Archive for: February, 2010

Are animal rights activists violence fetishists?

Feb 25 2010 Published by under Medicine

Ambivalent Academic made a fascinating observation today about certain parts of the animal rights movement:

What really strikes me is that a lot of this rhetoric reads like snuff-porn.
[...]
There is an undercurrent of appetite for the kind of violence they describe. It reads as if they take pleasure in imagining the violence they describe,... and they are inviting the reader to join in that sadistic pleasure. You can almost hear the drool.

I'm sure any sophisticated psychiatrist might have made this sort of observation, but I'm not even an unsophisticated psychiatrist. The images and language at websites such as Camille Marino's is violence-obsessed, and, as AA put it, almost erotic. Marino's loving and frantic depictions of violence are pornographic. Her enemies are portrayed bound, naked, and bloodied. Her use of words and image manipulation is full of masturbatory zeal.
And I don't think she is unique in this. Animal rights activists revel in violent imagery and language like very few other activists movements (save, perhaps, the anti-abortion movement). Their fantasies are far more disturbing than any slaughterhouse or laboratory.

30 responses so far

Animal Rights Terrorists Target Children

Feb 24 2010 Published by under Medicine

I have this friend. She used to be a scientist, but changed fields, earning a Ph.D. in philosophy. She now studies and teaches the ethics of the practice of science. I'm sure most of my readers understand how important this is. Without transparent, thoughtful, and informed discussions of ethics, the practice of science and medicine would be a disaster. The past has seen many egregious practices, such as the Tuskegee Syphilis Study, Nazi medical experimentation, and the historical abuse of the poor and minorities by science, but ethical dilemmas and disasters are not a detail of history.  Many of the historical abuses in the name of science and medicine, for example experimentation on prisoners and the mentally ill, were normative at the time.  This doesn't make them right, but it provides context, and reminds us that some of our current normative practices may later be judged wanting.

Ethicists don't simply sit around a conference table discussing useless theory (although I'm sure they do from time to time).  They help develop policies and solve problems.  Ethical questions arise as a natural course of my work as a physician, and being able to consult experts not only helps me, but helps my patients.  

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14 responses so far

Platelet rich plasma

Feb 23 2010 Published by under Medicine

Several months ago, Dr. Val Jones wrote about a growing fad in the treatment of musculoskeletal disorders. The therapy, called platelet rich plasma (PRP) injection, involves taking a small amount of blood from a patient, spinning it down in a centrifuge, and then injecting the plasma component into...somewhere. This treatment is becoming increasingly popular, and can be very lucrative for doctors. But does it work?
Blood platelets are very biologically active particles and plasma is not a bland fluid. Platelets and plasma contain many biologically active molecules, some of which may be implicated in "healing". This gives PRP at least a veneer of plausibility, but like any other treatment, plausibility is only the first step.
There have been a few human studies of PRP. A recent article in the Journal of the American Medical Association (JAMA) showed no difference between PRP and saline injections for chronic Achilles tendon problems.
A small pilot study looked at PRP for the treatment of a particular periodontal disease, and found some possible benefit.
Another interesting study looked at PRPs affect on the healing of anterior cruciate ligament (ACL) grafts in the knee. This study included long term (two year) follow up, and found no benefit.
And that's really about it. There is little evidence to support platelet rich plasma for the treatment of anything. And yet it is being hyped and sold everywhere as a miracle cure for musculoskeletal injuries. Perhaps more studies will enlighten the issue further, but at this point, PRP is nothing but expensive snake oil, and those who promote and use it should re-examine the data and their ethics.

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4 responses so far

Just because I wouldn't do it...

Feb 22 2010 Published by under Medicine

I've written previously about my decision not to assist patients in obtaining medical marijuana. My decision is based on my interpretation of the data and of medical ethics. This decision is independent of any opinion I may have about legalization.
But other doctors may see things differently. The data are clear to me, but the plausible nature of many of the claims made about marijuana make it anything but a no-brainer.
That's one of the reasons why a story out of New Mexico is disturbing. New Mexico has a medical marijuana program. Doctors who work for the Veterans' Administration are being told the following:

General Counsel has held that: "VA should not authorize completion of forms seeking recommendation or opinions regarding" participation in medical marijuana programs and that "applicable statutes and regulations do not require VA physicians to complete such forms."
Further "A VA physicians' completion of a form that would permit a patient to participate in a state medical marijuana program could result in DEA action to seek actual or threatened revocation of the physician's registration to prescribe controlled substances as well as criminal charges."
The language in the New Mexico form requires physician certification that "the potential health benefits of the medical use of marijuana would likely outweigh health risks for the patient." Informal advice received from the DEA suggests that the Department of Justice may seek civil or criminal penalties for Federal physicians and other practitioners who complete forms that either recommends the use of medical marijuana or forms that describe the patient's physical condition in order to facilitate the patient's entry into a state medical marijuana program.

