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Pump it up: osteopathic manipulation and influenza

First, my bias. I work in Portland and we have medical students, residents, and faculty who are DOs (Doctor of Osteopathy). Before he moved on to be a hospitalist my primary physician was a DO. From my experience there is no difference between an MD and a DO. In my world they are interchangeable. There are many more qualified applicants for medical education than positions in MD programs and some opt for a DO education. Osteopathy has a dark side.
As best I can determine from my colleagues, learning osteopathic manipulation (OM) is the price they pay to obtain an otherwise standard medical education. I have yet to see OM offered by any of my DO colleagues. It may be they know better than to offer such a modality around me given my ranty propensity for all things SCAM.

The literature would suggest that OM is left behind by most DOs upon graduation. DOs are not proud of their OM, and rarely invite them ‘round to dinner. It will be interesting to see if OM fades over time in DO school as the old time true believers die off and are supplanted by a generation of DOs trained with more traditional medical education.

OM, the small pseudoscientific aspect of DO medical school education, is a form of massage and manipulation invented in the 19th century with no basis in reality. OM postulates

the existence of a myofascial continuity – a tissue layer that interlinks all parts of the body. By manipulating the bones and muscles of a patient a practitioner is supposed to be able to diagnose and treat and variety of systemic human ailments.

Studies into the efficacy of OM find it to be ineffective for any process aside from low back pain (is there anything that does not help low back pain?), not surprising for a therapeutic intervention detached from reality. My purpose with this entry is not to review OM per se, which may be a good topic someday, but to focus on a specific application of OM. (more…)

Posted in: Chiropractic, Clinical Trials, History, Science and Medicine

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Ask the (Science-Based) Pharmacist: What are the benefits of coffee enemas?

How do you like your coffee? Rectally.

How do you like your coffee? Rectally.

It might not occur to you, sipping your morning coffee, that you could derive tremendous health benefits by simply shooting that coffee directly into your rectum. Yet many people believe this. Suzy Cohen, who calls herself, “America’s Pharmacist™” and also “America’s Most Trusted Pharmacist®” is a proponent. Her syndicated column Ask the Pharmacist recently contained this question and response: (more…)

Posted in: Cancer, History, Naturopathy

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Visiting a Victorian Duckpond

Ever heard of George Augustus Scott? Probably not. Although he was once touted as “Man of the Century,” he was actually a charlatan who sold electric hairbrushes. (No, an electric hairbrush isn’t a device that will brush your hair for you; it’s a hairbrush that supposedly produces a “permanent electric current” to cure everything from baldness to headaches.) He went on to sell magnetic corsets, electric rings for rheumatism, and sarsaparilla, advertised as the “GREATEST MEDICAL DISCOVERY of the AGE.” (You probably haven’t heard about that greatest discovery either.)

He and his many comrades in crime are profiled in a new book, The Medical Electricians: Dr. Scott and his Victorian Cohorts in Quackery by Robert K. Waits. You will find more quacks in this book than in any duck pond. It provides historical insights and reminds us that there is nothing new under the sun; similar charlatans continue to sell similar quack devices today, facilitated by the Internet and other media.

Electricity and magnetism sounded exciting to Victorian ears, but their properties were poorly understood. Great hopes were raised for medical applications. The opinions of experts varied. Priestly reported experiments from Italy and Germany in 1747-8 showing that a patient who held a vial of medicine while being electrified would get the same benefit as if he took the medicine by mouth. Benjamin Franklin, on the other hand, was persuaded that these reports were not true. (more…)

Posted in: Book & movie reviews, Energy Medicine, History

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“Alternative” cancer cures in 1979: How little things have changed

Sometimes blogging topics arise from the strangest places. It’s true. For instance, although references to how tobacco causes cancer and the decades long denialist campaign by tobacco companies are not infrequently referenced in my blogging (particularly from supporters of highly dubious studies alleging a link between cell phone radiation and cancer and the ham-handed misuse of the analogy by antivaccinationists, who seem to think that vaccine companies engage in deceit on a scale similar to the deceptive practices of tobacco companies in “denying” that vaccines cause autism and all the other conditions, diseases, and horrors their fevered imaginations attribute to them), I’ve never really delved particularly deeply into one of the most useful repositories of documents on the topic that exists, namely the UCSF Legacy Tobacco Documents Library. Actually, the reason I started poking around there is not due to tobacco science, but because a fellow blogger mentioned to me that there were some articles and documents about Stanislaw Burzynski there dating back to the late 1970s. My curiosity was piqued.

