It’s all the buzz around here, so it’s my turn to share some interesting verse with you. Death and dying is a common topic of discussion with my patients and colleagues.
Some of these are well-known to all, some of them aren’t, but I enjoy all of them.
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A reader of ours ran into a questionable book ad, and being a good citizen, sent it on to me. I glanced at it, and it seemed to be the usual silly book purporting to cure all that ails, but on deeper inspection, it was much uglier.
The book says that it “renders insulin and related medicines unnecessary within four days…”. This is a bit scary, not because this would be a bad thing, but because many diabetics are completely dependent on insulin to live. But, hey, maybe this is a good diet plan for type II diabetics and will at least help them reduce their need for meds. I mean, it could be, right? A quick trip to google disabused me of any thoughts of intellectual generosity.
The Crank
Dr. Gabriel Cousens is the writer who promises to get you off insulin. While I applaud the idea of healing people, his claims are obviously suspicious. I mean, why are the rest of us so ignorant that we are blindly keeping diabetics on all these evil medicines?
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Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws behind you, but you don’t want to get branded a trouble maker and risk subtle (or not-so-subtle) discrimination.
Now imagine you are sitting in the doctors’ lounge, and a senior physician says that sending women to medical school is a bit of a waste. The people sitting around the table make decisions every day about who to accept and reject to medical schools and residency programs, who to hire, who to promote, but hey, it’s just a group of guys having a cup of coffee. How would you react?
In the early 1960’s, about 5% of medical American medical students were women. Now about half are. Women are first authors on more medical papers than ever, yet fill only about 11% of department chairs, and fill about 15% of full professorship positions.
What’s behind this?
There is literature studying the trends in academic and clinical medicine. I’ll point you to the reference below as a starting point, but I’d like to give you a front-line perspective.
Something I hear every week is that women are likely to take time off for kids, and to work part-time, and that this somehow renders them less valuable. I’m not sure how this reasoning works. After all, doctors treat people of all ages, genders, and ethnicities, and doctors of different backgrounds often have different experiences and skills to bring to the table.
But I can see how some of these ideas are perpetuated. Slots in medical schools, residencies, and fellowships are quite limited, and it costs much more to create a doctor than tuition could ever cover. Some take a false utilitarian view that because it costs so much to create a doctor, only those who can give back the most in time and money should be trained.
Residencies are limited in both the number of residents they can take, and in how many hours these residents can work. When one becomes pregnant, it can burden the entire program.
Well, this is the real world, and in the real world, half of us are women, and women are the ones who bear children. Also, the prime years for physician training are prime child-bearing years. Get used to it. If we think women have at least as much to offer as physicians as men, we better get used to the fact that they have “lady parts” and that this has real effects. Are we to limit the contributions women are allowed to make because a short period of their lives may or may not involve child-bearing?
In clinical medicine (as opposed to academic medicine), there seem to be many more opportunities to work part-time than in the past. The less you work, the less you get paid, but the pay is still pretty good. But academia is still about productivity, and gaps are not acceptable.
As a society and a profession, we have to decide to take the role of women seriously. If we demean women’s role in our profession, we may be more likely to demean our female patients and family members.
Things are getting better, but we still have a long way to go.
References
Reshma Jagsi, M.D., D.Phil., Elizabeth A. Guancial, M.D., Cynthia Cooper Worobey, M.D., Lori E. Henault, M.P.H., Yuchiao Chang, Ph.D., Rebecca Starr, M.B.A., M.S.W., Nancy J. Tarbell, M.D., and Elaine M. Hylek, M.D., M.P.H. The “Gender Gap” in Authorship of Academic Medical Literature — A 35-Year Perspective. NEJM 355(3); 281-287. July 20, 2006.
Skepchick has apparently discovered that, as of yesterday, this is World Homeopathy Awareness Week. (Yes, starts on a Thursday…they were going to start on Monday, but the succussion took a while.)
Well, I can get behind a public service like this. My contribution will be a side-to-side comparison of a homeopathic treatment and a real one. Let’s pick a fun disease, say, heart attacks (the website I found offered homeopathic remedies for anthrax, but I think I’ll skip that).
Unfortunately, this will require a brief tutorial on myocardial infarctions (MIs, heart attatcks). As is usual with my medical posts, this will be a gross oversimplification, but good enough to explain the issue.
