Medicine

If you grew up, as I did, a child of the 1970s in the US (I graduated from high school in 1980), you probably couldn’t escape the influence of Kris Kristofferson. He was big, and he was at his biggest during the 1970s, pumping out country music and mainstream hits, appearing in movies, and generally rocking an awesome beard. Anyway, the 1980s came, and Kris Kristofferson’s career went. Well, it didn’t exactly disappear. Kristofferson continued to work and appear in movies, and his records still sold fairly well. However, he was never again as big as he was in the 1970s. It turns out that…
There are reasons that I’m not a pediatrician. First, and foremost, I like surgery. Indeed, when I first entered medical school, my intent was to become an academic internist, but things didn’t quite work out that way. To my surprise, when I did my surgery rotation I liked it way more than I ever thought I would, even with the then 100+ hour weeks. (This was long before the time of work hour restrictions on residents or medical students.) Then, when I did my internal medicine rotation, I found it far less interesting than I thought I would. So when it came time to apply to residencies, I…
It's been over three weeks now since hockey legend Gordie Howe died at the age of 88. Detroit, as I've pointed out elsewhere, is a serious hockey town, as hockey-crazy as any town in Canada (just look at the fancy new hockey arena being built downtown only a mile from where I work), and it worshiped Gordie Howe for as long as I can remember growing up here. The reason I mentioned this is because in late 2014, Howe suffered a series of debilitating strokes that brought him close to death. He survived, but with major neurologic deficits. As a result of Gordie Howe's fame, representatives of a…
There are so many ridiculous alternative medicine treatments being “integrated” via “integrative” medicine into medicine, no matter how ridiculous they are, that it’s not only hard to believe, but it’s hard to keep track. Homeopathy is, of course, the most ridiculous, although “energy medicine” definitely gives homeopathy a run for its money in the Department of Stupid. The depressing thing is that most physicians, even “integrative medicine” physicians, know that homeopathy is bunk (at least when they even know what homeopathy is—most think it’s just herbal medicine). However, those same…
I’ve been writing about this topic so long—ever since the very beginning of this blog—that it seems as though I’ve always been doing it even though this blog has been in existence only 11 years and I didn’t really come to appreciate the problem until after I had started this blog. No, I’m not referring to the antivaccine movement, which is another longstanding concern of mine. This time, I’m referring to what I like to refer to as “quackademic medicine,” defined as the infiltration of unscientific and pseudoscientific medicine into medical academia. Indeed, there was a time when I tried to…
One of the most frequent complaints about evidence-based medicine (EBM), in contrast to science-based medicine (SBM), is its elevation of the randomized clinical trial as the be-all and end-all for clinical evidence for an intervention for a particular disease or condition. Unknown but enormous quantities of "digital ink" have been spilled explaining this distinction right here on this blog, and I tened to like to refer to this aspect of EBM as "methodolatry," a term I originally learned from another ScienceBlogs blogger (now moved on) and defined as profane worship of the randomized…
I sense a disturbance in the antivaccine force. I had meant to write about it the other day, but other things intervened. Really, there’s so much pseudoscience out there at times that on some days it’s hard to decide what to tackle, and sometimes I feel as though I’m writing about vaccines too much. However, this time around I felt as though I couldn’t ignore this one because it involves two highly annoying and fact-challenged antivaccine activists and an attempt to influence a Congressional Representative. The annoying antivaccine activists are Del Bigtree, the producer of Andrew Wakefield’s…
One of the most frequent complaints leveled at pro-science advocates who defend vaccines against antivaccine misinformation and pseudoscience is that we’re way too fast to label them as “antivaccine,” that we use the term as a convenient label to demonize their views. We’re not really antivaccine, they tell us. We’re vaccine safety advocates. Really. Now, I have no doubt that this is how most of these antivaccinationists masquerading as vaccine safety activists see themselves, to the point where sometimes I find it refreshing when I encounter an antivaccine activist who proudly labels herself…
We in Michigan are dealing with yet another effort on the part of NDs, which stands for “naturopathic doctors” but more appropriately should mean “not a doctor, to achieve licensure in the form of Michigan HB 4531. As I mentioned when I first learned that HB 4531 was passed by the House Committee on Health Policy and sent to the full House for consideration, it’s a scary, scary bill. Moreover, it’s supported by the Michigan Association of Naturopathic Physicians (MANP), who are taking money from the supplement industry to lobby for this bill’s passage. It’s a bill that would grant NDs a wide…
Most scientists I know get a chuckle out of the Journal of Irreproducible Results (JIR), a humor journal that often parodies scientific papers. Back in the day, we used to chuckle at articles like "Any Eye for an Eye for an Arm and a Leg: Applied Dysfunctional Measurement" and "A Double Blind Efficacy Trial of Placebos, Extra Strength Placebos and Generic Placebos." (What saddens me is that this is basically what research into so-called “complementary and alternative medicine,” now more frequently referred to as “integrative medicine” boils down to.) Unfortunately, these days, reporting on…
