In the interest of blog synergy, I’m reposting this from my old blog.
I’m actually quite lucky. Despite being surrounded by infectious diseases for sixty hours a week, I don’t get sick all that much (OK, maybe more than most, but I don’t have data). I actually called in sick for part of the day, something I rarely do. And that got me thinking…
West Nile season is starting up, with the first few case reports trickling in.
Back in the summer of 2002, I was introduced to West Nile fever. This mosquito-borne viral illness had a minimal presence in North America in the preceding three years, but made its real American debut that summer. It may have hitchhiked over on boats or in an infected traveler, but either way, it’s here to stay.
That summer, as I took over rounding on an inpatient medical service, I was suddenly faced with a relatively large number of very ill patients. They were usually elderly, and would be brought to the ER with fevers, headaches, low sodium levels, and confusion. More often than not, they developed weakness, often severe enough to land them in the ICU on a ventilator. Recovery was variable, with some people doing fine after rehabilitation, and others dying.
I went hiking in the woods that summer (with plenty of DEET solution) and saw a number of dead crows and blue jays, who also serve as unfortunate hosts to the virus.
There is no specific treatment for West Nile, but prevention involves mosquito control and avoidance.
There hasn’t been another summer like ’02. My state had over 600 cases in 2002, including 51 fatalities. Last year saw fewer than 20 cases. I’ve seen plenty of living blue jays so far.
Some of our success is due to vector control, but much is due to immunity. When the virus landed, very few Americans had been exposed. Now, many of us have, and our immune systems have been reasonably effective at mitigating the effects of this now wide-spread disease.
I still view mosquitoes differently. They never really bothered me, but after seeing so many horribly ill people, I think about those little pests before I go out in the evening.
West Nile is a beautiful model for emerging infectious diseases. I wonder what we’ll see next?
I was glancing at the Huffington Post today when I ran into yet another piece of what I wish was absurdist health reporting. Unfortunately, it’s meant to be taken seriously.
What’s even worse is that there is a real problem hidden in the hyperbole, but the author’s over-the-top rant does more to obscure than expose the issue.
In this country, we’ve never known how to deal with psychiatric disease. From the mass institutionalization present for much of our history, to the massive de-institutionalization of the mid-1960’s, from forced lobotomies and sterilizations, to the development of helpful medications and their use, and perhaps overuse, we have lived with a chaotic mental health care system. This system is somehow divorced from the rest of the health care system, despite the fact that the brains is an organ like any other. Mental health care is expensive and spotty, and compared to health care involving every other organ, is nearly completely uncovered by insurance.
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Spring is here, despite this week’s frost (I’m really happy I didn’t get around to planting last weekend). I love being outdoors, but my work keeps me inside a lot. Now that the days are longer, I have more opportunities to take my kiddo outside exploring. Her favorite thing to do is go “hiking”, which essentially means her getting into this kid-carrying backpack I’ve got and riding on my back for several miles of rail-trail.
We’ve often discussed the tactics favored by denialists, and prominent among these is the ad hominem attack. Physicians who speak out against quackery and speak up for science-based medicine are often often accused of lacking compassion. Orac wrote a little bit about the topic today. (OK, Orac never writes a “little bit” about anything, but it’s worth the read.)
The basic argument is that “conventional” doctors ignore patients’ experiences, deny them care that may work simply because science says it won’t, and a whole bunch of other things I don’t really understand. And while they whine about our lack of compassion, they wish ill on us and our loved ones. I don’t hear a lot of real doctors doing that.
Let me tell you what physicians’ compassion is: it’s listening to a patient, talking to a patient, and formulating a plan for a patient based on science and the doctor’s knowledge of the individual.
What clearly is not compassion is making false promises, and offering miracles. What is not compassion is convincing a patient that you are the only one with access to these miracles, and that everyone else has it wrong. One of the wonders of science-based medicine is that, for the most common and serious problems, most doctors will give you similar advice, and that advice will be based on what is likely to help, and less likely to harm.
Cranks and denialists hate being confronted with truth. An ignorant fool over at some fringe autism website recently launched an attack on a doctor whom he perceives to have wronged him. Orac wrote quite a bit about it, so I won’t repeat his points, but there are a few things that need re-emphasizing.
