medicine
palmd | February 19, 2009It's been a slow flu season this year---until now. In the last week I've seen people dragging themselves into the office looking like absolute hell---fevers, cough, severe muscle aches---in other words, they've got the flu.
The latest CDC data shows a marked increase in flu activity.
A large percentage of isolates are influenza A, type H1N1, which is currently resistant to one of our antiviral medications oseltamivir (Tamiflu). Of 110 influenza isolates collected so far in Michigan this season, 74 are A(H1N1). The strain is still susceptible to zanamivir (Relenza), rimantadine, and…
palmd | February 19, 2009It seems the same questions keep coming up when looking at the cult leaders of the infectious disease promotion movement. When you listen to them preach or read their liturgy you can't help thinking, "dumb, evil, or both?" I think I'm going to vote for "both" when it comes to Deirdre Imus. Her sermon last week in the Huffington Post was so far over the top that my nose is still bleeding from climbing her tower of intellectual excrement.
Her title advises health consumers, "On Vaccinations: Consider the Source and Follow the Money."
I don't know what that means, but Deirdre explains, "…
oracknows | February 19, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
j7uy5 | February 19, 2009The NEJM has published a provocative article about the ethics of the
globalization of clinical trials. (The article is openly
accessible.) The big issue is this: clinical trials are very
expensive. It is cheaper to do them overseas, but this raises
questions of scientific integrity, as well as questions of ethical
integrity.
Ethical
and Scientific Implications of the Globalization of Clinical Research
Economic globalization is an important development of the past half
century. Proponents of globalization highlight the benefits of greater
economic growth and prosperity; critics point to…
oracknows | February 18, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
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…
oracknows | February 18, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
oracknows | February 17, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
oracknows | February 17, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
jstemwedel | February 17, 2009Owing to the fact that children are vectors of disease, three out of four members of the Free-Ride household have been feverish, achy, sneezy, sleepy, and grumpy for the past few days. (It's not clear yet whether the progression of this bug will include other dwarves.)
Since I'm still kind of dopey, in lieu of a content-ful post, I'm offering some random musings from the sickbed.
Parental fever detection:
Before we go looking for the ear-thermometer, we check for fevers the old-fashioned way: kissing the forehead. If a forehead feels hot (or even warmer than usual) to our lips, then you can…
oracknows | February 16, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
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.…
oracknows | February 16, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
palmd | February 16, 2009The New York Times is reporting that the economic stimulus bill will include over a billion dollars to fund research into medical evidence. This is a good thing, but it's bound to be controversial. I've mentioned before that we need to spend money to improve our medical infrastructure, and this could be a step in the right direction.
Much of what we do in medicine is science-based, and much of it has evidence to support it, but some does not. There are plenty of open questions about how we practice medicine, and in order to deliver safe, quality care, we need answers. For example, a…
oracknows | February 15, 2009What's an advocate of evidence- and science-based medicine to think about the National Center for Complementary and Alternative Medicine, better known by its abbrevation NCCAM? As I've pointed out before, I used to be somewhat of a supporter of NCCAM. I really did, back when I was more naïve and idealistic. Indeed, as I mentioned before, when I first read Wally Sampson's article Why NCCAM should be defunded, I thought it a bit too strident and even rather close-minded. At the time, I thought that the best way to separate the wheat from the chaff was to apply the scientific method to the…
oracknows | February 15, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging. Because I foresaw this day coming, however, I did set up a series of "Best of" reposts to autopost for you while I am in mourning. Some I have even updated and/or spiffed up with actual editing. If you've been reading less than a year or two, they're new to you. This particular one I've updated slightly.…
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…
oracknows | February 13, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging. Because I foresaw this day coming, however, I did set up a series of "Best of" reposts to autopost for you while I am in mourning. Some I have even updated and/or spiffed up with actual editing. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don'…