Science is the Concept by which
we measure our reality
I don’t believe in magic
I don’t believe in I-ching…
I just believe in science…and that reality.
John Lennon. Sort of.
As regular readers of the blog are aware, I am science/reality based. I think the physical and basic sciences provide an excellent understanding of reality at the level of human experience. Physics, chemistry, biology, anatomy, biochemistry, physiology, evolution etc. provide a reliable and reproducible framework within which to understand health and disease. My pesky science may not know everything about reality, but day to day it works well.
“There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy. – Hamlet (1.5.166-7).”
Perhaps, but all the medical advances in my lifetime have been not yielded new science, just (amazing) variations and extensions of known processes. I sometimes think the blog should have been called reality based medicine, but science is the tool by which we understand reality, and while the tool is constant, our understanding of reality is prone to changing. An understanding of the rules of the universe combined with an awareness of the innumerable ways whereby we can fool ourselves into believing that those rules do not apply to us is part of what makes a science and reality based doctor.
We are often told of the need to keep an open mind, but I like to keep it open to reality. Not that I do not like fantasy and magic, it is a common category for my reading. I just finished Red Country by Joe Abercrombie, and while I love the world he has created, I would not want to apply the rules of that imaginary world to my patients. Well, one exception. As Logen Ninefingers would say, “You have to realistic about these things.” Fictional worlds should be limited to the practice of art, not the practice of medicine.
The interwebs are more than a series of tubes, it has the power of endless distraction and tangents, a series of clickable rabbit holes that can drag you deeper and deeper into the alternative universes that are parallel with our own. One moment you can be on Science Based Medicine, grounded on the terra firma of reality, and then with a click of the mouse you can lose your way in the electronic warren.
It started as an advertisement on a skeptical website, perhaps SBM, perhaps not. The entrances to rabbit holes are Hogwartian in nature, never being in the same place twice. It is how I remember it.
Google serves up ads based on what their algorithm perceives as the content of the website. The algorithm lacks a certain, shall we say, nuance, and fails to understand that advertisements suggesting training in homeopathy or the promoting the practice of chiropractic may not have a close relationship to the content of Science Based Medicine. Still the ad did intrigue me, as it mentioned that the practitioner was Oregon’s only MD Acupuncturist. So I clicked. (more…)
Topics, as I noted a fortnight ago in my uniquely misspelled and ungrammatical way, never die**. Or even fade away. There are popular ideas that persist in the world that have little to do with reality. In the reality based world of medicine there are concepts that refuse to die. Atelectasis causing fever or the need to ‘double cover’ Pseudomonas. Neither are true, yet every year medical students tell me that is what they have been taught. It is said the only way new ideas take hold is for those that hold the old ideas to die off. So maybe 50 years from now those medical myths will be gone.
Popular culture also its myths. Take the immune system. Please. It is not a bicep that can be made stronger with a little exercise. It is a complex network of cells and proteins. There are antibodies (IgG (with five subtypes, IgM, IgA, IgE),the complement pathway, polymorphonuclear cells, monocytes, lymphocytes in a profusion that rivals beetles. God, I think, has an inordinate fondness for lymphocytes. There is the Toll system, the cytokines and lymphokines, the non-specific defenses like cilia and mannose binding lectin and on and on and on.
I have a journeyman’s understanding of the immune system, what is needed to understand why a given patient has an infection, although there is little I can do to reverse the immunologic defects: abnormal antibodies from Waldenström’s or low mannose binding lectin levels from liver disease are not amenable to clinical intervention. (more…)
It feels like I live in the real world example of Ray Bradbury’s All the Summer in a Day but for the last two weeks we have had sun and heat and it has been glorious. I get Christmas and Thanksgiving and New Years as vacation, but who needs that? I need July and August to live the vida loca in the Oregon summer. Who wants to blog when I can be outside, at concerts, golfing, hiking and…
Yes Dr. Gorski. I did agree to write an entry every other Friday. Yes Dr. Gorski. I know you have the documentation. Yes Dr. Gorski, I do not want any of that information made public. No one needs to know that I wanted to be a naturopath when I was young. Sigh. Yes, Sir, I will get to blogging. Damn those youthful indiscretions. Let’s see how little I can do and meet my obligations with the powers that be.
My professional career is based upon inflicting death, and in my time I have obliterated uncountable numbers of unicellular organisms. If there were such a thing as Karma, I would certainly return in the next life as a rabbit in a syphilis lab. But there isn’t, and I can kill and kill with a clean soul. There is no guilt or hesitation in killing unicellular life, or even multi-cellular life, as long as it cannot be seen without a microscope. I start to get a wee bit squeamish as soon as I can see a life form. I tend to not kill bugs or animals, unless, of course, they can be eaten. If it tastes good, all bets are off. But as a tree hugger, I tend to look upon killing wildlife and extinctions as a bad thing. (more…)
Note: This article originally appeared in Skeptical Inquirer, 28(1), 48-50 & 55, January/February 2004. I’m recycling it now because I have been at The Amazing Meeting in Las Vegas instead of home at my computer writing new posts. It’s still timely: despite multiple debunkings and FTC actions, vitamin O is still for sale. Amazon has it for $4.80 an ounce. I’m no Mark Crislip; but I like to think this article borders on the Crislipian. Enjoy!
Oxygen is not just in the air; it’s on the shelves. It has been discovered by alternative medicine and is being sold in various forms in the health supplement marketplace. Back when I was an intern, we used to joke that there were four basic rules of medicine: (1) Air goes in and out. (2) Blood goes round and round. (3) Oxygen is good. (4) Bleeding always stops.
