Denialism Blog

Author: denialism_bv2x6a

  • Thanks for playing

    First, thank you for all the wonderful comments on yesterday’s post. I never really know which posts are going to rake in the comments—my favorites are usually the quietest, and some of my quickies bring ’em in by the dozen. According to my uber-seekrit data, I’ve had two unique visitors to my naturopath post. As erv would say, “UR DOING IT RONG!11!!”

    Anyway, I would like to thank my commenters on that post. Even those of you who I think are terribly wrong were at least civil.

    I’d love to address all of the issues raised in the comments but I’m far too lazy busy at the moment, but I’d like to focus on a few issues.

    First, I still haven’t found an over-arching authority over naturopathic education and practice equivalent to real doctors. Second, much of what I’ve read so far follows an new and interesting path—a large number of very intelligent, very well-educated, very well-intentioned shamans.

    Anyway, let’s examine some of the misconceptions raised in the comments.
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  • Can't get into med school? Legislate your own doctorate!

    I guess it’s not just doctors watching this one—an alert reader and a fellow SciBling both picked up on this one. Apparently, in my neighboring state of Minnesota (really, check the map), home to Greg Laden, PZ Myers, and lutefisk, doctor wannabes have legislated themselves into “doctorhood”. You see, there is this entity called a “naturopath”, or “naturopathic doctor”, which is some sort of shaman that likes to think that if you study woo long enough, it becomes science.
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  • On being a doctor—humility and confidence

    The practice of medicine requires a careful mix of humility and confidence. Finding this balance is very tricky, as humility can become halting indecision and confidence can become reckless arrogance. Teaching these traits is a combination of drawing out a young doctor’s natural strengths, tamping down their weaknesses, and tossing in some didactic knowledge. I supervise residents—they make the decisions, but it’s my name and my ass on the line, so I keep a close eye on things. Some teaching physicians dictate every decision on patients, some do nothing at all. I try to keep toward the end of the spectrum that allows for resident autonomy. When I’m presented with a case, and asked what I would do, I cry foul:

    “You are the doctor,” I say. “Tell me what you’re planning. I’ll tell you if I disagree, and I’ll let you know if I disagree enough to override your decision.”

    This technique must, like all others, be tailored to the individual learner, but I want them to worry—I want them to think, “if I don’t do this right, no one else will, and a patient will be hurt,” because that is what the rest of their careers will be—being awakened in the middle of the night out of a sound sleep, having to make a quick assessment, and being reasonably sure that you’re right.

    Except I’ve got their backs.

    Of course, that confidence can lead to arrogance. It’s an occupational hazard. If it’s simply a personality quirk then it’s annoying. If it includes a lack of humility, a lack of knowing what you don’t know, then it is as dangerous as indecisiveness.

    It takes years of training to develop the decision-making skills that go into being an effective attending physician.

    This is one place where we part ways with the cranks and quacks.
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  • I'm Late! Skeptics' Circle #88

    It’s up at Jyunri Kankei. Go and visit!

  • Adventures in staffing—a new physician

    When a resident of student presents a patient with me and I help them formulate a plan, we call it “staffing” the case. Recently while I was staffing, I was presented with a patient who speaks little English, but speaks another language fluently. Unfortunately for us, this language wasn’t Urdu, Spanish, French, Romanian, or Hindi (languages spoken by the people immediately within my reach). The medical instructions we needed to give were fairly complex—too complex for Pidgin English, so I paged one of my interns.

    “Hey, S.,” I said, “how well do you speak (insert little-known language here)?”

    “Quite well, why?”

    “Well, I have a nice older woman who speaks it as well, and her resident happens to be graduating. She could really use your care, both for your medical skills and your language skills.”

    “You can put her in my schedule as soon as you need to. If there aren’t any openings soon, tell her to come right at 1pm and I’ll just see her before I start my clinic.”

    Wow.

    It takes a lot to make a doctor. I’ve talked about teaching medicine: how to give bad news, how to help patients with difficult diseases, and I’ll probably write a lot more.

