Denialism Blog

Author: MarkH

  • Healthcare reform

    With the recent victory of this administration in passing health care reform I felt it was time to talk again about the importance of this issue and some of my own experiences in the last year of my surgical training.

    I was, and still am of the belief that reform, whatever form it might take, will be successful as long as we manage to make health care universal. Partly because our system already is universal but defective. No matter if you have insurance or not, if you show up in a hospital with a problem that needs to be addressed, we’ll treat it. We ethically can not turn people away because they lack insurance. People therefore who lack insurance regularly show up in the ER for primary care, or worse, with a problem that could have been addressed by a primary care doc weeks before but now has become so severe they have no choice but to get treatment whether they are insured or not. For instance, I had a patient who arrived in the ER with a gaping, necrotic sore on his cheek. It had started as an abscess, gotten progressively worse, and he tried draining it himself, inadequately, because he was uninsured. Over the course of a week though the sore had eaten through his face until it actually communicated with the inside of his face. The result? Two teams of surgeons later, an ICU stay, and an extensive reconstruction, a 10 dollar problem became who knows? A 50 thousand dollar problem? More?

    We have a choice here. We can have an ethical system that treats people who need care in a thoughtful, sensible fashion, addressing problems through prevention, and appropriate care at the right time. Or we can have a system where people get their primary care in ERs, often showing up long past time their problem becomes critical and inevitably, more expensive. Guess which is less expensive? It’s not necessary to have a single-payer system like Great Britain, Canada or New Zealand. It’s not even necessary to have a public option as countries like the Netherlands demonstrate. You can even have a very generous system that is based on highly-regulated private insurance with subsidization for the poor, as in France or Germany. All of these systems beat ours with regards to cost and performance. What do all these systems have in common but is lacking in ours? It’s simple, they’re universal.
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  • This day in Crankery, November 16th

    So who here has actually read the health care bill?. I’ve been devoting a bit of time each week to peruse more and more of it, and while there are endless obstacles to a complete understanding of it (including legalese and the annoying tendency of legislation to contain edits to other bills without including the text of the other bills being edited) it is telling that opponents of the bill are having some difficulty coming up with real criticisms of it. For example, the now infamous death panel fiasco was a willful misunderstanding of a completely wholesome concept, the idea that physicians should be compensated for having end-of-life discussions with patients. It makes sense on multiple levels to reward such discussions. For one, they are hard conversations to have, and without a motivating factor, they are avoided by many physicians. The result is a situation in which many patients fail to communicate their desires for the end of their lives, they fall in the default pathway of over-utilization of resources at the end-of-life, with invasive and often pointless interventions that have no benefit and burden and overwhelm the health-care system. The ideologues who sank that language in the bill should truly rot in hell, because they destroyed a good thing just to create a bogus political argument.

    And speaking of the death panel conspiracy theory, has anyone been checking out Arthur Goldwag’s coverage of Sarah Palin’s conspiratorial beliefs? How sad is it that we still have candidates for national office that believe things that fail the snopes.com test? Palin gives me the creeps, she represents my worst nightmare, a crank candidate with inroads towards a national campaign. Goldwag’s writing on the birther movement is also excellent and I’m glad to see these crackpots are being laughed out of court for the fools they are. In particular I liked the text of Judge Carter’s decision describing what it’s like to deal with cranks in court:

