Denialism Blog

Denialism Blog

  • 2 weeks of General Medicine

    I’m sorry I’ve been buried the last couple weeks, as I’ve just started my general medicine rotation. Today is my post-call day, which means I get to sleep in and then study all day long. The fire hydrant of information is cranked open full bore again, and the shelf exam for medicine is supposed to the hardest. There is an incredible amount to know, and only a limited amount of time to assimilate it.

    Inpatient medicine is especially challenging. It’s funny because most people’s perception of medicine is from all the TV shows about medicine and you see doctors constantly fixing some patient’s problem and then they get better. If I had to pick one thing to change about the fictitious practice of medicine it would be this idea that people ever have a single problem. The more realistic medicine patient would be someone over the age of 50 with at least 5 or 6 chronic problems, and just one (or two, or three) that has put them over the edge requiring hospitalization. It’s not about solving the medical mystery of the one thing wrong with your patient, it’s about first stabilizing people who are very ill and then figuring out why someone who already has half a dozen things wrong is suddenly getting worse.

    Let’s do some recaps of fake medicine versus real medicine for fun. Let’s start with a good House patient (spoilers abound):
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  • Journalist becomes the story: Discover Magazine luvs teh denialists.

    HT erv.

    This is truly annoying because it is so patently wrong. It’s wrong in lots of different ways, but I’ll help point out some of the major flaws. What happens when journalist becomes the story, rather than reports it?

    You see, there is this journalist, Celia Farber, who apparently has been following the HIV denialists since the beginning. From reading this interview with her in Discover Magazine, it would seem that she is suffering from some sort of Stockholm Syndrome. Not only that, but the journalist interviewing her shows a complete lack of suspicion, and seems to be one of those modern journalists who thinks that everything has two valid sides to report on. Not everything does.

    Instead of chronicling the history of HIV denialism, she has truly drunk deep of the Flav-R-Ade. Ever wonder how to tell if a journalist has lost her objectivity? How about this?

    It’s changed in that so much of what the orthodoxy proclaimed has not come true. The paradigm has failed miserably on virtually all counts. So the orthodoxy right now is particularly venomous and vicious against anybody who is what they call an AIDS denialist.

    Uh oh. I sense someone begging the question. The interviewer follows up with a WTF.

    What are the failures of the paradigm?

    Good question, but I would have also asked, “WTF is the ‘HIV paradigm’?”

    Response? Right out of the HIV denialist handbook: (all emphasis mine, –PalMD)
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  • Skeptics' Circle #86—don't bitch to me about it

    It’s a really good edition up at Skepbitch (who is surprisingly nice). Don’t miss it!

  • What's in store for Burma?

    As the death toll in the immediate aftermath of Cyclone Nargis becomes clear, new dangers loom. Complete breakdown in essential services and sanitation will conspire to kill thousands more via disease unless the world moves quickly (and maybe, even if we do).

    Arthropod-borne diseases such as malaria and dengue fever are likely to flourish as standing water serves as breeding ground for mosquitoes. Malaria kills around a million people a year. Dengue is most often a disabling illness characterized by fever and severe pain, but in endemic areas it can lead to dengue hemorrhagic fever, a fatal illness resembling Ebola and Marburg viruses (but not as contagious).

    Diseases related to lack of clean water, such as diarrhea, cholera, and hepatitis A can be especially nasty with little fresh water available for rehydration.

    Tetanus, acquired from wounds, is a particularly grizzly death, and was seen frequently in victims of the Pakistan earthquake.

    As bad as the initial death toll is (perhaps around 100K), it can get much worse quickly. Hopefully the world will respond as it did after the Great Tsunami, and hopefully the Burmese Junta won’t stand in the way. If they do, they may not have much left to rule over.

  • Aye, there's the rub–open dream thread.

    I’ll admit right of the bat that I didn’t do any research before posting this one. I haven’t read any literature on dreams in years, but somehow discussion among some egghead-types turned to common dreams. Among these:

    –The one where you sign up for a class and forget about it until finals

    –The one where you are in class and notice you’re naked

    –The one where your teeth are falling out

    Now all of these have, in each person, all sorts of interesting associations, but I’m curious whether these particular dreams are more common in academic types. Do folks outside of academia have similar dreams, or are their anxieties expressed differently?

    Thread now officially open.

  • GINA—why we should make it irrelevant

    GINA, the Genetic Information Non-discrimination Act, has been passed by the House and the Senate, and will be signed by the president. Others have explained some of the implications of the bill, but the need for the bill is a grave sign.

    GINA is a symptom…a symptom of a diseased health care system. Health insurance works by pooling risk. Ideally, an insurer will take as many people as possible, regardless of their health histories, and the premiums of the healthy will support the care of the unhealthy few. Of course, insurance companies aren’t stupid. They would rather have the healthiest people possible…every penny the don’t spend is profit. That is why a small business, such as mine, will see rates skyrocket if someone gets sick. The risk isn’t being widely pooled, and the cost is being passed on to a few.