    But some things aren’t taught—you just know them. My resident just knew the right thing to do. Despite her hellish schedule, she offered time to a patient in need. This behavior is not a given. It is the mark of a true physician.

  • Food dye—a new bugaboo

    If you’re around my age, you remember the disappearance of the red M&M. One day, they were just…gone. Apparently, folks worried that a red food dye not even used in M&M’s caused cancer.

    Well, the red ones came back, but food dyes are back in the news. The Center for Science in the Public Interest is concerned about a possible link between certain food dyes and (presumably bad) child behavior.

    Now I don’t really care what color my food is (unless my lettuce is brown and my meat is green), but these dyes are used ubiquitously to make food appear appealing, appetizing, and profitable. Given that these dyes don’t contribute nutritionally, there really is no health reason to use them, but food producers like them because they work; they help sell food.

    What’s the claim, and what’s the science?
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  • Diarrhea!

    This topic has been running through my mind quite a bit lately. Infectious diarrhea is one of the world’s most vicious killers, but is susceptible to basic public health measures such as clean water and good sanitation, which is why cholera-ridden Americans aren’t dropping dead in pools of their own feces. (Citizens of other countries aren’t quite so lucky.)

    There are many causes to this common problem—various bacteria, viruses, parasites, and a host of non-infectious causes. Even in here in the U.S., public health measures sometimes fail us, as seen in the ongoing Salmonella outbreak.

    But diarrhea isn’t just a load of crap. Let me explain.
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  • How do you say it?

    I am often the bearer of bad news. I don’t think I’ve ever been formally taught how to deliver bad news, but I’ve developed a style over the years, and I’m pretty good at it.

    I work with medical residents every day in their outpatient clinics. Most of them have never had to deliver bad news. Some people are natural communicators, and some aren’t. Often, one of my residents just “gets it”—they have a great deal of empathy, can “read” the patient from moment to moment, and without any help from me, they can successfully give the news.

    What does it mean to give bad news “successfully”?

    In medicine, it means giving complex information in a short period of time, with proper emotional content, and in such a way that the patient takes it seriously, but doesn’t become so frightened that they forget the entire discussion. Once the word “cancer” comes out, little after that is retained. Over and over, I hear people say, “what was that thing you said I have?”

    There is no substitute for young doctors giving bad news to their own patients, but it’s good to model behaviors and to pass along tips.

    For example, if I have to tell someone they have HIV, I usually make sure to shake their hand, put a hand on their shoulder, sit near them, and keep my arms uncrossed. These signals set the tone for how they will view their illness. If you, as a doctor, seem physically distant, the patient will sense that, and may end up feeling stigmatized, isolated, and more afraid. Also, they may disappear out of fear, delaying further treatment.

    Giving bad news has to be a flexible skill. All patients are different, and need to hear news differently. For example, I had a patient with a breast lump. She is a bright and straight-forward person, so I asked her, “Do you prefer a good surgeon who is warm and fuzzy and will hold your hand, or who will just get the job done?” She chose the latter.

    I can only hope that my skills keep improving and that my residents keep learning. Unfortunately, there will always be people to give the news to.

  • Ah, the credulity!

    Yesterday, it was the Times with “Experts Revive Debate Over Cellphones and Cancer”. Today, it’s the Journal with “Do Fuel-Saving Gadgets Take You for a Ride?”, which includes this little gem from a gadget maker:

    The EPA and FTC “only test the ones that don’t work,” says Louis H. Elwell III, chairman and president of Vortex Fluid Optimizer Corp. The Hattiesburg, Miss., company makes the Vortex Fuel Saver, a system that uses magnets to affect the fuel, air and coolant entering an engine. He says the Vortex uses technology that boosts fuel economy by at least 10%.

    Yes, Louis, that’s right, the government only tests the ones that don’t work, because the government wants you to waste fuel, and because it is against magnetism. You see, everyone in science, the EPA, and the FTC is actually in cahoots with Exxon-Mobil to sell more gas. Here at UC-Berkeley, we got $500M from BP, and you know what, all I do now is figure out ways to get people to waste gas. Brilliant!