    The hearings have been interesting to say the least. Plaintiffs’ arguments through Taitz have generally failed to aid the Court. Instead, Plaintiffs’ counsel has favored rhetoric seeking to arouse the emotions and prejudices of her followers rather than the language of a lawyer seeking to present arguments through cogent legal reasoning. While the Court has no desire to chill Plaintiffs’ enthusiastic presentation, Taitz’s argument often hampered the efforts of her co-counsel Gary Kreep (“Kreep”), counsel for Plaintiffs Drake and Robinson, to bring serious issues before the Court. The Court has attempted to give Plaintiffs a voice and a chance to be heard by respecting their choice of counsel and by making every effort to discern the legal arguments of Plaintiffs’ counsel amongst the rhetoric.
    This Court exercised extreme patience when Taitz endangered this case being heard at all by failing to properly file and serve the complaint upon Defendants and held multiple hearings to ensure that the case would not be dismissed on the technicality of failure to effect service. While the original complaint in this matter was filed on January 20, 2009, Defendants were not properly served until August 25, 2009. Taitz successfully served Defendants only after the Court intervened on several occasions and requested that defense counsel make significant accommodations for her to effect service. Taitz also continually refused to comply with court rules and procedure. Taitz even asked this Court to recuse Magistrate Judge Arthur Nakazato on the basis that he required her to comply with the Local Rules. See Order Denying Pls.’ Mot. For Modification of Mag. J. Nakazato’s Aug. 6, 2009, Order; Denying Pls.’ Mot. to Recuse Mag. J. Nakazato; and Granting Ex Parte App. for Order Vacating Voluntary Dismissal (Sep. 8, 2009). Taitz also attempted to dismiss two of her clients against their wishes because she did not want to work with their new counsel. See id. Taitz encouraged her supporters to contact this Court, both via letters and phone calls. It was improper and unethical for her as an attorney to encourage her supporters to attempt to influence this Court’s decision. Despite these attempts to manipulate this Court, the Court has not considered any outside pleas to influence the Court’s decision.
    Additionally, the Court has received several sworn affidavits that Taitz asked potential witnesses that she planned to call before this Court to perjure themselves. This Court is deeply concerned that Taitz may have suborned perjury through witnesses she intended to bring before this Court. While the Court seeks to ensure that all interested parties have had the opportunity to be heard, the Court cannot condone the conduct of Plaintiffs’ counsel in her efforts to influence this Court.
    …
    Plaintiffs have encouraged the Court to ignore these mandates of the Constitution; to
    disregard the limits on its power put in place by the Constitution; and to effectively overthrow a sitting president who was popularly elected by “We the People”-over sixty-nine million of the people. Plaintiffs have attacked the judiciary, including every prior court that has dismissed their claim, as unpatriotic and even treasonous for refusing to grant their requests and for adhering to the terms of the Constitution which set forth its jurisdiction. Respecting the constitutional role and jurisdiction of this Court is not unpatriotic. Quite the contrary, this Courtconsiders commitment to that constitutional role to be the ultimate reflection of patriotism.
    Therefore, for the reasons stated above, Defendants’ Motion to Dismiss is GRANTED.

    You can just taste the crankery. The complete looseness with the truth as long as it conforms to the warped worldview of these crackpots is part and parcel of cranks the world over. Reading the follow-up of this case from right wing sites like Free Republic, and Storm Front, it’s impossible to tell the difference between the conservative ideologues and the unrepentant racists. All the appeals to patriotism and the constitution are such weak cover for the fact these cranks are angry we have a black president.

    I continue to work the long hours of a surgical intern and must say, it’s a lot of drudgery. Internship is much more about paying your dues than about learning a whole lot, although my daily routine is occasionally punctuated by moments of extreme excitement. For instance, I will not forget the first time I placed a chest tube in a patient in the bedside, the blood that poured out of the guys chest that was keeping him from breathing, or the time I walked into a room to discover a patient in the midst of having a heart attack. Luckily, the training sets in, and we have a lot of supervision, so even when things get crazy I’ve always got someone with me who has seen it all before.

    I also am increasingly motivated to write more as I feel less plugged-in than ever to the outside world since writing at least forced me to read tons of diverse information on lots of different topics. Cranks and crankery are all around us and I’m constantly reminded of the problems they create. It seems every time I see some topical show, and the commentators pause to reflect for a moment on the problem they’re all facing, it seems like they all know what the problem is but just don’t have a good name for it. The problem is that lies can be equally effective as the truth, and denialism creates very real problems for us and our democracy every single day. Denialism works, and cranks run amok throughout our country and the world. We have to keep writing about it until rather being on the tip of everyone’s tongue, people are willing to come out and call out denialism for what it is, and shout it down when it rears its ugly head.

  • Surgical Internship

    You might have noticed I’ve been busy for the last couple of months. This is because I’ve started my surgical internship, and when not working, am usually either sleeping or eating. I’m going to endeavor to write more though, because I think important things are going on in the world, and because it’s somewhat therapeutic.

    I’ll tell you first about a day in the life. What does a surgical intern do? Well, pretty much what most interns do in medicine. We are the ones who run the floor, who do the day-to-day stuff that keeps a medical or surgical service running. The work isn’t that exciting. We put out fires, do a lot of administrative work, and deal with the moment-to-moment issues with patients admitted to the hospital. But it is important work and necessary to keep the system running.