One major thing that differentiated science-based medicine (SBM) from alternative medicine and quackery is that in SBM there is a generally accepted standard of care. This was even the case back in the days before the proliferation of evidence-based guidelines, in which professional societies and expert panels try their best to synthesize what is often an unwieldy mass of sometimes conflicting studies into guidelines on best care practices for different conditions. True, back then there was wider latitude because each physician was largely left to fend for himself in applying the medical…
One common theme that has been revisited time and time again on this blog since its very founding is the problem of how science and medicine are reported. For example, back when I first started blogging, one thing that used to drive me absolutely bonkers was the tendency of the press to include in any story about vaccines an antivaccine activist to “tell the other side” or for “balance” to the story. So in a story on vaccines, on the one side you would have Paul Offit, a bona fide, legitimate vaccine expert, and on the other side you would have J.B. Handley, Jenny McCarthy, Andrew Wakefield,…
With a bill to license naturopaths (HB 4531) wending its way through the Michigan legislature supported by supplement manufacturers, its current status being in consideration by the full House of Representatives, periodically I feel the need to provide ammunition to the bill’s opponents, because we need to protect the patients in the state of Michigan from the naturopathic quackery that would be unleashed if this bill were to be passed into law. If there is one area that naturopaths have been invading with a vengeance and even gaining enough seeming legitimacy to propose what they risibly…
"Complementary and alternative medicine" (CAM), now more frequently referred to as "integrative medicine" by its proponents, consists of a hodge-podge of largely unrelated treatments that range from seemingly reasonable (e.g., diet and exercise) to pure quackery (e.g., acupuncture, reiki and other "energy medicine") that CAM proponents are trying furiously to "integrate" as coequals into science-based medicine. They do this because they have fallen under the sway of an ideology that posits a false dichotomy: To practice true "holistic" and "preventative" medicine, physicians and other health…
To say that I, as a cancer surgeon, am not a fan of Ty Bollinger is a massive understatement. He’s not exactly one of my fans, either, but I view the hatred of a man like Bollinger directed at me as a badge of honor. Indeed, if a man like Bollinger didn’t detest me, I would view my efforts as a failure because I view him as a quack whose desperately deceptive film series The Truth About Cancer has been correctly dubbed untruthful about cancer by Harriet Hall and whose message has led cancer patients into rejecting conventional medicine in favor of treating deadly cancers with alternative…
One of the more annoying health crazes going around right now is the gluten-free diet. While it’s a boon to the very small proportion of the population who have real celiac disease and thus truly cannot tolerate gluten, at the same time gluten has become the health demon that is touted as the cause of virtually all health problems, be they major or minor, with the cure—of course!—being the now nearly ubiquitous gluten-free diet. The gluten-free diet has become so popular that restaurants and food manufacturers ignore it at their financial peril. Indeed, restaurants that don’t have some gluten…
There's always been a major thread of distrust of the medical profession in the African-American community, understandably so given the history of abuses such as the Tuskegee Syphilis Experiment, in which the natural progression of untreated syphilis was studied in African-American men for 40 years. It’s not just that experiment that’s responsible, either. During the time of slavery, slaves often served as the subjects of medical experimentation. Dr. Crawford Long, for instance, conducted most of his early experiments with ether on slaves, while Dr. Walter F. Jones used slaves to test a…
I realize that it's a cliché to say so, but some clichés are true. Time really does fly. It's hard to believe that a year ago California—and, by proxy, the rest of the country—was in the throes of a major political war over the bill SB 277. SB 277, you will recall, was a bill introduced into the California Assembly in the wake of the Disneyland Measles outbreak in early 2015 that eliminated non-medical exemptions to school vaccine mandates beginning with the 2016-2017 school year. Ultimately, SB 277 passed and was signed into law by Governor Jerry Brown last July. It was an uncommon victory…
If there's one lesson that I like to emphasize while laying down my near-daily dose of Insolence, both Respectful and not-so-Respectful, it's that practicing medicine and surgery is complicated. Part of the reason that it's complicated is that for many diseases our understanding is incomplete, meaning that physicians have to apply existing science to their treatment as well as they can in the context of incomplete information and understanding. The biology of cancer, in particular, can be vexing. Some cancers appear to progress relentlessly, meaning that it's obvious that all of them must be…
I hate these stories, because they so seldom end well. Unfortunately, this one is more messy than even the usual messiness of the typical story of this type. The type of story I’m referring to, of course, is one that I’ve told from time to time ever since near the first year of this blog’s existence, that of the child or teen with cancer who, for whatever reason, refuses curative chemotherapy in favor of some sort of quackery. The litany of names depresses me to contemplate: Katie Wernecke, Abraham Cherrix, Sarah Hershberger, Daniel Hauser, Makayla Sault...the list goes on. In the vast…