As I explored, however, I learned that the documents there were not so much about Stanislaw Burzynski per se. In fact, they were more about the state of the underground “alternative cancer cures” industry in the late 1970s, which interested me greatly. The reason is that, when it comes to having delved so deeply into cancer quackery, I’m a relative newbie. Compared to, for example, Wally Sampson, Stephen Barrett, Peter Moran, or even Kimball Atwood, I’m inexperienced, having only noticed this phenomenon in a big way in the Usenet newsgroup misc.health.alternative back around 2001 or so, give or take a year. As a result, I don’t have the shared historical perspective that they do, mainly because I can only learn about that era from reading, studying, and talking to people who were active then. After all, in the late 1970s I was still in high school, and in the 1980s I was in college and medical school. There was no Internet (at least none that I had access to and that contained the wealth of easily accessible information to which we have become accustomed). In any case, in high school I had other interests, and throughout the 1980s I was too focused on getting an education and training to be a surgeon and researcher, a process that extended into the late 1990s. (Yes, it takes that long sometimes, particularly if you are masochistic enough to want to get a PhD, complete a general surgery residency, and do a fellowship in surgical oncology.)
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Posted in: Cancer, Health Fraud, History

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Uneasy Lies the Head That Wears the Flu

Infectious diseases (ID), as those who read my not-so-secret other blog know, is without a doubt the most interesting speciality of medicine. Every interesting disease is infectious in etiology. What is cool about ID is that it has connections into almost every facet of human culture and history.

I note that at some point I have gone from being the young whippersnapper to the Grandpa Simpson at my hospitals and am one of the few who has been around long enough to be a repository of institutional memory. I remember what it was like 20 plus years ago, when no one consistently washed their hands, when all S. aureus (S. aureui?) were sensitive to beta-lactams and we wore an onion on our belt, as was the style of the day. Oh the changes I have seen.

Besides remembering the not so good old days of my professional career, ID keeps me reminded of how the world used to be in the past. Medicine used to be about the epidemics that would routinely sweep across the world. Polio, measles, mumps, scarlet fever, rheumatic fever, tuberculosis and on and on. I occasionally see TB but thanks to modern medicine many of these scourges have mostly faded from medical practice in the US. Not a one, I might add, has faded due to the efforts of alt med practitioners.

Influenza still gives me pause. It is, as infections go, quite the tricky virus and it remains a difficult beast to treat and prevent. Which is a drag as it remains one of the more consistent causes of infectious morbidity and mortality. (more…)

Posted in: Basic Science, Epidemiology, History, Science and Medicine

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Adventures on the Alimentary Canal

I write about a lot of depressing subjects, and sometimes a change of pace is welcome. Mary Roach, billed as “America’s funniest science writer,” has followed up on her earlier explorations of cadavers (Stiff), sex (Bonk), the afterlife (Spook), and survival on spaceships (Packing for Mars) with a new book entitled Gulp: Adventures on the Alimentary Canal.

Forget all that mythology about diet, detoxification, and 10-year-old hamburger accretions in the bowel. The reality of human digestive physiology is far more interesting and has the extra-added attraction of being true. And in Roach’s hands, often howlingly funny.  She is a hands-on investigative reporter who is ready to try anything; among other adventures she inserts her entire arm in a cow’s stomach. Her highly entertaining odyssey takes her to Igloolik to eat narwhal skin, to a dog food tasting lab in Missouri, to Minnesota to observe a fecal transplant, and to strange and exotic outposts at the cutting edge of science, populated by colorful characters. (more…)

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

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Homeopathic regulation diluted until no substance left

Homeopathy is quackery but it is perfectly legal to prescribe homeopathic products and to sell them directly to consumers in the United States as well as other supposedly civilized countries such as the United Kingdom and Germany. This makes as much sense as allowing the sale of batteries that don’t produce electricity.

What makes this state of affairs even stranger is that homeopathic products are classified as drugs under U.S. law. Does this mean that they undergo the same pre-market approval process and are subject to the same post-market requirements as pharmaceutical drugs? No, not by a long shot. In fact, the federal government and the FDA have pretty much handed regulation of homeopathic products over to their manufacturers.

How did this happen?

In 1938, Congress passed the Food, Drugs and Cosmetics Act. The Act’s principle author was Senator Royal Copeland, a physician who practiced homeopathy. He managed to include all articles monographed in the Homeopathic Pharmacopeia of the United States (HPUS) in the definition of drugs within the FDCA, although why he did so remains in dispute. The HPUS is a source for monographs, identity, methods of manufacture, standards and controls and potency levels of homeopathic products, both prescription and OTC. (The vast majority of homeopathic products are OTC.) In short, if the product is in the HPUS, it’s legal.

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Posted in: History, Homeopathy, Legal, Naturopathy, Politics and Regulation

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It’s a part of my paleo fantasy, it’s a part of my paleo dream

There are many fallacies that undergird alternative medicine, which evolved into “complementary and alternative medicine” (CAM), and for which the preferred term among its advocates is now “integrative medicine,” meant to imply the “best of both worlds.” If I had to pick one fallacy that rules above all among proponents of CAM/IM, it would have to be either the naturalistic fallacy (i.e., that if it’s natural—whatever that means—it must be better) or the fallacy of antiquity (i.e., that if it’s really old, it must be better). Of course, the two fallacies are not unrelated. In the minds of CAM proponents, old is more likely to have been based on nature, and the naturalistic fallacy often correlates with the fallacy of antiquity. Basically, it’s a rejection of modernity, and from it flow the interest in herbalism, various religious practices rebranded as treatments (thousands of years ago, medicine was religion and religion was medicine—the two were more or less one and physicians were often priests as well), and the all-consuming fear of “toxins,” in which it is thought that the products of modernity are poisoning us.

