Archive for the 'Uncategorized' category

We're Moving!

Aug 27 2011 Published by under Uncategorized

For a variety of reasons, I've decided to head back out on my own.  Part of this has to do with my lower output of writing and my inability to share in the duties of maintaining a group site like Scientopia.  Scientopia is a wonderful blog community but I don't feel like I have the time to contribute fairly to the management of this site.  I'm indescribably thankful for everyone who has put so much work into developing Scientopia.

I hope you will follow me over to the new White Coat Underground (expect some bumps along the way).

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Dr. Pal, why do you love Big Pharma so?

Aug 24 2011 Published by under Medicine, Uncategorized

After my recent post attacking the journal Cancer which published a horrid piece on quackery, a twitterer asked me question: "Why do Sci writers go in harder on quacks than pharma?"  (I think this begs the question; I don't believe that we neglect abuses among Pharma, but let's pretend that there is data to support her assertion). She continues, "My problem with selectively trashing these studies is we presume pharma studies better-so our audience does, as well. All quackery should be pilloried yet we selectively pillory the faith healer & homeopath. Why? B/C they're easier targets."

Assuming, once again, that her assertion is true, there are a number of good reasons to focus on blatant quackery above corporate malfeasance.  The pharmaceutical industry, while motivated primarily by profit, is required to go through extensive scientific testing of plausible drugs and devices.  This process is long, expensive, and is frequently successful at actually fighting disease.  There have been many infamous cases of burying data, of inappropriate promotion of drugs, but in general, science has won; sometimes it takes years, and sometimes there is harm done, but eventually, ineffective drugs, or drugs whose risk/benefit ratio is horrible tend to die.  There are of course exceptions, but not many.  The very fact that drugs have been given post-marketing black box warnings or have been withdrawn from the market (sometimes despite the work of bad actors in industry) is a marker of the ultimate success of the system.

This happens because science and medicine is designed to look for faults. Sure, the system can be gamed by dishonest players, but the scientific community is more than willing to toss out a modality that proves itself wanting.  Medical science, while influenced by ideology, is not ruled by it.

So-called alternative medicine and quackery works in a completely different way. Rather than asking a question and accepting an answer good or bad, altmed comes up with an answer and no amount of data will  cause it to be abandoned.  Despite hundreds of years of ineffectiveness, homeopathy is still used.  Despite its utter implausibility and proven inutility, reiki is still practiced.  There are very few if any altmed modalities that have been abandoned because of unfavorable data.  They are ideologies rather than science.

It is science and plausibility that separates quackery from real medicine.   Pharmaceutical companies develop and test hypotheses.  Sometimes they behave badly, but generally they have been successful at helping us live better and  longer.  There is an entire legal infrastructure in place to prevent them from doing ill, and to punish them when they are caught.  This system is far from perfect but it does work.

No system is in place to regulate or punish those who sell snake oil, and since patients are often "true believers" they are unlikely to sue quacks.

It's not a matter of choosing to go after quacks rather than pharmaceutical malfeasance.  We do speak out about it; there is a regulatory structure in place to monitor pharmaceuticals, as imperfect as it may be; and pharmaceutical science is science, whereas quackery is simply immoral, made up practices profiting off the hope of people who hurt.  It deserves every smack-down we can deliver.


3 responses so far

Happy campers

Aug 05 2011 Published by under Uncategorized

This is the first time I've ever tried posting by cell phone, but this being paradise it's the only option available to me.

20110805-124849.jpgHere's my quarters for the week.

20110805-124955.jpgThe views aren't too bad.

20110805-125119.jpgAs camp doctor I don't really have to follow all of the usual rules around here but I thought it important that PalKid take her swim test. She passed rather magnificently, then spiked a fever, puked, and spent the next two days in bed.

But all was not lost. In the way that kids do, she bounced right back. Last night we stayed up late. I wanted to show her the real night sky, just as my father did with me. When I asked her if she wanted to see the Milky Way she said, "Daddy, that's not real."

We fixed that misconception moments later, and she also saw her first four meteors.

The week here is short and full of sore throats and splinters. I can't wait to come back.

7 responses so far

Shame on you, New England Journal of Medicine

Jul 25 2011 Published by under Medicine, Uncategorized

For specialists in internal medicine, the New England Journal of Medicine is one of the journals you really read.  It's not a free throwaway journal or bathroom reading---it's where you find good original research, interesting case studies, cogent editorials.  Usually.  More or less.

