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In Pursuit of Patient Safety

[Editor’s note: With Dr. Gorski enjoying a vacation to recharge his batteries, we present a second offering from contributor James Thomas. Enjoy!]

From the

This might hurt a little…
From the Wellcome Trust Image Librar via the Wikimedia Commons

Advocates of CAM* (Complementary and Alternative Medicine) have long argued that mainstream medicine is a dangerous undertaking using toxic drugs and invasive interventions that often do more harm than good, while the various quackeries huddled under the CAM umbrella are said to use natural interventions that aid the body in healing itself. A recent BMJ article naming medical errors as the third leading cause of death in the United States was trumpeted as proof of that claim and predictably enough unleashed a maelstrom of pearl-clutching commentary from the CAMsters. David Gorski has already deconstructed the ‘medical error is the third leading cause of death’ argument comprehensively. Rather than re-till that ground, I will use this essay to examine the allied accusation that medicine has little interest in the actual inherent dangers of medicnie, and less interest still in addressing those dangers. (more…)

Posted in: History, Science and Medicine, Surgical Procedures

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The Gene: An Intimate History

A superb writer, Siddhartha Mukherjee's books are easier to read than his name is to spell

A superb writer, Siddhartha Mukherjee’s books are easier to read than his name is to spell

Six years ago I reviewed Siddhartha Mukherjee’s book The Emperor of All Maladies: A Biography of Cancer. It was hands-down one of the best books I have ever read on a medical topic. Now he’s done it again. His new book is titled The Gene: An Intimate History.

Mukherjee is a superb writer. Much of what I said about his first book applies equally to his second, so I will quote myself:

It is a unique combination of insightful history, cutting edge science reporting, and vivid stories about the individuals involved: the scientists, the activists, the doctors, and the patients. It is also the story of science itself: how the scientific method works…

Beautifully written and informative

Reads like a detective story with an exciting plot.

He links this second book to his first by pointing out that cancer is an ultimate perversion of genetics, and that studying cancer means also studying its obverse: normalcy. He gives the subject a human face by interspersing anecdotes from his own family’s struggles with mental illness and its connection to inherited genes. He sets out to tell the story of the birth, growth, and future of one of the most powerful and dangerous ideas in the history of science: the gene. He says it is one of three destabilizing ideas that have transformed science: the concept that irreducible units underlie matter (the atom), digitized information (the byte or bit), and biological information (the gene). He explains how the consequences of these ideas have transformed our thinking, our language, our culture, politics, and society. (more…)

Posted in: Basic Science, Book & movie reviews, History, Medical devices

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Why Science-Based Medicine Matters

A child with smallpox; the cost of unscientific medicine. This is why science-based medicine matters.

A child with smallpox; the cost of unscientific medicine. This is why science-based medicine matters.

The regular contributors at Science-Based Medicine (SBM) work diligently every week to explore the world of science-based medicine and the gauzy, nebulous netherworld of fantasy-based medicine. They shine light on the leading edge of medical science, dissect the nuances of mainstream care, expose the misconceptions and sometimes the frank deceptions of so-called alternative medicine. Launching SBM on January 1, 2008, sbmadmin (Steven Novella?) described the mission of the blog as: “scientifically examin[ing] medical and health topics of interest to the public [including] reviewing newly published studies, examining dubious products and claims, providing much needed scientific balance to the often credulous health reporting, and exploring issues related to the regulation of scientific quality in medicine.” He went on to propound an elegant yet simple core philosophy that “safe and effective health care is critical to everyone’s quality of life; so much so that it is generally considered a basic human right.”

This last deserves, I think, especially careful consideration. Enshrined in the aspirational manifesto of the United States, the Declaration of Independence, is the claim for all people to inherent and inalienable rights to “Life, Liberty and the pursuit of Happiness.” And while Jefferson used the phrase in the context of personal political freedoms, health is central to the exercise of those rights. It is the role of medicine to secure health, to provide a structure and a system by which all can live life as long and as free from disease and disability as our individual circumstances allow. (more…)

Posted in: History, Science and Medicine

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Zika virus, microcephaly, and calls to bring back DDT

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If there’s one thing I’ve learned over the last decade-plus of blogging about medicine and alternative medicine, it’s that any time there is an outbreak or pandemic of infectious disease, there will inevitably follow major conspiracy theories about it. I saw it during the H1N1 pandemic in the 2009-2010 influenza season, the Ebola outbreak in late 2014, and the Disneyland measles outbreak last year, when cranks of many stripes claimed that either the outbreaks themselves were due to conspiracies (usually, but not limited to, conspiracies to promote the “depopulation” vaccination agenda of—who else?—Bill Gates) or that nefarious forces were seizing on the outbreak to take away our freedom. The second thing I’ve learned is that inevitably people will try to impose their ideology on to the disease and try to use outbreaks to push their own ideological agenda. Indeed, the Ebola outbreak, for example, was rapidly seized on by politicians to promote quarantines and to halt immigration from the affected countries. This year, the biggest infectious disease-related story thus far is the Zika virus outbreak in Brazil that has been linked to microcephaly and other birth defects, and it’s a case of the same stuff, different year.