New Mexico law permits medical marijuana with a doctor's certification. The VA is claiming that a doctor's status as a federal employee supersedes all other considerations. That is disturbing.
I have no doubt that there are doctor's out there running pot certificate mills, but I doubt they make up the majority of those filling out pot certificates. The Feds have created an ethically untenable situation. If state law allows a doctor to certify someone as benefiting from pot (not prescribing it), and the doctor truly feels the data support this certification, who should bend? Many veterans get all of their care from the VA system.
An analogy could be made that since heroin is an excellent analgesic, doctors should be allowed to prescribe it, and while this analogy is tempting, marijuana, for social, legal, and scientific reasons, is not perfectly analogous to other narcotics. Any physician certifying someone for marijuana use should be aware that the data are thin, and that health risks, including addiction, are real. But this comes very close to forbidding a doctor from giving advice as they see fit.

13 responses so far

Clinical Marijuana Research Update

Feb 22 2010 Published by under Medicine

Human beings are fundamentally narcissistic, and this narcissism can be antithetical to good science and good medicine. We place far too much confidence in our individual abilities to understand what happens to us, and we place far too much importance on our own experiences, inappropriately generalizing them. That's why science is so important in medicine---to avoid basing life-or-death decisions on something some guy thinks he might have heard once.
In my recent piece on medical marijuana in Forbes, commenters took me to task for what they perceived to be a host of errors in my reasoning. Some of these deserve to be specifically addressed, but not before a summary of the topic.
Marijuana's legal status is a political issue, not a scientific one. I will leave the politics to those cursed with such things. But I'm responsible for medical decisions, and as much as is possible, I have to look at data dispassionately. I have no doubt the individuals find marijuana beneficial for a wide range of problems---this may be a basis for study, but is not adequate data to prescribe a powerful pharmacologic agent.
In 2000, the University of California established the Center for Medicinal Cannabis Research. This month, they released a summary of results to date.

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24 responses so far

Inevitabilities

Feb 22 2010 Published by under Fatherhood

Every morning I get to wake up my daughter and get her ready for school, but often that's the last time I see her until the next day. The other day, my wife took her out of school to go to the dentist (apparently the entire school became aware of this just after my daughter). Despite her initial boisterous objections, she did quite well at the dentist, and thanks to technology, I was able to share in the experience---my wife sent me an MMS of my daughter showing me her three loose teeth.
My baby. Losing her baby teeth. This. Isn't. Cool.
But she's excited, and she should be. No matter what I may wish, she will keep growing up. Certain things are inevitable.
Most nights I don't come home until about 9:30, well after the little PalKid has gone off to sleep. But she knows that Tuesday nights belong to us. I come home early, and we either go out as a family, or I take her out to a little sushi place down the street. My schedule is regular enough, and she is rigid enough, that when there is a change, she knows it. A week or so ago, I took the morning off to be with her on a snow day. Her cousin slept over, and after making them Daddy Waffles, we suited up and went sledding on the front lawn, with its dangerous 2 degree slope. She couldn't believe I was there to push her on the sled.
Every second with the kiddo is precious, from cuddling on the couch, to clipping her nails while she turns on the drama. So the other night when I went to pick her up at her little friend's house and she begged me to let her sleep over, I wouldn't let go.
"Are you sure you don't want to come home and cuddle?"
"Daddy, I want to sleep over! Pleeeeeease?"
The damned kid is losing her teeth, sleeping over at her friend's house, and generally growing up like a normal kid. I guess I'm going to have to be OK with that. But the house sure was quiet the next morning.

11 responses so far

Blogging and disaster response

Feb 18 2010 Published by under Medicine

There are plenty of bloggers who consider themselves to be serving a larger social purpose. How much of a service they actually provide depends very much on your own ideology. I'm sure RedState thinks they are providing vital, timely political analysis, while I think they're a waste of bandwidth. Similarly, there are countless quacks offering all sorts of bad medical advice (in fact, one of Pal's Laws is that the internet is 90% porn and 10% bad medical advice). Some of this bad medical advice serves an active "anti-public health" purpose, discouraging vaccination or claiming that the latest flu pandemic was some sort of hoax.