    A day usually starts around 5-6AM, when you show up on the floor and get “sign out”, or information on the patients on the service from the person covering them at night. We then start collecting data from the previous day, the vital signs and labs that let us know the status and trends of our patients, and put them together in a list. The list, they say, is life. It becomes the vital piece of reference information the team uses throughout the day to determine what has happened with our patients so far, where they stand now, and what needs to be done in the future. Usually consisting of a few pieces of paper, in tiny print it contains the information we use for rounds that morning, and then use to refer to our plans for the patients on service for the rest of the day.

    Rounds are critical. Rounds are when everyone on the team learns what is happening with every patient, we talk to them to hear about any new issues or new complaints, do a physical exam, discuss plans with members of the team and the nurses, write our notes for the day and address acute issues that have come up in the previous night. On surgical services, because the first cases are usually scheduled to start between 7-8AM, rounds have to be efficient and succinct.

    Then between 8AM and around 5PM my day is dividing between implementing the plans decided on by the chiefs and attendings during rounds, addressing issues that come up during the day, and hopefully getting into the OR once or twice a day to continue to improve my surgical skills. Internship is mostly about the basics of patient care though, and keeping the service rolling to the patients get better and out the door so a new batch can come in and get treatment.

    Around 6PM the night call person usually gets sign out from us, and we endeavor to communicate the critical issues for our patients that need to be addressed during the night, and the problems we anticipate coming up. It’s an under-emphasized aspect of hospital medicine, the day-to-day communication that makes sure nothing falls through the cracks and when we try to make the care of patients as seamless as possible, despite the need to hand-off care to the next guy. We are only human after all, and can only keep the plates spinning for so long before we need to eat, sleep, and get cleaned up for the next day’s work. During the day you’re running from task to task as quick as you can, and I lost about 15 lbs in the first month (unintentionally) from the constant activity and lack of time for meals. Fortunately I can miss the weight. My second month has been a bit calmer and there is free food, so I’ve stabilized, but I’ll start to melt again once I get back on one of the more crushing services.

    Every 3-4 days, or just on weekends if there is a night-float system, you have call. This means you start at 6AM and work until about 11AM the next day in a 30-hour marathon shift. At 6PM you pick up a couple of other surgical services you will have to cross-cover overnight. It’s brutal, but necessary, and you learn to deal with issues as they come up efficiently, and even more importantly, to ask for help from the covering chiefs when you’re out of your level of comfort or expertise. Post-call you sleep for about 12-14 hours and show up the next day at 6AM to start the process all over again. Amazingly, despite these requirements we have to keep our total hours under 80 hours a week on average.

    We’ll talk some more about what it’s like to be a new intern. Specifically, we’ll have to talk about the July effect (whether or not it even exists), the 80-hour workweek, and the impact medical reform may have on graduate medical education. It’s an exciting time to be in medicine, I can only hope we get past the current noise and nonsense to make some real improvements in how we apply the science of medicine to human health.

  • Welcome Back to Denialism Blog

    Despite rumors to the contrary, I am not dead. Instead I’ve been working hard as a new surgical intern and sadly not finding the time to write for the denialism blog. However, now more than ever, it seems that we need to talk about the problem of denialism.

    Two major new issues for denialism have cropped up, and both are major new forms of political denialism. The first, I’ll broadly describe as Obama-denialism. Obama is a muslim, Obama was not born in the US, there is a giant conspiracy involving the Hawaii Secretary of State, the Democratic Party and muslims worldwide to take over the US government with a madrassa-trained presidential double agent etc. These are of course nonsense. FighttheSmears a website created by Obama supporters has most of the more ridiculous rumors debunked, including the absurd birth certificate/birther conspiracy theory. appropriately mocking LA Times blog entry. Whatever. As readers of denialism blog, it should have been clear from the get-go that this is just the usual conspiracist-drivel propagated by people who are upset at having a black president, and, just like the truthers, holocaust deniers, AIDS denialists, or any other group driven by racism, paranoia or just plain stupidity they won’t be satisfied by any evidence that contradicts their illogical conclusions. The format of the arguments is prima-facie absurd. The conspiracies are non-parsimonious, and lead immediately to more questions that just don’t make any sense. Despite this, bigots and crackpots like Fox News and Lou Dobbs “cover the controversy” to keep it stirred up. We must address it for what it is, closet racism and sour grapes over losing an election.

