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sb admin | June 17, 2008I love fountain pens, but I'm far to busy for the regular ritual of cleaning, filling, etc. Most of my day is spent scrawling notes or typing on a keyboard. But there is one task for which only a fountain pen will do.
I've lost a number of patients lately. Most were in hospice, all were elderly, but it's always tough. I take care of my patients until they die, including hospice care, so I often get to follow them on the journey from health to death. Sometimes, great debility and dementia is a step on that journey. I've taken to writing short notes to the spouse of the deceased, to…
sb admin | June 12, 2008My little post on naturopathy was more controversial than I had anticipated. Some of the commenters gently (and otherwise) suggested that I should learn more about the subject, so I've been doing a little reading. Here are the basic questions: what is naturopathy, and what might it have to offer that "conventional" medicine lacks?
One of the first places I visited was the website for Bastyr University, which is often cited as having the most prestigious naturopathic program. Their website posts a definition of naturopathy (all emphasis mine):
Naturopathic medicine is a distinct profession…
sb admin | June 11, 2008Many of you were too busy trying to ace organic chemistry to know what a deus ex machina is. For those of you who managed to squeeze in a classics course, please stick with me anyway.
Deus ex machina ("god from the machine") is a literary device. In ancient Greek literature, a complicated dilemma was sometimes solved by having one of the gods literally pluck the unfortunate protagonist off the stage from the arm of a crane. It's sort the ancient version of the Superman gambit---don't like the ending? Just turn back time by reversing the rotation of the Earth. In either scenario, an…
sb admin | June 9, 2008I guess it's not just doctors watching this one---an alert reader and a fellow SciBling both picked up on this one. Apparently, in my neighboring state of Minnesota (really, check the map), home to Greg Laden, PZ Myers, and lutefisk, doctor wannabes have legislated themselves into "doctorhood". You see, there is this entity called a "naturopath", or "naturopathic doctor", which is some sort of shaman that likes to think that if you study woo long enough, it becomes science.
OK, OK, I'll settle down, but let's examine this "naturopath" thing. You see, to be a real doctor, you must attend…
sb admin | June 6, 2008The practice of medicine requires a careful mix of humility and confidence. Finding this balance is very tricky, as humility can become halting indecision and confidence can become reckless arrogance. Teaching these traits is a combination of drawing out a young doctor's natural strengths, tamping down their weaknesses, and tossing in some didactic knowledge. I supervise residents---they make the decisions, but it's my name and my ass on the line, so I keep a close eye on things. Some teaching physicians dictate every decision on patients, some do nothing at all. I try to keep toward the…
sb admin | May 15, 2008A few months ago, I gave you a short primer on the immunology of vaccines. It's time now for another short, oversimplified primer, this time on the immunology of HIV. This was originally up on the old blog, but it will provide some necessary background for upcoming posts (I think).
HIV denialists form a persistent little cult, and one of their newest leaders is Gary Null. Despite their small size and dearth of academic heavy-weights, they are quite loud, and can affect health policy.
Let's delve into the immunology, and, once again, please forgive the over-simplification.
HIV---nasty non-…
sb admin | May 9, 2008HT erv.
This is truly annoying because it is so patently wrong. It's wrong in lots of different ways, but I'll help point out some of the major flaws. What happens when journalist becomes the story, rather than reports it?
You see, there is this journalist, Celia Farber, who apparently has been following the HIV denialists since the beginning. From reading this interview with her in Discover Magazine, it would seem that she is suffering from some sort of Stockholm Syndrome. Not only that, but the journalist interviewing her shows a complete lack of suspicion, and seems to be one of those…
sb admin | May 5, 2008I can't tell you the number of people who complain to me about having their hope taken away. Exactly what this means, though, isn't always clear.
Sometimes an oncologist will tell them (so they say) that they have a month to live. Sometimes their cardiologist tells them (so they say) not to travel to their grandson's Bar Mitzvah. Sometimes the spine surgeon tells them their back will always hurt, no matter what. So they say.
Patients tell me a lot of things. I'm not always sure what other doctors really told them, but what is important is what the patient heard. The oncologist might have…
sb admin | May 5, 2008I recently lost a close family member to cancer. She was old, she had been ill a long time; it still hurts. But in her dying, she made some wise choices. She was a very bright woman, and retained her mental capacities right up until the end. This gave her the opportunity to decide how she would approach death. She chose to enroll in hospice.
Hospice is widely misunderstood, partly because of the way we misunderstand death in the U.S. Instead of an inevitable part of life, death here is seen as an enemy to be fought at all costs, no matter the futility. Intensive care units, which were…
sb admin | May 4, 2008I'm not going to lie to you. This post contains some actual science. WAIT! Don't click away! I'll make it palatable, I promise!
It's just that this is such an interesting story, and I can't help sharing it. It is a shining example of one of the great successes of modern medical science, and stands in such stark contrast to the unfulfilled promises of the cult medicine crowd, with their colon cleanses and magic pills. This is the story of a real magic pill.
It starts back in 1960. A couple of researches at the University of Pennsylvania were looking at chromosomes in the blood cells of…
sb admin | April 14, 2008A reader of ours ran into a questionable book ad, and being a good citizen, sent it on to me. I glanced at it, and it seemed to be the usual silly book purporting to cure all that ails, but on deeper inspection, it was much uglier.
The book says that it "renders insulin and related medicines unnecessary within four days...". This is a bit scary, not because this would be a bad thing, but because many diabetics are completely dependent on insulin to live. But, hey, maybe this is a good diet plan for type II diabetics and will at least help them reduce their need for meds. I mean, it could…
sb admin | April 8, 2008What is alternative Medicine, anyway?
That's a great question. I know it is, because I asked it. I get this question almost daily. The secret answer is that there is no such thing as alternative medicine. You don't believe me? Why not--I am a doctor.
There are several ways to define alternative medicine, and sometimes it is contrasted with "complementary medicine". CM refers to treatments that "complement" traditional medicine, while AM refers to treatments that stand in the stead of mainstream medicine. CAM is a broad category used to refer to both.
So what's my problem? How can I say…
denialism | October 15, 2007The inability to achieve erection has been a source of consternation for men for, well, a really long time. But the recent history of treatments for impotence, wait, I mean Erectile Dysfunction, oh no, now they're calling it Male Sexual Dysfunction, represents a medical revolution. In the last 100 or so years, we've gone from nonspecific and largely ineffective treatments, to progressively more successful treatment, finally resulting in a highly specific and effective pharmaceutical solution to the problem. The goal of this post is to share a history of this unique field of medical…