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Lyme: Two Worlds Compared and Contrasted

The Lyme tick

The western black-legged tick, carrier of the Borrelia burgdorferi bacteria which causes Lyme disease.

The practice of infectious disease (ID) is both easy and difficult. If you read my ID blog on Medscape you are aware of my trials and tribulations in diagnosing and treating infections.

ID is easy since, at least in theory, diseases have patterns and an infecting organism has a predictable epidemiology and life cycle. So if you can recognize the pattern and relate it to the life cycle and exposure history, you can often make a diagnosis before the cultures come back.

My favorite story is the time I was asked to see a young girl with endocarditis. The history was she had a week of fevers, headache and myalgia that went away for five days, returned for a week, went away for five days and returned yet again.

So I asked her “How was your vacation at Black Butte?”

The look of astonishment on her face as she asked how I knew she had been to Black Butte was so satisfying. (more…)

Posted in: Legal, Naturopathy, Politics and Regulation, Public Health, Science and Medicine

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Bias and Spin

We all construct our narrative based on our biases and spin the facts so that the narrative confirms our biases. Among other characteristics, what separates an SBM provider from a SCAM provider is realizing that biases are always active and apply to me as well as everyone else.

My biases are simple: I am skeptical that humans can reliably understand reality without assistance and the best source of assistance is science.

I have a job where the expectation is that I will change practice as information changes. How I practiced medicine 30 years ago is very different from how I practice it today. Still, I note it is harder and harder to change my approaches as I get older. I get more set in my ways and it takes more effort to change as new studies are published. Sometimes it seems almost physically difficult.

Again, it is expected that not only will I change my mind over time, as the sole ID doctor at my hospitals, I will be the one to lead the change. Imagine how much harder it would be to change your mind if you were committed to a universal truth such as those that are alleged to underlie reiki or chiropractic. Years committed to a pseudo-medicine probably renders changing one’s mind virtually impossible. (more…)

Posted in: Chiropractic, Science and Medicine

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A Day of Science and Skepticism with NECSS SfSBM

Screen Shot 2015-01-09 at 1.35.26 PM

A day of Science-Based Medicine, a weekend of science and skepticism

Registration for NECSS, the North-East Conference on Science and Skepticism, is now open. Included in the program will be a day of Science-Based Medicine.

Full Conference schedule here with Bill Nye as the KeyNote.

Speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.

NECSS will be held April 9th–12th, 2015, in New York City at the Fashion Institute of Technology. The SfSBM program will be Friday, April 10 and you can attend one or more of the days. $95 for one day or $195 for the entire conference.

Preliminary SfSBM Program  (Updated 2.15.15, subject to change)

09:00 – 10:00 60 minutes Registration/Will Call
10:00 – 10:10 10 minutes OPENING: Steve Novella and David Gorski
10:10 – 10:45 35 minutes: Steve Novella. SBM – Going Beyond Evidence-Based Medicine.
10:45 – 11:20 35 minutes: Harriet Hall. Chiropractic.
11:20 – 11:55 35 minutes: David Gorski. Integrative Medicine
11:55 – 12:30 35 minutes: Mark Crislip. How Acupuncture ‘Works’
12:30 – 02:00 90 minutes LUNCH
02:00 – 02:35 35 minutes Speaker 4: Jann Bellamy. Political Pseudoscience
02:35 – 03:35 60 minutes Panel 1 Discussion
03:35 – 03:50 15 minutes BREAK
03:50 – 04:35 45 minutes Q&A from Twitter & Audience
04:35 – 05:20 45 minutes SBM Jeopardy
05:20 – 05:30 10 minutes CLOSING
05:30 – 06:00 30 minutes SBM Business Meeting

For more information and to register, go to NECSS or this registration page.

The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.

Posted in: Announcements

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Traditional Chinese Pseudo-Medicine Hodgepodge

Qing Dynasty (1662-1722) painting, traditional Chinese medical view of the human viscera from the back.  Image L0039962 from the Wellcome Trust image library, via the Wikimedia Commons.

Qing Dynasty (1662-1722) painting, traditional Chinese medical view of the human viscera from the back. Image L0039962 from the Wellcome Trust image library, via the Wikimedia Commons.

As I have noted before, more is published on acupuncture and traditional Chinese pseudo-medicine than the other SCAM. Here are some of the articles that drew my attention.

Captain Hook and acupuncture

Here is one of the more curious articles on acupuncture I have yet to find, “Psychophysical and neurophysiological responses to acupuncture stimulation to incorporated rubber hand.”

I did not know this, but you can fool a person into thinking that a rubber hand is their own.

The synchronous tactile stimulation of the real hand of an individual and rubber hand leads to the feeling that the rubber hand is incorporated with the body of that individual. This is referred to as the rubber hand illusion (RHI), and it occurs because the brain is attempting to interpret the interaction of the visual, tactile, and proprioceptive systems of the body, which in turn, leads to a re-calibration of the touch and the felt position of the hand. The multimodal visuotactile stimulation inherent in the RHI induces the brain to temporarily incorporate external objects into its body image. In addition, when the experimenter threatens the rubber hand with a needle during this illusion, it generally elicits an enhanced sympathetic response and a measurable cortical anxiety response, which indicates that the bodily ownership of the rubber hand causes changes in the interoceptive system of the brain.

