On my recent trip to Nashville for CSICon, I took advantage of the long hours on the plane to read Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle, by Thea Cooper and Arthur Ainsberg. One of our commenters recommended it. I’m not sure who (was it Chris?), but I want to thank you.
It’s the history of insulin told from the perspective of the scientists and of a typical patient, and it touches on a number of issues that we have addressed on SBM. It shows how science works to save lives, in stark contrast to the empty promises of CAM. (more…)
In 2011, chiropractor J.C. Smith published The Medical War Against Chiropractors: The Untold Story from Persecution to Vindication. He promises an exposé comparable to Harriet Beecher Stowe’s exposé of slavery in Uncle Tom’s Cabin. His thesis is that the AMA waged a shameless attack on competition, motivated only by money. I think the reality is closer to what he quoted from Dr. Thomas Ballantine, Harvard Medical School:
The confrontation between medicine and chiropractic is not a struggle between two professions. Rather it is more in the nature of an effort by an informed group of individuals to protect the public from fraudulent health claims and practices.
The book is self-published, long-winded, repetitive, and flawed. It is a vicious screed crammed with bias, half-truths, insulting language, and innumerable references to Nazis and racial prejudice. In my opinion, Smith not only fails to make his case but degrades chiropractic.
I intended to read Sam Kean’s new book The Violinist’s Thumb: And Other Lost Tales of Love, War, and Genius as Written by our Genetic Code just for fun. I was expecting a miscellany of trivia loosely gathered around the theme of DNA. But I found something much more worthwhile that I thought merited a book review to bring it to the attention of our readers. Kean interweaves entertaining stories into a somewhat disjointed but nonetheless valuable history and primer of genetics. The title refers to Paganini, whose DNA created the unusual joint flexibility that facilitated his unprecedented feats of virtuosity on the violin.
In 2005, cardiologist Barbara Natterson-Horowitz was called to the zoo to examine a non-human patient, an emperor tamarin with heart failure. She was surprised when the veterinarian told her not to look her patient in the eyes because eye contact could cause capture myopathy. In this condition, when an animal is captured, restrained, and feels threatened, there is a catastrophic surge of adrenaline that damages muscle tissues and can kill. It was described decades ago, but medical doctors don’t read the veterinary literature. It wasn’t until the early 2000s that American doctors began to recognize a similar phenomenon in human patients, takotsubo or stress-induced cardiomyopathy.
She began to wonder whether animals got other human diseases. She quickly learned that they did. Jaguars get breast cancer and may carry the same BRCA1 gene that plagues Ashkenazi Jewish women, rhinos get leukemia, penguins get melanoma, gorillas die from ruptured aortas, and koalas are in the midst of an epidemic of sexually transmitted chlamydia. Wild dragonflies infected with parasites become obese and develop a form of metabolic syndrome. Pretty much every human disorder occurs in animals too.
With the help of writer Kathryn Bowers, she distilled her findings into a book: Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing. It’s a good read: informative, well argued, spiced with intriguing trivia, and more entertaining than a trip to the zoo. (more…)
Do you have any skeptical blind spots? I’ve had a skeptical perspective for a long time (my teenage cynicism wasn’t just a phase) but the framework for my thinking has developed over years. Professionally, the blind spot that the pharmacy profession has towards supplements and alternatives to medicine was only clear after I spent some time working in a pharmacy with thriving homeopathy sales. In looking for some credible evidence to guide my recommendations, I discovered there was quite literally nothing to homeopathy. Once I discovered blogs like Respectful Insolence, the critical thinking process, and scientific skepticism, took off. (more…)
3 years ago I wrote an article critical of “evolutionary medicine” as it was presented in a new book. Recently a correspondent asked me if I thought another book, Why We Get Sick: The New Science of Darwinian Medicine, by Randolph M. Nesse, MD and George C. Williams, PhD, was a more reasonable approach to the subject. It was published in 1994 and got good reviews from respected scientists like Richard Dawkins (“Buy two copies and give one to your doctor.”) and E.O. Wilson (“bringing the evolutionary vision systematically into one of the last unconquered provinces…”). I was able to obtain a copy through interlibrary loan.