An MI occurs when part of your heart muscle stops receiving enough oxygenated blood. There are a variety of possible ways for this to happen, but most of the time we are talking about a typical acute MI, where a specific artery becomes suddenly occluded. When this happens, a person usually experiences chest pain, and, if the heart attack is serious enough, heart failure, arrhythmias, and death.
Over the last couple of decades we’ve figured out how to interrupt the natural history of MIs. Clot-dissolving medications or angioplasty can be used to quickly open up an artery, hopefully saving the heart muscle from death. In addition, several medications can be used to help save lives. Beta-blockers, aspirin, angiotensin-converting enzyme inhibitors and statins have all been proved to help in an acute MI or to prevent further MIs. The literature to support these practices is quite voluminous but just to give you a sampling, see the references below.
Now let’s examine the homeopath’s guide to heart attacks…
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In order to bring you your daily dose of science, the Great Seed Overlords must pay the bills. Like any other medium, one of the ways this is done is by selling ad space. Internet ad engines generally have some sort of algorithm that choses ads based on the page content, thereby targeting readers’ interests. If you doubt the sophistication of these methods, check your amazon.com suggestions, or your google search page.
For a skeptical blogger, this can make for some interesting ads. One of mine is for a book called Water: For Health, For Healing, For Life, by F. Batmanghelidj, M.D. I’ve never heard of this guy, so I gave him a click (although I probably should have just googled it to avoid giving him my business—as usual, I’m not providing links to the woo-meister so you’ll just have to google it).
What I found is an example of how the rejection of science and adoption of woo can lead inexorably toward some pretty nasty denialism.
The book advertised offers these promises:
Based on more than twenty years of clinical and scientific research into the role of water in the body, a pioneering physician and the acclaimed author of Your Body’s Many Cries for Water shows how water – yes, water! – can relieve a stunning range of medical conditions. Simply adjusting your fluid and salt intakes can help you treat and prevent dozens of diseases, avoid costly prescription drugs, and enjoy vibrant new health. Discover:
# The different signals of thirst and chronic dehydration in you body
# How much water and salt you need each day to stay healthy
# Why other beverages, including tea, coffee, and sodas, cannot be substituted for water
# How to naturally lessen, even eliminate, symptoms of asthma and allergies
# How to help prevent life-threatening conditions such as heart failure, stroke, Alzheimer’s disease, Parkinson’s disease, and cancer
# How hypertension may be treated naturally, without diuretics or medication
# Why water is the key to losing weight without dieting
# How to hydrate your skin to combat premature agingThis book will save you from medical ignorance and killer chemicals that are used in health problems caused by chronic unintentional dehydration.
So, the usual woo—lots of promises based on nothing. I’d let it go at that, but I was curious about this Batmanghelidj guy. The first hit I got on google was—surprise!—his website full of wacky pseudoscience. First is the hilarious link to a 20 year old NYT article about his supposed water cure.
Then comes the denialist literature. Provided “free, as a public service” a bunch of AIDS denialist screeds. Thrown in for good measure was some cholesterol-denialism. His AIDS paper is actually humorous, or would be if it weren’t for, you know, AIDS. He talks quite a bit about semen and “rectal manipulation”. This is from a guy who, unfortunately, spent a lot of time in a Persian prison.
The point here is that once you abandon science you are open to anything. This may sound like a slippery slope fallacy, but it’s not. Abandoning scientific thought allows you to believe any idea a credulous mind can invent. Sometimes it’s sad, sometimes it’s funny, but more often than not it’s dangerous.
The new Skeptics’ Circle is up at Archeoporn. Never miss an episode!
Despite my usual cynical nature, I had a favorable brush with politics last night. I was up in my kid’s bedroom, getting her bathed and ready for bed, when the phone rang. When my hands are full of soaking wet toddler I don’t usually answer the phone, but for some reason I picked it up. To my surprise it was my Congressman—he was holding a phone conference with his constituents. I did not vote for this guy, and I’m pretty certain I never would, but he is my representative, so I joined the conference (by failing to hang up).
The district I live in is quite mixed. Economically it runs from moderately wealthy to not-doing-so-great. There are a huge number of home foreclosures, and people are losing auto industry-related jobs. Within a square mile of my house there is a Korean market, two Indian markets, a Halal butcher, a Kosher butcher, an Israeli restaurant, a Lebanese restaurant, a Chaldean market, a Jain Temple, two Synagogues—you get the idea.
