Posts Tagged residency training

The elusive “potential” of integrative medicine

The Integrative Medicine Wheel

The Integrative Medicine Wheel


UPDATE: Dr. Katz has responded to this post in his usual venue, The Huffington Post.

Alternative medicine was all about “potential” from the get go:

In 1991, the Senate Appropriations Committee responsible for funding the National Institutes of Health (NIH) declared itself “not satisfied that the conventional medical community as symbolized at the NIH has fully explored the potential that exists in unconventional medical practices.”

Thus, the Committee, led by chair Sen. Tom Harkin, directed the NIH to create an advisory panel that would “fully test the most promising unconventional medical practices.”

The advisory panel became the Office of Alternative Medicine, which became the National Center for Complementary and Alternative Medicine, which became the National Center for Complementary and Integrative Medicine, its current iteration.

This effort to unlock the “potential” of unconventional (renamed alternative, renamed complementary and alternative, renamed integrative) medicine forced an uncomfortable alliance between science and pseudoscience from the beginning. Advocates like Harkin, and his two quackery-promoting constituents, Berkeley Bedell (colostrum and something called “714-X,” derived from camphor) and Frank Wiewel (immuno-augmenative therapy for cancer), were all for “fully testing” until they realized what “fully testing” meant to a scientist: double-blind, placebo controlled trials. It was thus that the true believers discovered the value of special pleading: they “favored quick field studies that would validate alternative treatments.”

Taxpayer monies flowed into legitimate medical and scientific research institutions to conduct alternative medicine research: the Maryland School of Medicine, Harvard Medical School, University of California at Davis, and the Texas Health Science Center, among others, received funds for the study of antineoplastons, cartilage products, magnets, mind-body control, and even Bedell and Wiewel’s beloved “714-X” and immuno-augmentative therapy. (more…)

Posted in: Clinical Trials, Medical Academia, Public Health

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Naturopathic Medical Magic in the NW

Me and my lovely wife Phyllis Schlafly, amazed at what naturopaths will believe. From the Wikimedia Commons, because we're that famous.

Me and my lovely wife Phyllis Schlafly, amazed at what naturopaths will believe.
From the Wikimedia Commons, because we’re that famous.

As regular readers know, I live in the great Pacific Northwest, specifically Portland, Oregon. I am at home in the organic/hippy/environmental mind-set. It is what I grew up with. It is a relaxed, informal place to live. It is not much of an exaggeration to say that formal attire is tucking your tee shirt into your jeans. At least the metro area, and perhaps much of the state, is relatively tolerant of the actions of others. A real what’s the harm/shruggie approach to life, the universe and everything.

I will admit that the irrational/shruggie/emotional/Oregonian/goateed part of my brain is often at odds with my more rational brain, which wants me to give a rat’s ass about issues I think are just wrong. It showed up strongly with fluoridation in Portland, where my rational brain knew adding fluoride to the water was a great idea and my Oregonian nature said water should be pure, man, like nature intended. I keep my inner Oregonian under tight control as his approach often sounds good until you carefully examine how his ideas are implemented. Except at the pub of course. Bring on the hops, man, like nature intended beer to be.

Naturopathy is well tolerated in Oregon, with two schools in the NW producing NDs. We have a Board of Naturopathic Medicine, whose vision is to:

To protect the health, safety and welfare of the public in the matters of care provided by Naturopathic physicians in Oregon.


Posted in: Legal, Naturopathy, Politics and Regulation

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What Doctors Feel

Doctors are often accused of being unfeeling technicians who treat their patients like cases of disease rather than people (think Dr. House). We were taught in medical school to remain detached, not get too close to patients, and not show our emotions. That attitude was epitomized in William Osler’s essay Aequanimitas. But doctors have feelings like anyone else, and no one is Spockishly rational. A patient might reasonably say “I don’t give a damn how my doctor feels as long as she gets me better,” but emotions affect everything we do, influencing clinical decisions and patient outcomes. This subject is investigated in a new book, What Doctors Feel: How Emotions Affect the Practice of Medicine, by Danielle Ofri, MD, PhD, an associate professor of medicine and an accomplished writer who has written extensively about her experiences in medicine.

She tells anecdotes from her training to give the reader a feel for what it was like to be in an extremely stressful situation with time pressure, conflicting duties, lack of sleep, life-or-death responsibilities, the highest expectations, and the impossibility of both getting everything done and doing each thing well. It reminded me of times in my own training when I desperately wanted to just somehow survive the day and not kill anyone. Medical residency can be almost as stressful as a war zone, and has its own PTSD victims, complete with flashbacks.

Part of the stress is being suddenly immersed in a new culture with its own tribal customs, slang, in-jokes, and a foreign language: “82WM w/PMH of CAD, CVA, MIx2, s/p 3V-CABG, c/o CP, SOB 2 wks PTA. BIBA s/p LOC. No F/C/N/V/D.” (more…)

Posted in: Book & movie reviews

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Resident’s Working Hours: Should We Let Sleeping Docs Lie?

The Accreditation Council for Graduate Medical Education (ACGME) has released proposed new standards to limit working hours for medical residents. Bus drivers are allowed to drive for 10 hours and then are required to have 8 hours off duty. Airline pilots can be scheduled for up to 16 hours on duty — being at work, ready to fly — and up to eight hours of actual flight time in a 24-hour period, with a minimum of eight hours for rest between shifts. Physicians in residency training work 80 hours or more a week (compared to 75 hours a month for airline pilots) and are regularly on duty for more than 24 hours at a time. If adequate rest is an important safety measure for drivers and pilots, isn’t it important for doctors too?

When I was an intern and resident, my hours were a little better than some. Instead of every other night, I was on call every third night. I had to work from about 7 AM one day to 5 PM the following day (34 consecutive hours). I stayed in the hospital: there was a call room with a bed, but if we got to lie down it was never for very long. When I got off duty, my sleep-deprived body demanded that I go home and crash. It was only every third day when I worked “only” a 10 hour shift, that I could devote an evening to all the other activities of my life like laundry, grocery shopping, and trying to read medical journals. One memorable weekend I worked from Saturday morning to Monday evening and only got to lie down for about 20 minutes. I don’t think I made any fatigue-induced mistakes that hurt patients, but by Monday afternoon I was groping my way through brain fog and running on fumes. (more…)

Posted in: Politics and Regulation

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