Covering topics related to the Society and Science-Based Medicine.

JAN
23
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Combinations

Pseudo-Medicines combine and recombine in a continual fantastical dance. Pick any two alternative medicines and someone, somewhere, has combined them into a unique treatment modality. My favorite is Tong Ren, a form of voodoo acupuncture.

I had thought, perhaps incorrectly, that no one could come up with a more ludicrous combination. Perhaps it would be dark energy homeopathy or dark matter acupuncture. I suppose it is just a matter of time before someone combines some pseudo-medical modality with the time cube and their nonsense will reign supreme.

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JAN
22
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Googlewhack?

Photographic representations are worth on the order of 103 words, or so the old chestnut would have us believe.

I have been in charge on infection control at my hospital system for 23 years and in that time we have slowly driven down the rates of hospital acquired infections. There have been many initiatives that have helped with the decline, but I would wager that none have been as important getting out hand hygiene rates to almost 100%.

Hands are a wonderful vector for germs and it you want to have an entertaining, if somewhat nausea inducing time, spend a few hours focusing on what people to with their hands. Euw.

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JAN
21
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Hanlon's Razor

I have no idea why people use pseudo-medicines. Well, I can understand why a particular person may use a given pseudo-medicine, but I find the surveys unsatisfying. There are probably as many motivations for using pseudo-medicines as they are people using them.

I empathize. To be human is to be susceptible to all the cognitive biases that make pseudo-medicine attractive.

I am sure those reading this have, at some time in their past, succumbed to the allure of one unsubstantiated or unfounded idea or another. Mine was Chariots of the Gods by Erich von Daniken back in high school. I was quite enamored of the concept that we were once visited by aliens, not a surprise for a sci-fi addict. It was discovering critical information in the Zetetic all those many years ago that sent me down the critical thinking path.

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JAN
20
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First Principles

I like to reason from first principles and move down the chain of reasoning. 

One of the characteristics of physiology I remember from medical school is that most of the structural molecules are made on-site from primitive precursors.  The food we eat is broken down to its smallest components which are transferred  to where they are needed and then these building blocks are altered or strung together with other chemicals to form more complex structures.

Simplistic, I know, but a reasonable rule of thumb.  

That is one of the issues about glucosamine and chondroitin for osteoarthritis that bother me.  Both products are made on site by cartilage, not imported complete into the joint. So why would taking them help joint disease?  Unless you are eating a diet rich in pig snout and cows ears, most peoples diets have little of either glucosamine or chondroitin.

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JAN
19
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People Die. Homeopathy Can Help.

Death probably has more inevitability than taxes. Everyone dies. The question is not are you going to die. You are. The question is are you going to die before you should. Is your death preventable?

There are a lot of reasons why people die prematurely. I spend 95% of my time in in-patient medicine and my sense is a major reason people die is lack of health care insurance. They have illnesses like HIV or high blood pressure and they do not seek care until it is too late to halt or reverse the course of their disease. It is sad.

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JAN
17
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Filthy Lucre

We all like money. I certainly do. It makes life easier and we all enjoy the benefits that money brings.

What would you do for money? At what point could you be unable to look yourself in the mirror? Where would you draw the line? It is probably different for everyone. Johnny Rocco is not my role model; I tend towards the other extreme. I have taken one thing from a drug representative in the last 23 years. The Pfizer rep sent me a Fleets enema with a Unasyn sticker on it, I suspect, as a sign of disrespect. I keep it on my desk.

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JAN
16
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How Medicine Advances Redux

Randomized clinical trials (RCT’s) are the worst form of  research except all the others that have been tried. ~Sir Winston Churchill

As a rule, those who object to RCT are those whose pet ideas are disproved by RCTs. Often the response of practitioners of pseudo-medicine to the results of negative trials for their idee fixe is to try and kill the messenger. There was a case in point today.

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JAN
14
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Advocacy

One advantage CAM practitioners (chiropractors, acupuncturists, naturopaths and the like) have over science-based medicine practitioners is the ability to make things up and pretend they are real. They can then sell these creations to the public as health care. State licensing of CAM practitioners helps tremendously in marketing this pseudo-medicine, especially when the product itself is enshrined in state law.

