Dana Ullman is an idiot. Or maybe insane. I'm not sure which, but his latest article at the Huffington Post reveals such a severe defect in rational thought that it must be one or the other (charitably speaking). He calls it "Lies, Damn Lies (sic), and Medical Research," and the point of it is quite clear: Ullman calls himself an "expert in homeopathic medicine" (which is akin to being a unicorn veterinarian) and since he has never been able to show that his particular health religion has any validity, he lashes out futilely at reality.
His entire argument boils down to a profound ignorance of medical science and a series of rhetorical/logical fallacies. His first straw man is a typical argument of alternative medicine gurus: that modern medicine only treats symptoms and not their causes. His first claim in this regard is that clinical studies define efficacy wrong because we consider symptom relief to be "efficacy". This is simply wrong. End points of studies depend on what is being studied. If, for example, we wish to know if a pain medication works, then pain relief is a reasonable end point. If we want to know if a particular drug prevents heart attacks, then heart attack is a reasonable end point. Ullman is either intentionally raising a straw man, or simply too ignorant to understand the barest basics of medical science:
The bottom line to scientific research is that a scientist can set up a study that shows the guise of efficacy. In other words, a drug may be effective for a very limited period of time and then cause various serious symptoms. For example, a very popular anti-anxiety drug called Xanax was shown to reduce panic attacks during a two-month experiment, but when individuals reduce or stop the medication, panic attacks can increase 300-400 percent (Consumer Reports, 1993). Would many patients take this drug if they knew this fact, and based on what standard can anyone honestly say that this drug is "effective"?
Continue Reading »
I've never liked Gary Null. Early in my blogging "career" I wasted thousands of words expressing my incredulity at his horrible health advice, his paranoid rants, and his shameless hucksterism. Then I saw something shiny and forgot about him for a while. But now blog bud Orac has ruined my reverie. He informs me that Gary Null took a dose of his own medicine---and nearly died.
As a compassionate human being, I can only hope he recovers quickly with no serious sequelae. As a physician, educator, and writer, I hope we can use this as an object lesson in the dangers of idiotic medical advice.
From the news reports, it appears that Null suffered the toxic effects of too much vitamin D, a condition known as "hypervitaminosis D". Vitamin D has multiple, complex effects on our physiology. One of the primary affects of vitamin D is on blood concentrations of calcium and phosphorus. Excessive amounts of vitamin D cause calcium to be released from bone into the blood, which can lead to constipation, kidney stones, and other more serious problems. When the both phosphorus and calcium levels are sufficiently elevated, they can precipitate in the skin leading to a condition called "calciphylaxis" which looks and behaves like a serious (often deadly) burn injury.
Continue Reading »
Thanks for all of your help since yesterday. Here's some of the data I've culled out from the first 24 hours:
24% of entrances to the post were from Greg Laden's blog
- Feedburner (probably multiple sources): 165
- facebook: 98
- Retweets: 83 (probably)
- rationalwiki: 88
I never thought it would happen, but here we are. I can smell the ocean, hear the wind in the coconut palms. My arms are leaden from swimming, my shoulders reddened by the sun.
A little while ago, I was body surfing. When you catch a wave---really catch it---you are weightless, and it is magnificent. But even the missed waves have their surprises. A large breaker sneaked up behind me, brown with sand, capped with white, and tried to take me. It could have---if the ocean wants someone, it will take them. But it didn't, and after it passed, it left a pool of calm. Out of this pool leaped dozens of small slips of gold, making a snapping sound as they broke the water. The sounds of the wave and the fish covered everything else, and suddenly I felt them---innumerable pops on my legs and trunk as the shoal passed.
I think I'm going to like it here.
A young relative of mine recently asked me my thoughts about medicine as a career. It's a relatively common question in my mail bag, and a tough one to answer, especially when asked by strangers. Career choices are very personal, so I don't like to give advice as much as let people know what they can expect from a career in medicine. Here's one of the latest letters to show up in my inbox (edited by me for anonymity, etc.).
I'm a third year medical student at the end of my clerkships now, and I've found that I pretty well like everything. I did my pediatrics rotation early and absolutely loved it, but I also really liked women's health and it turns out that adult medicine is also pretty good. I used to think that I want to be a super expert on one system or group of diseases, but I also like the relationships you can have with people in a primary care setting, and I find the epidemiology of preventive medicine interesting.
With this conundrum brewing as I near the point of applying to a residency, I've started to think about family medicine. Could you please tell me your opinion on family medicine as a career? Do you think family practitioners provide high quality care? Or do you think that people should generally go to pediatricians, internists, and OB/gyns? I realize that this is very highly doctor dependent.
Brutal honesty is appreciated. Thanks, and have a good weekend.
Medical training is so prolonged, and practice so specialized, that medical students often have to choose a specialty before they've had the change to really explore potential careers. This particular student is a third-year, meaning that he is done with his basic science coursework and is rotating through various clinical specialties. As is not uncommon, this student has found that developing longitudinal relationships with patients can be both rewarding and interesting. From the perspective of more than ten years out of medical school, it sounds like he is interested in primary care of one sort or another.
Continue Reading »
A few months ago, DrugMonkey reported on a study about how we as health care workers view narcotic users. Narcotic use and abuse is something we deal with every day and presents many challenges. Narcotics are an important tool for controlling pain and many different strategies have been used to try to prevent their legitimate use from changing to abuse. Despite this, prescription narcotic abuse is very common.
