palmd | February 13, 2010What constitutes quackery depends very much on how quackery is defined. If part of that definition is making false or unsubstantiated claims about a medical product you are selling, then Dr. Rolando Arifiles is a quack.
Dr Arafiles and his cronies in the Winkler County government may not realize is that this "internet" thing works both ways. It may increase your ability to sell fake cures, but it also opens you up to being discovered. Of course, increasing your profile by abusing the legal system to quiet critics doesn't help.
The FDA and FTC aren't too happy about the proliferation of…
palmd | February 13, 2010I love writing about quackery and other medical shenanigans, but there are some activities and organizations that are so distasteful that I can rarely force myself to write about them. One of these is the Association of American Physicians and Surgeons (AAPS). This is an organization that has supported the lie that abortion leads to breast cancer, has defended child abuse by attempting to "debunk" shaken baby syndrome, or worse, blame it on vaccines, and fought for treating mental health as moral failing rather than a real illness. And that's just a sampling.
So it should come as no…
palmd | February 12, 2010Human papillomavirus (HPV) is a fascinating little bugger. Certain strains can interfere with tumor suppressor genes leading to cancer, especially cervical, anal, and some mouth cancers. Other strains cause genital warts. The vaccine offered in the U.S. (Gardasil) protects against the two strains that cause most cancers and against two strains causing warts. The vaccine has the potential to change the way our population is affected by these diseases.
But we are still learning more about this virus. We know that HPV can be transmitted even without visible lesions. But where are these…
palmd | February 11, 2010Good news out of Texas. Anne Mitchell, the nurse who filed an anonymous complaint about a doctor with the Texas Medical Board, was acquitted of felony charges.
Mitchell brought her concerns about Dr. Rolando Arifiles to her hospital administration, and when she got nowhere, she felt forced to bring her patient safety concerns to the state medical board. The local sheriff, a friend and possibly business partner of Arifiles, used is investigative super-powers to figure out who filed the anonymous complaint, and had her indicted for misusing state information (the medical record numbers of…
palmd | February 10, 2010I get a lot of email asking me about various alternative therapies and supplements. A recurring theme on this blog has been the hyperbolic claims of alternative practitioners and supplement makers, and while I can't answer every email, I can at least address some of them in the blog. Supplements are often marketed using unsupported health claims to which is appended the Quack Miranda Warning, essentially allowing the makers to say that the pill will have such and such a benefit, while simultaneously denying any responsibility for the claim. Since the FDA isn't examining these claims, it's…
palmd | February 10, 2010There have been some disturbing rumors circulating about Dr. Rolando Arafiles, the Texas doctor who enlisted a local sheriff to harass and ultimately prosecute local nurses. The nurses filed anonymous complaints with the state medical board about Arafiles' practices, and one of them is now in court facing felony charges for doing her job.
One of the complaints that nurse Anne Mitchell registered was regarding Dr. Arafiles alleged that he was hawking supplements to patients. While this is not necessarily illegal, it is ethically questionable, and if the patients were in the ER and not under…
palmd | February 8, 2010There's a prosecution going on in Texas that sounds so corrupt, and could have such a chilling influence on the pursuit of quackery nationwide, that it cannot be ignored. I urge you to read the story in the Times, but here's a brief recap.
In Kermit, a small Texas town, two nurses at local hospital became concerned about the practices of one of the physicians, Dr. Rolando G. Arafiles, Jr. Among the alleged practices were the improper peddling of herbal medicines to hospital patients, and the performance of (sometimes unorthodox) surgical procedures without the appropriate privileges to do…
palmd | February 4, 2010I recently raised some questions about narcotic therapy contracts and my readers raised even more issues. Some of these questions deserve further discussion.
First, despite the examples I gave, when I'm speaking about narcotic contracts I am talking about people chronically on narcotics. I don't normally use contracts for people with self-limited problems. That doesn't mean these patients aren't susceptible to the same problems as long-term users of narcotics, but the thinking is (based on what data, I don't know) that people with a clear, self-limited, anatomic problem, such as a kidney…
palmd | February 4, 2010Medicine has traditionally been full of hierarchies. Employees' uniforms make their role easy to identify: one color for radiology techs, another for secretaries, etc. When I was a resident, medical students wore short white coats, residents long blue coats, and attendings long grey coats.
Medicine is also a traditionally male-dominated field, and despite the fact that a small majority of medical students are female, the higher academic and administrative positions are still male-dominated.
