Denialism Blog

Author: denialism_bv2x6a

  • What is an internist, and why should you care?

    A (long) while back, I gave you a brief explanation of what an “internist” is. I later gave you a personal view of primary care medicine and some of the challenges involved in creating an infrastructure of primary care (only 2% of American medical grads are going into primary care). We also had a little chat about medical mistakes and medical training.

    No matter what changes we ultimately make in the way we train internists, one of the lessons that residency teaches is to identify who is truly sick. I don’t mean who is faking it, I mean being able to look at someone briefly and decide whether or not they need your immediate attention. It may seem obvious, but it’s not. Objective factors can sometimes be deceiving. For example, an asthmatic may have perfectly normal vital signs, including a normal oxygen level, and yet be moments away from needing a breathing machine. For an asthmatic, a normal respiratory rate may indicate fatigue rather than health, and absence of wheezing my indicate such severe airway obstruction that wheezes aren’t even possible. The ability to recognize severe illness is one of the critical goals of residency.

    This is one area in which the so-called alternative medicine folks can really be dangerous.
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  • Doctoring in real life

    There’s been a lot of talk about the work hours of resident physicians. Given that sleep deprivation has been shown to impair various aspects of human performance, it certainly seems reasonable to limit the level of “resident impairment”. But we have surprisingly little data to work from. And, for better or worse, physicians post-residency don’t have much of a choice when it comes to work hours.

    My wife often remarks on how I’m able to answer a page out of a deep sleep, give orders, and go back to sleep. Upon morning review, these orders do, in fact, make sense. It was my training that allowed me to be able to function this way, and it’s a damned good thing. I’m not arguing that residents should be worked into the ground like in the good old days. We must take into account the impairment that lack of sleep may cause, but we must also recognize that learning to think and act under a variety of conditions is important. Also, patient continuity of care is important, and the more that a patient is “handed off” from team to team, the less likely any one doctor is to take responsibility for that patient.

    But that’s not really what I meant to write about. Let me give you an a glimpse of doctoring in real life.
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  • It's back! Get ready for the flu

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    Yes, it’s that time of year again. Last year, I gave you weekly flu updates from the CDC and from my position on the front line.

    So far, it’s still quiet. I haven’t personally seen any cases yet, but I’m sure to soon enough.

    It’s not too late to get vaccinated. Wash your hands frequently.

    Remember what the flu is and is not. Influenza is characterized by the sudden onset of high fevers (usually greater than 102), muscle pain, and sometimes runny nose and cough. If you can get to your doctor within the first 48 hours, there are medications that may help you get better a little bit faster. Best, though is prevention.

  • Improving medical care—arrogant doctors are a distractor

    (Tangentially related podcast here)

    Here’s the thing: all this talk about arrogance in medicine is a red herring. It’s distracting us from the real question that we should all be asking: how do we improve quality medical care?

    The personality of individual physicians is important, but not very, just as the medical mistakes of individuals have limited significance. As medicine has become more science-based, we have learned some important lessons about how to prevent and treat disease, and while the physician-patient relationship will always be important, as will the relationship between physicians and other professionals (see this discussion), implementing what we know about how to improve health care (and have known for years), will render much of it irrelevant.

    Take the Keystone program. This simple program, developed at Johns Hopkins and piloted in Michigan, as well as a few other places, uses mandatory checklists for certain hospital procedures, and has been shown to reduce complication rates of these procedures. Unfortunately, bureaucracy threatened to strangle this program in the cradle, but that particular storm has apparently passed.
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  • Podcast!!!!!

    OK, so I guess I’m not busy enough, cuz I’m experimenting with podcasting. I have a voice best left to typing, but I want to try a new medium.

    The first episode is on arrogance in medicine, and the rss feed looks funky cuz i’m still learning, but let me know how it goes. This discussion is a continuation of one that has gone on right here. I’m opening a thread in the forums to discuss the issue. Please…please let me know what technical difficulties arise, as I’m quite new to this.

    That is all.

  • Blogospherics—giving folks their due

    Orac is celebrating his 4th blogiversary today, and folks are giving him his props over at his place. I was about to give him congrats over there, but I figured this deserved a post of its own.

    I started blogging seriously in May of 07. I had been attracted to the crankosphere via the cesspit of inanity that is Conservapedia. A small cabal of folks set up a parallel site called rationalwiki to refute the hate-filled lies at the other site. I ended up writing a number of medical pieces over there, and eventually decided I needed to write pieces less consistent with what a wiki requires, so I started up WhiteCoat Underground at wordpress. Originally, I was going to write a lot more medical anecdotes, but I was seduced by the need to refute ridiculous medical claims, and finally stumbled on the term “woo”. Trying to hunt down this term, I came upon Respectful Insolence (and from there, the rest of scienceblogs.com).