    The second major issue, even more distressing to me now that I’m fully immersed in our health-care system, is that of universal health care denialism. Most upsetting to me was pronouncements like that of Sarah Palin that health care reform will lead to “death panels”. This is where the political opponents of progressive governance have crossed the line from the usual political ignorance and lies to truly despicable tactics designed to sink health care reform at any cost. The reality of the language originally in the bill was that it was designed to encourage physicians to have end-of-life discussions with their patients by paying them for such consultations. This is an area in which our health system currently fails miserably to the detriment of our patients. We truly need to have all patients interacting with our health system to have frank discussions about their wishes at the end of their lives, to have living wills, and make their desires for their level of intervention clear before they end up in the ICU, on a ventilator, and having invasive treatments performed ad nauseum that they may or may not approve of if they were able to communicate their wishes. But no, the political opponents of health care reform have instigated a scorched-earth policy, and even something as noncontroversial as asking people what they want their physicians to do when they’re sick has been thrown under the bus by the denialists. Other lies? Universal health care reform will turn us into communist Russia! A belief inconsistent with the fact that every other country in the industrialized world has survived the conversion to universal systems without requiring Stalinist dictatorships to enforce the dastardly public option. These arguments transcend mere denialism and can only be described as ideological insanity.

    There is a legitimate debate to be had over health care, but we clearly are not having it. One legitimate question is how do we pay for it? I’m confident that reform will pay for itself and it is more expensive not to have universal access. As we discussed in our health care series, every other country in the world has accomplished this feat, provide equivalent or measurably better care in terms of access, health of populations, and life expectancy. Despite their universal coverage they all spend less than half as much per capita than the US on health coverage. Having people access the system in our ERs, lacking preventative care, and failing to provide the universal inexpensive interventions costs more than just providing care to people. After all, we already pay for the uninsured, hospitals and doctors are ethically obligated to provide care for everyone who walks in the door, insured or not. The costs of covering the uninsured are already built into our excess costs. Worse, having a administrative system designed to deny care is costly and unnecessary. The “privatization” or “subcontracting’ of medicare administration under Bush increased the cost of healthcare administration by 30% in three years despite the number of patients covered increasing by only about 4%. Paying for things in a planned, thoughtful and systematic way is cheaper than allowing problems to stew and boil over. I’ve already had way too many patients showing up in the ER with disastrous and expensive health problems requiring a huge expenditure of resources that if they had been addressed early would have cost next to nothing. And yes, they always tell me they didn’t get it addressed before it was critical because they lacked insurance. This is stupid and not the kind of care I want to be providing. Another legitimate question is will universality damage our technological and research prowess? Again I believe the answer is no. The US has excellent technology and research because we pay for it through government agencies like the NIH. The technology won’t go away because that has more to do with the culture of our healthcare system than the fact that we have oodles of money to pay for it (because we don’t really). It’s also not a fact that our technology necessarily makes our care better. CT scans, and MRIs are not as important to provision of health care as having ready access to services and adequate access to primary care physicians and preventative care. Another good question, is a public option necessary? Again I believe not. While I believe countries that provide a public option like Australia are ones on which we may model our system, other countries such as the Netherlands or Germany have developed excellent healthcare systems through insurers by tightly regulating them and not letting them screw their citizens. Here’s a great question, would anyone under these systems choose the US one? As evinced by the commentary from our health system, the critics of universal healthcare are speaking from ignorance when they claim citizens of other countries are suffering in their systems. The data we presented, and reinforced by commentary from all over the world, was that these systems have problems, but no one in their right mind would trade them for the US system.

    Let’s get back to having a public debate that is not overwhelmed by the ideological fanatics and deniers and instead focus on the very real and critical problems that this president was elected to address. The denialists and their scorched earth tactics have done a great deal of harm to our debate on reform. Now more than ever, we need to talk about the difference between denialism and debate.

  • Holocaust Museum Shooter – Anti-semite and conspiracy theorist

    Orac has already pointed out the disgusting hate behind the Holocaust museum shooter and his holocaust denial. Others around the internet, in particular Pat at Screw Loose Change have pointed out he was an example of crank magnetism. Not surprisingly, he was also a 9/11 truther (which as Pat says, “scratch a 9/11 truther and you get a holocaust denier”), loved Mel Gibson, and promoted conspiracies about how Obama isn’t a US citizen.

