surgery
oracknows | July 8, 2008Having lived in Ohio for eight years and married a woman from the Toledo area, I had come to think that Ohioans had more common sense. I guess I was wrong.
On the other hand, I should have realized that I was wrong. After all, Ohio is home to The Ohio State University Center for Integrative Medicine and the Cleveland Clinic Department of Integrative Medicine. So much for hard-nosed Midwestern skepticism, I guess. My only consolation as a University of Michigan graduate is that Ohio seems to be trying to surpass Michigan for promoting woo in academia. Or it would be were it not that a major…
oracknows | June 29, 2008I have some bad news for the medical blogosphere. Well, actually Sid Schwab does. Apparently, he's decided to drop out of the blogosphere, at least for now.
Sid's grown enormously as a blogger since he first started hawking his book a couple of years ago in the comments here. He got on my nerves at first, but I quickly took a liking to him and his blog, realizing that his early self-promotion came from his being new to the blogosphere and not realizing that too much of that sort of stuff is generally frowned upon. Now he's a well-respected medical blogger, and definitely one of the best. The…
oracknows | June 26, 2008
Sigh.
He's baaack. Yes, that dualism-loving Energizer Bunny of antievolution nonsense, that "intelligent design" apologist neurosurgeon whose nonsense has driven me time and time again to contemplate hiding my head in a paper bag or even a Doctor Doom mask because of the shame of knowing that he is also a surgeon, that physician who denies that an understanding of evolution is important to medicine and who just doesn't know when to quit, Dr. Michael Egnor, is back to embarrass me yet again. It's been a long time--months, actually--and, quite frankly I found the break from his specious…
oracknows | June 23, 2008If there's one thing that lay people (and, indeed, many physicians) don't understand about screening for cancer is that it is anything but a simple matter. Intuitively, it seems that earlier detection should always be better, and it can be. However, as I explained in two lengthy posts last year, such is not always the case. To understand why requires an understanding of cancer biology. The reason is the extreme heterogeneity of tumor behavior and prognosis. This variability was well described in a study from about a month ago, in which it was observed that the doubling time of breast cancers…
oracknows | June 12, 2008From my perspective, one thing that's always been true of surgery that has bothered me is that it is prone to dogma. I alluded to this a bit earlier this week, but, although things have definitely changed in the 20 years since I first set foot, nervously and tentatively, on the wards of the Cleveland VA Medical Center for my first ever surgical rotation, some habits of surgeons die hard.
Of course, regardless of the tendency towards dogma, one thing that differentiates evidence- and science-based medicine from pseudoscientific woo is that studies do make a difference. In general and…
oracknows | June 9, 2008After having subjected my readers to all those posts about the antivaccination lunacy that was on display in Washington, D.C. last week, I think it's time for a break from this topic, at least for a while if not longer. In the run-up to the "Green Our Vaccines" rally events on the antivaccinationism front were coming fast and furious, and I felt it was my duty to comment on them. Now, with great relief I can say that the rally is over. How many people actually attended the rally is uncertain. The organizers themselves claim that 8,500 people attended, while more objective estimates from…
oracknows | June 2, 2008Thanks to the ASCO meeting and meeting up with some relatives here in Chicago, I didn't quite finish what I was going to post this morning. There have been at least a couple of abstracts presented that I wouldn't mind blogging about; I just haven't gotten to them yet. I also haven't forgotten about Jenny McCarthy's upcoming antivaccination-fest in Washington, D.C. on Wednesday. More will be forthcoming on these and other topics, perhaps even as early as later today.
In the meantime, I wanted to mention that that I walked by the booth for the Colorectal Association of Canada and their infamous…
oracknows | May 21, 2008"Early detection of cancer saves lives."