Cool. Check out this video to see how it is done. So what happens when you do acupuncture on a rubber hand that the brain thinks is its own?

The findings of the present study clearly demonstrate that acupuncture stimulation to a rubber hand resulted in the experience of the DeQi sensation when the rubber hand was fully incorporated into the body.

As judged by fMRI findings (always taken with a grain of salt substitute) and patient reports. DeQi is what dey feel when de needle is twirled in de skin. (more…)

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

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A Day of Science-Based Medicine at NECSS

Screen Shot 2015-01-09 at 1.35.26 PM

A day of Science-Based Medicine, a weekend of science and skepticism

Registration for NECSS, the North-East Conference on Science and Skepticism, is now open. Included in the program will be a day of Science-Based Medicine.

Speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.

NECSS will be held April 9th–12th, 2015, in New York City at the Fashion Institute of Technology. The SfSBM program will be Friday, April 10 and you can attend one or more of the days. $95 for one day or $195 for the entire conference.

Preliminary Program  (Updated 2.15.15.  Subject to change)

09:00 – 10:00 60 minutes Registration/Will Call
10:00 – 10:10 10 minutes OPENING: Steve Novella and David Gorski
10:10 – 10:45 35 minutes: Steve Novella. SBM – Going Beyond Evidence-Based Medicine.
10:45 – 11:20 35 minutes: Harriet Hall. Chiropractic.
11:20 – 11:55 35 minutes: David Gorski. Integrative Medicine
11:55 – 12:30 35 minutes: Mark Crislip. How Acupuncture ‘Works’
12:30 – 02:00 90 minutes LUNCH
02:00 – 02:35 35 minutes Speaker 4: Jann Bellamy. Political Pseudoscience
02:35 – 03:35 60 minutes Panel 1 Discussion
03:35 – 03:50 15 minutes BREAK
03:50 – 04:35 45 minutes Q&A from Twitter & Audience
04:35 – 05:20 45 minutes SBM Jeopardy
05:20 – 05:30 10 minutes CLOSING
05:30 – 06:00 30 minutes SBM Business Meeting

For more information and to register, go to NECSS or this registration page.

The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.

Posted in: Announcements

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SfSBM at NECSS

Screen Shot 2015-01-09 at 1.35.26 PM

A day of Science-Based Medicine, a weekend of science and skepticism

Registration for NECSS, the North-East Conference on Science and Skepticism, is now open. Included in the program will be a day of Science-Based Medicine.

Speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.

NECSS will be held April 9th–12th, 2015, in New York City at the Fashion Institute of Technology. The SfSBM program will be Friday, April 10 and you can attend one or more of the days. $95 for one day or $195 for the entire conference.

The precise program will be announced soon.

Preliminary Program  (Subject to change)

09:00 – 10:00 60 minutes Registration/Will Call
10:00 – 10:10 10 minutes OPENING: Steve Novella and David Gorski
10:10 – 10:45 35 minutes Speaker 1: Steve Novella
10:45 – 11:20 35 minutes Speaker 2: Harriet Hall.
11:20 – 11:55 35 minutes Speaker 3: David Gorski
11:55 – 12:30 35 minutes Speaker 4: Mark Crislip
12:30 – 02:00 90 minutes LUNCH
02:00 – 02:35 35 minutes Speaker 4: Jann Bellamy
02:35 – 03:35 60 minutes Panel 1 Discussion
03:35 – 03:50 15 minutes BREAK
03:50 – 04:35 45 minutes Q&A from Twitter & Audience
04:35 – 05:20 45 minutes SBM Jeopardy
05:20 – 05:30 10 minutes CLOSING
05:30 – 06:00 30 minutes SBM Business Meeting

For more information and to register, go to NECSS or this registration page.

The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.

Posted in: Acupuncture

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Do two half-truths add up to a complete truth or a complete falsehood?

olivia-twenty-dahl

I swear that the evidence that I shall give, shall be the truth, the whole truth and nothing but the truth

The interwebs are not a court of law, that is for sure. The whole truth. Interesting idea. I have no idea how applicable Godel’s theorems are outside of mathematics, but from a practical point knowledge is always incomplete. There is too much to know and too little time and brain power to acquire perfect knowledge of a topic.

It is why medicine is a challenge. You have to synthesize all the available data, which is often incomplete. You have to decide what is quality information, what is not, and why, and how a given study or fact fits into the overall picture, on the continuous asymptotic journey towards unobtainable total knowledge. But you try for the whole truth, the good, the bad and the ugly.

Half-truths, partial stories, can be hard to challenge. In part because, well, they are half-true. They have an air of truthiness. It is perhaps much easier to counter an out-and-out lie. Well, maybe not. I’m thinking Wakefield here. I suspect that in having to admit that half-truths have some validity, it renders them more believable.