Right now it's "less".  A few days ago I posted my review of a recent study on placebos.  I found it interesting but somewhat problematic. It's real benefit seems to have been that it has sparked substantive and vigorous discussions about placebos.   To save you from reading my entire review, the study basically took asthmatics and gave them either real medicine, fake medicine, "sham" acupuncture, or nothing at all.  All the patients reported feeling at least somewhat better, but only the patients treated with real medicine had significant improvement in measured lung function.  Another way to state the findings might be "the placebos and the real medicine all made the patients feel better.  Oh, and only the real medicine made actually better." I have a problem with this presentation as you will read below.

What we've learned about so-called placebos over the years is that "placebo" is not an intervention like a medication or a surgery.  It is an artifact of observation.  A certain amount of change can be expected any time you study a group of people.  "Placebo" is simply all of the change that can't be explained by the primary intervention.  Taking the asthma study as an example, simply enrolling people in the study and doing nothing else caused them to feel a bit better.  But treating them with real medicine caused them to feel better and get significantly better physically.    The bit of "better" that was seen simply by enrolling is referred to as placebo effect, and is a mix of various factors, such as patients' being cared for, regression to the mean, desire to please researchers, and other effects not due to a "real" intervention.  It is likely that a good deal of placebo is subsumed in standard care: if you go to the doctor for a broken leg, being cared for and listened to makes you feel better, but setting the bone and placing the cast does most of the work.  Good doctors maximize our ability to make people "feel" better along with treating the underlying illness.

The current object of my ire is an editorial published in the Journal to accompany the asthma study.  It was written by an anthropologist named Danial Moerman who completely misreads the study, the meaning of placebo, and what a disease actually is.  He first fails to understand that there were actually four interventions:

They found that three of the interventions — active albuterol, sham albuterol, and sham acupuncture — were all equally effective in controlling asthma symptoms, as judged by patient-reported improvement.


The fourth intervention was “no treatment,” in which patients were told to wait for several hours and then return home. Waiting had no effect on either subjective asthma symptoms or lung function.

Perhaps I misread the results and the graphs, but it appears to me that the "do nothing" group did in fact report feeling better, just not as much as the other groups.   The importance of this lies in the fact that part of the placebo phenomenon is simply being cared for or enrolled in the study (in this case it also involved repeated lung function testing).  If this were subtracted out in some way, we might find a much less significant effect.   But we are still speaking of "subjective" improvement, an important factor, but not one nearly as important as being able to breathe better.

Professor Moerman, perhaps being used to dealing with less concrete ideas, misses the importance of objective vs. subjective outcomes in medicine.  Holding a cancer patient's hand can make them feel better, a lot better in the short term than chemotherapy.   But it won't shrink a tumor.  Moerman thinks we have it the wrong way 'round:

It is the subjective symptoms that brought these patients to medical care in the first place. They came because they were wheezing and felt suffocated, not because they had a reduced FEV1. The fact that they felt improved even when their FEV1 had not increased begs the question, What is the more important outcome in medicine: the objective or the subjective, the doctor's or the patient's perception? This distinction is important, since it should direct us as to when patient-centered versus doctor-directed care should take place.

First, I hate it when people misuse "begs the question", but that's not important.  What's important is that he's asked the wrong question.  It's not whether subjective or objective is most important, or whether a "patient-" vs. "doctor-centered" care (whatever that means) is the best model.   In medicine, we assess both how a patient feels, and how well they are doing physiologically.  We do this in the exam room and we do this in our research.  We (meaning doctors and medical scientists) don't think one is "more important" than the other; we know that any intervention is a balance between changing physiology and making a patient feel better.  Reading this editorial makes me think of Columbus "discovering" America: it was already here, the folks living here obviously knew it, and he really had no idea where he was anyway.

Another example of his profound ignorance is his complete lack of understanding of common medical conditions:

For subjective and functional conditions — for example, migraine, schizophrenia, back pain, depression, asthma, post-traumatic stress disorder, neurologic disorders such as Parkinson's disease, inflammatory bowel disease and many other autoimmune disorders, any condition defined by symptoms, and anything idiopathic — a patient-centered approach requires that patient-preferred outcomes trump the judgment of the physician.

None of the conditions he mentions above are what he thinks they are.  There is nothing "subjective" about the cognitive dysfunction of schizophrenia or the tremors and stiffness of Parkinson's disease.  And there are drugs and other physiologic interventions that improve both the way patients feel and objective measures of how they are doing.

