palmd | December 10, 2009It's not always easy to figure out that you are not normative. If you grow up in an ethnic enclave, when you're young you probably think everyone is black/Spanish-speaking/Korean. When I was a little kid one of my parents' friends remarried. I remarked on how the new wife was Jewish. My mom corrected me.
"But Mom, she talks Jewish."
"No, honey, she's just from New Jersey."
If you're visibly different from the majority, or you speak a language other than English, you learn pretty quickly what "normal" is supposed to be---and it's not you. My daughter has grown up in an area of mixed…
palmd | December 10, 2009Human medicine advances in the way much of science does. People make systematic observations, form plausible hypotheses, and collect data. One of the more important questions in medicine is how people are affected by certain exposures. When that exposure is a medicine, we prefer data from double-blinded, randomized controlled trials. Other types of exposures (such as cigarette smoke) are less amenable to RCTs and we must rely on case-control, cohort, and other studies that examine correlation.
But before we can run RCTs on human subjects we need more than just a plausible hypothesis;…
palmd | December 8, 2009Some time ago I issued a naturopath challenge in which I invited naturopaths to analyse a typical primary care problem. Today, I'd like to issue a broader challenge.
With health care reform in the works, it would be wise to look north (or in my case, south) to our Canadian neighbo(u)rs, but not for the reason you think. Assuming we are able to extend health insurance coverage to millions of more Americans, we will need primary care practitioners (PCPs) who can care for these new medical consumers. In Canada, legislation to deal with a shortage of PCPs by giving modest new powers to other…
palmd | December 8, 2009My kid is growing, and I'm of course ambivalent about it. It's not that she's becoming some sort of giant---she's still a tiny little thing, but now she picks up books and starts reading them. When she does, I usually start shouting excitedly, but she reminds me that I'm not allowed to be excited. She wants to enjoy her new powers in peace.
She's outgrowing her car seat, especially when bundled up for winter. And with Midwestern winters being what they are, she's bundled more mornings than not. It's time for me to buy a booster.
When I wake up in the morning, I take my shower, shave…
palmd | December 7, 2009A common theme in alternative medicine is the "One True Cause of All Disease". Aside from the pitiable naivete, it's implausible that "acidic diet", liver flukes, colonic debris, the Lyme spirochete, or any other problem---real or imagined---can cause "all disease" (in addition to the fact that most of these ideas are intrinsically mutually exclusive).
One of the popular new ideas in this category is that of "endocrine disrupting chemicals" (EDCs). These are chemicals in the environment that physiologically or chemically mimic naturally occurring human hormones. That some environmental…
palmd | December 5, 2009I wanted to sleep in this morning, but somehow it's tough to change gears that quickly. I don't normally get up too early---6:30---but I really felt like sleeping in. I made it to 7:00. That early, I have the house to myself, so I brewed up a pot of some killer new coffee that Dr. Free-Ride sent me (thanks!) and enjoyed the silence. After an all-too-short period of peace and quiet I had to wake up PalKid.
I'm a bit blown away by how busy my little family is. MrsPal had to work most of the day so I took PalKid to dance after being "forced" to make "daddy waffles" (from scratch). The dance…
palmd | December 4, 2009When Major Nidal Malik Hasan opened fire on his comrades at Ft Reed, he gave no indication of his motives, other than a generic shout of "God is great!" Generally we think of terrorist acts as involving a conspiracy rather than the actions of an individual, but the difference is unlikely to matter to the dead. Understanding Hasan's motives may, however, help prevent future murders. If this was a terrorist conspiracy, hopefully the government will display more competence than has been apparent. But if his actions were more closely related to those of a disgruntled teenage loner with a gun…
palmd | December 3, 2009He looked sick---really sick. He was sitting on a stretcher in an ER bay, flushed, breathing a bit quickly, but his youth seemed to compensate for the acuity of his illness, and he didn't feel nearly as bad has he looked. His fever was 104, his systolic blood pressure was in the 90s, his heart was racing. He'd had a sore throat recently, and rather than getting better started to feel weak, tired, and feverish. His mom finally dragged him in when he wouldn't stop shivering. His blood work was not normal, and his chest X-ray looked as if he'd inhaled a box full of cotton balls…
palmd | December 2, 2009Remember the Zicam debacle? To catch you up, Zicam has been promoted for years as a "homeopathic cold remedy". It is of course neither. Since it contains measurable amounts of zinc, it isn't "homeopathic", and since there is no cure for the common cold, it's not a remedy. In addition to having neither of it's promoted qualities, the FDA has received hundreds of reports of people losing their sense of smell (became "anosmic") after using intranasal Zicam. As Steve Novella has pointed out, there is some scientific evidence pointing to a causal connection between zinc and anosmia. Now…
palmd | December 1, 2009Today, the 21st annual World AIDS day, comes at a time when AIDS has become an everyday fact of life. Conservative estimates have over 33 million people living with HIV world-wide with an adult prevalence of 0.8%. This is a common disease, but its distribution is unequal. Due in part to economic, cultural, political, and genetic differences, Sub-Saharan African has been hit particularly hard, although comparisons can be difficult. It is widely believed that some large countries, including China and Russia, significantly under-report HIV disease.