The Zika virus is a mosquito-borne flavivirus related to dengue virus and transmitted primarily by Aedes aegypti mosquitoes. On the surface, this virus would appear to be relatively benign, with 80% of those infected by it remaining asymptomatic, while the other 20% suffer from what is usually a self-limited, relatively mild illness characterized by fever, rash, arthralgias (joint aches), and conjunctivitis. In the grand scheme of things, after decades of being endemic in many tropical areas Zika virus infection probably didn’t seem so bad and didn’t appear to be much of a public health priority in the regions where Aedes aegypti mosquitoes live, mainly tropical regions in South and Central America, Africa, southeast Asia, and the Pacific islands. Then came the evidence that prenatal infection might cause microcephaly, and everything changed. Not surprisingly, conspiracy theories galore arose with social media speed, as did the ideologically motivated overselling of proposed solutions, such as bringing back DDT to combat the mosquito carrying the disease.
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Posted in: Basic Science, Epidemiology, History, Politics and Regulation

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Worshiping at the altar of the Cult of the Brave Maverick Doctor

Death of Cancer

One of my favorite television shows right now is The Knick, as I described before in a post about medical history. To give you an idea of how much I’m into The Knick, I’ll tell you that I signed up for Cinemax for three months just for that one show. (After its second season finale airs next Friday, I’ll drop Cinemax until next fall.) The reason why I’m bringing up The Knick (besides I love the show and need to bring it up at least once a year) is because an article by Malcolm Gladwell in The New Yorker entitled “Tough Medicine“, which is a commentary based on a new book on cancer by a veritable god of cancer research, Vincent T. DeVita, Jr., immediately resonated with a storyline in this season of The Knick. I haven’t yet read The Death of Cancer: After Fifty Years on the Front Lines of Medicine, a Pioneering Oncologist Reveals Why the War on Cancer Is Winnable–and How We Can Get There by Vincent T. DeVita and Elizabeth DeVita-Raeburn, but I want to. I can tell, though, that there will be parts of the book I find annoying just from Gladwell’s take on it, which approvingly describes DeVita as railing against the cautiousness and incremental nature of today’s cancer research. To give you an idea of where Gladwell’s coming from, I note that his article shows up in the title bar of my web browser not as “Tough Medicine” but rather “How To Cure Cancer”, even as the title on the web page itself remains “Tough Medicine”. On the other hand, the article does conclude with Gladwell demonstrating a better understanding of the disadvantages of what DeVita is proposing than it seems that he will in the beginning. In fact, it is Gladwell who is more reasonable than his subject, although he does appear share DeVita’s apparent assumption that potentially all cancer patients are savable if only we try hard enough. (more…)

Posted in: Cancer, Clinical Trials, History, Medical Ethics

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Matt Ridley’s not-so-mythical “myth” of basic science

Matt Ridley: Specious arguments against government research funding.

Matt Ridley: Specious arguments against government research funding.

I’m a clinician, but I’m actually also a translational scientist. It’s not uncommon for those of us in medicine involved in some combination of basic and clinical research to argue about exactly what that means. The idea is translational science is supposed to be the process of “translating” basic science discoveries in the laboratory into medicine, be it in the form of drugs, treatments, surgical procedures, laboratory tests, diagnostic tests, or anything else that physicians use to diagnose and treat human disease. Trying to straddle the two worlds, to turn discoveries in basic science into usable medicine, is more difficult than it sounds. Many are the examples of promising discoveries that appeared as though they should have led to useful medical treatments or tests, but, for whatever reason, didn’t work when attempted in humans.

