Medicine
palmd | January 11, 2010Yesterday I wrote a piece expressing some concerns about a physician's practice featured in the news recently. Dr. John Crisler is a self-described anti-aging and men's health physician. A couple of my concerns regarded his prescribing practices and his possible practice of distance medicine.
From closer perusal of his site it would appear that he may not require the use of his pharmacy, but he does charge his patients to send prescriptions to pharmacies other than his own. It's not unreasonable to charge patients for the use of your time, but I feel very uncomfortable with what amounts to…
terrasig | January 10, 2010Our post on drugs and documents found in the Sedona resort room occupied by self-help guru James Ray requires a correction and a clarification related to the Michigan doctor of osteopathy who, according to publicly-available records, prescribed some of the drugs as detailed in these publicly-available documents.
1. Correction: Dr. John Crisler was referred to as an "Internet physician from Michigan." To be clear, he is a physician with an office in Lansing, Michigan, with an internet presence at allthingsmale.com. On his website, he lists an "Office Visit Fee - Office or Virtual" for $60.00…
cpikas | January 9, 2010In most of the discussions of using usage as a metric of scholarly impact, the example of the clinician is given. The example goes that medical articles might be heavily used and indeed have a huge impact on practice (saving lives), but be uncited. There are other fields that have practitioners who pull from the literature, but do not contribute to it.
So it was with interest that I read this new article by the MacRoberts:
MacRoberts, M., & MacRoberts, B. (2009). Problems of citation analysis: A study of uncited and seldom-cited influences Journal of the American Society for…
terrasig | January 9, 2010While the coffee wasn't quite ready this morning, I ventured to the Wall Street Journal health page at the Wall Street Journal, one of my frequent first-reads.
I was immediately intrigued by a short article from the excellent Jennifer Corbett Dooren about Roche-Genentech gaining US FDA approval for a new rheumatoid arthritis drug, Actemra.
Actemra (tocilizumab) is a monoclonal antibody that works via a novel mechanism of blocking the receptor for interleukin-6, a pro-inflammatory molecule called a cytokine. What is most important is that Actemra appears to work in patients who have not been…
razib | January 6, 2010I got interested in vitamin D a few years ago because I was trying to figure out a plausible explanation for why many of the genetic variants implicated in lighter skin seem to have risen in frequency relatively recently, 10,000 years ago, when modern humans have been extant at higher latitudes on the order of 30,000 years. So I started mooting the speculative idea that the switch to agriculture might have reduced vitamin D levels. Initially I assumed that rickets was the main issue, but over the past few years there has been a veritable explosion in the medical literature pointing to…
revere | January 3, 2010New York Times correspondent Don McNeil is an excellent medical reporter. He always asks intelligent questions at the CDC pressers and he writes good articles. And he's written one for The Times yesterday that I agree with, although his support for it seems to me less than objective. In essence he asked the country's flu establishment how well the US handled swine flu. None of his sources are CDC employees but all of them are deeply involved in flu and flu policy in one way or another. And they gave themselves a big pat on the back. I hope they didn't wrench their shoulders. That might be a…
revere | January 2, 2010I've noticed that whenever I have the temerity to suggest (e.g., here and here) that maybe the word of the Cochrane Collaboration isn't quite the "last word" on the subject and indeed might be seriously flowed, I hear from commenters and see on other sites quelle horreur reactions and implications this blogger doesn't believe in the scientific method. Why? Because "everyone knows" that a randomized controlled trial (RCT) automatically beats out any other kind of medical evidence and any Cochrane review that systematically summarizes extant RCTs on a subject like flu vaccines is therefore a…
palmd | December 30, 2009Dr. Sherri Tenpenny is reportedly a doctor, although according to her website, she no longer practices medicine in any recognizable way. Perhaps that's why she utters completely idiotic statements such as this one pointed out to me by Brother Orac:
Study these numbers. We've had SARS, Bird flu and Swine flu. On average, approx. 190 children/year die from the flu. Considering there are about 62M kids under the 14 years of age in the US, this is NOT "statistically signficant" and should not even make the radar screen. See how they manipulate parents into vaccinations?
Next year, PLEASE do not…
oracknows | December 24, 2009If there's one thing that's irritated the crap out of me ever since I entered the medical field, it's celebrities with more fame than brains or sense touting various health remedies. Of late, three such celebrities have spread more misinformation and quackery than the rest of the second tier combined. Truly, together, they are the Unholy Trinity of Celebrity Quackery.
The first two of them, of course, are that not-so-dynamic duo of anti-vaccine morons, Jenny McCarthy and her much more famous and successful boyfriend Jim Carrey. Having apparently decided that selling "Indigo Child" woo was not…
sa smith | December 23, 2009Clinical trials for using pig cells to treat diabetes are now legal Down Under!
Most countries health/medical regulatory bodies have been hesitant to approve of animal organ/part transplants because of the risk of Creating Another HIV. Theoretically endogenous retroviruses still active in pigs (PERVs) could cause trouble once they are transplanted into a human.
Happily scientists have 'optimized' some pigs to be free of the most dangerous PERVs.