But there are a number of reliable blogs that serve a useful public health purpose, whether or not that is their aim. Could these blogs be a valuable resource during public health and other disasters?

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11 responses so far

More details emerge in Texas nurse whistleblower affair

Feb 16 2010 Published by under Texas nurse case

The story of the Texas nurses who were fired and prosecuted for reporting a flaky doctor just keeps getting better. This case was surprising in that it at first seemed to be a clear abuse of power by local officials but on deeper exploration involved a whole army of unorthodox medical thinkers (my prior coverage of the case is here).  This case was surprising in that it at first seemed to be a clear abuse of power by local officials  but on deeper exploration involved a whole army of unorthodox medical thinkers.

In Kermit, TX, two nurses at a small community hospital registered complaints about a local doctor named Rolando Arafiles.  When their complaints were ignored by the hospital administration, they sent an anonymous letter to the state medical board.  When local officials found out about the letter, the nurses were fired and prosecuted.

Dr. Arafiles, who lists himself as a family physician but hold no board certifications, was working in Texas under a limited medical license, having been censured for, fail[ing] to adequately supervise a physician assistant and fail[ing] to make an independeint medical professional decision."  The Texas Medical Board's censure required Arafiles to stop supervising physician assistants and nurse practitioners, to pay a fine, and to take continuing medical educational courses, including specific training on ethics.  The hospital where he was working agreed to give him privileges if he had the restrictions on his license lifted.

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20 responses so far

Everyone else on the internet is wrong

Feb 15 2010 Published by under #FWDAOTI

I'm crabby. Normally I'm a pretty easy-going dude, but right now I'm crabby and some of the stuff I'm reading on the internet lately is so stultifyingly stupid, I just can't contain myself any longer.
It's not unexpected for Dr. Communication-is-My-Field to belie his title with every word he writes, but last week's post of his is truly a new level of dumbassery. Nisbet, who revels in telling the rest of the world how poorly they communicate, lobbed a shit-bomb into the blogosphere when he declared:

Much of the incivility online can be attributed to anonymity. And with a rare few exceptions, if you can't participate in a dialogue about issues without using your full name and true identity, then what you have to say is probably not that valuable.

I've written quite a bit about anonymity and pseudonymity in the past, but if you can't think on your own of at least five reasons his statement is idiotic, you probably have a PhD in communication (and "he forgot to show data" doesn't count, because it's too easy, and his response is, "just google it.").
Anyway, Chad Orzel at least isn't a "communication expert'---but he still doesn't seem to get all this "blog" stuff. Today he announced on his blog that he's giving up blogs for Lent; not his own--he'll probably put up another piece about his book at least forty times---but he's giving up reading blogs.

I'm not down on blogs as a communications medium-- I still think they're a great way to present information to a very broad (potential) audience. Rather, I'm coming to doubt the idea of blogs as a conversation medium.

Really? So basically, you're against everything that makes a blog bloggy rather than book-y. Seriously, it's the fucking blogosphere. Lemme help you, in case Nisbet doesn't get a chance: books and magazines ("traditional media") allow a writer and an editor to present a story without any fear of ongoing, real-time feedback. Blogs allow "the world" to write whatever the fuck they want, even if the original author doesn't understand why. Sometimes, a thoughtful author might actually learn from. As Chad sees it:

I'm finding this more and more irritating as time goes by. I find myself walking around wanting to punch something, all because people on the Internet are pissing me off. And, you know, this isn't good.

"Isn't good"? Of course it's good. If no one challenges your basic assumptions, what's the fucking point?
Whatevs...I'm still gonna read his blog whenever it's not an add for the book, and I'll probably read his book too (but I definitely won't comment on it because it might be uncivil).
Finally, I love love Sharon Astyk over at Casaubon's Book---I really do, but I don't really get it, on a fundamental level. I love her IRL experiment in (illusory) sustainable living, but her type of sustainable living seems really anti-social to me. It's about surviving some sort of society-disrupting disaster alone. Today's post is about getting your family on board with creating your absolutely necessary food reserve, and the day before was about how to get your family to eat all the rotten food you preserved. It's all very interesting, but hardly seems relevant in the real world where when The End comes, some white supremecist militia is just gonna kill you for your pickled kale before they resort to eating each other.
Finally, I'd like to point out that Lucky Charms and California Zinfandels make a surprisingly good pairing.
That is all.

54 responses so far

Happy Valentine's Day

Feb 14 2010 Published by under Uncategorized

vdaycake.jpg

6 responses so far

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