    I am particularly interested in his anti-Federal Reserve craziness, which these days, especially among the Ron Paul crowd, I’ve noticed seems to be a stand-in or euphemism for “Jewish bankers”. I think it’s no surprise that Ron Paul is the Stormfront candidate, as his theories about the gold standard and federal reserve being the source of all evil are congruent with the classic jewish/banker/protocols conspiracies usually espoused by the extreme right wing and neo-nazis. Is this the mainstreaming of an anti-Jewish conspiracy theory? Or is it just another example of crank magnetism?

    Finally, this is another example of the importance of understanding and working to correct the problem of the suspicious personality. This type of thinking isn’t just unscientific, historically bankrupt, irrational, and just plain crazy, it also leads to extremism as it feeds into persecutory delusions, and as people become more disenfranchised due to their insane beliefs, it eventually will cause violence. This violence, evidenced by shootings loosely directed at liberals and gays like at the Knoxville Unitarian Church, is likely being ratcheted up by the increasingly unhinged conspiracy-mongering coming from the right. Liberals are being described as destroying America, major right-wing media moguls like Andrew Breitbart are spreading conspiracies about the liberal intent to destroy the country, Glenn Beck is spouting off total gibberish about how his country is being destroyed by liberals, etc. This is only going to get worse and the paranoid conspiracy-mongering from the right is stoking the flames.

  • The psychology of crankery

    ResearchBlogging.orgOur recent discussions of HIV/AIDS denial and in particular Seth Kalichman’s book “Denying AIDS” has got me thinking more about the psychology of those who are susceptible to pseudoscientific belief. It’s an interesting topic, and Kalichman studies it briefly in his book mentioning the “suspicious minds”:

    At its very core, denialism is deeply embedded in a sense of mistrust. Most obviously, we see suspicion in denialist conspiracy theories. Most conspiracy theories grow out of suspicions about corruptions in government, industry, science, and medicine, all working together in some grand sinister plot. Psychologically, suspicion is the central feature of paranoid personality, and it is not overreaching to say that some denialists demonstrate this extreme. Suspicious thinking can be understood as a filter through which the world is interpreted, where attention is driven towards those ideas and isolated anecdotes that confirm one’s preconceived notions of wrong doing. Suspicious thinkers are predisposed to see themselves as special or to hold some special knowledge.
    Psychotherapist David Shpairo in his classic book Neurotic Styles describes the suspicious thinker. Just as wee see in denialism, suspiciousness is not easily penetrated by facts or evidence that counter individuals’ preconceived worldview. Just as Shapiro describes in the suspicious personality, the denialist selectively attends to information that bolsters his or her own beliefs. Denialists exhibit suspicious thinking when they manipulate objective reality to fit within their beliefs. It is true that all people are prone to fit the world into their sense of reality, but the suspicious person distorts reality and does so with an uncommon rigidity. The parallel between the suspicious personality style and denialism is really quite compelling. As described by Shapiro:

    A suspicious person is a person who has something on his mind. He looks at the world with fixed and preoccupying expectation, and he searches repetitively, and only, for confirmation of it. He will not be persuaded to abandon his suspicion of some plan of action based on it. On the contrary, he will pay no attention to rational arguments except to find in them some aspect or feature that actually confirms his original view. Anyone who tries to influence or persuade a suspicious person will not only fail, but also, unless he is sensible enough to abandon his efforts early will, himself, become an object of the original suspicious idea.

    The rhetoric of denialism clearly reveals a deeply suspicious character. In denialism, the science of AIDS is deconstructed to examine evidence taken out of context by non-scientists. The evidence is assimilated into one’s beliefs that HIV does not cause AIDS, that HIV tests are invalid, that the science is corrupt, and aimed to profit Big Pharma.
    …
    The insights offered by Shapiro are that denialists are not “lying” in the way that most anti-denialists portray them. The cognitive style of the denialist represents a warped sense of reality for sure, explaining why arguing or debating with a denialist gets you nowhere. But the denialist is not the evil plotter they are often portrayed as. Rather denialists are trapped in their denialism.
    …
    Psychologically, certain people seem predisposed to suspicious thinking and it seems this may be true of denialism as well. I submit that dienialism stems from a conspiracy-theory-prone personality style. We see this in people who appear predisposed to suspiciousness, and these people are vulnerable to anti-establishment propaganda. We know that suspicious people view themselves as the target of wrongdoing and hold persecutory ideas.