But narcotics are not the most frequently used addictive substances. For example, about a fifth of Americans smoke. But we as health care providers react differently to different kinds of substance use. I certainly cannot speak for all doctors, but narcotic abuse seems to push our buttons in a way that nicotine and caffeine (and even alcohol) don't.
So I asked around to try to understand why so many of us have negative reactions to people with narcotic use disorders. After talking to a few professionals in person and via email one factor stood out: narcotic abusers often use health care providers to obtain their fix. Most of us don't like being lied to or being involuntarily enlisted as a drug dealer.
So what do you think, folks? The social and medical consequences of various substances of abuse don't seem to track with our perceptions of the users. Do lay people differ from medical folks on this one?
In the Soviet Union, party membership was everything. Your job, your access to food and other consumer goods, and your apartment all depended on your standing with the party. And votes were simply a tool to provide a patina of legitimacy. No one who liked warm weather voted against the Party.
One of the many advantages of the protections provided by the U.S. constitution is that we generally cannot be hired or fired based on our personal or political beliefs. We also get to elect our leaders frequently. So it should be with a great sense of irony that various teabagger groups shout and stomp about the US becoming a socialist regime, while simultaneously threatening armed rebellion for not getting their way in an election. And it is with disgust and disdain that I view professionals punishing others based on their vote or their political views.
When a physician fired an employee for voting for Obama, that was---I assume---a clearly illegal act. It was also immoral. But it has nothing to do with medical ethics.
But when a doctor refuses to see patients based on their politics, this is a gross violation of medical ethics. In fact, it's hard to think of a precept of medical ethics not violated by this sort of behavior.
Continue Reading »
Right now I'm feeling rather civilized. I had a yummy brick-oven pizza with my family, including my parents and one of my sisters, and I just finished getting my cranky, over-tired child to sleep. Now I'm sitting at my kitchen table drinking some seriously killer single-malt bought for me by my loving spouse, and listening to a Haydn string quartet.
Just what the doctor ordered
All was well until my buddy Isis, who is several orders of magnitude hotter and smarter than I, noticed a disturbance in the force (as manifested by a google alert, the tool of internet narcissists everywhere). In this case, it is a group of college students at Ball State getting their jock straps all in a bunch about a text message. Apparently, a few women on campus were assaulted by a male on a bicycle. The campus authorities sent out a text message warning the campus community. But because it was just some harmless grab-assery, a number of students were annoyed and started a facebook group mocking the whole incident. Well, Dr. Isis called them out on it--by name. And some of the boys are upset about it. I mean, can't a bitch take a joke?
No. If it is not immediately obvious to you what the problem here is, then it is time for some introspection. I'll lay it out for those of you having trouble with some of the concepts here.
There is nothing "harmless" about someone riding by a woman and grabbing or slapping her behind. It may or may not cause immediate physical harm. But touching someone against their will is not only a shitty thing to do, it's against the law. The reason it's a shitty thing to do is because many women walking across a college campus are legitimately concerned about being assaulted, either by some asshat on a bike, or by some rapacious frat boy who thinks ass-grabbing is just fine. It is a power play, one that creates an environment where women feel less safe and secure. Given that many campus rapists tend to be repeat offenders, and that smaller acts often escalate into larger ones, the authorities were right to send out a warning.
But more interesting to me is the reaction of some on campus. This facebook group mocks the university for "over-reacting" (you know, like girls often do). There are a number of factors contributing to this sort of reaction. One of them is the incredulity of privilege. Most young men have no idea what it is like to be a not-man and many never acquire the empathy and knowledge to improve on this cultivated naivete. They genuinely cannot understand what all the big deal is about.
Many men absolutely understand what all the big deal is about, and are scared shitless of losing their position of power. I mean, if you can be judged harshly for a little ass-grabbing, you can be judged for every little thing you say and do. You know, like women are.
It's time for the no-longer kids at Ball State to take a deep breath and think a little. Or they could form a misogynist facebook group, comment on it using real names, and then whine like babies when adults call them out on it.
As an internist, my specialty is the prevention and treatment of adult diseases. One of the most common of these diseases is diabetes.
There are two main variants of diabetes: Type I (juvenile) and Type II. Type II accounts for about 95% of the 20 million cases of diabetes in the U.S. Diabetes is can be a disabling and deadly disease, but not because of the blood sugar fluctuations per se. High blood sugar damages blood vessels, which in turn damages the organs they supply.
We generally divide diabetic complications into two categories: microvascular (small blood vessel), and macrovascular (large blood vessel).
Microvascular complications include things like kidney failure, blindness, and nervous system damage (such as painful peripheral neuropathy which causes numbness and burning especially of the feet).
Macrovascular complications include strokes and heart attacks. Heart disease and stroke account for about 65% of deaths in diabetics.
Prevention of these complications has been the goal of diabetic treatment for years. Large-scale studies of type I and type II diabetics have shown that better control of blood sugar levels (to an extent: data indicate that being too aggressive can increase mortality) reduces the incidence of microvascular complications) . Control of cholesterol and blood pressure have been shown to prevent macrovascular complications in type II diabet
es. (DCCT and UKPDS)
What does this mean in the day to day life of a diabetic? One of the most devastating complications of diabetes is amputation, which is often due to both the macrovascular and microvascular complication of peripheral neuropathy. This can begin as a tingling, burning pain in the feet, but can lead to loss of sensation. Small injuries can rapidly become limb-threatening. (Warning: Yucky picture under the fold)
Continue Reading »