Archive for: August, 2010

Vitamin D

Aug 18 2010 Published by under [Medicine&Pharma], Medicine

Vitamin D is a fascinating molecule with a fascinating story.  Historically, "vitamins" were defined as chemicals that humans required from their environment that were "vital" to human health.  These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri.  Other vitamin deficiencies were found to be a bit more complicated: vitamin B12 deficiency was found to cause a type of anemia, dementia, and spinal cord problems.

Because vitamins are required in such small amounts, and are often present in small amounts in foods, their discovery was an opportunity to prevent and cure several diseases.  One of these diseases was rickets.

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19 responses so far

When "compromise" really means "STFU"

Aug 17 2010 Published by under Politics

As regular readers may have noticed, I don't often write about politics. It's not that I don't care, it's just not my thing. I can only keep up with and write about so many topics. But when someone uses the opinion page of what can arguably be called our national newspaper to continually spew irrational, hate-filled idiocy onto my laptop, well, sometimes enough is enough.

Such is the case with Ross Douthat. I think the guy styles himself as some sort of moderate conservative, and a bridge builder: someone who can see both sides of an issue and find the compromise. What he does in fact, though, is find the reactionary side and his side and then argues for a compromise between reactionary hate mongers and what his own biased mind thinks is slightly more rational.

In his latest piece, Douthat notes that their are "two Americas". Most recently, this phrase was used by presidential candidate John Edwards to note the growing divide between "haves" and "have-nots". This is not what Douthat means. He describes the first America as:

An America where allegiance to the Constitution trumps ethnic differences, language barriers and religious divides. An America where the newest arrival to our shores is no less American than the ever-so-great granddaughter of the Pilgrims.

If he had stopped right there, he would have had a very short Op-Ed piece, but one that reiterates basic American Constitutional ideals. But Ross just can't shut up.

But there’s another America as well, one that understands itself as a distinctive culture, rather than just a set of political propositions. This America speaks English, not Spanish or Chinese or Arabic. It looks back to a particular religious heritage: Protestantism originally, and then a Judeo-Christian consensus that accommodated Jews and Catholics as well. It draws its social norms from the mores of the Anglo-Saxon diaspora — and it expects new arrivals to assimilate themselves to these norms, and quickly.

That is a great lead-in to a discussion of why assimilation, while often desirable, is a complicated issue, and one that is more about our own biases than about Constitutional ideals.   And he does go on to contrast the high ideals of the first America with the parochial xenophobia of the second.  But then he reveals which America he thinks is really the "right" one:

But both understandings of this country have real wisdom to offer, and both have been necessary to the American experiment’s success.

No.  No they don't.  He admits that the second America is xenophobic and discriminatory.  What could it possibly have to offer other than hate and intolerance?  His examples are equally unfortunate:

The post-1920s immigration restrictions were draconian in many ways, but they created time for persistent ethnic divisions to melt into a general unhyphenated Americanism.

Bullshit.  The Johnson Immigration Act was a purely racist piece of legislation built on incorrect but popular ideas about eugenics, and it led to the deaths of perhaps millions of Europeans who were denied entry to the U.S.  because of their ethnicity.

His senseless screed is in service of his ideas on the "Ground Zero mosque" controversy.  He argues for the first America as the carrot, the second as the stick.  The first welcomes our Muslim brothers, the second demands that they give up their identity if they want to be real Americans (forgetting that many are not recent immigrants and that Muslims have been here for a very long time).

He doesn't argue that this same argument applies to our own nativist hate groups.  He doesn't mention that violent, hate-filled rhetoric that happens to come from American-born Protestants is also "anti-American"; he can't argue this, because he just finished telling us that Protestant Americans are always right, even when they argue against the Constitutional protections of religious practice.

When you compromise with reactionary, anti-American hate-mongers, some would call it "negotiating with terrorists".  I wonder why Ross only sees the hate on one side?

