palmd | September 22, 2009Science-based medicine, my other blogging venue, is temporarily down. The posts are written by a stable of fantastic professionals, and they are always a good read---except for today. Recently, we migrated to a new server and shortly thereafter, the blog became buggy until it crashed completely. The culprit appears to be traffic---lots of traffic. That's a good thing (unless it's a DDOS attack, which is not completely implausible).
So, Steve Novella, the guru behind SBM and many other skeptical ventures is moving us to a new host where all will be unicorns and rainbows. Stay tuned.
palmd | September 21, 2009As my readers know, I take a very hard line on alternative medicine, not because I just don't like it, but because it harms, both actively with dangerous treatments, and passively by keeping people from effective science-based treatments. So what am I to think about a hospital in California that is now allowing Hmong shamans to perform healing rituals on patients?
There is a long history of religious and quasi-religious beliefs interfering with good health care. This interference comes in many forms.
"Mainstream" Religions
Religion obviously has a strong influence on people's health…
palmd | September 18, 2009Within 72 hours of starting kindergarten, my daughter caught a cold, and within 72 hours of that, she gave it to me.
The common cold sucks. It affects millions of people every year causing misery and lost days of school and work. It's terribly hard to prevent, and there aren't really any effective treatments. Vitamin C, Echinacea, zinc---all useless. Newer, more expensive antihistamines and steroid nasal sprays, both of which are great for allergies, don't seem to help either. I find myself dispensing lots of grandmotherly advice this time of year. Thankfully, tonight is Rosh Hashanna…
palmd | September 16, 2009There are so many things I want to blog about today, but the muse just isn't with me. But I have a deal with myself to at least put out a little something once or twice a day (and my diet updates don't count).
Things I'm happy about today:
I'm keeping to my diet very well.
My child is not only surviving kindergarten but wants to be dropped off and have me disappear.
Things I'm finding painful today:
I'm keeping to my diet very well.
My child is not only surviving kindergarten but wants to be dropped off and have me disappear.
palmd | September 16, 2009I started this little adventure on August 5th, and at the time my BMI was over 30 and I weighed about 212#. Today, it's 203#.
It's an interesting journey. For the first time, I've found what seems like a sustainable way to eat healthy. I feel like I'm actually a good role model for my daughter and my patients. I've also eaten several acres of lettuce.
In the beginning I stated that if you're not hungry, you're doing it wrong, and was taken to task by many educated readers. And while I don't always feel hungry, I do wonder about certain phenotypic differences between individuals. "…
palmd | September 15, 2009A recent piece of mine caused a bit of a "blogwar", if you will. It lead to a "rebuttal" on Dr. Bremner's blog, and an additional response from Dr. David Gorski. The discussion has been interesting (no, not Doug's incoherent response, but the comments and emails of others). One letter in particular helps sum up the ideologic rift between science-based medicine and "everything else".
The following was written by a physician:
I would ask Drs Gorski and Lipson if an iconoclast like Dr Bremner might be serving a valuable role as gadfly to an entrenched failing status quo in bio-medicine who…
palmd | September 14, 2009There has been a murmur (albeit an insane one) at many of the anti-Obama and anti-health care reform rallies about the Nazi "T4" program, something most Americans have never heard of. The absurd analogy apparently goes like this: the Nazis euthanized undesirables, and the proposed health bill would effectively do the same thing, therefore Obama is Hitler.
Let's back up a bit. Aktion T4 was Hitler's personal pet program of tasking the medical community to identify and murder those considered "incurable". In practice, this meant the murder of the mentally ill and cognitively disabled---the…
palmd | September 14, 2009I got a little cranky earlier during a facebook discussion, then heard the voice of a friend in the back of my head saying, "Blog it! Blog that shit!"
And I was about to, when the hospital called with a minor crisis, and then I realized it was the probably one of the last nice days of they year, so I went to the pool with the family, then my wife made a yummy dinner...you get the idea. Anyway, here's the deal. I was reading this piece in the Times about a woman with a complex disease who died at least in part because of our Byzantine health care system. It was a familiar story.
And it's…
palmd | September 11, 2009In the current debate over health care, the Right is pissing me off. They are whining about a "government takeover" that will lead to rationing and death panels, but also about runaway costs. Guess what?
You can't have it both ways.
I just got off the phone with a Major Private Insurance Company. In order to save costs, certain tests must be pre-approved. In this case, I spent about twenty minutes on the phone, first with a clerk, then with a nurse (interspersed with a number of long hold periods). In the end, the study was approved. (I've never made such a call for a Medicare patient…
palmd | September 10, 2009This morning I woke up early, showered, and dressed. Then my wife and I woke up our daughter, who seeing it was dark did protest loudly. But we got her out of bed, and a few minutes later she was her usual happy loquacious self at the breakfast table.