The world of pseudo-medicine, and pseudo-science, is filled with half-truths. I wonder when I read these half-truths whether the author is deliberately avoiding all the information, especially since the rest of the story often results in the weakening the impact of the half-truth. Paul Harvey could have had a field day with the anti-vaccine literature.

One of the greatest challenge facing young people today, is the large scale availability of half truth’s and manipulated facts
– Oche Otorkpa, The Unseen Terrorist

Influenza

Beware of the half-truth. You may have gotten hold of the wrong half.
– Author unknown

Take “Do Not Believe Everything You Read About Flu Deaths” from the October, 2014 Journal of Advanced Practice Nursing. As best I can tell this is a peer reviewed journal. You know, “peer“, as in “to appear partially or dimly.”

I imagine someone squinting over the top of their glasses at the manuscript, muttering, “that ‘peers to be a paper about influenza deaths. Let’s publish it.”
(more…)

Posted in: Critical Thinking, Vaccines

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Gut Check

Lactobacillus acidophilus

Some apparently rather useless Lactobacillus acidophilus

I always cringe when I see an acupuncture headline with ‘needle’ or ‘point’ in the title. Can’t the writer avoid the clichéd pun? I had an editor who commented that the titles of my essays are often obtuse. Probably true. In going back over my essays on SBM I often can’t tell from the title what I have written about until I read the article. It is a fine line between (what I think) is a clever title and obscurity. So gut check it is.

Time flies when you are having fun. I wrote about probiotics back in 2009.

My conclusion at the time:

Probiotics are useful for the prevention of antibiotic-associated diarrhea. Probiotics may be helpful in preventing other overgrowth syndromes or diseases associated, and perhaps with perturbations of the gut microbial flora such as IBS and colic.

Probiotics are foreign bacteria that are not a normal part of your GI tract; they do not enhance your immune system and, in normal people do not promote the nebulous bowel health.

If you are a normal human, with a normal diet, save your money. Probiotics have nothing to offer but an increased cost.

Medicine is not static and there have been interesting advances in the understanding of the human microbiome in health and disease since 2009, so for SBM and my own medical understanding, I thought it would be a good opportunity to review the topic. Although with over 12,000 references on the PubMeds, I will only touch on a smattering of the papers. My ID attending in medical school always referred to reading the medical literature as drinking from a fire hose. Indeed. (more…)

Posted in: Herbs & Supplements

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SfSBM at NECSS. Update and More

Screen Shot 2015-01-09 at 1.35.26 PM

A day of Science-Based Medicine, a weekend of science and skepticism

Registration for NECSS, the North-East Conference on Science and Skepticism, is now open. Included in the program will be a day of Science-Based Medicine.

Speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.

NECSS will be held April 9th–12th, 2015, in New York City at the Fashion Institute of Technology. The SfSBM part of the program will be Friday, April 10 and you can attend one or more of the days. $95 for one day or $195 for the entire conference.

A preliminary program, subject to change

Time Speaker Topic
10:00 Steve and David Introductions and Welcome.
10:10 Steve TBA
10:40 Harriet Chiropractic
11:10 David Integrative Oncology
11:40 Mark Acupuncture
12:10 A buffer because we will run over
12:30 Lunch
1:00 Lunch
2:00 Jann Legislative alchemy
2:30 Panel Topic pending
3:15 Question and answer Questions from the twitter and audience
4:15 Break
4:00 Crislip MC, Jann, David, Jeopardy
Steve and Harriet Compete
5:00 Wrap up
5:15 SfSBM business meeting
5:45 End

For more information and to register, go to NECSS or this registration page.

The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.

This would be a good time to consider joining or renewing a membership in the Society for Science-Based Medicine.

But wait! There’s more.

A self-aggrandizing moment.

You may not know this, but for a year I blogged on my own on the topic of infectious diseases.

I had self-published those early essays in a volume and readers gave it good reviews: 4.5 Stars on Amazon and a 3.89 on Goodreads, but they complained about the lack of copy editing. Go figure.

Screen Shot 2015-01-17 at 8.54.52 AMNo longer. Bitingduck press is my publisher and has collected, edited, and organized the first year’s Rubor, Dolor, Calor, Tumor blog entries, now available on Kindle for a mere $5.99. Other versions, including a paperback, to follow in about 10 days. It should be 99% typo free.

Puswhisperer: A year in the life of an Infectious Disease Doctor.

The perfect gift for the pus lover in your life.

Posted in: Announcements

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SfSBM at NECSS

Screen Shot 2015-01-09 at 1.35.26 PM

A day of Science-Based Medicine, a weekend of science and skepticism

Registration for NECSS, the North-East Conference on Science and Skepticism, is now open. Included in the program will be a day of Science-Based Medicine.

Speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.

NECSS will be held April 9th–15th, 2015, in New York City at the Fashion Institute of Technology. The SfSBM part of the program will be Friday, April 9 10 (that’s the 10th, not the 9th) and you can attend one or more of the days. $95 for one day or $195 for the entire conference.

The precise program will be announced soon.

For more information and to register, go to NECSS or this registration page.

The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.

Posted in: Announcements

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