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Facing Decline and Death

Gawande book

Note: Atul Gawande and his book will be featured on a Frontline episode airing on PBS tonight.

We’re all going to die. (There’s nothing like starting on a positive note! :-) ) We’re all going to die, and if we are fortunate enough to survive long enough to become old, we’re all going to experience a decline of one sort or another before we die: reduced hearing and vision, less strength, poorer memory, etc. As a society, and as a medical profession, we have been reluctant to confront those issues head on. Dr. Atul Gawande faces them unflinchingly in his thought-provoking new book Being Mortal: Medicine and What Matters in the End.

In a simpler time, there were fewer old people; they were respected for their knowledge and were cared for by their families who supplied their increasing needs as age made them more dependent on others; they died at home surrounded by supportive loved ones. Today we warehouse our elders in nursing homes, where they are denied the independence of even making simple everyday choices like when to get up and when to eat. We consign them to a regimented, less enjoyable, less meaningful life; and they frequently die alone in hospitals, connected to tubes and machines.

Doctors are not always good at making it clear to terminally ill patients that they are going to die soon. They are not always good at discussing end-of-life issues and securing advance directives. They often treat end-of-life diseases so aggressively that they end up causing more suffering or even shortening lives. (more…)

Posted in: Book & movie reviews, Cancer, Medical Ethics

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A Scientist in Wonderland

Edzard Ernst is one of those rare people who dare to question their own beliefs, look at the evidence without bias, and change their minds. He went from practicing alternative medicine to questioning it, to researching it, to becoming its most prolific critic. I have long admired his work, and I finally met him in person when we were invited to speak at the same conferences. He shattered my stereotype of the stern, formal, self-important German “Herr Professor Doktor.” He was affable, unassuming, and funny; he was even a jazz musician. I wished I knew more about his history, and my wishes have been granted in the form of his new autobiographical book, A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble.

This is a well-written, entertaining book that anyone would enjoy reading and that advocates of alternative medicine should read: they might learn a thing or two about science, critical thinking, honesty, and the importance of truth.

This is a well-written, entertaining book that anyone would enjoy reading and that advocates of alternative medicine should read: they might learn a thing or two about science, critical thinking, honesty, and the importance of truth.

Edzard Ernst, the early years

Dr. Ernst was born in post-war Germany; his family had suffered greatly during the war and his uncle had been a general in the Waffen SS. He felt slightly ashamed to be German, and as a result he researched and wrote about Nazi health beliefs and medical atrocities so the history of their misdeeds would not be forgotten.

His father was a doctor, his mother an enthusiastic devotee of alternative medicine who subjected him to homeopathy, ice cold baths, and barefoot walks at dawn through wet grass. Early in life, Ernst began to manifest a tendency towards doubt and irreverence, along with an irrepressible sense of curiosity.

Music was his first love. He earned good money when he and his friends spent their summer vacation busking on the beach at St. Tropez, and he had been seriously considering a musical career until his mother persuaded him to study medicine. He earned an MD in Germany, in an environment where alternative medicine was unquestioningly integrated with mainstream medicine. He received hands-on training in acupuncture, autogenic training, herbalism, homeopathy, cupping, massage therapy, spinal manipulation, even leeches. His first job was in a homeopathic hospital where a colleague chose remedies by dowsing with a pendulum. (more…)

Posted in: Book & movie reviews, Clinical Trials, Critical Thinking

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The Marvelous Dr. Mütter

The Mütter Museum in Philadelphia has a marvelous collection of human bones, surgical specimens, monsters in jars, and medical memorabilia. It holds attractions for everyone, from the jaded medical professionals who thought they’d seen it all to the coveys of youngsters who compete to point out the grossest items to their friends, from the student of history to the connoisseur of the macabre. There is an enormous megacolon said to look like a sandworm from Dune, a plaster cast of the famous Siamese twins Chang and Eng along with their actual preserved conjoined livers, a collection of bizarre swallowed objects, an iron lung, a tumor removed from president Grover Cleveland’s jaw while he was in office, a shocking assortment of deformed fetuses…the list goes on.

I knew about the museum and greatly enjoyed visiting it, but I didn’t know anything about Dr. Mütter himself until I read a delightful new book by Cristin O’Keefe Aptowicz , Dr. Mutter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. I learned that the good doctor was every bit as marvelous as his museum, and the book took me on a fascinating trip back to the medicine of the early 1800s that made me better appreciate all that modern medicine has accomplished.