Yes, there is a definite belief underlying much of CAM that technology and pharmaceuticals are automatically bad and that “natural” must be better. Flowing from that belief is the belief that people were happier and much healthier in the preindustrial, preagricultural past, that cardiovascular disease was rare or nonexistent, and that cancer was seldom heard of. Of course, it’s hard not to note that cancer and heart disease are primarily diseases of aging, and life expectancy was so much lower back in the day that a much smaller percentage of the population lived to advanced ages than is the case today. Even so, an implicit assumption among many CAM advocates is that cardiovascular disease is largely a disease of modern lifestyle and diet and that, if modern humans could somehow mimic preindustrial or, according to some, even preagricultural, lifestyles, that cardiovascular disease could be avoided. Not infrequently, evolutionary and genomic arguments are invoked, claiming that the estimated 10,000 years since the dawn of human agriculture is not a sufficiently long period of time for us to have evolved to handle diets rich in grains and meats and that we are “genetically wired” to exist on a diet like those of our paleolithic hunter-gatherer ancestors. For instance, in 2004, James H. O’Keefe Jr, MD and Loren Cordain, PhD wrote an article in the Mayo Proceedings entitled Cardiovascular Disease Resulting From a Diet and Lifestyle at Odds With Our Paleolithic Genome: How to Become a 21st-Century Hunter-Gatherer that asserted in essence, just that. Over the last decade, Cordain has become the most prominent promoter of the so-called “Paleo diet,” having written The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat and multiple other books advocating a paleolithic-mimetic diet as the cure for what ails modern humans. Meanwhile, diets thought to reflect what our hunter-gatherer ancestors ate, such as the Paleo Diet consisting largely of animal and fish that can be hunted and fruits and vegetables that can be foraged for in the wild, have been promoted as a near-panacea for the chronic diseases of aging, such as cardiovascular disease and cancer.

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Posted in: Evolution, History, Nutrition

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Gender Differences and Why They Don’t Matter So Much

Several incidents have recently created divisions within the skeptical community.  The latest one was over a casual comment Michael Shermer made in an online talk show. He was asked why the gender split in atheism was not 50/50, “as it should be.” He said he thought it probably was 50/50, and suggested that the perception of unequal numbers might be because attending and speaking at atheist conferences was more of “a guy thing.” They might have asked him to explain what he meant. They didn’t. He didn’t mean to say it was encoded in the male DNA. He was simply recognizing a reality of our society: male/female interests and behavior tend to differ due to all sorts of cultural influences. Among other things, women might find it more difficult to attend meetings because of lower incomes and the need to arrange for babysitters. Watching sports on TV with other guys and beer is a guy thing too, but not because it’s hardwired into the male brain. It’s a guy thing because of customs and attitudes in our society.  And it certainly doesn’t mean women are less capable or that societal influences can’t be overcome.

Nevertheless, Ophelia Benson assumed Shermer meant:

that women are too stupid to do nontheism. Unbelieving in God is thinky work, and women don’t do thinky, because “that’s a guy thing.”

That’s not what he meant. It’s not fair to judge him by one off-the-cuff remark. His record stands for itself: there is not a hint of sexism in his writings and he has always fully acknowledged women’s intelligence and their ability to think critically.

In a rebuttal article, Shermer quoted me:

I think it is unreasonable to expect that equal numbers of men and women will be attracted to every sphere of human endeavor. Science has shown that real differences exist. We should level the playing field and ensure there are no preventable obstacles, then let the chips fall where they may.

PZ Myers called this “a sexist remark.” (more…)

Posted in: Evolution, History

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780.6

You can tell what a doctor does for a living by the ICD-9 codes they have memorized. There is an ICD-9 code for nearly every medical condition. Weightlessness is 994.9. Must be there for NASA, I have yet to see a weightless patient. Decapitation by guillotine is E978. There, I suppose, in case Marat returns from the dead. There is an ICD-9 code for the initial visit after being sucked into jet engine (V9733XA) and one for subsequent visits (V9733XD). Why do I suspect V9733XD has yet to be used?

780.6 is my personal favorite. Fever. All my patients have fever and 780.6 was certainly the first ICD-9 code I committed to memory. I have an endless interest in fever and after last Fridays post I thought I would toss in my two cents worth. I will remind my readers that I am an adult ID doctor (who I treat, not necessarily how I behave) and unless specifically mentioned, all that follows applies to those who can legally drink, vote and serve in the military.

98.6 F. It is not normal body temperature. Well it is. But it is not. 98.6 F as average body temperature is an enduring medical myth. (more…)

Posted in: Basic Science, Evolution, History, Science and Medicine

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