11 responses so far

Thank you, SEED, for PepsiGate

Aug 16 2010 Published by under [Information&Communication], Journalism, Medicine

I have to thank Seed Media Group. In the month or so since Pepsipocalypse fractured the ScienceBlogs network, there has been a surge of writing on science blogging and science journalism (much of it by Bora Zivkovic, but also quite a lot in in other venues, such as here, here, here, and infamously here).  Science writing continues to diversify, with some networks (such as this one) being "bottom up", independent, and non-commercial, and others (such as Discover and ScienceBlogs) being tied to traditional media, or at least traditional media models.  Discover has used this well, concentrating on supporting a small stable of excellent writers, while others have attracted a diverse group of scientists, writers, and others who simply enjoy writing about science.

I (and others) have complained about the spotty quality of mainstream science journalism, but the real picture is, of course, more complex.  There are many traditional journalists who recognize the potential synergy between science journalists and bloggers, and who are looking to improve both sorts of media.  There are some data that support the idea that when scientists blog about science, they use a more diverse set of sources.  Rarely will the usual suspects in science blogging simply re-hash a press release, something all to common in science journalism (although many science journos are bravely fighting this trend of endumbificaiton).

The fracture of ScienceBlogs has helped to both focus and diversify the discussion of how to best write about science.  This is not a bad thing.

5 responses so far

Revisiting placebo

Aug 16 2010 Published by under [Medicine&Pharma], Medicine

The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, "placebo" is.

A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients.  This is both true and overly simplistic.

First, we must review what "placebo" is.  There are basically two primary uses of the word.  The first is technical.  In randomized controlled trials, making sense of an intervention requires some sort of control group.  If I give Fabulostatin to one group, any changes I see in the group may be due to chance alone or to bias.  I can minimize this effect by subjecting a similar group to an identical-appearing sugar pill, one which we call a "placebo".  If the only significant difference between the two groups is Fabulostatin or placebo then significant differences between the two groups can be more readily attributed to Fabulostatin.

This doesn't mean that the placebo group will be unchanged.  If there is a third arm of the study, one in which no pill was given, we can often measure a difference between this group and the placebo group.  This difference is usually called the "placebo effect", that is, the group that is treated with a sugar pill improves despite being given no active drug. Continue Reading »

25 responses so far

Weekly Scientopia links

Aug 15 2010 Published by under [Et Al]

Scientopia has been up and running for a couple of weeks now. I'm quite pleased with the way things are going. I'm particularly amused, educated, and informed by the ability of This Scientific Life to crank out so many interesting pieces. Here's some links from around Scientopia from the last week.

There's much more.  We're still new and currently working on tweaking our site-wide feed.  Enjoy your stay, and come again soon.

One response so far

What a day!

Aug 15 2010 Published by under Narcissistic self-involvement

To end off the summer, we hopped in the car and shot up to the Lake Michigan shore. Folks who aren't from around here often have a hard time believing that a "lake" can look like this. Today a stiff onshore wind created an endless field of whitecaps, and the near shore waves were about 4-5 feet high.

The lighthouse has been restored to its original maroon, but I haven't taken a picture of it yet.

Charlevoix South Pier Light

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To live deep and suck out all the marrow of life

Aug 13 2010 Published by under [Medicine&Pharma], Cancer, Medicine, Science-y stuff

There are few procedures in medicine more complex, dangerous, and remarkable than stem cell transplantation. This procedure has enabled us to successfully treat cancers that were previously uniformly fatal. For certain types of acute myeloid leukemia, for example, stem cell transplant increases 5-year survival from less than 15% to about 44%.

But the full story of stem cell transplant is much more complicated.  The data are complicated and the research is full of fits and starts, new questions and dead-ends.

Chimera. Apulian red-figure dish, ca. 350-340 BC. The Louve, Paris, France. Image from Wikimedia Commons

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2 responses so far

Farmers' market

Aug 12 2010 Published by under [Et Al], Narcissistic self-involvement, Uncategorized

One of my diabetic patients explained that his recent increased blood sugars were due to Michigan peaches. I had to have a Michigan peach.