The calls that came in were a mix. One of the things that politicians are usually good at is responding to individuals when given the opportunity. I’ve written to representatives on behalf of patients and gotten wonderful responses. Many calls were from people about to lose their homes, and the rep gave them contact numbers, etc. A few calls complained about illegal immigration, although I’m not sure why—Michigan had a hard time bringing in the crops last year, a folks from my area weren’t heading Up North to do field and orchard work.
Most of the calls were handled without the usual political lip service (most—not all). Some callers were clearly disturbed, and he handled them very well.
All in all, I was very impressed with the job my Congressman did communicating his ideas, even the ones I think are idiotic. I was even more impressed with the way he dealt with his constituents. He seemed to be in politics for all the right reasons (and, no, I don’t think I’m being credulous).
So, despite my dislike of this individual’s politics, I felt a renewed sense of optimism about American democracy. Plus, I got two loads of laundry folded and one poopy diaper changed while participating in my government. Woo-hoo!
My recent post on a local “holistic” doctor brought a number of considered and interesting comments (all of whom are quite polite and patient, even when I disagree with them).
Some of the issues deserve fleshing out.
Heart disease is a major killer. Hypertension is one of the strongest risk factors for heart disease. In some people, salt contributes to hypertension, and reduction of salt intake reduces bad outcomes. In people with congestive heart failure, salt-restriction is crucial.
The statement of this idea led to some interesting objections, with a good helping of goalpost-shifting.
The objections raise some important points, but also engage in some typical denialist tactics.
I’ve just been looking for basic information, and coming up empty-handed, so I hope you can understand my frustration. I’m not one to hold on to bad ideas in the face of evidence, but I’d like to see a prima facie case made first.
and
I’ve also seen a study in the news in the last few months that was reported to show a significant increase in mortality among high-risk patients over a 10-year period for those who maintained a high salt intake. That raises questions that weren’t answered in the news article, such as: How did the diets compare otherwise? It’s reasonable to assume that someone who reduces their salt intake because of blood pressure is going to make other dietary changes as well, and vice versa. If other variables were controlled, then by what mechanism does salt increase mortality? What do those results mean for individuals with normal blood pressure?
and
The correlation between sodium intake and heart disease doesn’t prove anything. This is a classic example of correlation not equalling (sic) causation. Processed and fast food, the biggest sodium offenders, also tend to be loaded with saturated fat and cholesterol. Could these not also be the cause of the artery disease, and the salt just be a relatively innocent bystander?
I am not saying that there is no place for a low-sodium diet, I’m just saying that I’ve yet to see any evidence for one in general. (emphasis mine –PalMD)
This is simply an argumentum ad ignorantiam. The fact that the commenter doesn’t know the answers does not affect the validity of the conclusions stated. Does he think that researchers have never asked these questions?
How about a plausible method by which salt causes ateriosclerosis?
and
We have no convincing evidence that blood pressure increases resulting from salt intake contribute substantially to heart disease or stroke. You, and the medical profession in general, are taking a giant illogical leap.
Actually, I gave references. If he can’t be bothered to check them, it’s hardly my fault, or the fault of the medical profession.
High salt intake may raise blood pressure in some groups, but it does not necessarily lead to chronic or dangerous hypertension. And chronic hypertension might be an effect, rather than cause, in many cases. We don’t really know.
I already said that there is great variability to patients’ susceptibility to salt, so objection noted. Actually, we do know that hypertension is a cause rather than an effect of heart disease.
We do know that the major causes of artery disease leading to heart attacks and strokes are cigarette smoking and type 2 diabetes. So we do not have any clear connection between a high salt diet and artery disease. And you have admitted that.
In addition to cigs and diabetes is hypertension. As cited, in many patients, high salt intake leads to hypertension. Hypertension leads to heart disease. To require the most proximate cause is an absurd argument. Medical science looks for correlations, and tries to explain them. Much of the time we understand the specific mechanisms involved. To ask for more and more detailed explanations is simply moving the goalposts—if you don’t like the answer, just ask more detailed questions until everyone is tired of answering you.
