Medicine
oracknows | April 24, 2012About two and a half weeks ago, I was disappointed to learn that Dr. Stanislaw Burzynski had somehow managed to delay justice again. At the time, I didn't know what had happened other than that his hearing before the Texas Medical Board, which had been scheduled to begin on April 11 and to which I had been greatly looking forward, given that Dr. Burzynski could well have lost his Texas medical license if the hearing had gone against him. Fortunately, in the comments, readers informed me that this was nothing unusual, a continuance was issued due to legal maneuvering on both sides. Contrary to…
lborkowski | April 18, 2012April 28th is Workers Memorial Day, and groups California to Nebraska to Kentucky are planning events -- see a complete list at the National Council for Occupational Safety and Health (COSH) website. Events in Washington, DC are happening in advance of Workers Memorial Day: On Thursday, April 19th at 10am, the Senate Health, Education, Labor and Pensions Committee will hold a hearing on the failures of the OSHA standard setting process. On Friday, April 20th at noon, several groups are holding a Worker Memorial Day event in front of the US Chamber of Commerce headquarters (1615 H Street NW),…
denialism | April 13, 2012But you'd never know that reading AEI's highly dubious contribution to the literature in this week's Health Affairs (lay Reuters article here). Consistent with their free-market solves everything and can do no wrong (cover ears and yell "nananananananana") attitude towards the broken US healthcare system, they have managed to contaminate the literature with a paper that suggests our higher expenditures on cancer are generating significant returns in patient survival. Except that it doesn't show this, and to her great credit, Reuter's Sharon Begley nails it:
Cancer patients in the United…
oracknows | April 12, 2012Proof. You keep using that word. I do not think it means what you think it means.
That thought kept running through my mind as I perused an article appearing on an antivaccine website. Another thought that rant through my mind is that this was clearly not a scientist of any sort speaking. In science, in general, we don't speak of "proof." We speak of evidence and experimentation. Lawyers speak of proof, as in "proof beyond a reasonable doubt." Scientists speak of evidence in shades of gray, because most evidence is on a continuum. Besides, the article asked the question, "Has 'science based…
oracknows | April 10, 2012Over the years, I've written a lot about overdiagnosis and overtreatment. Basically, overdiagnosis is the diagnosis of a condition that, if left untreated, would very likely never cause the patient harm. Because I'm a cancer surgeon, I've almost always written about overdiagnosis in the context of--you guessed it--cancer, particularly breast cancer. In breast cancer, for instance, it's been estimated that as many as one in three cancers diagnosed by screening mammography might represent overdiagnosis. Personally, I think that particular study overestimated the rate of overdiagnosis, but there…
oracknows | April 6, 2012April 11 is a mere five days away.
What's the significance of April 11? Easy. April 11 is the date when the hearing before the Texas Medical Board to determine whether Stanislaw Burzynski will lose his license to practice medicine in Texas. Dr. Burzynski, as you recall, is the Texas doctor who has somehow managed to continue to treat cancer patients with something he calls antineoplastons, which he claims to have originally discovered in urine. More recently, he had a fawning "documentary" made about him by Eric Merola, an advertiser who now mostly produces infomercials, which is entirely…
denialism | March 23, 2012We've already extensively discussed why it costs twice as much for the US to provide healthcare for it's citizens all the while failing to cover health care for all. Most recently, we discussed the hidden tax of the uninsured and the perverse incentive structure of US healthcare which encourage costlier care, more utilization, and more procedures.
To summarize, the US spends more on healthcare compared to other industrialized nations because
We deliver it inefficiently
Without universality problems present when critical and in the ER
Fee-for-service incentives in the form of excessive…
oracknows | March 23, 2012I've discussed the concept of "misinformed consent" multiple times before. Quacks in general, particularly the "health freedom" movement proclaim their dedication to "informed consent." "All we're asking for," they will say, "is informed consent." The antivaccine movement in particular demands "informed consent" about vaccines. Be it Barbara Loe Fisher, the bloggers at the antivaccine crank blog Age of Autism, or any of a number of antivaccine warriors, demanding "informed consent" seems to be every bit as much of the antivaccine arsenal as the "toxins gambit" or ranting about "fetal cells"…
denialism | March 21, 2012In the continual spread of assaults on women's reproductive freedom in the wake of the 2010 tea party movement, another state, Idaho, is legislating women receive unnecessary and invasive medical procedures prior to obtaining abortion.
This is part of an unprecedented effort at the state level to restrict reproductive rights, and in 2011 a record number of these measures have passed.
And it won't stop here, as we've seen in Georgia, they are trying to pass a law to force women to carry all 20 week gestations to term, even if the fetus is dead. And if you think that's creepy, Georgia isn't…
oracknows | March 20, 2012Sometimes you find good skepticism in strange places. One example of this has been Cracked.com. Normally, Cracked.com is a humor site based on the magazine that I used to read sometimes back in 1970s. Unfortunately, the magazine folded several years ago, but the website lives on. For example, Cracked.com once did a snarky article making fun of the "heroes" of the antivaccine movement and contrasting them to "villains" like (of course!) Paul Offit. It even featured for emphasis the infamous "baby eating" poster that Age of Autism ran a couple of years ago that featured Steve Novella, Paul…
oracknows | March 18, 2012About a month ago, I wrote about a study that looked at metrics of patient satisfaction and compared them to hard outcomes often used to evaluate quality of care, including frequency of emergency room usage, frequency of hospitalization, and overall mortality. Even though these days there appears to be an implicit assumption that increased patient satisfaction comes about as a result of better quality of care (or at least that patient satisfaction correlates with quality of care), this study found almost exactly the opposite. Patients who were in the highest quartile for patient satisfaction…
oracknows | March 12, 2012"Patient-centered care."
