti-Semitic text purporting to describe a plan to achieve global domination by the Jewish people. Despite the fact that the Protocols is a work of fiction, there have been and still are folks who believe it to be real, from Hitler on down. (Or is that “on up”? Can one be lower than Hitler? And have I already committed a breach of Godwin’s Law?)
Inventing apparently legitimate information is a useful propaganda device not limited to anti-Semites. Having people appear evil or uncaring using their own words is far more effective than calling them evil and uncaring.
There are many in the community who suffer from a variety of complaints that I cannot diagnose, and, as people do not like uncertainty about their health, they will find someone who will give them a diagnosis. Not infrequently they will come upon the idea of chronic Lyme disease.
The Institute of Medicine report is a frequent ‘rebuttal’ to science based/real medicine. The argument is usually phrased something to the effect that since medicine can be dangerous, SCAM’s are legitimate. Of course, one does not follow the other. It is the equivalent of saying since you are old, bald and pudgy, I am young, have a full head of hair, and are thin. If every doctor and hospital were to vanish tomorrow like an episode of the Outer Limits, SCAM’s would be just a ineffective.
Despite the flawed logic of the comparison, I have always had an affinity for the estimates that 44,000 to 98,000 were (note the deliberate use of the past tense) killed each year in hospitals. There may be methodological flaws in the estimate but the ballpark figure is probably correct.
This is not an easy blog to write. Doctors Novella and Gorski want the entries to be formal, academic, referenced, with a minimum of snark.
For the most part I comply. But sometimes. Sometimes. It is hard, so hard, not to spiral into sarcastic diatribes over the writings that pass for information on the interwebs. How should one respond to profound ignorance and misinformation? I wish, sometimes, that I could be an irascible computer as well.
What brings on this particular bit of angst is a bit of whimsy on the Internet called “9 Questions That Stump Every Pro-Vaccine Advocate and Their Claims.” by David Mihalovic, ND. Mr. Mihalovic identifies himself as “a naturopathic medical doctor who specializes in vaccine research.” However, just where the research is published is uncertain as his name yields no publications on Pubmed. BTW. I specialize in beer research. Same credentials.
Back in 2008 I wrote on Near Death Experiences (NDE’s). I have an interest in this topic as I have frequent exposure to near death; my wife has a predilection for watching Judge Judy. Since 2008 there have been a few studies on the topic of NDEs as researchers try and find evidence that consciousness transcends the brain, if that is what a NDE represents. I have also been ill for most of the last week and have not had the usual time to spend generating typos to drive some readers to distraction. Fortunately, I have a miracle cure that is 100% effective in resolving all my self-limited illnesses: time. It passed and with it the illness. As a result I am about 10 days behind in the commitments in my life, so this will be a shorter than usual post.
There have been, in the last 20 years, natural, or perhaps unnatural, experiments that have helped shed light on the efficacy of vaccines. Many societies, for reason of political unrest, religion, or a lack of understanding of science and medicine have seen the rates of vaccination decline and, with that decline, an increase in the cases of vaccine-preventable diseases.
Infectious disease spread in populations is not simple. Hygiene, nutrition, access to health care, and education all play a role in the spread of communicable diseases. Vaccines have been critical in driving the rates of vaccine preventable illnesses to almost zero, but they are not the only intervention in our armamentarium. (more…)
Get your facts first, and then you can distort them as much as you please.
There is an educational approach to becoming a doctor. It involves learning massive amounts of basic science, followed by massive amounts of pathophysiology, which barely prepares you for the clinical years of the last half of medical school and subsequent residency, with the massive knowledge dump you will have to absorb. Much of the information is given by experts in the field, usually MDs or PhDs (or both), who lecture formally and informally. Being considered an expert in infectious disease (ID) at a teaching hospital, I now spend hours a day yammering on about infections to anyone who will listen, students in all the medical fields who rotate through our hospitals. I value the facts I have learned in my field and respect those who have worked to provide me with the information. I greatly value facts and the people who provide them.
Most of the information I get in medicine is from those in the field. It is rare for people to write about aspects of medicine that I will take seriously. Yes, there are a lot of people who write on the web about medicine, but given what it takes to achieve even a solid knowledge in medicine, much less develop expertise, I usually can’t take them too seriously. Call me arrogant, but if you want to be a legitimate source of information there are dues that have to be paid.
“Conversation about the weather is the last refuge of the unimaginative.” – Oscar Wilde
I will state my bias up front. I am convinced by the preponderance of data in favor of man made global warming. At the most simplistic level, I can’t see how converting humongous tons of fossil fuel into CO2 and dumping it into the the atmosphere cannot have effects on the climate. To my mind its like determining vaccine efficacy or evolution. Plausible mechanism(s), good basic science, multiple studies using different lines of evidence that all come to the same conclusion. There are lots of fine points and nuances to be worked out, but the basic truth is reasonable and well defined. Infectious diseases lend some validation to the concept that the world is warming, since with global warming comes a variety of infectious diseases.
It is one big IF:THEN statement. IF global warming, THEN infections. Of course if the IF is not true, then the THEN doesn’t follow.
Why is my mind so clean and pure? Because I am always changing it.
In medical school the old saying is that half of everything you learn will not be true in 10 years, the problem being they do not tell which half.
In medicine, the approach is, one hopes, that data leads to an opinion. You have to be careful not to let opinion guide how you evaluate the data. It is difficult to do, and I tell myself that my ego is not invested my interpretation of the data. I am not wrong, I am giving the best interpretation I can at the time. For years I yammered on about how it made no sense to give a beta-lactam and a quinolone for sepsis until a retrospective study suggested benefit of the combination. Bummer. Now when I talk to the housestaff about sepsis, I have to add a caveat about combination therapy. It is why my motto is, only half jokingly, “Frequently in error, never in doubt”.
At what point do you start to change you mind? Alter your message as a teacher? Have new behavior? Medicine is not all or nothing, black and white. Changes are incremental, and opinions change slowly, especially if results of a new study contradict commonly held conclusions from prior investigations.
Nevertheless, I am in the process of changing my mind, and it hurts. I feel like Mr. Gumby.
I will start, for those of you who are new to the blog, with two disclaimers.
First, I am an infectious disease doctor. It is a simple job: Me find bug. Me kill bug. Me go home. I spend all day taking care of patients with infections. My income comes from treating and preventing infections. So I must have some sort of bias, the main one being I like to do everything I can to cure my patients.
Second, in 25 years I have, to my knowledge, accepted one thing from a drug company. The Unisin (that’s how I spell it) rep, upon transfer from my hospital, sent me a Fleet enema with a Unisin sticker on it. I show it proudly to all who enter my office. I do not even eat the drug company pizza at conference, and I cannot begin to tell you painful that is.
As we leave (I hope) the H1N1 season and enter seasonal flu season, there has been a flurry of articles, originating in the British Medical Journal , questioning whether oseltamivir is effective in treating influenza. The specific complaint at issue is whether or not oseltamivir prevents secondary complications of influenza like hospitalization and pneumonia. Although you wouldn’t guess that was at issue from the reporting. As always, there is what the data says, what the abstract says, what the conclusion says, and what other people say it says. Reading the medical literature is all about blind men and elephants.
There is, evidently, going to be an investigation by the European Union Council of Europe into whether or not the H1N1 pandemic was faked to sell more oseltamivir. Sigh.