Alternative medicine has latched on to rule number three and won’t let go. The rationale, apparently, is that oxygen is required to support life; therefore more oxygen should make you more healthy. It’s not clear how this relates to alternative medicine’s advice on anti-oxidants, but that’s irrelevant. OXYGEN IS GOOD, so we should put it in our soft drinks and breathe it at oxygen bars. Take an oxygen tank home with you — you might feel better. The oxygen vendor might feel better, too. Dr Andrew Weil, the renowned health guru, tells patients with chronic fatigue to ask their doctors to prescribe oxygen for a home trial. Sure, why not? The money it costs will literally vanish “into thin air,” but who cares? OXYGEN IS GOOD.
Ignore the fact that you could find out whether you need oxygen by testing your blood oxygen saturation with that little-clip-thingy-they-stick-on-your-finger-in-the-emergency-room (aka pulse oximeter). Who cares if your blood is fully saturated with oxygen already? OXYGEN IS GOOD. If your oxygen saturation is a little less than 100 percent, there is no evidence that raising it will help with anything. If it is a lot less, and you do need oxygen, any competent doctor should be able to figure that out. But try an oxygen tank anyway: OXYGEN IS GOOD. Is this starting to sound like a mantra? It should. This is religious belief I am talking about, not science. (more…)
Earlier today, I gave you the blow-by-blow description of a debate that occurred on Thursday between Dr. Steve Novella and Dr. Julian Whitaker. After that debate, I got an opportunity to “discuss” one of Dr. Whitaker’s points, specifically a scientifically illiterate graph that he had constructed. Because Dave Patton was there doing photography of the event for Michael Shermer, I suggested that we do a picture, even though Dr. Whitaker was still on the podium. The picture came out…well, differently than I had expected. Looking at it again, though, I see that this is a perfect picture to have a little fun with, so I’m going to. Let’s have our SBM readers do something we haven’t done before on this blog. It’s a little thing called “Caption This.” In the comments, I’d like to see what sort of caption you think to be appropriate for this photo.
Have fun, and if I like any of them particularly well, I might add them to the picture and post them here and on Facebook.
Having a housefire is a one of the most stressful, dehumanizing experiences a family can experience. Like cancer, fires appear unexpectedly, and fill victims with fear, grief, and hopelessness. Western firefighting methods do not adequately meet the needs of these victims. No one knows your house as well as you do, yet firefighters take a very paternalistic approach, removing you from the decision-making process, then leaving you to clean up their mess. In the same spirit as integrative oncology, advocates of integrative firefighting believe that families, practitioners of conventional firefighting, as well as advocates of alternative firefighting philosophies should work as a team to achieve their common goals. The integrative approach offers victims choices, and empowers them by inviting them to participate in their own journey through the extinguishing process.
The first fire department was in ancient Rome and provided free firefighting services to citizens. Today firefighting services are a dominated by a consortium of of big business (producers of firefighting equipment) the government (public works) and a militia of mercenary firefighters, collectively known a “Big Hydrant.” This alliance has resulted in a proliferation of expensive, impersonal technology, but firefighting results have not improved since the times of the ancient Romans.
It is one of the pleasures of travel to read the local newspapers of places I visit. I wholly agree with In a Sunburned Country author Bill Bryson, who observed,
It always amazes me how seldom visitors bother with local papers. Personally I can think of nothing more exciting – certainly nothing you could do in a public place with a cup of coffee – than to read newspapers from a part of the world you know almost nothing about. What a comfort it is to find a nation preoccupied by matters of no possible consequence to oneself. I love reading about scandals involving ministers of whom I have never heard, murder hunts in communities whose name sound dusty and remote, features on revered artists and thinkers whose achievements have never reached my ears, whose talents I must take on faith.
In a Sunburned Country chronicles Bryson’s travels in Australia, which I recently visited, along with New Zealand. Lovely places both – friendly people, jaw-dropping scenery, delicious food and wine. And a welcome vacation from American political wars, American economic wars and American war wars.
It is hard to Sokalize alternative medicine. The closest has been buttock reflexology/acupuncture, but that is a tame example. Given the propensity for projections of the human body to appear on the iris, hand, foot, tongue, and ear, postulating a similar pattern on the buttocks are simple variations on a common SCAM (Supplements, Complementary and Alternative Medicine) theme. The buttocks? Not really different from any of the other focal acupunctures. Most of SCAM does not concern itself with application of reality and physiology, anatomy, biochemistry, etc can all be expected to be ignored with virtually all SCAM modalities.
Every time I think the heights (or depths) of absurdity has been reached, I discover a Braco the Starer or Himalayan Salt Inhalers. This blog is not affiliated with the British Medical Journal in any way, and although this is being published near Christmas, I want no one think that what follows is a hoax. I am not, I repeat not, making up what follows. It is not fiction. Well, it is fiction, but not written by me and believed and practiced by some who really should know better.
I’ve frequently lamented what might happen if the current trend towards quackademic medicine continues unabated, and quackery becomes fully “integrated” with science-based medicine as a co-equal. Interestingly, this concept has provided fodder for several comedians. For example, the first comedy sketch I discovered on this theme was homeopathic e.r. Then a couple of years ago, Mitchell and Webb brought us the British version of essentially the same idea (but done so much better), namely Homeopathic A&E. What I didn’t realize is that predating both of these was…Holistic E.R. (Embedding disabled, unfortunately.)
This sketch comes from an old sketch comedy show known as Almost Live!, which I had never heard of before, but if this sketch is any indication, it was brilliant. Favorite bits from Holistic E.R.: The part about vitamin C, the use of visualization, and, of course, the crystals. Sadly, with the way academic medicine is being infused with quackery such as energy healing, homeopathy, and even anthroposophic medicine at my medical alma mater, I could see this happening within my lifetime.