    I wrote prolifically, if not always well, and found ideas here at Sb to riff on. After sharing some cross-traffic from Orac, I emailed him for blog advice, and was surprised to receive a prompt and helpful response. This is not what I expected.
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  • Two Developments in DTC Drug Marketing

    Jeanne Whalen of the Journal reports that European officials are taking a step towards allowing drug marketing:

    The European Commission proposed legislation Wednesday that would let drug companies give consumers “objective and nonpromotional” information about their medicines in print and online. Currently, drug companies can’t provide any information to European consumers, except on leaflets found inside drug packaging. The legislative proposals must be approved by the European Parliament and Council of Ministers before becoming law, a process that could take years.

    Meanwhile, in the US, it looks as though drug companies have agreed to largely meaningless reforms in advertising. Jonathan Rockoff and Shirley Wang of the Journal report that prescription drug marketers, represented by former congressman Billy Tauzin, have said, “…they will halt advertising that includes promoting prescription drugs for uses that the Food and Drug Administration hasn’t approved or using actors as physicians without saying so. The guidelines say celebrity endorsers shouldn’t say they use a drug unless they actually do.”

    And here’s the big b.s:

    Billy Tauzin, president of Pharmaceutical Research and Manufacturers of America, the industry trade group that issued the standards Wednesday, said the aim was to address the concerns of doctors, Congress and other critics while continuing to keep patients informed about valuable treatments.

    “Our goal is to constantly look at [the ads] and see if we can improve them, so they are more informative, more educational and less promotional,” Mr. Tauzin said.

    How philanthropic!

  • Credulous medical reporting

    Science and medicine reporting is hard. In this space we’ve dealt with some of the problems that arise when “generalist” reporters try to “do” science and medicine. And now, CNN has shut down its science unit. Given the increasing complexity of medical and scientific knowledge, this is very bad news.

    As a fine example of poor medical reporting, let’s look at a local business magazine. The article, called “The Fatigue Factor”, is about fibromyalgia, and manages to get it wrong from the very beginning.

    Some medical reporting is destined to be bad simply because the topic is too complex for a generalist reporter. But sometimes, a reporter succumbs to journalistic sloth. In this story, for instance, if the reporter had spoken to a recognized local expert rather than a self-proclaimed expert, she would have written a much different article.

    Let’s start with the headline:

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  • H. influenzae—it ain't the flu, but it's still pretty cool

    This was first posted at Science-Based Medicine on Monday, but I can’t seem to keep myself from cross-posting. –PalMD

    I’ve been thinking about an interesting organism lately, an organism that illustrates some basic principles in science-based medicine.

    The organism is called Haemophilus influenzae (H flu), a gram-negative bacterium discovered in the late 19th century. H flu has a great story, both in historic and modern times.

    The brilliant microbiologist Richard Pfeiffer isolated H flu from influenza patients in the late 1800’s (hence its name) and for many years, it was believed to be the cause of the epidemic illness, and when the flu pandemic of 1918 hit, researchers worked tirelessly to develop anti-sera against H flu.

    But some things weren’t adding up. As thousands died of the flu, doctors were isolating H flu from victims, but also other virulent bacteria such as Streptococcus pneumoniae. Influenza was decimating military camps, and was seriously degrading our ability to fight in WW I, so military bases were a focus of research. Doctors looked for H flu in patients, but could not find it consistently. For example in Camp Dodge, Iowa, an autopsy series showed H flu in only 9.6% of victims.

    Some researchers were focusing on something else.
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  • Chuck E. Choke 'em!

    If you’re looking for some fun, family fighting, the place to go is Chuck E. Cheese’s. Who knew? The Journal reports:

    In Brookfield, Wis., no restaurant has triggered more calls to the police department since last year than Chuck E. Cheese’s.

    Officers have been called to break up 12 fights, some of them physical, at the child-oriented pizza parlor since January 2007. The biggest melee broke out in April, when an uninvited adult disrupted a child’s birthday party. Seven officers arrived and found as many as 40 people knocking over chairs and yelling in front of the restaurant’s music stage, where a robotic singing chicken and the chain’s namesake mouse perform.

    Bring on the science!

    The environment also brings out what security experts call the “mama-bear instinct.” A Chuck E. Cheese’s can take on some of the dynamics of the animal kingdom, where beasts rush to protect their young when they sense a threat.

    Stepping in when a parent perceives that a child is being threatened “is part of protective parenting,” says Frank Farley, a psychologist at Temple University and former president of the American Psychological Association. “It is part of the species — all species, in fact — in the animal kingdom,” he says. “We do it all of the time.”

    Of course they blame the alcohol. But how else does one tolerate Chuck E. Cheese’s, and don’t we all love that delicious wine on tap?

    …CEC also took alcohol off the menu at a Chuck E. Cheese’s in Flint, Mich., in February, a month after police responded to a fight there involving as many as 80 people.