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Law
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JAN
14
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Cognitive dissonance

F. Scott Fitzgerald said "The test of a first-rate intelligence is the ability to hold two opposing ideas in mind at the same time and still retain the ability to function."

The Wikipedia says cognitive dissonance is the "presence of incongruent relations among cognitions (thought and understanding) that frequently results in excessive mental stress and discomfort."

I wonder about both: that it is the mark of a first rate intelligence and that it causes mental stress.  In the world of pseudo-medicine cognitive dissonance seems to work just fine. Today I found several examples of cognitive dissonance.

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JAN
13
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How UTI's can cause depression

As some may know I am infectious disease doctor. Urinary tract infections (UTI) butter my bread. Figuratively speaking. There is an enormous amount known about the pathophysiology of UTI’s and how E. coli  binds to uroepithelial cells to cause infection.  It is both a common and complex problem. But for all our knowledge, chronic and recurrent UTI’s remain a vexing problem.

One reason for recurrent UTI’s is not due to altered chi along meridians fixed by needles. That would be ridiculous. Much to my embarrassment, Clinical Infectious Disease (CID), the flagship journal of my specialty, published Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a markov chain monte carlo model  and included acupuncture in their analysis. Really.  They thought a pseudo-medical intervention divorced from reality to be worthy of consideration.

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JAN
12
0

Understood

Science-based medicine, obviously, does not have the answer to everything.  Maybe someday, but not now.

In my practice the medical problem with no good etiology or treatment is chronic fatigue syndrome.  As I have mentioned elsewhere, in some cases I suspect CFS is similar to post-infectious arthritis, a reaction to an infection that has come and gone.  But suspect is not know.

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JAN
11
2

A Perfect Example of Why This Organization is Needed

It is still odd to my mind. As a rule, major Universities not have departments of Astrology or Bigfoot Studies or UFO studies or Economics. Except, perhaps, as part of the Sociology Department as part of the study of human superstitions.

They recognize that these disciplines have no basis in reality and are worthy as study as part of a reality based curriculum.

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Recent Comments
Janet Camp
Thank you for your integrity.
Friday, 23 January 2015 01:54
Janet Camp
Thank you for your integrity.
Friday, 23 January 2015 01:54
4241 Hits
JAN
10
0

An Offer You Can Refuse

I don't know if this will work or not, but here is an offer. There are Skeptics in the Pub and other meetings that I cannot visit in person to preach the good word. That is assuming I would be wanted.

I was thinking of attempting a Max Headroom.

Skype is not a good way to do a lecture or talk, but I could Skype into any small meeting and I could be pimped about issues concerning SBM.

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JAN
08
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Scant hours spent do not a Doctor make

Training in Internal Medicine is 7 years (4 in Medical School, 3 in residency), about 19,000 hours. It takes another 5600 hours, an extra two years, to be an ID specialist, assuming an 8 hour day I do not think I ever worked in my life.

Not a single student is even remotely ready to take care of patients after 4 years of medical school much less after a year and a half. It is why we have residencies: so we can learn from our elders and (hopefully) betters how to care for the sick.

Even after residency and fellowship most doctors are competent, but it takes another 5 or 10 years to get good.

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JAN
07
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First Day Live: Lots of Pain

I feel like 'Bones' McCoy.  Damn it Jim, I'm a doctor, not a programmer.  So it has been definitely proven I am not a flawless Joomla programmer.

There are a series of issues I will work on tonight:

1) ebook downloads.  I think I fixed the issue, but I have to go back and fix every ones permissions who paid for a membership.  It will hopefully be done tonight,

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JAN
06
0

Friends, Koreans, countrymen. Lend me your ears.

Certainly this is the case where ear acupuncture was used as an adjunct to weight loss and found to be effective, only if you lend credence to terribly done clinical trials. Almost every error that could be applied to a study, was.