Nursing, on the other hand, is traditionally female. Nurses, despite their indispensable role…
palmd | February 3, 2010I'm heartened by the discussions of medical ethics arising out of The Immortal Life of Henrietta Lacks. From reading and listening to interviews with writer Rebecca Skloot, and from my brief conversations with her, I know that medical ethics were very much on her mind during the ten years it took her to create the book. If you read the book, you will see that she was also very concerned that she not be just another exploiter of the Lacks family. That's one reason comments such as this one are disturbing----and at the same time not really disturbing at all. It helps to highlight the amount…
palmd | February 1, 2010Treating patients with narcotic analgesics is not simple. Narcotics can be very effective at relieving pain, but they come with a whole set of problems, including risk of adverse effects such as nausea, constipation, and altered mental status; overdose; and dependence. As I've written before, narcotic-dependent patients can be a challenge to treat. One of the tools we use is the "narcotic contract", a document which explicitly states the rights and responsibilities of the health care provider and the patient (although in practice, it tends to put more emphasis on the rights of the provider…
palmd | January 31, 2010This is a special shout out to the doctors and scientists out there. Everything we do in our fields has repercussions, often unexpected ones. Because of this, we strive to practice ethically to help prevent or minimize negative repercussions.
This discussion comes up specifically as an epiphenomenon of the release of The Immortal Life of Henrietta Lacks (my full review can be found here.) How one reacts to this book would, I suppose, depend on your perspective. A neighbor of the Lacks's might react quite differently than a 22 year old doctoral student. And that's really the point.
This…
palmd | January 30, 2010It's a cold day here in Lake Woebegone southeast Michigan. I'm looking out the kitchen window at the thermometer: +11 F, which is apparently the same -11 C. From my kitchen table, I can see the neighbors let out the dog, who seems unfazed by the cold. He's some sort of little fuzzy white dog and he's currently sniffing happily. It's not quite cold enough for the air to have that extra clarity you see when it gets really cold, but I'm still not rushing outside.
It's pretty cold upstairs. We probably need to replace more of the windows, and I'm not so sure about our insulation, so we were…
palmd | January 27, 2010"...It never was our guise
To slight the poor, or aught humane despise:
For Jove unfold our hospitable door,
'Tis Jove that sends the stranger and the poor..."
---Homer: The Odyssey, Translation by Alexander Pope
A few weeks ago, Drugmonkey wrote a piece about perceptions of drug users. Specifically, the study looked at how mental health providers perceive people with substance use disorders depending on whether the patients were referred to being a "substance abuser" vs. having "a substance use disorder." These data revealed something interesting. Among the mental health…
palmd | January 27, 2010I'm hard on hardware, apparently. My current computer, an hp tablet, is falling apart. I need to start thinking about replacement. Cost is the number one issue, so I was thinking about an Acer or a Dell Mini or similar product.
I use my computer all day, every day, for work and for writing. My hospital and my office use IT systems that requires Windows.
So, geeky folks, I need some suggestions. What have you folks found to be useful and economical?
palmd | January 25, 2010Salmonella is lots of fun. Human infection usually involves fever, abdominal cramping, and diarrhea, which is often bloody. Salmonella infections are reasonably common, especially food-borne outbreaks. It's unknown exactly how many people in the U.S. suffer from salmonellosis each year since many probably never seek medical care or never have a stool culture done. The CDC gets approximately 40K reports of salmonella in the U.S. each year with about 400 deaths (the real case number is estimated to be closer to 1.4 million). Most of these cases are preventable.
There are two large…
palmd | January 25, 2010After learning of the British vicar who sent the cops after a blogger, I decided to read up a bit more about this guy.
Sizer is a Mideast activist. By "activist", I mean that he sees the State of Israel as an abomination. He has revisionist ideas about Middle East history which he feels was influenced by "the Zionist lobby". What's interesting is his condemnation of the insane rantings of the Evangelicals who want to see the Temple rebuilt in order to bring about the End Times. In fact, he seems to believe that it was misguided Christians who were responsible for the founding of the…
palmd | January 25, 2010From my pal Arikia, I learned of a disturbing case in the UK. A blogger over there has been posting information about Stephen Sizer, an Anglican vicar and holocaust denier. The vicar apparently felt so threatened by the dissemination of his own ideas that he called the cops.
According to various news and blog reports, Sizer is cozy with terrorists and neo-fascists.
I don't know much about this guy, but he apparently is very active in anti-Israel activities that have blended into frankly anti-Jewish activities. He has apparently take his concern for the plight of Palestinians and thrown…
palmd | January 24, 2010In The Checklist Manifesto (Amazon, Borders, b&n), Dr. Atul Gawande expands on his previous writing about the work of Dr. Peter Pronovost. Pronovost developed a system to help reduce complications of hospital care, such as infected venous catheters. This system has been very successful. It is based on the idea that some tasks are simply too complex to be error-free. Medical care has become very successful, but also very complex, to the point where one person cannot possibly remember every step in some processes, even simple steps such as scrubbing in.
The simple and successful…