How many times have you heard this statement or something resembling it? It's a common assumption (indeed, a seemingly common sense assumption) that detecting cancer early is always a Very Good Thing. Why wouldn't it be, after all? For many cancers, such as breast cancer and colon cancer, there's little doubt that early detection at the very least makes the job of treating the cancer easier. Also, the cancer is detected at an earlier stage almost by definition. But does earlier detection save lives? Does finding more disease before surgery that wouldn…
oracknows | May 20, 2008I hate it when I fall behind in my journal reading. Of course, it happens all the time, as you might expect, with my time sandwiched between running my lab, writing grants, seeing patients, and operating. Sometimes, though, I get a chance to try to catch up a bit. Such was the case the other day, but unfortunately I came across an article that almost made me wish I hadn't. It was a study published in the February issue of Annals of Surgery1 and it showed that the situation is much worse than I expected. it also shows that I may be a rarer bird than I thought I was, and not just because of my…
oracknows | May 15, 2008Perhaps one of the most common misconceptions held about cancer among lay people is that it is one disease. We often hear non-physicians talk about "curing cancer" as though it were a single disease. Sometimes, we even hear physicians, who should know better, using the same sort of fuzzy thinking and language about "curing cancer" as well. But cancer is not a single disease. Indeed, it's a collection of dozens of different diseases, with different cell types of origin, pathophysiologies, behaviors, and treatments. True, there are a fair number of commonalities between cancers in terms of…
oracknows | May 13, 2008Last week, I wrote about factors that lead to the premature adoption of surgical technologies and procedures, the "bandwagon" or "fad" effect among surgeons, if you will. By "premature," I am referring to widespread adoption "in the trenches," so to speak, of a procedure before good quality evidence from science and clinical trials show it to be superior in some way to previously used procedures, either in terms of efficacy, cost, time to recover, or other measurable parameters. As I pointed out before, laparoscopic cholecystectomy definitely fell into that category. The popularity of the…
oracknows | May 8, 2008In science- and evidence-based medicine, the evaluation of surgical procedures represents a unique challenge that is qualitatively different from the challenges in medical specialties. Perhaps the most daunting of these challenges is that it is often either logistically impossible or unethical to do the gold-standard clinical trial, a double-blind, randomized placebo trial, to test the efficacy of an operation. After all, the "placebo" in a surgical trial involves exposing patients to anaesthesia, making an incision or incisions like the ones used for the operation under study, and then…
oracknows | April 30, 2008
I may have joked a bit about certain surgeons whom, because they say such dumb, pseudoscientific things with alarming regularity, I consider embarrassments to the noble profession that is surgery. Usually, it's been surgeons who reveal an astonishing ignorance of the science of evolution as they parrot long discredited and debunked canards about evolution while spouting creationist nonsense. You know about whom I speak: surgeons like neurosurgeon Dr. Michael Egnor and general surgeon Dr. Henry Jordan. But, as mind-numbingly dumb as some of the things that, for example, Dr. Egnor has said…
oracknows | April 28, 2008It's that time again: The 20th edition of the only blog carnival (that I know of, at least) for blogging about surgical topics has landed over at Surgeonsblog. Yes, Sid Schwab takes on the 20th SurgeXperiences, with limericks, even!
Head on over!
oracknows | April 22, 2008Yesterday I came across a blog exchange between Dr. Jekyll & Mrs. Hydeand fellow SBer Physioprof about principal investigators (PIs) who still do experiments in the lab. For those not in the science business, a "principal investigator" is in general the faculty member who runs the lab and whose grants fund the salaries of the postdocs, graduate students, and technicians working in the lab. J&H pointed out (correctly) that few PIs who have been faculty more than five years do any actual lab work anymore and described the case of a PI who persists in doing experiments himself,…
oracknows | April 7, 2008...or so says #1 Dinosaur, who was buried under a blizzard of radiology reports.
I tend to agree up to a point, but the only problem from my perspective is this: Until recently, it was not at all uncommon for me to get seemingly millions of copies of every radiology report for mammography, ultrasound, and core needle biopsies on my patients. There's a preliminary report, a final report, an amended report, a report with the pathology report added, a report with the pathology report and the estrogen/progesterone receptor status added, and then multiple copies of the final report. We ended up…
oracknows | March 19, 2008Imagine that you're a soldier in Iraq. Imagine further that you're on patrol in a dangerous area in the middle of summer, the desert heat penetrating your 80 lb pack much the way boiling water penetrates the shell of a lobster. Your heart is racing as you and your unit nervously dart to and fro, every shadow a potentially deadly threat, every alley a refuge from which the enemy can attack and kill. The area's thick with insurgents and terrorists, and you feel as though you have a huge bullseye painted on both your chest and back.
A loud roar fills your ears, and you feel as though you have no…
oracknows | March 5, 2008Perusing the news early this morning, I noticed an article on ABC News about placebos. One thing I found interesting about it was that it was a story about a research letter to JAMA, not a full study. Heck, there isn't even an abstract.
Even so, the study was rather interesting and described thusly:
The more expensive your pain medications are, the better the relief you get from taking them -- even if they're fake.
That's according to a study published this week in the Journal of the American Medical Association, which suggests that sugar pills labeled as expensive drugs relieve pain better…
oracknows | February 28, 2008In the two days since I first mentioned an attempted home invasion of a researcher at the University of California Santa Cruz (UCSC) by bandana-masked animal rights terrorists, there have been new developments worth posting an update here.
First, last night the Santa Cruz Sentinel posted a story indicating that the FBI are now involved in the investigation:
SANTA CRUZ - The FBI is investigating a possible connection between a militant animal rights group and the weekend attack on the home of a UC Santa Cruz researcher, a spokeswoman confirmed Wednesday.
"The reason we said we'd look into it…
oracknows | February 28, 2008I didn't want to blog about this. I really didn't.
No, the reason why I didn't want to blog about this latest screed by mercury militia enabler David Kirby is not because it is about any sort of slam-dunk proof that vaccines do after all cause autism, a mistaken impression that you might get if you just looked at the crowing throughout the antivaccination blogosphere. Rather, it's because I've been forced once again to wade through Kirby's smug, self-congratulatory, and intentionally obfuscatory prose to try to figure out just what the hell he was talking about and then try to make sense of…