It's the new buzzword in patient care. Personally, I find the term mor ethan a little Orwellian in that it can mean so many things. Basically, it's a lot like Humpty Dumpty when he says to Alice, "When I use a word, it means just what I choose it to mean -- neither more nor less." So it is with "patient-centered care." It's such a wonderfully--shall we say?--flexible term. That's why I took more than a little interest a week and a half ago when I picked up the New England Journal of Medicine and saw in the Perspective section three articles about "patient-centered"…
oracknows | March 12, 2012I don't know what it is about the beginning of a year. I don't know if it's confirmation bias or real, but it sure seems that something big happens early every year in the antivaccine world. Consider. As I pointed out back in February 2009, in rapid succession Brian Deer reported that Andrew Wakefield had not only had undisclosed conflicts of interest regarding the research that he did for his now infamous 1998 Lancet paper but that he had falsified data. Of course, in response Keith Olbermann was totally played by the antivaccine movement, resulting in some truly mind-numbingly dumb…
drorzel | March 9, 2012
Still not as bad as Division I revenue sports § Unqualified Offerings
Still, at the end of the day, there's at least some notion of accountability and standards behind the assessment movement. I don't think it's been a very effective effort at accountability and standards, but somebody somewhere was clearly pushing for standards. However, I haven't heard a peep about assessment in more than a year. I have, however, heard all about graduation rates. Now, they swear up and down that they want to raise standards while raising graduation rates, and they've even put token money toward pilot…
oracknows | March 6, 2012If there's one thing that practitioners of dubious cancer therapies rely upon, it's testimonials. If there's one such practitioner who really, really relies on testimonials, it's Dr. Stanislaw Burzynski, founder of the Burzynski Clinic. Dr. Burzynski is known for what he refers to as "antineoplaston" therapy (which he massively oversells and is currently rebranding as sodium phenylbutyrate) and a highly dubious "personalized gene-targeted cancer therapy." The results of these testimonials are patients from all over the world organizing fundraisers, or, as I put it, harnessing the generosity…
oracknows | March 2, 2012I was originally going to write about an amazing article that appeared in the NEJM today, but then, as happens all too often, something more compelling caught my eye. Unfortunately, it's compelling in exactly the wrong way. It's infuriating and saddening, all at the same time. It's also yet another example of how it's so very, very difficult to blog about these cases. Yes, unfortunately, it's Dr. Stanislaw Burzynski again in the news, and this time around he's managed to snare yet another unfortunate family into believing the hype about his "antineoplastons," his "personalized, gene-targeted…
denialism | February 29, 2012Turns out I gave Virginia governor McDonnell too much credit after he rejected the VA ultrasound bill on the grounds the state should insert itself into medical decisions. He's gone and flip-flopped as a slightly revised version of the bill passes through the VA Senate:
The 21 to 19 vote, mostly along party lines, came a week after Gov. Robert F. McDonnell (R) asked legislators to revise the bill following protests on Capitol Square and repeated mocking on national television. Lawmakers amended the original bill, which mandated that women undergo a transvaginal ultrasound, a procedure that…
sastyk | February 23, 2012Note: I wrote a slightly different piece under this title on ye olde blogge back in August, but given the emphasis on discussion of contraception going on, I thought it was worth reiterating and mulling over further.
When your specialty as a foster family is taking large sibling groups, you hear a lot of stuff you'd rather not. The typical comment involves forced sterilization, and it is hard sometimes not to have a little sympathy. Of the kids we've taken or been called about, we've had three groups of five and three of four, and almost all have involved very young mothers, sometimes with…
denialism | February 16, 2012**Update, the NYT has an editorial in their Sunday edition recommending the passage of two bills in congress requiring advanced notice from drug manufacturers in event of likely shortage.
Health affairs discusses the increasingly frequent shortages of critical, life-saving, generic drugs. This is a serious problem that seems mostly limited to the U.S. healthcare system, and may adversely affect you or someone you know.
Many of the same drugs are not in such short and unpredictable supply in Europe, where in some cases they carry higher prices. This provides one major clue to the root cause…
oracknows | February 16, 2012Since 2012 was rung in a month and a half ago, I've been writing a lot more about placebo medicine than I have in a while. Specifically, I've written a lot more about placebo effects than usual. This proliferation of posts on the topic was sparked by how Harvard University's very own not-a-PhD faculty, credulous promoter of acupuncture and all things "integrative medicine," and generally clever propagandist for woo, Ted Kaptchuk seemed, like Elvis, to be everywhere for a while. The message he was spreading was, although he didn't admit it or put it that way, a response to the growing body of…