This anti-vaccination cult leader singled out Dr. David Gorski, a surgeon and scientist who writes for sciencebasedmedicine.com. I know this guy. I’ve sat down and broken bread with him. I’ve read his posts over at SBM. This guy does not lack compassion. More importantly, he is a real doctor. He doesn’t promise miracles, and he actually cures cancers (by most conventional definitions). And that requires teamwork. He actually has to be able to work and play well with oncologists, pathologists, radiation oncologists, and the rest of the supporting staff of a modern cancer center. If he can’t cure someone, he won’t lie to them. Would it be more compassionate for him to lie and then perform unnecessary operations?
That is what the cranks and quacks offer: bad information, bad advice, and bad outcomes. But they wrap it in a veneer of pseudo-compassion, as if that makes it OK.
It’s not OK. Real doctors are out there every day preventing and treating disease, and occassionally saving a life. Quacks, at there mildest, offer pipe dreams, at their worst, a clean kill.
The fight against HIV occurs on several different levels: prevention of transmission and acquisition, treatment of the infection, and prevention and treatment of opportunistic illnesses.
Prevention has been addressed extensively (and perhaps will be again later), and opportunistic illnesses is a huge topic, so first I’ll delve a bit into the origins and biology of the treatment of HIV infection (and of course the usual caveat; this is grossly oversimplified, and Abbie has a whole lot of good, ungrammatical science over at her place).
For better or worse, this requires another short biology primer…
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Given Ford’s early track record, this story out of California is rather disturbing. (Via PZ). A SoCal Ford dealership is using prejudice against non-Christians as a prominent selling point for their business.
Henry Ford I was a well-known antisemite, and published the Protocols of the Elders of Zion in his personal rag, the Dearborn Independent. During the pre-war/depression era, Detroit hosted a number of prominent isolationists and antisemites, including Ford and Father Coughlin.
But, if you know your market, intolerance sells, and hard times sometimes bring out the worst in people. Still, it’s rather sad to see my hometown company doing nothing to rein in their renegade dealership. Unless of course, they approve of the marketing tactic of hate and prejudice. Hey, I’m sure they can afford to lose a few customers. The U.S. auto industry is doing well enough to alienate anyone they please. They are an unstoppable juggernaut, dominating the world auto market. I think.
I am giving out a previously non-existent award today to a truly great denialist. Andrew Schlafly, spawn of anti-feminist Phyllis Schlafly and some long-forgotten sperm-donor (ironic, eh?), was not content just being the legal counsel to the uber-crank Association of American Physicians and Surgeons. No, he had to take it one step further, and clog our precious intertubes with Conservaepedia, a repository of all things stupid. In fact, there is so much stupid there, an entire wiki is devoted to documenting it. I was newly enraged when a commenter over at the “blogging on peer-reviewed research” site tried to use this pile of electronic dreck as a legitimate reference.
For those of you who might have forgotten, Conservaepedia hit teh ‘tubes a little over a year ago, with a mission to counter the horrid liberal bias at Wikipedia. Well, no one is going to accuse Conservapaedia of liberal bias. In fact, the entire site is essentially a demented play book for reactionary Christian cults and denialists.
I don’t want to take you too far through the looking glass, but here are some fun examples of reactionary lunacy for you.
Here’s the conundrum:
Let’s say your patient’s insurance has decided that they will pay for 12 sessions of reiki for, say, back pain. All that the patient needs to have this therapy approved and paid for is their primary care doctor’s referral.
Let’s say that doctor has examined the evidence, and found reiki to be unsupported for any use. You explain to the patient the correct evaluation and treatment of low back pain, and explain that you will not be making the referral.
The patient is angry. She doesn’t want to have to pay for the treatment out of pocket.
What would you do?
Now let’s say you have a patient with cancer. It’s incurable, but the patient is receiving several standard and experimental treatments to prolong his survival. Otherwise, same scenario. Now what?
Over at sciencebasedmedicine.com, Mark Crislip has a great post on the history of medical advances. First, go read it. WAIT! Don’t forget to come back and read the rest of my post! OK, you can go now.
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