health
palmd | February 23, 2009A while back I wrote about a naturopathic "physician" who was specifically preying on the Latino community. This is troubling for a number of reasons, some of which I mentioned. In my zeal to rant about the quackery, I may have not delved deeply enough into some of the other important issues.
For example, Hispanics have rates of diabetes and stroke well above the white Anglo population. These are conditions for which we have very effective science-based treatment. Proper treatment of high blood pressure in diabetics reduces the rate of heart attack and stroke by 35-50%. Proper foot care,…
palmd | February 18, 2009Before I started medical school I worked at a clinic that served the deaf and hard-of-hearing community. I was the "front office", greeting patients, answering the phone by TDD/TTY or by relay service (this was before the existence of text messaging, instant messaging, or anything else that relied on cell phones or on the internet---none was in common use). I learned some rudimentary ASL (simple, polite phrases), and was introduced to the deaf community. It was simply fascinating. I learned about the controversies surrounding deaf culture (such as cochlear implants, assimilation, and…
palmd | February 18, 2009There was a piece of good news on vaccine front this week. The first judgments from the Autism Omnibus Trial were announced, and the special masters (who served as judges) agreed with the rest of the reality-based community in ruling that vaccines do not cause autism. The rulings weren't subtle, using phrases such as "misled by physicians who are guilty, in my view, of gross medical misjudgment". This is the Dover of the "other" ID promotion movement.*
Like any cult, however, the infectious disease promotion movement is unlikely to be persuaded by any level of evidence. This, despite…
palmd | February 17, 2009I'm getting really tired of this nature vs. nurture debate when discussing homosexual rights. It's always interesting to investigate the origins of human behavior, and occasionally something is found to be purely genetic, but I suspect that sexuality, like many human attributes, has a complex mix of biological and non-biological causes. That doesn't piss me off. What pisses me off is the insistence by right wing religious cults on "proving" that homosexuality is a choice.
Sexuality phenotype is a tough concept if you really think about it. The harder you try to nail down the difference…
palmd | February 16, 2009Morning report is a daily conference for medical residents. It is done differently at different institutions, but normally a case is presented, often by the post-call team, and discussed by the senior residents and an attending physician. Today's case will be the first in an occasional series. It is best read above the fold first, and then going below the fold after digesting the first part adequately. --PalMD
A fifty year-old woman presented to her primary care physician with hemoptysis (bloody cough). She has a history of emphysema and tuberculosis, which was treated about 25 years ago.…
edyong | February 15, 2009
A child in the womb is not just some hapless creature waiting to be born into a world of experience. It is preparing. Through its mother, it senses the conditions of the world outside and its body plans its growth accordingly.
There is strong evidence that people who are under-nourished as embryos grow up to have higher risks of heart disease and other chronic illnesses. For example, people born to women during the Dutch Famine of 1945 had higher risks of coronary heart disease as adults.
We might nod our heads at this as if it were expected news, but it's actually quite a strange result.…
palmd | February 15, 2009Science is hard. But science, and the methodological naturalism that underlies it, has proved to be the best way to observe, describe, and explain our reality. Sure, people can come up with ridiculous straw man arguments like, "but how do you measure love?" but these arguments ring hollow. (We measure "love", a behavior, by the observable behaviors that human beings report when they are "in love".) To a scientist, the appeal to magic to describe the world is difficult to understand, since the real puzzle is so much more fun. If, for example, you discover the cause of a particular disease…
gregladen | February 14, 2009For the last couple of decades, perhaps beginning around the time of the publication of Laurie Garret's excellent thesis (The Coming Plague: Newly Emerging Diseases in a World Out of Balance) on disease and politics and continuting through Gina Kolata's "Flu: The Story Of The Great Influenza Pandemic" there has been increased attention on the 1918 flu virus and pandemic, as well as subsequent outbreaks. This interest has probably been fueled by increased knowledge of (or incidence of?) tragic and highly newsworthy outbreaks of Ebola, SARS, and so on. More recently, the perception has grown…
gregladen | February 11, 2009A Bolivian woman has died from an injection of urine allegedly administered by her friend as a form of health therapy, a prosecutor said Tuesday. Investigating prosecutor Oscar Flores told The Associated Press that 35-year-old Gabriela Ascarrunz died Saturday of an "infection caused by urine that was injected by fashion designer Monica Schultz."
Local newspapers reported that Schultz, who is known across Bolivia for her clothing lines, is a practitioner of urine therapy -- a form of alternative medicine using human urine for cosmetic purposes or to treat various diseases. Some people rub it…
palmd | February 9, 2009I keep pandagon.net on my google reader. I don't agree with everything I read there, which is a good thing, but I do respect Amanda Marcotte's opinions (and they are always well-written).
I must take some exception with her recent analysis of the octuplet fiasco. It's not just that I have a problem with blaming everything bad on Teh Patriarchy (which I do), but I think that sometimes dealing with patriarchy distracts from other real issues. Yes, sexism and patriarchy are important in society, but not everything is that simple. Let's take a look (emphasis mine):
At this point in time, I…
omnibrain | February 9, 2009I love 'I told you so' moments...Brain games don't do shit.