The book was interesting and gave me some things to think about, but it didn’t convince me that “Darwinian medicine” is a new science, that its existence as a separate discipline is justified, or that its unique approach offers any real practical benefits for improving medical care.
Why do we get sick? A simplistic view of evolution holds that it systematically eliminates any factors that decrease fitness for survival. So why does disease persist? Why didn’t we evolve to be “fit” enough to never get sick? Because evolution is not a straightforward process.
The term “evidence-based medicine” first appeared in the medical literature in 1992. It quickly became popular and developed into a systematic enterprise. A book by Ulrich Tröhler To Improve the Evidence of Medicine: The 18th century British origins of a critical approach argues that its roots go back to the 1700s in Scotland and England. An e-mail correspondent recommended it to me. Can’t remember who, but I would like to thank him.
Francis Bacon (1561-1626) differentiated between “ordinary experience” (chance observations) and more objective “ordered experience” (methodological observations). Both of these involved empirical knowledge. It’s hard to get back into the mindset of his time, when most physicians rejected empiricism as the sphere of quacks and surgeons. Tröhler helps us understand why they did:
…since antiquity, the mark of distinction of a learned man had been the certainty of his knowledge. A doctor knew — he did not need to test his kind of knowledge empirically because this would imply acknowledgement of uncertainty.
For decades Consumer Health: A Guide to Intelligent Decisions was the only textbook available for college classes on the subject, and it is still the best: the most comprehensive and the most reliable. It was first published in 1976, and it has clearly had staying power. An updated 9th edition has just been released. The authors have changed over the years: this edition’s authors are Stephen Barrett, William London, Manfred Kroger, Harriet Hall, and Robert Baratz. It’s an invaluable compendium of information that would be useful to any consumer, and it’s unfortunate that McGraw-Hill is marketing it as an expensive textbook ($163).
What exactly is “consumer health”? The book’s preface and the table of contents are available here. They will provide the long answer to that question. The short answer is:
The book’s fundamental purpose is to provide trustworthy information and guidelines to enable people to select health products and services intelligently. (more…)
I usually rely on the Secret. Every two weeks or so the Universe offers up some bit of wacky whimsey and I have a topic for an SBM blog entry. This week the Universe has failed me. Nothing has crossed my LCD so I have no studies to evaluate and I have been unusually busy at work preventing my browsing the Interwebs for material. But try telling that to the Managing Editor. I write half to amuse myself, half to learn about the topic, and half to clarify in my own mind the topics at hand (1). So this week is content free idle thoughts for my own benefit.
I have been reading 13 Things That Don’t Make Sense by Michael Brooks. The book concerns topics in science that are unexplained by the current understanding of the laws of the universe or contradict the dominant paradigm. Well, almost. His final topic is homeopathy, and it is the one topic whose conclusions, while qualified, belong on Failblog. The first chapter concerns dark matter and dark energy and how what we can see makes up only a small fraction of the content of the universe. (more…)
Eric Topol, MD, has written a book about the convergence of the digital revolution and medicine. It is full of fascinating information and prognostication, but I wish he had given it a better title. He called it The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. Medicine will not and cannot be “destroyed.” It will be improved and transformed, perhaps, but not destroyed. And any new developments will have to be evaluated for safety and effectiveness by the good old time-tested methods of science.
The future world of medicine is really exciting: science fiction is becoming real. As I read Topol’s book I serendipitously found it paraphrased by a character in another book I was reading, Chop Shop, by Tim Downs.
I see a world where no one ever dies from an adverse drug reaction; where physicians have an entire range of medicines to choose from to treat a deadly disease; where medications target tumors like smart bombs and leave surrounding tissues unharmed; where genetic susceptibility to disease can be determined in childhood, and possibly even prevented.
(If you haven’t yet discovered Downs’ hilarious “Bug Man” detective series about a crazy forensic entomologist, you have a treat in store.)
But back to non-fiction. Our world is changing almost too rapidly to comprehend: the Internet reaches everywhere, and there are far more mobile phones in the world today than toilets. We have hardly begun to tap the current potential of new technologies, and unimagined further developments await us. Topol is a qualified guide to this new world: he is a respected cardiologist and geneticist who ha s been on the forefront of wireless medicine and who was a major whistleblower in the Vioxx fiasco. He knows whereof he speaks, and he writes lucidly and accessibly.