It's not so much Moerman's ignorance that disturbs me: anyone can be ignorant.  But this piece of idiocy was published in one of the world's most respected medical journals.   Well, his ignorance really does disturb me too.  He closes with a false dichotomy:

Do we need to control for all meaning in order to show that a treatment is specifically effective? Maybe it is sufficient simply to show that a treatment yields significant improvement for the patients, has reasonable cost, and has no negative effects over the short or long term. This is, after all, the first tenet of medicine: “Do no harm.”

As a physician and a patient, I'm unwilling to settle for "no negative side effects over the short or long term."   There are no such things as "side effects"; only "effects", some of which we desire, some of which we do not, so risk can only be minimized, never eliminated.   The precept is "First, do no harm", not "Do nothing and hope for the best."


Moerman, Daniel E. Meaningful placebos—controlling the uncontrollable. N Engl J Med 365(2):171-172 (2011). DOI:10.1056/NEJMe1104010.

8 responses so far

Mid-week meanderings

Jul 13 2011 Published by under Narcissistic self-involvement, Uncategorized

Wednesday again and it's been three days since my last bike ride.  I treated myself to a new bike this year, upgrading from the used bike I bought about eight years ago.  I'm not a serious road biker and probably never will be, and serious mountain biking is pretty much laughable around here so I went and got myself a hybrid, and all of you hybrid haters can kish mir in tuchas. I kept the old bike attached to the trail-a-bike for PalKid, but the new one is all mine.  Wouldn't you know, PalKid decided this was a good time to figure out how to ride a two-wheeler, so now we get to go for actual rides together, rather than my simply pulling her along.  She isn't fast, but she keeps going.

Since it was the best way to get around as a kid, I rode a lot.  I rode to middle school every day, as long as it was 40F or above, about 2 miles each way.  I expanded my commuting significantly when I lived in San Francisco as a twenty-something, with a 15 mile round trip commute (in the flatter part of town).  When I wasn't commuting, I would ride over the Bridge to Marin and head out into the headlands or ride up Mt. Tam.  Riding over the Golden Gate and looking back at the City is something everyone should do at some point in their lives.

Med school and residency were a biking low.  I would ride around Evanston just to get around, but mostly when I traveled I was on the El or in a car.   When I moved back here, getting a bike felt like getting younger---getting a good bike felt like getting younger still.  I was happy to find this past weekend that my I can still do some serious riding.  Pulling the kiddo has probably been a good work out, because 14 miles up and down the small hills around here felt awesome.  All those little voices in the head (the pestering "get this done" ones, not the "redrum redrum" ones) just fade away when I'm pumping up a hill, or better yet, coasting down with the wind in my face.

Plenty of people ride in the winter around here but I'm fairly certain they all have the "redrum redrum" voices, so I have to get it in while I can.   We don't generally get a lot of snow around here, but the last few years have been wetter, and I'm thinking about snow shoes for a winter activity.  I understand that they can give you quite a work out.

Meanwhile, on the home front, poor PalKid.  She did not like having Mommy sick in the hospital.  She gave up sleeping in my bed fairly shortly after MrsPal came home from the hospital and is really bouncing back, but now she's terrified of tornadoes.  We don't get a lot of tornadoes around here.  The sirens did go off early this spring when a nasty storm was approaching, and poor little PalKid came down to the basement in four layers of clothes, snow boots, and an armful of dolls.  Now she "hears" sirens every day.

She'll get through this, but meanwhile it's affecting our bike riding.  We've told her that tornadoes only happen "out in the country", so now I can't get her to come for a ride with me "out in the country."  Oops.


9 responses so far

Wednesday wackiness

Jul 06 2011 Published by under Uncategorized

So it's the middle of the week (a short week here in the US) and it looks like it's time for a little chat.  First, go read Sister Isis on the Dawkins's idiocy.  In case you weren't keeping up, the basic story is that Skepchick Rebecca Watson (of whose work  I am a bit of a fan) openly wrote about an uncomfortable incident in the greater context of sexism in the skeptical community.  Famed biologist and atheist Richard Dawkins responded to her in a horridly sexist, belittling, "get back to the kitchen and STFU" manner.  And now there seems to be a bit of an imbroglio in the skeptical movement.  Thank God; it's about time.

