In medicine we use all of our senses to evaluate patients. If I open up an abscess and I'm overwhelmed by the smell of rotted cheese, I can be pretty sure the abscess started as a sebaceous cyst. If I hear a "whooshing" sound over the abdomen in a smoker, I look more closely for an aortic aneurysm. A subtle buzzing sensed through my fingers can indicate an arterial fistula. And the glowing yellow of jaundiced skin can point me straight to the liver.
Archive for: November, 2009
The struggle to promote the scientific practice of medicine and the fight against pseudo-science and quackery just got a big boost. The newly-announced (but long in the making) Institute for Science in Medicine was launched this morning with an inaugural press release calling attention to quackery in the current U.S. health reform bills.
Many of the folks involved in the Institute are familiar names, and represent an international effort to keep health care safe and effective.
So help spread the word, and keep an eye on this space and the ISM website for more updates and for ideas on how you can help.
I have in front of me a weathered copy of Cecil's Textbook of Medicine from 1947. It belonged to my father, who graduated from medical school in the 1940s. Even then, it was known that pneumoccus, a common bacterium, can live harmlessly in the nose and throat and only sometimes causes disease. Pneumoccocal disease was and is still a leading cause of disease and death*, killing perhaps a million children per year. It causes ear and sinus infections, but also meningitis, and is the most common cause of pneumonia. In the past it was referred to as "the captain of the men of death" for it's ability to claim so many. It is also closely associated with influenza---the pneumococcus that may live harmlessly in the mouth may find the damaged lung of the flu patient a nice place to set up shop. The pneumonia that follows an influenza infection can be devastating and preventing it is an important public health goal.
The bacteria itself has been known for over a century, when it was discovered by US Army doctor George Sternberg in a frontier post in 1881. A couple of decades later, sera were developed to fight the disease. There were no antibiotics at the beginning of the 20th century, and as influenza killed millions, often of pneumonia, scientists were were working feverishly (and often dying) trying to save lives. They discovered some of the most important serotypes of pneumococcus, created serum from horses, and injected it into sick patients with significant good results.
A news item this week profiles a northeast naturopath who is using thermal imaging to screen for breast cancers. This is a frightening development. The news about conflicting mammogram recommendations has women wondering what the right approach really is. The question in the new USPSTF recommendations is one of values. The science says that a lot of women in their 40s need to be screened and undergo invasive procedures to save one life. We are left to decide if that life is worth it. Or we can throw our hands in the air and start charging women for useless alternatives.
I live about ten miles due north of "Canada's automotive capital". We often look across the straits to the medical system in Ontario, one in which all citizens have a provincial insurance card. We see how everyone has access to care---or at least some care. I've treated many Canadian patients who have access to American insurance and prefer to get their care on this side of the border, where there are fewer hassles. Of course if you have no insurance at all, hassles abound, and we'll leave a discussion of the merits and difficulties of the Canadian system to another day. But one move being considered by the province of Ontario promises to take a modern health care system one step closer to the 19th century.
We already know about the Huffington Post's war on science and its shameless publication of snake oil ads disguised as journalism. Now, Mark Hyman, an evangelist for the cult known as "functional medicine", is giving even more bad flu advice (and shilling for his books).
He begins his blathering, misleading sales pitch with this bit of mendacious drivel:
The main question my patients have been asking is whether they should get vaccinated against H1N1 or against the regular flu.
This is not a simple yes or no answer. The guiding principle of functional medicine is personalized care, not the one-size-fits-all belief that everyone should have the same treatment. This applies equally to vaccines. There is risk and benefit to every medical treatment or procedure.
He is of course implying that real medicine does have a one-size-fits-all philosophy, which is of course incorrect. There are many factors that go into advising someone whether or not to get a flu shot. First, are they in a recommended high-risk group? Second, are there any contraindications to a flu shot? And that's about it really. After that, the patient has to decide. As I think about it, it's not that hard. There is no secret information out there, no special tests, no "personalized" magic other than that. Anyway, what follows is much more disturbing. There are "the facts as he sees them", to which I will respond with the well-known adage that you are entitled to your own opinions, but not your own facts. But this stuff is dangerous enough to require a more detailed response.
One of the most frightening symptoms of advanced cancer is "cachexia", or severe, unintentional weight-loss and wasting. It's a terrible prognostic sign, and the only truly effective treatment is removal of the cancer. Treatment of this syndrome has the potential to improve quality of life in patients with advanced cancers. Various types of medications, including antidepressants, hormones, and cannabis derivatives have been tried with little effect. Treating the symptoms of incurable cancers is difficult and although we're pretty good at it, we sometimes fail. Cannabis seems a plausible intervention, given the anecdotal and clinical data associating it with increased appetite, although appetite in normal, healthy individuals may be mediated by different pathways than the cachexia in cancer patients. Still, it's worthy of investigation.
Today over at Science-Based Medicine, Dr. Novella has a review of the so-called "biomed" movement in autism treatment. Anyone should be able to understand the desperation of parents with sick kids, but grief can lead to very bad decisions. As physicians, one of our jobs is to guide people away from these decisions and not to give false hope. Telling people what they want to hear might make you as a caregiver feel good, but as physicians, our goal is not to make ourselves feel good but to help others.