    I agree that this certainly represents a portion of denialists, but not all. I think others, for example creationists and global warming denialists, tend to have a different motivation and style, due to ideological extremism that warps their worldview. Ideological and paranoid denialism can co-exist within denialist camps, or even within an individual, but there are areas where the overlap is incomplete. Still, the issue of the suspicious personality style is important.

    We all know this person. If you don’t, maybe you know Dale Gribble (AKA Rusty Shackleford).

    i-eca7a089974f18961e4073138eeda24c-dalegribble.jpg

    I just know Mike Judge has met the suspicious personality style and encapsulated the extreme of this personality in this character. Dale inevitably sees every event as tied to some bizarre government/alien conspiracy, and inevitably the other men in the alley ignore his interjections or Hank simply says, “that’s asinine”. Hank is a wise man. To argue with a Dale would only make you look like the fool.

    Some anti-denialists sites have recently brought to my attention a growing body of work trying to understand how people become conspiracy theorists. Two papers in particular are of interest, the first Unanswered Questions: A Preliminary Investigation of
    Personality and Individual Difference Predictors of 9/11 Conspiracist Beliefs     [1] is an interesting study because it provides some explanation for crank magnetism.

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  • Changing medical school requirements for scientific medicine

    Science has an editorial today discussing a topic near and dear to me, what medical schools should require from undergraduates before admission.

    Since I was a bit non-traditional as an undergraduate premed (I was a physics major), I am happy to see that they’ve ignored calls to overload undergraduate education with a bunch of pre-professional courses that prevent people from being anything but biology majors.

    How should preparation for medical study be assessed? Medical schools generally determine scientific readiness for admission by course requirements and scores on the MCAT, which mainly reflects the traditional content of those courses. In contrast, medical schools have long evaluated readiness for medical practice in terms of competency–specific learned abilities that can be put into practice–rather than by mandating standard courses and curricula for all medical schools. The report recommends that scientific readiness for medical school entry be assessed similarly: The current list of required premedical school courses should be replaced with required science competencies. Instead of a nationwide requirement that premedical undergraduates take specific chemistry classes, for example, a required competency might be described as being “able to apply knowledge of the chemistry of carbon compounds to biochemical reactions.” The report suggests competencies for premedical and medical school science education, recognizing that there may be multiple routes to gaining a competency. An integrated approach to both undergraduate and medical education may help both to innovate.

    The editorial discusses this report from the American Association of Medical Colleges and the Howard Hughes Medical Institute that suggests what should medical students arrive at medical school knowing. For years, I’ve thought the premedical requirements were absurd. You are required to have a year of physics, a year of calculus, a year of organic and a year of inorganic/analytic chemistry (at least when I went through). While I benefited from having a basic science background before arriving at medical school, I have to say, the only things I’ve retained from organic chemistry class of any importance are that like dissolves like, and hot solvent is great for cleaning. I still can not think of anything valuable I learned from inorganic chemistry that I didn’t get in high school like computing basic stoichiometry or making solutions. Physics? Maybe it was more useful (and for me it was interesting in fun), but mostly as a course of study in rigorous scientific thinking, statistics, error analysis, etc. Calculus? Totally worthless for medicine. Even the biology courses tend to be exceedingly general (which I think is good). You know what’s been most useful? Knowing how to write. Knowing how to research for a paper, whether it’s on history or quantum mechanics. Knowing how to think and teach yourself about subjects rather than just memorize them. That’s what college should do, and that’s what medical schools should select for, rather than those who memorized the most facts in premed science requirements. And the MCAT? Don’t get me started. The smartest people I know did the worst on that test, and some of the most useless do well, because it doesn’t test reasoning or anything useful, just memorization of all that worthless junk in all those premed classes.

    The report acknowledges this, and emphasizes a different skill set and set of “competencies” for premed requirements, rather than some rote knowledge on subjects you’ll never use again in your life. This made my heart swell and brought a tear to my eye.