(this is totally going to come back and bite me in the ass though)
A number of months ago, I made a claim that paying for brain games was a waste of money. I got jumped on pretty hard for that claim - even though there isn't much evidence of their benefits except for perform the brain game itself better after a lot of practice (and maybe a couple other semi-related ones). I've been vindicated now by a meta-analysis of the relevant literature by Peter Snyder of the Brown med school.
Check this out from the press release:
Through a…
gregladen | February 7, 2009An investigation by the Sunday Times (UK) indicates that the doctor who reported information suggesting a link between MMR vaccine and autism may have "misreproted results in his research." The investigation purpots to show that ...
...Andrew Wakefield manipulated patients' data, which triggered fears that the MMR triple vaccine to protect against measles, mumps and rubella was linked to the condition.
The research [originally] claimed that the families of eight out of 12 children attending a routine clinic at the hospital had blamed MMR for their autism, and said that problems came on…
palmd | February 7, 2009The movement against vaccination is old---very old. All medical interventions require scrutiny. Like any medical intervention, vaccines require systematic investigation before deployment, and monitoring during their use. Still, vaccines have done more for public health than most Westerners under the age of fifty can imagine.
Inoculation and vaccination have been vilified in many ways, from interfering with the will of God, to being a vast conspiracy to infect [insert ethnic group here] with [insert disease here], to a cause of autism.
There have been "bad" vaccines, and when this has…
palmd | February 6, 2009Apparently, it's time once again to remind people why vaccination is important. Pertussis ("whooping cough") is a nasty vaccine-preventable illness that is highly contagious and can be deadly to little ones. And it's making a comeback. The Michigan Department of Community Health is tracking this disturbing trend:
Michigan saw a significant increase in reported cases of pertussis (whooping cough) in the second half of 2008 compared to the first half of the year, prompting officials to remind parents and doctors of the importance of vaccinating infants as well as teens and adults against…
gregladen | February 5, 2009When word of this study gets around, you may start to hear that voluntary vaccination "works." This would not be an accurate statement. There is a new study just now out in PLoS Computational Biology that reveals that under certain conditions, which may actually be quite rare, voluntary vaccinations might lead to the eradication of a disease (contrary to 'popular wisdom'). However, you must realize that the study has some important limitations and the results do not suggest that most (if any) current vaccination issues be voluntary rather than mandatory.
The idea that voluntary…
gregladen | February 5, 2009Multiple sclerosis (MS) is the most common serious neurological disease that affects young adults, wiht about 2.5 million victims worldwide. The disease involves a loss of myelin in brain and spinal cord neural tissues. Myelin is the protective and insulating layer that covers most axons in the mammalian nervous system.
can be caused in part by a particular set of genetic variations in the Major Histocompatibility Complex (MHC), which in turn cause significant neurological effects. There is compelling epidemiological information to suggest that there is also an important environmental…
palmd | February 4, 2009So I was checking out my incomming links on sitemeter and I found a great one. You see, fake diseases alway bring out the wackos.
This is the thing about medical wackos. Not only do they think that they have diseases that no real doctor thinks exists, but they think everyone else must have it, too.
Niels, a guy who I've had to ban before for hostile comment spam, and whose designation on his own board is, appropriately, "Ultimate Member", has this to say about my back woes:
this time, i believe karma has already taught him the lesson he needs to learn (sounds like he has lyme disease...…
gregladen | February 4, 2009How much are we actually spending on the development of pharmaceutical tools to treat HIV/AIDS, TB, leichmaniasis, malaria and sleeping sickness?
Today, PLoS Medicine Policy Forum asks this question. According to a press release from PLoS:
The first comprehensive survey of global spending on neglected disease R&D, published in this week's PLoS Medicine, finds that just over $US 2.5 billion was invested into R&D of new products in 2007, with three diseases--HIV/AIDS, TB, and malaria--receiving nearly 80% of the total.
However, the survey finds that many neglected diseases,…
palmd | February 3, 2009She sat on the exam table looking tired an cranky. Otherwise there wasn't much to note about her appearance---not young, but not old; not thin, but not fat; she didn't smell of smoke or have pet hair on her clothes. A glance at her demographics sheet confirmed that she was middle-aged, domiciled, and employed---and uninsured. But why tired and cranky?
She's been wheezing for weeks and this was her second visit to the doctor for the same problem. She has been using her short acting inhaler every few hours, with some temporary relief, but she's run out. It's hard for her to sleep at night…
palmd | February 2, 2009One of the frequent complaints I hear about real medicine is that it is dangerous. Of course, it's true---so is riding in a train, but it sure beats walking. And that's the danger of this particular fallacy---yes, medicine is a sharp tool, but it's also an effective tool, so we must use it properly. And this is where the tools of evidence- and science-based medicine can give us a hand.
The potential harms of modern medicine must be approached carefully. If they are ignored or approached in an ineffective way, we'll miss an opportunity to save lives. This comment is typical of the type of…