We all may suffer from the incredulity of privilege.  Just as we don't often notice the air we breathe until it's taken from us, we don't often notice the "isms" that we swim in.  Patriarchy, like racism, anti-Semitism, Islamophobia, homophobia, undergirds everything in our society (some would argue that patriarchy is actually the basis for all other -isms).  It is so much a part of our society that even outrageous acts can seem normal.  When you step back and look objectively (skeptically, if you will) at gender and society, you can see that ours is a culture that views women as sex objects first and people last, in which sexual violence is a normative cultural tool used to control women.  To you who are unfamiliar with this view, it helps to read a bit from those who are more familiar with it.

Feminism is both radical and obvious.  It overturns many of our basic assumptions, assumptions that are so much a part of our society that we see them as fundamental truths.  But it's really, really obvious once the veil is lifted.  And for those of us who benefit from cultural assumptions such as patriarchy and homophobia, we may have little occasion to notice something is wrong.  But we are drunk on it, deceived into complacency.  Those who value justice because it is right, who value human rights for all humans because it is simply right, we must all speak out whenever we can.

In my work I am confronted daily by sexual violence, financial entrapment in relationships, and other horrors, horrors people are easily blinded to and blinded by.  We blame the victim either because it may benefit us to eschew change, or because we are relieved it wasn't us---this time.

One of my hesitations about being labelled a fervent skeptic is that the community is often skeptical of everything except its own beliefs.  It houses the same sexism, racism, and other societal norms as any other community---skepticism, which at its best can help to remedy these, is simply not immune to human foibles.  It is not enough to promote skeptical thinking, a value of empiricism over faith.  We must use these tools to root out some of the most irrational "memes" we encounter.  Which is more harmful, Creationism or racism?  Which is less rational?  Why must we fight one and not the other?

Brava, Rebecca.  Hopefully, the skeptical community isn't dominated by porn-surfing nerds ignorant of the real world.  We all should apply our thinking skills to everyday problems, not just our pet inconveniences.

35 responses so far

In Congress, July 4th, 1776

Jul 04 2011 Published by under Uncategorized

I've taken to reposting this every July 4th.  It's worth re-reading this remarkable document from time to time, especially given recent notable events (same-sex marriage legalization in NY, the Arab Spring, Michele Bachmann's meteoric rise to the head of the kakistocracy).

It does, for example, give special importance to representative government; that is, in fact, one of the main purposes of the document. It does not call for a "right" to toss away any government someone disapproves of but lays out specific grievances and makes its declaration through the representatives of the people, not by mob action. It also gives an interesting historical perspective into our founding documents as living documents.  Certain political elements would have us see our founding documents as immutable and mute with regards to modern problems, but just as we no longer speak of "merciless Indian savages" or of African Americans as 3/5's human, we cannot ignore conflicts not foreseen by the Framers.

The document's wording was very carefully developed and has specific meaning to those who wrote it at the time and their descendants. If you've never read it, or haven't for a long time, give it a try.

The unanimous Declaration of the thirteen united States of America

When in the Course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. -- That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, -- That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security. -- Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.

He has refused his Assent to Laws, the most wholesome and necessary for the public good.

He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their Public Records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved Representative Houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected, whereby the Legislative Powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.

He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.

He has obstructed the Administration of Justice by refusing his Assent to Laws for establishing Judiciary Powers.

He has made Judges dependent on his Will alone for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of New Offices, and sent hither swarms of Officers to harass our people and eat out their substance.

He has kept among us, in times of peace, Standing Armies without the Consent of our legislatures.

He has affected to render the Military independent of and superior to the Civil Power.

He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his Assent to their Acts of pretended Legislation:

For quartering large bodies of armed troops among us:

For protecting them, by a mock Trial from punishment for any Murders which they should commit on the Inhabitants of these States:

For cutting off our Trade with all parts of the world:

For imposing Taxes on us without our Consent:

For depriving us in many cases, of the benefit of Trial by Jury:

For transporting us beyond Seas to be tried for pretended offences:

For abolishing the free System of English Laws in a neighbouring Province, establishing therein an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies

For taking away our Charters, abolishing our most valuable Laws and altering fundamentally the Forms of our Governments:

For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.

He has abdicated Government here, by declaring us out of his Protection and waging War against us.

He has plundered our seas, ravaged our coasts, burnt our towns, and destroyed the lives of our people.

He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation, and tyranny, already begun with circumstances of Cruelty & Perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.

He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the executioners of their friends and Brethren, or to fall themselves by their Hands.

He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince, whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.

Nor have We been wanting in attentions to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these united Colonies are, and of Right ought to be Free and Independent States, that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. -- And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

2 responses so far

Today at Science Based Medicine

Jun 22 2011 Published by under Uncategorized

I just wanted to point you toward my piece up today at SBM. Otherwise, Happy Hump Day.