    The fact is, the first year of medical school is a great deal of catch-up for many students, even chemistry and biology majors, because the majority of what we learn in college is irrelevant to medicine, and that’s a good thing. College should not be treated as a pre-professional school that merely exists to give you specific knowledge to get you ready to be a doctor. There is great value in young people coming to medical school with a diversity of experiences and knowledge. If you like chemistry? Great! By all means, take 3 years of organic chemistry if that’s what you like, but we shouldn’t pretend it will ever be used again for medical school. I’m still angry about the hours of life I wasted in organic chemistry class, never to be used again, when I could have been learning about something I really cared about, or exploring more of the liberal arts classes at my university.

    This is why it’s good that experts in medical school have begun to acknowledge that premed requirements do nothing useful to prepare one for medical school, but only really serve as a barrier to the unmotivated by virtue of being a giant pain in the ass. One could easily imagine a 1 year, or 1 semester course containing all the basic science required for medical school (which should be administered pass/fail). It’s more important that people arrive at medical school knowing how to think, knowing how to evaluate the scientific literature, having knowledge of the world and hopefully having a higher level of maturity. The physiology, pharmacology, anatomy – all of it is available in the basic science years of medical school. There is very little specific knowledge one needs at the start.

    I’m glad to see there is talk of finally breaking from the stodgy and pointless premed requirements that generations of medical student hopefuls have had to suffer through (despite some, like Jules Dienstag, defending the premed torture as a “necessary gauntlet”. Let’s just hope they implement some of these changes, save premeds years of excessive study of irrelevant subjects, and maybe, if we’re lucky, burn the MCAT for the useless test that it is.

  • The Obama Plan – Part I

    We’re starting to hear about how Obama intends to implement healthcare in this country.

    President Barack Obama says he’s open to requiring all Americans to buy health insurance, as long as the plan provides a “hardship waiver” to exempt poor people from having to pay.

    Obama opposed such an individual mandate during his campaign, but Congress increasingly is moving to embrace the idea.

    In providing the first real details on how he wants to reshape the nation’s health care system, the president urged Congress on Wednesday toward a sweeping overhaul that would allow Americans to buy into a government insurance plan.

    Obama outlined his goals in a letter to Sens. Edward Kennedy, D-Mass., and Max Baucus, D-Mont., chairmen of the two committees writing health care bills. It followed a meeting he held Tuesday with members of their committees, and amounted to a road map to keep Congress aligned with his goals.

    The letter published at whitehouse.gov, lays out some basic ideas, but it seems as though Obama is willing to have congress work out the specifics.

    Let’s go through his recommendations and talk about the implications.
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  • Oprah is a crank

    PZ brings to my attention this article in Newsweek which sums up Oprah’s views on health, and one sadly must come to the conclusion that Oprah is a crank. Based on our definition of crankery, one of the critical aspects is the incompetence of an individual in judging sources of information. How else can you describe her dismissal of legitimate medical opinion for the pseudoscience of celebrities like Suzanne Somers or Jenny McCarthy?

    That was apparently good enough for Oprah. “Many people write Suzanne off as a quackadoo,” she said. “But she just might be a pioneer.” Oprah acknowledged that Somers’s claims “have been met with relentless criticism” from doctors. Several times during the show she gave physicians an opportunity to dispute what Somers was saying. But it wasn’t quite a fair fight. The doctors who raised these concerns were seated down in the audience and had to wait to be called on. Somers sat onstage next to Oprah, who defended her from attack. “Suzanne swears by bioidenticals and refuses to keep quiet. She’ll take on anyone, including any doctor who questions her.”