So New Zealand just started clinical trials in diabetes patients who have problems controlling their blood sugar levels, even with diet/exercise/…
oracknows | December 20, 2009If there's one thing that irritates me about the anti-vaccine movement, it's the utter disingenuousness of the movement. How often do we hear the claim from anti-vaccine loons that "we're not 'anti-vaccine'; we're 'pro-safe vaccine'"? I've tried to pin such people down time and time again to answer just what it would take in terms of scientific studies and evidence or in terms of what "toxins" would have to be removed to convince them that vaccines are sufficiently safe that they will have their children vaccinated? Inevitably, the answer involves levels of evidence that are beyond what can…
oracknows | December 16, 2009Remember how yesterday I said that sometimes writing this blog depresses me? At the time, I made that observation because there are times when the unending constant onslaught of pseudoscience, anti-science, and woo leads me to despair that the human race will ever overcome its cognitive defects. However, there are other times when blogging depresses me. It's for an entirely different reason, though. There are times when people I admire, people who should know better, fall and fall hard. No, I don't mean Tiger Woods getting it on with a bunch of blondes. The level of horniness and lack of…
milhayser | December 16, 2009
With medical marijuana now legal in thirteen states, and President Obama's Attorney General advising Feds not to waste resources on users in compliance with state law, the tide of tetrahydrocannabinol seems to be on the rise. On The Scientific Activist, Nick Anthis reports that the American Medical Association has recently altered its view of the drug, calling for a revised federal classification and more research into its potential medical benefits. PalMD for one will wait and see, writing that "the available clinical data do not give a doctor a clear way to evaluate the risk/benefit…
palmd | December 14, 2009Over at Skeptic North there has been an ongoing discussion about naturopathy. Since it looks like naturopaths are going to get prescribing privileges in Ontario, it's reasonable to subject their practice to some pretty intense scrutiny. One naturopath left some interesting comments about treatment of heart disease, citing relevant literature, but failed to show an actual understanding of the clinical realities of treating heart disease. This is not surprising given that naturopaths aren't required to do residencies like real doctors are.
Another comment referenced the Canadian…
terrasig | December 14, 2009Update: New ScienceBlogs colleague, Sharon Astyk at Casaubon's Book, brought my attention to the fact that this local southern Colorado story has been picked up by CNN.
Although I originally wrote this post rather tongue-in-cheek, some scientific evidence has accumulated for the benefits of cannabis in neuropathic pain, cancer pain and nausea, as well as muscle spasticity in multiple sclerosis. For what appears to be a subset of individuals, marijuana is superior to prescription drugs in terms of efficacy and side effect profile. Equivocal results with a standardized cannabis extract…
oracknows | December 10, 2009Arguably, the genesis of the most recent iteration of the anti-vaccine movement dates back to 1998, when a remarkably incompetent researcher named Andrew Wakefield published a trial lawyer-funded "study" in the Lancet that purported to find a link between "autistic enterocolitis" and measles vaccination with the measles-mumps-rubella (MMR) trivalent vaccine. In the wake of that publication was born a scare over the MMR that persists to this day, 11 years later. Although peer reviewers forced the actual contents of the paper to be more circumspect, in the press Wakefield promoted the idea that…
revere | December 10, 2009The other day the British Medical Journal (BMJ) published a clutch of articles about whether Tamiflu was as useful a drug as some have touted. I read the main article, another one of the Cochrane Collaborative meta-analyses of the studies they deem useful about any particular subject, and it didn't seem to make much news. It confirmed what their previous review had said about the neuriminidase inhibitor antivirals for influenza (Tamiflu and Relenza): these drugs work but their effect is modest. We've been saying the same thing for years here, not because we did a fancy meta-analysis, but…
terrasig | December 4, 2009Earlier this week, I saw one of the best treatments of a misinterpreted story that has me thinking about how all news outlets should report in vitro laboratory studies.
Only thing is that it didn't come from a news outlet.
It came instead from a brainwashing site run by those medical socialist types - I am, of course, speaking of the UK National Health Service and their excellent patient education website, NHS Choices.
You may recall reading in the popular dead-tree or online press that investigators from New York Medical College in Valhalla published in British Journal of Urology…
revere | December 4, 2009Marilyn Mann pointed me to an interesting post by David Rind over at Evidence in Medicine (thanks!). It's a follow-on to an earlier post of his about the importance of plausibility in interpreting medical literature, a subject that deserves a post of its own. In fact the piece at issue, "HIV Vaccines, p values, and Proof," raises lots of interesting questions about different ways to view what we mean by probability (the nub of the frequentist/Bayesian debate), the difference between proof and evidence, the thorny and mental cramp produced by the question of multiple comparisons, and finally…
palmd | December 3, 2009He looked sick---really sick. He was sitting on a stretcher in an ER bay, flushed, breathing a bit quickly, but his youth seemed to compensate for the acuity of his illness, and he didn't feel nearly as bad has he looked. His fever was 104, his systolic blood pressure was in the 90s, his heart was racing. He'd had a sore throat recently, and rather than getting better started to feel weak, tired, and feverish. His mom finally dragged him in when he wouldn't stop shivering. His blood work was not normal, and his chest X-ray looked as if he'd inhaled a box full of cotton balls…