Clinical

When CBS-TV decided to run an anti-abortion ad during the Superbowl there was a lot of talk about the propriety of airing highly polarizing advocacy advertising in such a highly visible media slot. There has been less talk about the content of the ad beyond the obvious fact it was making an implied argument against abortion. Since I wrote a pro abortion post yesterday I was thinking about the issue and thought I'd revisit the ad from a different point of view, the weird (but common) anti-abortion counterfactual argument. First a brief summary of the ad. Tim Tebow is a talented college…
I am pro-abortion. Not in the sense that I think abortions are good. I don't. In the sense that I am pro-surgery for medical conditions that can be surgically treated, or pro-pharmaceuticals for medical conditions that can be treated with drugs. I consider an unwanted fertilization to be a medical condition with significant consequences that can be treated. Now that I have gotten that out of the way I hope I can be free to state some ambivalence later about some other matters related to the anti-abortion movement. But no ambivalence about a woman's ability to get an abortion. Roe v. Wade was…
I had to laugh when I saw FDA was warning consumers in Puerto Rico that some hand sanitizers had high levels of bacteria (Burkholderia cepacia) that can cause serious infections. It's not really funny of course, except that one of the hand sanitizers was called “MD Quality Hand Sanitizer” (the other one was "Bee-Shield Hand Sanitizer”). Most appropriate, considering that a persistent problem with hospital infections is that we doctors are insufficiently conscientious about washing our hands between patients, A study in 2004 showed that doctors washed their hands only about half the times…
We've written quite a bit about statins because there is evidence that these plentiful and cheap drugs may be useful in treating or preventing the innate immune system's catastrophic dysregulation sometimes called "cytokine storm" (see here, here, here, here, here for a few examples). A new study now suggests that daily statin use by people under 75 may also lead to a significant (40%) reduction in cataracts. This from a study in Epidemiology of 180,000 patients seen between 1998 and 2007 in Israel: Dr. [Gabriel] Chodick and his colleague Dr. Varda Shalev found that men aged 45 to 54 who took…
I know families that if you visited them and found them laughing, confused, dizzy, thirsty and vomiting and apparently hallucinating you would think, "everything's normal." On a July night in suburban Maryland, however, an after dinner social call by a relative didn't think it was normal at all and EMTs were called and six adults were headed for the hospital, five to the intensive care unit. Attention immediately focused on what they all had in common, a meal of stew and bread an hour earlier: On admission to the emergency department, two of the six patients were unconscious. The other four…
Grant writing makes you crazy and also forces bloggers to stoop to ever lower levels. Hence this from the Discover Magazine blog via Boingboing. While trawling for gold in the medical case literature they struck it rich with the story of the 15 year old girl with no vagina who got pregnant by giving her boyfriend a blow job (British Journal of Obstetrics and Gynaecology: 1988 Sep;95(9):933-4). Not possible? You be the judge: Case report: The patient was a 15-year-old girl employed in a local bar. She was admitted to hospital after a knife fight involving her, a former lover and a new…
While I work on my monster grant proposal -- I and my colleagues have been working on it for 9 months, but with the deadline only 3 months away it is time to turn the volume up to 11 -- blogging may be light or brief. But posting something is an excuse to take a break and surf the web a bit, so that's what you'll be getting for the next 3 months. After that I'll probably check into an institution with no internet access to be sedated. Yesterday I read on Medgadget that AccuWeather is selling an iPhone app to alert users of weather-associated health events in 16 locations: Do you suffer from…
[Previous installments: here, here, here, here] We'd like to continue this series on randomized versus observational studies by discussing randomization, but upon reviewing comments and our previous post we decided to come at it from a slightly different direction. So we want to circle back and discuss counterfactuals a little more, clarifying and adapting some of what we said for the coming randomization discussion. Let me change the example to a more recent controversy, screening mammography for breast cancer. Should women under 40 get routine screening given that there is said (on the…
Continuing our discussion of causation and what it might mean (this is still a controverted question in philosophy and should be in science), let me address an issue brought up by David Rind in his discussion of our challenge. He discussed three cases where a rational person wouldn't wait for an RCT before taking action, even though there remained uncertainty. The first was a single case report of rabies survival after applying an ad hoc protocol. The next was use of parachutes while sky diving. The third was the first reports of antiretroviral therapy for AIDS. Here's what Rind said in his…
I'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…