Patients received 5 point ear acupuncture, 1 point ear acupuncture or sham acupuncture for 8 weeks:

Those who received five-point acupuncture had needles placed 2 millimeters deep in one outer ear taped in place and kept there for a week. Then the same treatment was applied to the other ear... Other patients received similar treatment with one needle or with sham acupuncture where the needles were removed immediately after insertion.

 I suspect that there was such a high drop out in the sham treatment as because they knew they were not getting acupuncture. A lousy placebo renders an already  silly and poorly done trial completely meaningless, like most of the acupuncture trials.  

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Copyright

© SfSBM

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JAN
04
0

Science-Based Medicine Delivers

 

Then another brief flurry of hope with double drug therapy that was followed by an almost tangible sense of depression and sadness in those who took care of HIV patients. No matter what we did the virus mutated and the disease progressed.

Then there was triple drug therapy and I remember thinking, well, this may add a couple months but the virus will mutate again, and people will die.  Nope.

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Copyright

© 2014

2432 Hits
JAN
02
0

Popcorn

I found an announcement for a lecture on homeopathy and the speaker is going to give free door prizes as follows:

• An emergency homeopathy kit, valued at $100;

• An international travel homeopathy kit, valued at $165;

• A family homeopathy, kit valued at $250. Harriet Hall has discussed these kits and they contain nothing that could have any efficacy, although I cannot find the exact contents of the kits offered here. That is a serious chunk of change for collection of virtually nothing.  It would make a nice charitable donation or business expense on the tax form.  I wish my water was worth that much, and I drink Bull Run water, best in the world.  I wonder how Oscar would have categorized homeopathic products.  
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Copyright

© 2014

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JAN
01
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Day One. The First Blog Entry

It occurred  to me that most of the efforts concerning Science-Based Medicine (SBM) have been accomplished by individuals.  When these individuals die their work often dies with them.  Organizations can be resilient and continue long after their original membership is gone.  Organizations can keep the past alive so that each generation does not have to reinvent the efforts of those who proceeded them.  I want all the work and effort of SBM to live. Forever.

I also think the issues around SBM are more important than the limited attention provided by other organizations, both medical and skeptical. While medical and skeptical organizations are concerned  with issues surrounding SBM and the ever expanding influence of Integrative, Supplements, Complementary and Alternative Medicine (iSCAM), it is usually peripheral to their main mission.

In medicine there are often organizations devoted to specialized areas of interest and they add to, not detract, from more broad-based organizations.  There are, for example, organizations devoted to Internal Medicine, Infectious Diseases (a subset of Internal Medicine) and fungi or endocarditis (both subsets of Infectious Diseases).  All these organizations enhance the understanding and participation in medicine and allow for those with specialty interests to participate and those areas of interest.  Similarly we hope this organization enhances the both the medical and skeptical communities.

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DEC
31
0

7 +/- 2 Paragraphs of Idle Thoughts

One of the issues I have with writing for the Science-Based Medicine Blog is repetition.  If I have covered a topic in the past I feel I should not have to write about it again. But I have realized that while everything is available on the internet, it can be difficult to find and impossible to remember. People coming upon this blog for the first time will have no idea what preceded it and it is unlikely they will go back to read the old entries.  So repetition will be good. The assumption will be that each entry is an island, unique onto itself.  The issue will not be how many times can we demonstrate that, for example, homeopathy is uber-goofy, but how we can do so in a unique and memorable manner.  I have given myself a challenge.  Wish us luck.

I have worked at the same position for 23 plus years and there is only one other doc who has practiced as long in my hospital.  I have an institutional memory and remember the old days, when there were no CT scans, cephalosporins had two generations, and there was no electronic medical records.  I anticipate the Society will be a repository of Science-Based Medicine memory.  Every generation will have to renew the battle against pseudo-medicine, but hopefully the Society will be a scaffold upon which they can build.

The blog will be mostly about medicine and pseudo-medicine: how the former, despite the flaws inherent in every human endeavor, delivers and how the later, because of the flaws inherent in every human endeavor, does not.

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