Coming to terms with HIV has been hard for…
palmd | November 30, 2009In medicine we use all of our senses to evaluate patients. If I open up an abscess and I'm overwhelmed by the smell of rotted cheese, I can be pretty sure the abscess started as a sebaceous cyst. If I hear a "whooshing" sound over the abdomen in a smoker, I look more closely for an aortic aneurysm. A subtle buzzing sensed through my fingers can indicate an arterial fistula. And the glowing yellow of jaundiced skin can point me straight to the liver.
But what about subtle changes? With just our senses, distinguishing normal from abnormal is a coveted skill, one that some argue is being…
palmd | November 30, 2009The struggle to promote the scientific practice of medicine and the fight against pseudo-science and quackery just got a big boost. The newly-announced (but long in the making) Institute for Science in Medicine was launched this morning with an inaugural press release calling attention to quackery in the current U.S. health reform bills.
Many of the folks involved in the Institute are familiar names, and represent an international effort to keep health care safe and effective.
So help spread the word, and keep an eye on this space and the ISM website for more updates and for ideas on how…
palmd | November 28, 2009I have in front of me a weathered copy of Cecil's Textbook of Medicine from 1947. It belonged to my father, who graduated from medical school in the 1940s. Even then, it was known that pneumoccus, a common bacterium, can live harmlessly in the nose and throat and only sometimes causes disease. Pneumoccocal disease was and is still a leading cause of disease and death*, killing perhaps a million children per year. It causes ear and sinus infections, but also meningitis, and is the most common cause of pneumonia. In the past it was referred to as "the captain of the men of death" for it's…
palmd | November 27, 2009A news item this week profiles a northeast naturopath who is using thermal imaging to screen for breast cancers. This is a frightening development. The news about conflicting mammogram recommendations has women wondering what the right approach really is. The question in the new USPSTF recommendations is one of values. The science says that a lot of women in their 40s need to be screened and undergo invasive procedures to save one life. We are left to decide if that life is worth it. Or we can throw our hands in the air and start charging women for useless alternatives.
The technology…
palmd | November 27, 2009I live about ten miles due north of "Canada's automotive capital". We often look across the straits to the medical system in Ontario, one in which all citizens have a provincial insurance card. We see how everyone has access to care---or at least some care. I've treated many Canadian patients who have access to American insurance and prefer to get their care on this side of the border, where there are fewer hassles. Of course if you have no insurance at all, hassles abound, and we'll leave a discussion of the merits and difficulties of the Canadian system to another day. But one move…
palmd | November 25, 2009We already know about the Huffington Post's war on science and its shameless publication of snake oil ads disguised as journalism. Now, Mark Hyman, an evangelist for the cult known as "functional medicine", is giving even more bad flu advice (and shilling for his books).
He begins his blathering, misleading sales pitch with this bit of mendacious drivel:
The main question my patients have been asking is whether they should get vaccinated against H1N1 or against the regular flu.
This is not a simple yes or no answer. The guiding principle of functional medicine is personalized care, not the…
palmd | November 25, 2009Those of you who gave to DonorsChoose will find an email in your inbox with a gift card. This is free money for you to donate to any project you wish. It represents matching funds from Hewlett-Packard, so don't let it go to waste.
Next, commenting. I keep a very open comment policy, since dialog is really the whole point of a blog, but moderating comments can be rather cumbersome, and the spam and hate-comments have been sneaking through. I am considering a trial run with comment registration. The ScienceBlogs overlords assure me that most of the bugs have been swept out of it. What…
palmd | November 24, 2009One of the most frightening symptoms of advanced cancer is "cachexia", or severe, unintentional weight-loss and wasting. It's a terrible prognostic sign, and the only truly effective treatment is removal of the cancer. Treatment of this syndrome has the potential to improve quality of life in patients with advanced cancers. Various types of medications, including antidepressants, hormones, and cannabis derivatives have been tried with little effect. Treating the symptoms of incurable cancers is difficult and although we're pretty good at it, we sometimes fail. Cannabis seems a plausible…
palmd | November 23, 2009Today over at Science-Based Medicine, Dr. Novella has a review of the so-called "biomed" movement in autism treatment. Anyone should be able to understand the desperation of parents with sick kids, but grief can lead to very bad decisions. As physicians, one of our jobs is to guide people away from these decisions and not to give false hope. Telling people what they want to hear might make you as a caregiver feel good, but as physicians, our goal is not to make ourselves feel good but to help others.
It pained me to read this story about a mom who gets her autistic son stoned. As a father…
palmd | November 21, 2009The latest Skeptics' Circle is up at Beyond the Short Coat.
The Giants' Shoulders #17 is also up at scibling Eric Michael Johnson's place. Go and read!\