Oh, and be careful about teaching your kid to read. We did that, and she saw "Tornado Watch" for our county on the TV last night. I ended up sharing my bed last night with a child and several dozen stuffed animals.

3 responses so far

Summer veggies

Jun 20 2011 Published by under Uncategorized

My neighbor keeps bees. Really it's her husband who is the apiarist, be she doesn't mind an occasional hive in the backyard during its transformation from nuisance infestation to pollinator of yummy local peaches. She happens to be a fine physician, and as I rode by her house yesterday I saw her out back watering the garden. The weather's been horrible for veggies, but she's growing some sort of heirloom radish that's doing great. She plucked one up for me, rinsed it off, and handed it to me. The leaves were a perfect medium green, tapering to white stems, and bulging into a perfectly round, deep pink bulb. I bit in expecting the usual bland but peppery taste of a grocery store radish. My teeth bit into the crisp flesh, and my mouth was filled with an earthy sweetness, almost like jicama, but with the peppery undertones typical of radishes. This was no garnish: this was real food.

I've been trying very hard to stick to real food, even when I eat crap (e.g. I'll buy real ice cream with only three ingredients). Kids watch everything you do, make note of it, and will use it against you at any opportunity. I'm far from perfect, but I try to let my kid see me eat real, good food rather than crap. She's made me a better eater. Like most kids, her major food groups are chicken nuggets and noodles, but if I sneak a bowl of ripe watermelon in front of her while the pasta is boiling, she'll dig in.

The Midwest is full of good food, if you know where to look, but much of the year we are dependent on imports for fresh fruits and veggies. It's not yet peach season here, but I did find some nice ones from Georgia, the kind that almost taste local and fall apart when you eat them. There are tons of farmers' markets, but for busy people, this just isn't always a feasible option, which is one of the reasons I'm happy to see more and more local produce at my supermarket.

Oh, but the local produce can be just wonderful---corn, apples, peaches, greens, berries. If they keep growing it, and my neighbor keeps sending out his pollinators, I'm a customer-for-life.

3 responses so far

Cranberry juice for UTIs?

Jun 15 2011 Published by under Medicine, Uncategorized

I can't seem to stop myself from writing about pee, and I'm not even a nephrologist.  But I deal with pee every day, and many of my younger patients with urinary tract infections will tell me all of the home and herbal remedies they tried before they came to see me.  One of the most common alternative treatments is cranberry juice.  There are several plausible reasons cranberry juice might work against UTIs.

Some studies have shown that cranberry consumption can acidify urine and raise urinary levels of hippuric acid, a compound that can slow bacterial growth. Subsequent studies have found that it is nearly impossible to consume enough cranberry products to significantly change the pH of the urine or to raise concentrations of urine hippuric acid.

Other studies have found that some of the chemicals in cranberry juice can prevent E. coli from adhering to the urinary tract lining.  Since E. coli are the cause of a high percentage of UTIs, this could be significant.  Unfortunately, studies have failed to show significant clinical benefit in several types of UTIs, especially when compared to usual antibiotic therapy.

Adding to our database is a study in the latest issue of Clinical Infectious Diseases. This study looked at preventing recurrent UTIs in young women, a group at significant risk for recurrence.

The results were unimpressive. During the six months of follow up, the cranberry juice group did not have significantly fewer recurrent UTIs than the placebo group.  One caveat to this conclusion is the observation in previous studies that the effect of cranberry is dose-dependent.  In the study, women were given eight ounces of cranberry juice cocktail daily.  It could be argued that this is too little to have an effect.  But to drink, say, 24 oz of low-cal cranberry juice cocktail daily hardly seems like a reasonable trade off.  That's a lot of juice.

For now, I'm not recommending cranberry juice to my patients wishing to prevent UTIs.


Barbosa-Cesnik, C., Brown, M., Buxton, M., Zhang, L., DeBusscher, J., & Foxman, B. (2011). Cranberry Juice Fails to Prevent Recurrent Urinary Tract Infection: Results From a Randomized Placebo-Controlled Trial Clinical Infectious Diseases, 52 (1), 23-30 DOI: 10.1093/cid/ciq073

Raz, R., Chazan, B., & Dan, M. (2004). Cranberry Juice and Urinary Tract Infection Clinical Infectious Diseases, 38 (10), 1413-1419 DOI: 10.1086/386328

15 responses so far

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