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Posted in: Book & movie reviews, History, Surgical Procedures

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Pesticides: Just How Bad Are They?

3D model of DDT, an insecticide

3D model of dichlorodiphenyltrichloroethane (DDT), an insecticide

I think everyone would agree that it would not be a good idea to put pesticides in a saltshaker and add them to our food at the table. But there is little agreement when it comes to their use in agriculture. How much gets into our food? What are the effects on our health? On the environment? Is there a safer alternative?

Where should we look to find science-based answers to those questions? One place we should not look is books written by biased non-scientists to advance their personal agendas. A friend recently sent me a prime example of such a book: Myths of Safe Pesticides, by André Leu, an organic farmer whose opinions preceded his research and whose bias is revealed in the very title. (more…)

Posted in: Book & movie reviews, Critical Thinking, Public Health

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Mirror Neurons and the Pitfalls of Brain Research

myth of mirror neurons

[Ed. Note: I realize that I normally post on Monday, but thanks to an R21 grant deadline tomorrow, I will not be able to post new material today (although you might have noticed some “familiar” material posted yesterday.) Harriet has graciously agreed to cover for me today, and we have a special guest post for you tomorrow. Fear not. I’ll soon be back. Trying to get the lab funded takes momentary precedence.]

In his new book The Myth of Mirror Neurons: The Real Neuroscience of Communication and Cognition , Gregory Hickok, a professor of cognitive science, challenges current conceptions about mirror neurons. He shows how a complex mythology arose and why it is unwarranted, how experimental results were misinterpreted and disconfirming evidence ignored, and how other interpretations might lead to better insights about how the brain works.

I couldn’t say it any better than Steven Pinker did on the jacket blurb:

Every now and again an idea from science escapes from the lab and takes on a life of its own as an explanation for all mysteries, a validation of our deepest yearnings, and irresistible bait for journalists and humanities scholars…Hickok puts an end to this monkey business by showing that mirror neurons do not, in fact, explain language, empathy, society, and world peace. But this is not a negative exposé—the reader of this book will learn a great deal of the contemporary sciences of language, mind, and brain, and will find that the reality is more exciting than the mythology. (more…)

Posted in: Book & movie reviews, Neuroscience/Mental Health

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An Overly Pessimistic View of Medicine

doctored book cover

Sandeep Jauhar wrote Doctored: The Disillusionment of an American Physician to express his frustration with the modern system of medical care in America. I found the book profoundly disturbing. If his experience is representative, I can understand why so many people have been criticizing doctors for only caring about money. His experience was so different from mine that I wondered if I had led a sheltered life as a military physician and was oblivious to what was going on in the civilian world. After further reflection, I think Jauhar is unduly pessimistic. Whatever the opposite of rose-colored glasses is, he’s wearing them.

His personal experience of medicine

Dr. Jauhar is a cardiologist who works in a large teaching hospital, where he had been hired to develop a program for patients with heart failure that would implement the most up-to-date medical knowledge and provide the best possible medical care. After long, grueling years of school, residency, and fellowship, he is elated to have finally finished his training and started a job where he can accomplish something good. But he soon sinks into despair. He is appalled by the realities of life as an attending physician, the many ways in which the “system” interferes with his efforts to provide the best care to patients, the unethical behavior of other doctors, and his inability to support his family.
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Posted in: Book & movie reviews

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Does the Movie Fed Up Make Sense?

fed up movie

The 2014 film Fed Up is an advocacy documentary. Its message:

  • There is a worldwide epidemic of obesity.
  • It is endangering our children.
  • Increased sugar consumption is responsible.
  • The food industry is responsible for our increased sugar consumption because it puts hidden sugar in processed foods, bombards us with advertising, favors profits over health, and lobbies against regulation.
  • The government is responsible because it has failed to control the food industry.

The film has received mostly positive reviews and has been called the Inconvenient Truth of the health movement. It was written and directed by Stephanie Soechtig, whose earlier films attacked GMO foods and the bottled water industry, and narrated by Katie Couric, who “gave anti-vaccine ideas a shot” on her talk show in late 2013.

The film shows families struggling with childhood obesity and “experts” expressing their opinions. Their selection of “experts” is heavy on politicians and journalists and light on nutrition scientists.
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Posted in: Book & movie reviews, Nutrition

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Why Does This Immunologist Reject Vaccinations?

