surgery

About a year ago, I discussed an article by Dr. Atul Gawande describing a quality improvement initiative that appeared to have been stalled by the Office for Human Research Protections and its apparent tendency to apply human subjects research protection rules to initiatives that are not exactly research using human subjects. The problem appeared to be an excessively legalistic and a "CYA" attitude more than a genuine concern for protecting human subjects. At the time, I was more concerned with the ethical and policy implications of the story rather than the actual research itself. After all…

Here's one for our favorite creationist neurosurgeon: A whole Grand Rounds all about the interface of and application to medicine of the theory of evolution.

I've been meaning to write about this topic for quite a while but never really found a reason to. Indeed, this one's been floating around in the back of my mind for a long time. Perhaps one reason is that it's hard for a surgeon to write about this topic without coming off sounding like an old fart, a curmudgeon, unhappy about change and thinking that a system that was good enough for me must sure as hell be good enough for the current generation of residents. In fact, even after seeing an article that normally would have spurred me to write about this topic more than two weeks ago, I stored…

...more not-so-Respectful Insolence, courtesy not of Orac this time but of other skeptical physician-bloggers! Enjoy: Smackdown, please (yes, Egnor, I'm talking to you) (by blog bud PalMD) Defending science-based medicine (by skeptical neurologist Dr. Steve Novella, who's been known to spar a bit with Dr. Egnor himself over evolution and neuroscience) Egnorance is Bliss (by Dr. Kimball Atwood IV)

I have to wonder if the most famous denizen of the Discovery Institute in medical circles, Dr. Michael Egnor, is on vacation or something. For some reason, he's been especially active over at the Discovery Institute's repository of pseudoscience, Evolution News & Views, over the last couple of weeks. Neurosurgeons tend to be very busy people, more so even than a humble breast cancer surgeon like me, and few are as motivated as I am to blog. Yet, these days Dr. Egnor's been flooding EN&V with more of his blather than I've seen him do in a long time, maybe ever. It's times like these…

Pretty IA, Hall RC. Self-extraction of teeth involving gamma-hydroxybutyric acid. J Forensic Sci. 2004 Sep;49(5):1069-72. Guy and girl are hanging out. Decide to get smashed on gamma-hydroxybutyric acid (GHB), a CNS depressant of historical medical use that is currently used as a recreational drug, as a date rape drug, and by bodybuilders looking to boost their endogenous production of human growth hormone. Bodybuilders are so weird. At some point during their GHB-fueled escapades, eighteen of the girl's teeth are extracted from her mouth with a pair of pliers. Not one, not two, but…

I tell ya, I'm on the light blogging schedule for a mere four days, thanks to the Thanksgiving holiday weekend, the happy invasion of family on Thursday and Friday, and a significant amount of grant writing I've had to deal with on Saturday and Sunday, and somehow I missed not only a study relevant to my field of interest, but the reaction of antiscientific quackery apologists to said study. First, let's look at the reaction, then the study, which reports that as many as 22% of mammographically detected breast cancer may spontaneously regress. First off the block is Dr. Joel Fuhrman: It's…

Here we go again. It seems just yesterday that I was casting a skeptical eye on yet another dubious acupuncture study. OK, it wasn't just yesterday, but it was less than two weeks ago when I discussed why a study that purported to show that acupuncture worked as well as drug therapy for hot flashes due to breast cancer therapy-induced menopause. Unfortunately, these days these sorts of dubious studies seem to be popping up fast and furious like Whac-A-Mole, so much so that I can't always keep up with them. So it is again, although this time it's acupressure, not acupuncture. Unfortunately,…

More than two-thirds of breast cancers make the estrogen receptor. What that means is that these tumors have the protein receptor that binds estrogen, which then activates the receptor and causes all the genes that are turned on or off by estrogen to be turned on and off. That's how estrogen acts on normal breast epithelial cells and on breast cancer cells. The significance of this observation is that estrogen receptor-positive (ER+) breast cancers respond to estrogen. Indeed, estrogen contributes to their growth, and blocking estrogen is an effective treatment against them. Indeed, that most…

I've often written about the intersection of medicine and religion. Most commonly, I've lamented how the faithful advocate inappropriately injecting religion into the doctor-patient relationship in a manner that risks imposing the religion of the health care practitioner on the patient, sometimes through physicians feeling no obligation to inform patients of therapeutic options that violate their religious beliefs or pharmacists refusing to dispense medications that (they claim) violate their beliefs. Another common thread running through this blog is criticism of religion when it leads…

The closest I've come to performing surgery on my self was the time I popped a really big zit behind my ear. Heck, that sucker might have even been a cyst or something. The cases I've managed to dig out and list below are, shall we say, way more friggin' impressive. Oh, and Wikipedia has a neat little entry on self-surgery that is worth a quick read. Personal self-surgery experiences, as always, are welcome in the comments section! Harper KA. Double fracture and wedging of a sewing needle interdentally in an attempt at self-treatment: a case report. Dent Update. 2002 Mar;29(2):78-9. How in…

"One dumb tumor is still smarter than ten smart oncologists." --George Sledge, MD My only retort is that, slowly but surely, oncologists and we oncologic surgeons are getting smarter.