    GINA isn’t necessary in most of the world (forget for a moment that most of the world doesn’t have money to spend on genetic testing). Most industrialized nations have some sort of universal health care—risk is pooled widely, in fact the pool includes the entire population. There are problems with this, but one of them isn’t discrimination. Under our current system, people are penalized for being sick, poor, or unemployed. It is inefficient and expensive.

    Surely we can do better. If we make GINA irrelevant, many of our health care problems will also fade.

  • TEOTWAWKI!

    The end of the world is a common religious idea. The end of this planet and the end of time itself are ideas not unknown to cosmologists, but are not exactly an immediate threat.

    To certain religious groups, the threat is now, and is welcome. “Signs” are everywhere. Of course, we’ve been down this road before, in the 9th century, a few times in the 19th century, and of course in 2000.

    Turn on the TV any Sunday—there are plenty of preachers reading and reading and reading, and of course finding signs of the imminent apocalypse. Hey, there’s that whole “Left Behind” series of books reveling in the end of the world.

    Aside from the fact that no one has yet correctly predicted The End, there are a few problems here. First, if God wanted you to know when the end was coming, wouldn’t he have just written a date clearly in the Bible, like, “HEY, MORTAL FOOLS, REPENT! THE END IS NIGH! 8 PM, FEBRUARY 22ND, 2010. I MEAN IT!”

    Or perhaps he doesn’t want us to know, and to look for it would be a sin against him?

    Or maybe, just maybe, all of this “End times” stuff is just human interpretations of human works and human fears. After all, since God hasn’t bothered to inscribe it on the clear blue sky, or appear on ABC during “Desperate Housewives”, all predictions of the End must necessarily be those of people, not a supernatural being who would know such things.

    So, here we are, on our usually pleasant little globe, worrying about when it will end. That’s just lovely. But perhaps—just maybe—we should worry about what happens if it doesn’t end. Cyclone Nargis in Burma/Myanmar, Hurricane Katrina in the U.S., famines, floods, fires—all of these so-called natural disasters, while not entirely preventable, are things we can plan for. This type of large-scale planning (such as the Dutch flood prevention systems) requires casting ourselves far into the future, and actually sacrificing present comfort for future survival. Of course, if the end is near, who cares? Wait for God to take us bodily into his arms, and to Hell (literally) with everyone else.

    I, for one, can’t live with that. Just because some sweaty preacher in a studio says the world is ending doesn’t make it so. I have kids, and I care what happens to them, so it really pisses me off when others say, “just come to Christ, and all will be well.” It won’t. If you put your head in the sand hoping for immediate Rapture, you are admitting that you don’t care a whit for your fellow human beings. How Christian is that?

  • Never say "hopeless"

    I can’t tell you the number of people who complain to me about having their hope taken away. Exactly what this means, though, isn’t always clear.

    Sometimes an oncologist will tell them (so they say) that they have a month to live. Sometimes their cardiologist tells them (so they say) not to travel to their grandson’s Bar Mitzvah. Sometimes the spine surgeon tells them their back will always hurt, no matter what. So they say.

    Patients tell me a lot of things. I’m not always sure what other doctors really told them, but what is important is what the patient heard. The oncologist might have said “incurable” but followed it up by “but treatable for years.” I suspect after hearing “incurable”, not much else gets in.

    One thing I’ve finally learned after a number of years is that patients actually listen, even if you don’t think they do. What they hear is a different story. Depending on their mood and circumstance, they may hang on single phrases, subtle inflection, the way your eyes dart.

    To be an effective physician, you must also be an actor of sorts; not in the sense of pretense, but in the way you pay attention to everything your words and body do, and how your audience reacts.

    I had a patient a few years back, a very pleasant older woman, who came to me with difficulty in swallowing. There can be a number of different reasons for this. A radiographic study, however, showed a lesion in her esophagus that was almost certainly cancer. Normally, I won’t speak on the phone to people about such things, but she and I had decided for various reasons that this would be the best way to communicate. I told her about the results:
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  • Why hospice matters

    I recently lost a close family member to cancer. She was old, she had been ill a long time; it still hurts. But in her dying, she made some wise choices. She was a very bright woman, and retained her mental capacities right up until the end. This gave her the opportunity to decide how she would approach death. She chose to enroll in hospice.

    Hospice is widely misunderstood, partly because of the way we misunderstand death in the U.S. Instead of an inevitable part of life, death here is seen as an enemy to be fought at all costs, no matter the futility. Intensive care units, which were designed to care for people with a severe but potentially curable illness are full of the incurable—people on ventilators who will never breathe on their own again, who will never have a significant interpersonal interaction again.

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  • Try and beat this one, alties!

    I’m not going to lie to you. This post contains some actual science. WAIT! Don’t click away! I’ll make it palatable, I promise!

    It’s just that this is such an interesting story, and I can’t help sharing it. It is a shining example of one of the great successes of modern medical science, and stands in such stark contrast to the unfulfilled promises of the cult medicine crowd, with their colon cleanses and magic pills. This is the story of a real magic pill.
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