Of course, if there’s one thing that the NIH and other funding agencies have been emphasizing, it’s been “translational research,” or, as I like to call it, translation über alles. Here’s the problem. If you don’t have basic science discoveries to translate, then translational science becomes problematic, virtually impossible even. Translational research depends upon a pipeline of basic science discoveries to form the basis for translational scientists to use as the starting point for developing new treatments and tests. Indeed, like many others who appreciate this, I’ve been concerned that in recent years, particularly with tight budgets, the NIH has been overemphasizing translational research at the expense of basic research.
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Posted in: History, Politics and Regulation, Science and Medicine

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Frontal Lobotomy: Zombies Created by One of Medicine’s Greatest Mistakes

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It’s not clear who first quipped “I’d rather have a bottle in front of me than a frontal lobotomy,” but it’s not just a joke. Almost anything would be preferable to a frontal lobotomy. It was a barbarous procedure with catastrophic consequences, and yet it was once widely accepted and even earned a Portuguese doctor a Nobel Prize. In the annals of medical history, it stands out as one of medicine’s biggest mistakes and an example of how disastrously things can go wrong when a treatment is put into widespread use before it has been adequately tested.

A new book by Janet Sternburg, White Matter: A Memoir of Family and Medicine, puts a human face on the suffering of mentally ill patients and their families, and helps us understand why they agreed to lobotomies. It is the affecting story of how her relatives made the difficult but misinformed decision to lobotomize two of her mother’s five siblings, one for schizophrenia and the other for depression, and the consequences of that decision.
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Posted in: Book & movie reviews, History, Neuroscience/Mental Health

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NCCIH and the true evolution of integrative medicine

NCCIH and the true evolution of integrative medicine

There can be no doubt that, when it comes to medicine, The Atlantic has an enormous blind spot. Under the guise of being seemingly “skeptical,” the magazine has, over the last few years, published some truly atrocious articles about medicine. I first noticed this during the H1N1 pandemic, when The Atlantic published an article lionizing flu vaccine “skeptic” Tom Jefferson, who, unfortunately, happens to be head of the Vaccines Field at the Cochrane Collaboration, entitled “Does the Vaccine Matter?” It was so bad that Mark Crislip did a paragraph-by-paragraph fisking of the article, while Revere also explained just where the article went so very, very wrong. Over at a blog known to many here, the question was asked whether The Atlantic (among other things) matters. It didn’t take The Atlantic long to cement its lack of judgment over medical stories by publishing, for example, a misguided defense of chelation therapy, a rather poor article by Megan McArdle on the relationship between health insurance status and mortality, and an article in which John Ioannidis’ work was represented as meaning we can’t believe anything in science-based medicine. Topping it all off was the most notorious article of all, the most blatant apologetics for alternative medicine in general and quackademic medicine in particular that Steve Novella or I have seen in a long time. The article was even entitled “The Triumph of New Age Medicine.”

Now The Atlantic has published an article that is, in essence, The Triumph of New Age Medicine, Part Deux. In this case, the article is by Jennie Rothenberg Gritz, a senior editor at The Atlantic, and entitled “The Evolution of Alternative Medicine.” It is, in essence, pure propaganda for the paired phenomena of “integrative” medicine and quackademic medicine, without which integrative medicine would likely not exist. The central message? It’s the same central (and false) message that advocates of quackademic medicine have been promoting for at least 25 years: “Hey, this stuff isn’t quackery any more! We’re scientific, ma-an!” You can even tell that’s going to be the central message from the tag line under the title:

When it comes to treating pain and chronic disease, many doctors are turning to treatments like acupuncture and meditation—but using them as part of a larger, integrative approach to health.

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Posted in: Acupuncture, History, Medical Academia, Naturopathy, Science and the Media

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The Gerson protocol, cancer, and the death of Jess Ainscough, a.k.a. “The Wellness Warrior”

The Wellness Warrior website now redirects to this photo.

The Wellness Warrior website now redirects to this photo.

Less than four days ago, a young Australian woman died of a very rare type of cancer. Most of my American and probably many of my European readers have never heard of her, but in Australia she had become quite famous over the last seven years as a major proponent of “natural health.” Her name was Jess Ainscough, but, like a certain American woman who has become famous for promoting dubious science, she was better known by her “brand” name. That brand name was The Wellness Warrior.

I first encountered Ms. Ainscough about a year and a half ago and have been intermittently following her career ever since. I’ve even blogged about her three or four times during that period over at my not-so-super-secret other blog. However, for whatever reason, even though it was my intent to write about her here on Science-Based Medicine, I never got around to it. Her death prodded me to write now, because her tale is a cautionary one important enough that I believe there should be something written here about it. Given that, those of you who follow my cubical other self will find some of this post repetitive. However, think of it as the first opportunity I’ve had to tell the story from beginning to end, along with a major deconstruction of the Gerson protocol. (Yes, unfortunately the Gerson protocol figures heavily in this story.) It’s a story that has led to the deaths of at least two people, and whose harm to others is impossible to quantify, given that the reach of The Wellness Warrior was long, at least in Australia.
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Posted in: Cancer, Herbs & Supplements, History, Science and the Media

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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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