    How does this stuff get into important newspapers?

  • Open letter to Jenny McCarthy

    Dear Jenny,

    Jenny, Jenny, Jenny. Oh, Jenny. Look, I realize I might have been somewhat less than kind in the past, but I’m hoping you haven’t written me off. I’ve been told you catch a lot more flies with honey than with vinegar, so please take this letter in the spirit it was intended—corrective, constructive, and condescending.

    I have it on good authority that you are planning on leading a “March on Washington” tomorrow. That’s a really interesting idea. Many groups have marched on Washington—the Bonus Army, Dr. Martin Luther King, anti-abortion groups, pro-choice groups, a Million Black Men—all to help bring attention to their causes. It is only natural (or should I say “green”) that you would wish to do the same. Other groups that have made the march have had pretty clear goals, whether they be veterans’ benefits, racial equality, or other political causes. I was wondering precisely what your goal is?

    According to the website, the goal is “to give everyone who loves a child with Autism (sic) a day for their voices to be heard.” That being sufficiently vague, the website also states that you wish to:

    …[d]emand [that] Congress take action to Green Our Vaccine Supply (sic) while reassessing our current vaccine schedule. Ask Congress to reenact legislation that would eliminate mercury and other toxins from our children’s vaccines, study the instance of Autism (sic) and other neurological disorders in vaccinated versus unvaccinated children, and to extend the statute of limitations to allow all children affected by vaccine induced Autism (sic) to file in the National Vaccine Injury Compensation Program (NVICP).

    I can understand racial equality and other socio-political causes, but I’m a little confused about your goals. The whole “giving a voice” thing seems rather devoid of actual content, so lets move on to your other statement.

    [d]emand [that] Congress take action to Green Our Vaccine Supply (sic) while reassessing our current vaccine schedule.

    First, I’m not sure what Congress has to do with this. Leaving that aside, what does it mean to “green our vaccine supply”? Do you wish them to be more verdant, like the Chicago River on St. Patrick’s Day? I suspect not. Perhaps you could clarify?

    Ask Congress to reenact legislation that would eliminate mercury and other toxins from our children’s vaccines…

    I’m sorry, Jenny, but that doesn’t make a whole lot of sense. You already made us stop using mercury compounds, despite the overwhelming evidence of safety, and yet autism rates haven’t dropped. What “toxins” do you mean? I’m sure you couldn’t mean that list of “chemicals” in some of your literature—since everything is “chemicals”, I’m not sure which ones are “greener” (except copper—that can get pretty green, but it’s not in vaccines—yet). You mention “anti-freeze”, and yet there isn’t any in vaccines. Some have a compound with a similar name (polyethylene glycol vs. ethylene glycol—that “poly” makes a big difference, but it’s kind of “science-y” so I’ll leave it out for now). You mention “formaldehyde”, which is used to inactivate the viruses in some vaccines, but it’s present is such small amounts, that common environmental exposures are much more significant. In some flight of fancy, you also mentioned “aborted human fetus cells”. That’s truly bizarre. A cell culture line has existed for over 40 years whose ancestor cells came from human fetal tissue. To call these culture “human fetal tissue” is, well, wrong.

    Oh, wait, here’s one of my favorites: “chick embryos”. Jenny, that’s a synonym (that means “means the same as”) “egg”. Eggs (yes, the same kind we eat) are used to make flu vaccines. It’s too bad, because people who are allergic to eggs will have to wait until we find a new way to make the vaccine in order to benefit from the shot.

    I hope you have good weather, and at least check out some of the museums. Even better, you might want to drive a short way out of town and visit the NIH. They do science there. That means the test hypotheses, keeping the good ones and discarding the bad.

    Jenny, you’ve been fed a disproved hypothesis (that means “you’re wrong”). It’s time for you to give up your degree from Google University and go back to being a mom and actress. You’re probably good at at least one of those.