If there's one thing that cancer researchers, indeed most biomedical researchers in the U.S., know today it's that the research funding climate sucks right now. Indeed, after the completion of the near-doubling of the NIH budget in 2003, during which time it was flying high, the NIH budget in essence crash landed--hard. Paylines, which had been well over the 20th percentile (meaning that over 20% of grant applications in any give deadline cycle were funded) plummeted to near single-digit ranges almost overnight. Indeed, I almost fell victim to this myself in 2004. The initial score on my R01…

...is through his plush guts, as Liz Ditz tells me: I particularly like the plush pancreas, even though I haven't done pancreatic surgery on a regular basis since the 1990s. I'm a little confused, though, about why the plush gallbladder is purple instead of green. Surgeons really, really hate to see purple gallbladders, because the only purple gallbladder is a dead or dying gallbladder. (OK, necrotic gallbladders are usually greenish black, but they can look purplish in some areas.) I'm also a bit puzzled by the choice of yellow for the liver, given that the liver is reddish-brown. But,…

Hanging out last night, the final night of a three day holiday weekend, I was momentarily at a loss for what to write. For one thing, having spent a good chunk of the last three days unpacking the remaining stuff we've had in our basement in boxes for the last six or seven months, my wife and I had a pretty good sense of accomplishment but not a lot of energy left. So much for one of my analyses of a study or a medical issue. I was also half-tempted to go back and listen again to the Science Friday last week because the antivaccinationist named Chantal who called in at the end was a perfect…

Since vaccines seem to be back in the news again, I would be remiss if I didn't mention a fantastic post that I saw the other day over at A Photon in the Darkness. Read it. Read it now. I've done fairly long posts about how pseudoscientists and antivaccine advocates are capitalizing on the case of Hannah Poling, who had a mitochondrial disorder that, the government conceded, may have been exacerbated by vaccines. Meanwhile, antivaccine mouthpiece David Kirby is shouting to the world that new findings that mitochondrial disorders are more common than previously thought is somehow vindication…

I don't much like Mike Adams of NaturalNews.com (formerly NewsTarget.com). Indeed, I haven't yet been able to find a more blatant purveyor of the worst kind of quackery and paranoid anti-physician and anti-medicine conspiracy theories anywhere on the Internet, with the possible exception of Whale.to. However, Whale.to is so utterly, outrageously, incoherently full of not just quackery but paranoid New World Order conspiracy theories and other paranormal silliness that any but the most deluded can easily see it for what it is with just a cursory reading of a few of its many, many pages. It's…

I've been a bit remiss in my duty toward a fellow ScienceBlogger. No doubt a few were wondering (or maybe not), why I, as the resident breast cancer expert here, didn't point out that my fellow ScienceBlogger Janet live-blogged her very first screening mammogram last week. Truth be told, I had meant to mention it a day or two after she first posted it, but it plumb slipped my mind. Maybe it's early stage Alzheimer's disease. Whatever the case, I had meant to use her post to point out that, as a breast cancer surgeon, I sometimes forget just how annoying and cumbersome getting a mammogram can…

Late Thursday night, I posted a full-out rant about what I considered to be an incredibly unfair and stupid generalization of the bad behavior of a single surgeon to an overblown and hysterical indictment of medical students, doctors, and surgeons by a fellow ScienceBlogger, posted on his own blog and on Feministe. Fellow ScienceBloggers Mark Hoofnagle and PalMD posted similar criticism, all of which, in my humble opinion (or IMHO, in Internet-speak) were justified. One thing I didn't mention was that I debated for a while whether or not to post my criticism, because the reputation and…

You know, it really annoys me when I see idiocy as idiotic as the idiocy of this surgeon in New Jersey: In a lawsuit filed yesterday, a Camden County woman accused her orthopedic surgeon of "rubbing a temporary tattoo of a red rose" on her belly while she was under anesthesia. The patient discovered the tattoo below the panty line the next morning, when her husband was helping her get dressed to go home after the operation for a herniated disc, her attorney, Gregg A. Shivers, said in a phone interview yesterday. "She was extremely emotionally upset by it," said Shivers. The suit, filed on…