    That would be a lot of doctors. Outside Oprah’s world, there isn’t a raging debate about replacing hormones. Somers “is simply repackaging the old, discredited idea that menopause is some kind of hormone-deficiency disease, and that restoring them will bring back youth,” says Dr. Nanette Santoro, director of reproductive endocrinology at Albert Einstein College of Medicine. Older women aren’t missing hormones. They just don’t need as much once they get past their childbearing years. Unless a woman has significant discomfort from hot flashes–and most women don’t–there is little reason to prescribe them. Most women never use them. Hormone therapy can increase a woman’s risk of heart attacks, strokes, blood clots and cancer. And despite Somers’s claim that her specially made, non-FDA-approved bioidenticals are “natural” and safer, they are actually synthetic, just like conventional hormones and FDA-approved bioidenticals from pharmacies–and there are no conclusive clinical studies showing they are less risky. That’s why endocrinologists advise that women take the smallest dose that alleviates symptoms, and use them only as long as they’re needed.
    …
    This is where things get tricky. Because the truth is, some of what Oprah promotes isn’t good, and a lot of the advice her guests dispense on the show is just bad. The Suzanne Somers episode wasn’t an oddball occurrence. This kind of thing happens again and again on Oprah. Some of the many experts who cross her stage offer interesting and useful information (props to you, Dr. Oz). Others gush nonsense. Oprah, who holds up her guests as prophets, can’t seem to tell the difference. She has the power to summon the most learned authorities on any subject; who would refuse her? Instead, all too often Oprah winds up putting herself and her trusting audience in the hands of celebrity authors and pop-science artists pitching wonder cures and miracle treatments that are questionable or flat-out wrong, and sometimes dangerous.
    …
    But back on the Oprah show, McCarthy’s charges went virtually unchallenged. Oprah praised McCarthy’s bravery and plugged her book, but did not invite a physician or scientist to explain to her audience the many studies that contradict the vaccines-autism link. Instead, Oprah read a brief statement from the Centers for Disease Control saying there was no science to prove a connection and that the government was continuing to study the problem. But McCarthy got the last word. “My science is named Evan, and he’s at home. That’s my science.” Oprah might say that McCarthy was just sharing her first-person story and that Oprah wasn’t endorsing her point of view. But by the end of the show, the take-away message for any mother with young kids was pretty clear: be afraid.

    Dangerous is right. One wonders why the CDC doesn’t have a public health authority devoted to studying the spread of quackery at the hands of celebrities and promoters of woo such as Oprah. It’s disappointing though, she’s clearly an intelligent person and has the potential to do so much good, but instead chooses to follow the advice of any celebrity at hand who will tell her and her audience what they want to hear.

    What’s worse is that while seeking advice from quacks who promote this wishful thinking, at the same time she reinforces that most fundamental aspect of medical woo. When you are sick it isn’t because human bodies are fragile, or they wear out, or are attacked by bacteria and viruses, instead it’s your fault. Sickness isn’t an accident. It’s your failure. You failed to take supplements, or you failed to protect yourself, or you are weak-minded, or you failed spiritually. Of course there are things that we can do to protect ourselves and stay healthy, I wouldn’t suggest some form of health fatalism. But medical quackery takes a healthy attitude of self-protection to an extreme of self-flagellation. It promotes the idea that there is always a way of staying healthy, (take this vitamin!) when in reality sickness and death comes to us all no matter how hard we wish it were otherwise. This wishful thinking and self-doubt is, of course, what is exploited to sell quack remedies.

    Oprah fails her audience, not only in her incompetence in judging medical expertise, but also for complicity in this most insidious aspect of quackery, that of blaming the victim.
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  • What's sad is that this actually works

    The onion, as always, nails it:

    Oh, No! It’s Making Well-Reasoned Arguments Backed With Facts! Run!

    I…I think it’s finally over. Our reactionary emotional response seems to have stopped it dead in its tracks. If I’m right, all we have to do now is smugly reiterate our half-formed thesis and–oh, no! For the love of God, no! It’s thoughtfully mulling things over!

    Run! Run! It’s making reasonable, fact-based arguments!

    Quickly! Hide behind self-righteousness! The ad hominem rejoinders–ready the ad hominem rejoinders! Watch out! Dodge the issue at hand! Question its character and keep moving haphazardly from one flawed point to the next!

    All together now! Put every bit of secondhand conjecture into it you’ve got!

    …

    All is lost. We don’t stand a chance against its relentless onslaught of exhaustive research and immaculate rhetoric. We may as well lie down and–Christ, how it pains me to say it–admit that it’s right. My friends, I would like to take these last few moments of stubborn close-mindedness to say that it’s been an honor to dig myself into this hole with you.

    Unless…wait, of course! Why didn’t we think of it before? Volume! Sheer volume! It’s so simple. Quickly now, we don’t have much time! Don’t let it get a word in edgewise! Derisively cut it off mid-sentence! Now, launch the sophomoric personal attacks! Louder, yes, that’s it, louder! Be repetitive, juvenile, and obstinate! It’s working! It’s working!

    We’ve done it! It’s walking away and shaking its head in disgust! Huzzah! Finally–defeated with a single three-minute volley of irrelevant, off-topic shouting!

    Ironic, really, isn’t it?

    Thanks lbcapps