Vaccination is arguably medicine’s greatest success. It has eradicated smallpox and has saved millions from death and suffering from a growing list of preventable diseases. It’s surprising that it has so many critics. Most of them are either not educated in medical science (like Jenny McCarthy) or are educated but prefer to reject science in favor of anecdotal experience (like Jay Gordon). Their arguments have been examined ad nauseum on this blog and elsewhere, and are easy to dismiss. But when I learned that an immunologist had written a book rejecting the whole idea of vaccination, I couldn’t dismiss it so easily. An expert in the field obviously knows more than I do about the relevant science; and if nothing else, she might have some valid criticisms of vaccines that I had overlooked. In 2012 Tetyana Obukhanych, PhD, published a short (53 page) book that is available in a Kindle edition: Vaccine Illusion: How Vaccination Compromises Our Natural Immunity and What We Can Do To Regain Our Health. I read the book hoping to learn something, and I did learn some things, but not anything that would make me question the current vaccine recommendations. I tried valiantly to understand her message; I think I succeeded. I’ll try to summarize what she is saying and explain why I think she got it wrong.

Vaccinefear
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Posted in: Book & movie reviews, Vaccines

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The Unpersuadables

The Unpersuadables

The Unpersuadables

We would like to believe people are rational. We would like to believe that if they have formed a false belief based on inaccurate information and poor reasoning, they will change that belief when they are provided with accurate information and better reasoning. We are frequently disappointed.

An example of what should happen

I recently talked with a college professor who believed chiropractic treatment could lower blood pressure. His belief was based on a media report of a chiropractic study. He thought it was plausible that neck manipulation could somehow relieve obstructions to blood flow to the base of the brain, thereby somehow correcting the cause of high blood pressure. I told him that rationale was anatomically and physiologically implausible. I pointed out that the researchers used NUCCA, a form of manipulation that is rejected by most chiropractors. He did not know what NUCCA was. I provided him with information, including links to the study itself and to chiropractor Sam Homola’s excellent critique of the study. My friend changed his mind and thanked me for educating him.

An example of what all too often happens

I was invited to give the “con” side of a pro/con presentation on dowsing to a local discussion group. I lent my opponent my copy of Vogt and Hyman’s classic book Water Witching USA so he would know ahead of time what I was going to say. He read it. The book explains how the ideomotor effect creates the illusion that the dowsing rod moves of its own accord and explains that dowsers have never been able to pass controlled scientific tests. I said as much in my “con” presentation. His “pro” presentation consisted of two arguments: he had personally seen dowsing work, and lots of people believed in it. He didn’t even try to rebut my facts and arguments; he simply refused to engage with them in any way. It was as if he had not read the book and had not heard anything I said. Afterwards, one of the audience was heard to say she would have liked to hear more about how dowsing worked and less about how it didn’t work!

Will Storr investigates

Sadly, some people are unpersuadable. They might as well be saying “My mind’s made up; don’t confuse me with the facts.” We have seen plenty of glaring examples in the comments section of this blog. Will Storr wrote a book The Unpersuadables: Adventures with the Enemies of Science about his struggle to understand the phenomenon. He did a great job of investigative reporting, interviewing people with strange beliefs, spending time with them and also with their critics, and reading pertinent research. (more…)

Posted in: Book & movie reviews, Critical Thinking

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Diet Cults vs. Science-Based Healthy Eating

Diet Cults
This will be shorter than my usual book reviews and is something of an afterthought. I just finished writing a long article on “Food Myths” that Michael Shermer had asked me to write as a cover article for an upcoming issue of Skeptic magazine, and while researching the subject I read a book that someone had suggested to me (I’ve forgotten who you are, but thank you!). It occurred to me that since not everyone who reads SBM subscribes to Skeptic, it would be good to tell this audience about the book too.

(Note: if you subscribed, you could not only read my upcoming “Food Myths” article but also my regular SkepDoc column and my long article “On Miracles” in the next issue. And there’s lots of other great stuff in the magazine, including the Junior Skeptic section for your kids and grandkids. A digital subscription is available for only $14.99 and you can even get a trial issue for free, so you have no excuse not to check it out. End of commercial.)

The book is Diet Cults: The Surprising Fallacy at the Core of Nutrition Fads and a Guide to Healthy Eating for the Rest of Us, by Matt Fitzgerald, an endurance sport and nutrition writer. Not a doctor, but he understands science better than a lot of doctors who have written about diet and nutrition. His reasoning is persuasive and is supported by the scientific evidence. (more…)

Posted in: Book & movie reviews, Nutrition

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