The Director of Loyola University Medical Center's clinical microbiology laboratory is reported as saying that rapid flu tests are a public health risk. Here's some of what he said and then my explanation as to why it is misleading or just plain wrong: Rapid influenza diagnostic tests used in doctors' offices, hospitals and medical laboratories to detect H1N1 are virtually useless and could pose a significant danger to public health, according to a Loyola University Medical Center researcher. "At Loyola, we determined four years ago that the rapid tests for influenza detected only 50 percent…
One of the most feared outcomes of infection with influenza is Acute Respiratory Distress Syndrome (ARDS; in less severe form it mahy be called Acute Lung Injury, ALI). For reasons we still do not understand, cells deep in the lung that are involved in gas exchange (oxygen and carbon dioxide) become so damaged that the basic work of supplying the body with enough oxygen for life and getting rid of the carbon dioxide generated by metabolism is too much for the patient and either some intervention to relieve the lungs of some of the work is made or the patient dies. ARDS is so severe that often…
Two elite flu reporters, Helen Branswell (Canadian Press) and Declan Butler (Nature), both noted yesterday the dearth of clinic information on the serious and fatal swine flu cases. First Butler: Clinical researchers have been slow to respond to the 2009 flu pandemic, lament researchers writing in today's Lancet. "Public health officials, virologists, epidemiologists, and policy makers have done well in responding to a rapidly emerging and complex problem. By contrast, the clinical research community's response has been delayed and modest, " writes Jeremy Farrar, a researcher in Ho Chi Minh…
Since I talk a lot about flu in my real life as well as on the blog, I get questions from moms and care givers who wonder when they should start to get worried about a sick child or relative. It's context dependent, of course. The same symptoms that would be shrugged off at any other time take on a different meaning during a flu outbreak, especially when everyone seems uncertain about what is happening or what might happen. There's nothing irrational about this. Infection with influenza virus is always potentially serious and when the young and healthy are in the cross-hairs even more so.…
A reader (hat tip River) sent me a link to a New York Times piece quoting a physician who recently saw swine flu cases in Mexico City. He called attention to what seemed like an anomalous clinical presentation of many cases. Besides a higher proportion of gastrointestinal symptoms (nausea, vomiting, diarrhea), Virginia Commonwealth infectious disease specialist Dr. Richard P. Wenzel was surprised that many cases, even severely ill ones, did not have fever: Many people suffering from swine influenza, even those who are severely ill, do not have fever, an odd feature of the new virus that…
CDC has just concluded a press briefing and the big news is there is no big news. In fact there was hardly any small news. The major questions have been identified -- how transmissible, what is the epidemic curve, are there more cases in the US, are there subtle genetic differences in the US and Mexican versions to account for the apparent difference in clinical and epidemiological features, etc. -- but answering them will take longer. Meanwhile, no new cases have been identified in the US, but CDC in collaboration with state and local health departments and the academic and medical sectors…
There are certain things that go under the rubric "complementary medicine" that also boast they represent the Wisdom of the Ages -- old therapies for currently difficult conditions that turn out to be just as good as our current therapies. Or just as bad. This week the British Medical Journal has a case in point: the use of maggots for wound healing (Dumville et al., "Larval therapy for leg ulcers (VenUS II): randomised controlled trial," BMJ 2009;338:b773 [doi:10.1136/bmj.b773]). The wounds in this case were the notoriously difficult to treat leg ulcers that develop as a result of impaired…
If the 1960s film, The Graduate, were to be made today (Graduate, II: The Stimulus), the iconic scene at the party where a friend of the family takes Dustin Hoffman aside and whispers in his ear, "I have only one word for you, Plastics") would be transmogrified into, "I have only three words for you, Health Information Technology." HIT, and its love child with the recently passed stimulus package, the Electronic Medical Record, have all the characteristics of a good idea destined to go bad. One of my vivid memories from my early career was being shown a new kind of quiet printer, called an…
Papers on biodiversity are not my regular science reading fare and the reason I found my self reading the article "Initial community evenness favours functionality under selective stress" by Wittebolle et al. in Nature from last week isn't very important. But I did find myself reading about the "biodiversity-stability relationship" in a microbial ecosystem, so rather than let all that effort go to waste I decided to write about it here. Like most things that wind up on this page, there is an extra little twist at the end, this time where I come out against biodiversity, but to get there you'…
The Supreme Court ruled yesterday that if the FDA approves a drug, it doesn't mean you don't have to keep the labeling up to date if you should warn people. So that settles one question about FDA approval. The FDA put its stamp of approval on the drug Vioxx, too, but approved or not, Vioxx was not OK. Some unfortunate people traded their arthritis pain for a heart attack. Not a good trade. So the maker of Vioxx got sued. When the regulatory agencies don't do their job, that's about the only remedy left. More important, it is the only way to change the behavior of companies whose negligence…