We got her dressed in a navy dress with white polka dots and black patent leather shoes, straightened her hair, took some pictures, and got in the car. We parked about a half a block from the school and put her back pack on her. She wanted me to carry it because it was so heavy (sic). Then she wanted "uppy"---also a non-starter. A…
palmd | September 9, 2009In the latest conversation about placebos, Steve Silberman got a number of things just right, including these converse statements:
Anthracyclines don't require an oncologist with a genial bedside manner to slow the growth of tumors.
...the placebo response has limits. It can ease the discomfort of chemotherapy, but it won't stop the growth of tumors.
Placebo, if it exists as a utile clinical entity (and I'm still not convinced) cannot cure cancer---but chemotherapy can, no matter what hand waving and chanting may or may not accompany it. This goes directly to the concept of "plausibility…
palmd | September 9, 2009I'm not gonna lie: the holiday weekend wasn't easy. Thankfully, I didn't lose ground---I'm still at 205#. But that puts me in a difficult position.
Obviously, my ratio of calories consumed to calories expended is still too high. I'm not doing great on the exercise---I just threw out my damned back again. Still, there's plenty of room for me to cut back on my intake, which is what I'm going to have to do.
See you next Wednesday.
palmd | September 8, 2009During our Labor Day fun fest, my kiddo lost her shit, leading my spouse to lose her shit. I was on one side of a crowded village green and got a phone call to come over and "deal with your daughter". She needed to be dealt with. She was not getting her way and letting everyone in town know how pissed off she was. I picked her up and carried her to a patch of grass away from my wife, and held her in my lap to keep her from taking off across the crowded green. She was screaming and wiggling and I found myself saying, "Stop resisting! Stop resisting!"
palmd | September 7, 2009I didn't get my usual week up north on Lake Michigan this year, but the mild summer took some of the sting out of it. Now that Labor Day is here, we get into a whole other set of rituals.
One ritual which is sure to become popular is summer sledding. It turns out there's a park not to far from here with astroturf hills and a sign that basically says, "you are absolutely not allowed to go get a nice piece of cardboard and use it to sled down the turf hills. Really, don't do it no matter how fun it looks."
That's my kiddo and her friend on their bajillionth run. The mosquitoes were…
palmd | September 6, 2009Doug Bremner has a blog. That blog sucks.
Bremner is an apparently well-regarded psychiatrist, and takes a refreshing look at the influence of industry not just on pharmaceuticals but on the conduct of science itself. His outspoken views have led to attempts to squelch his academic freedoms. But his sometimes-heroic record does not excuse dangerous idiocy.
I can understand how wading into the shit pool that is conflict of interest can leave one cynical. But cynicism and suspicion turned up to "11" is no longer bravery---it's crankery. It's not his snarkiness that burns---it's his…
palmd | September 6, 2009Holiday weekends are supposed to be quiet around here. People head up north for the last long weekend of the summer, eat ripe cherries, melon, and peaches, go to street fairs. Apparently they also go to doctors. But I have a brief lull before the next onslaught of twisted ankles, hand-foot-mouth disease, flu, strep throat, chest pain, back pain, or whatever other common medical complaints walk in the door attached to a person.
There's a little cemetery up the street from me. This isn't New England, and old cemeteries aren't the norm, but this one look interesting from the car window. So…
palmd | September 4, 2009You really should be reading Zuska's pieces. As usual, she cuts through the crap to the meat of the issue. Go now and read.
palmd | September 4, 2009I'm finding my "diet" remarkably tolerable. I'm still losing weight, albeit slowly, and enjoying what I eat. And aside from the weight loss, I'm eating better---lots of fruits and veggies, fewer simple carbohydrates. But I'm also noticing things that I hadn't before. I'm noticing just how much everyone eats. Sure, it's not like it isn't obvious, when you see commercials for restaurant chains the the huge fat and sugar laden meals they serve. But just watching people out to eat or in the hospital cafeteria, seeing how they may eat an appetizer, main dish, sides, desert---meals that add up…
palmd | September 3, 2009If I read one more crappy article about placebos, something's gotta give, and it's gonna be my head or my desk. Wired magazine has a new article entitled, "Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why." Frequent readers of skeptical and medical blogs will spot the first problem: the insanely nonsensical claim that "placebos are getting better". This not only "begs the question," but actually betrays a fundamental misapprehension of the concept. I've written several times about the nature and ethical implications of placebos, but it's time for a serious…
palmd | September 2, 2009Influenza kills somewhere around 36,000 Americans every year (and perhaps twice that number, depending on the estimate). The novel A H1N1 ("swine") flu circulating this year has found a world population with little natural immunity (at least those of us under 65---older folks may have some immunity from previous pandemics). The attack rate is ridiculously high, but the virulence is thankfully not much worse than other seasonal influenza. Unfortunately, the virulence doesn't have to be higher to increase the total number of hospitalizations and deaths.
Now, here's what won't help:…