Ripe peaches don't travel well. When I lived in California, we used to get great peaches, trucked in ripe and gone from the shelf in a couple of hours. Here in the land of supermarkets, peaches are photogenic but that's about it. They are hard without being crisp, and tart without having flavor.

For the last couple of summers, my hospital has hosted a weekly farmers market. I don't usually make it out of the office in time, but today, thinking of peaches, I made it.

Once there were four

This is what a peach should be.  The first bite pierces the crisp skin, and the flesh beneath is impossibly sweet and flavorful, the juice inevitably dripping down the wrist.  I bought four.

As I was trying the peaches, my nose was drawn to the left where a pile of cantaloupes were perched  on the top of a cart.  There was no need to check them for ripeness---I could smell them from across the driveway.  I brought one of them back with the peaches.  I have no idea what I'll do with a whole melon tonight at work.  Both of my residents are fasting for Ramadan, and I don't think I can eat a whole melon for dinner.  But if it's as good as the peaches, I don't care.

8 responses so far

Homeoprophylaxis: An idea whose time has come---and gone

Aug 11 2010 Published by under [Medicine&Pharma]

One of the strengths of modern medical education is its emphasis on basic science.  Conversely, the basic weakness of so-called alternative medicine is its profound ignorance of science and its reliance on magical thinking.  Nowhere is this more apparent than in the attempts of altmed cults to conduct and publish research.  From "quantum water memory" to "almost as good as placebo", the altmed literature is filled with basic failures in the proper formulation and testing of hypotheses.

One of the finest examples of these failures was just published in the journal Homeopathy.  Leaving aside for the moment the absurdity of a journal devoted to magic, let's see what they did here. Continue Reading »

4 responses so far

Why do chiropractors order so many X rays?

Aug 10 2010 Published by under [Medicine&Pharma]

People often visit primary care physicians and chiropractors for low back pain (LBP).  It is a very common problem, and one that usually resolves on its own.  Research has repeatedly shown that X rays are rarely useful in the evaluation and treatment of simple back pain.  Outside of certain "red flags" (fever, history of cancer, weight loss, and a few others), there is rarely any reason to get an X ray of someone's spine when they come to see the doctor for low  back pain.

Both anecdotal and quantitative studies have shown that chiropractors are very likely to order spine X rays. Given the inutility of these studies, and the radiation exposure, what reason could there be (aside from financial incentive) for chiropractors to order X rays?

Diagnosis of bone and joint disease

X rays can be very effective at diagnosing traumatic bone and joint injuries such fractures and dislocations.  These films can be very tricky to interpret, and nearly all doctors have their films over-read by a radiologist.  Given that chiropractic is not useful in the treatment of an acute fracture or dislocation, and that chiropractors are not qualified to read these films, this seems a poor excuse for ordering films.

X rays are not very sensitive or specific for the diagnosis of other important bone diseases such as osteoporosis, and can be very tricky when cancer is a consideration, as some bony cancer lesions show up on X rays and some do not.  X rays done and interpreted by a chiropractor or any other unqualified individual can lead to a false sense of security.

Diagnosis of "subluxation"

Subluxation is a word with two meanings.  In orthopedics, it refers to a specific kind of dislocation of a joint, one that can be clearly identified on an X ray.  In chiropractic, it refers to an often-invisible displacement of the vertebrae that can cause back pain and even systemic disease.   Subluxation in the chiropractic sense has never been shown to exist.  Vertebral subluxations in the orthopedic (i.e., real) sense are rarely clinically significant and are outside the purview of chiropractors.

X rays are a significant intervention. Anytime ionizing radiation is applied to a human being, there better be a good reason for it.  If there is no evidence that the X ray will help in a meaningful way with diagnosis or treatment, then no X ray should be done.  There is no clear reason any chiropractor should ever order an X ray.

32 responses so far

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