Unfortunately, I am not a member of the AMA, so I don’t have access to that article. I did want to read it given the alarmist wording of the headline, but it wasn’t $15 of want, especially since I’d need to pay for the references, ad infinitum….
If the commenter is unwilling to accept my expert status, that is quite reasonable. But then to be unwilling to dig up the data himself, well, that’s just silly. To gain information, you can either listen to an expert or try to interpret the data yourself. To be unwilling to do either is simply intentional ignorance. To then expect others to buy that as a legitimate argument is not just unfair, it’s asinine.
The point here is not about individual commenters—it’s about strategy and errors in thinking. For complex information, we trust in experts—we have no choice. If we are curious about going deeper, we look up the primary sources.
Salt may or may not be an important cause of heart disease, although evidence favors the connection; there are certainly more important causes. But in some people, salt very directly causes increased blood pressure, and high blood pressure most certainly does lead to heart disease. That fact does not negate other causative factors (which is another non sequitur brought up in some comments).
Denialism involves, well, denial. If you don’t like a fact, then just keep looking for ways around the truth. Or plug your ears and go, “la la la la la.” Either has the same effect.
So, Answers in Genesis cranked out the first issue of its new journal, and with all deliberate speed! It’s remarkable. I’m guessing that creation research doesn’t take quite as long as, say, real science. The pilot issue is a true testament to the idiocy of the Creation Cult. I guess we have to actually look inside this waste of electrons to see what’s going on.
While it is true that no scientist with an intact cerebral cortex will take the Answers Research Journal seriously, still, it’s hard to ignore. If this is the best shot the Creationist cults can do at making their point then I don’t think the NIH is going to be sending them a lot of money any time soon. Each article from the pilot edition has its own kind of stupid..
Remember that “Answers” is supposed to be a “professional, peer-reviewed technical journal.” One article is called “Proceedings of the Microbe Forum”, but what this “forum” was is not clearly indicated. This doesn’t start well (nor does it end well). If fact, it ends so badly, that I’ll start with the footnotes:
These are pseudonyms. The writers, who hold PhDs in fields related to the topics of their abstracts, are scientists at prominent research facilities in the eastern part of North America. They prefer to keep their creationist credentials hidden for the moment until they achieve more seniority.
If you publish a scientific paper anonymously, it isn’t scientific. There is no way to verify anything. If what they publish is quality research, then they have nothing to fear. If it is crap, well, then academia can be very harsh on non-productive idiots (productive idiots, however…). Let’s go back to the top and see what has the authors so verschrecked.
Introduction
For many years the roles of microbes as part of God’s wonderful design have been neglected. Creationist literature is largely void of topics related to these tiniest creatures. Perhaps it is because many people associate microbes as the cause of death, disease, and suffering. This is true for only a fraction of microbes; the large majority are extremely vital for sustaining life on earth. Their roles range from recycling nutrients in soil and water to symbiotic relationships that provide necessary factors to their host. Their role in death and disease is a result of the Fall and the Curse on all living things.
Ouch! That is a steaming pile of burning stupid. I can see why the authors are scared. A tenure committee would look pretty foolish if they promoted a microbiologist who believes that “the role [of microbes] in death and disease is a result of the Fall and the Curse”….
What is alternative Medicine, anyway?
That’s a great question. I know it is, because I asked it. I get this question almost daily. The secret answer is that there is no such thing as alternative medicine. You don’t believe me? Why not–I am a doctor.
There are several ways to define alternative medicine, and sometimes it is contrasted with “complementary medicine”. CM refers to treatments that “complement” traditional medicine, while AM refers to treatments that stand in the stead of mainstream medicine. CAM is a broad category used to refer to both.
So what’s my problem? How can I say that there is no such thing?
Because “mainstream” medicine is medicine that works. It has been studied, tested, deployed, followed, and it is proven to do what it says. Alternative medicine is any treatment that is not yet, or may never be, mainstream. If it is found to work, it becomes mainstream very rapidly. If it is not proven to work, it remains “alternative”.
So, I guess there is, after all, such a thing as alternative medicine. It is any treatment that doesn’t work. Why would anyone want that?
There’s lots of answers to that question. There are also several incorrect answers. The most common incorrect answer describes a conspiracy of doctors and Big Pharma. Others include the myth that patients are dissatisfied with their physicians and the care they provide. In fact, most people like their doctors. But they like their friends even more, and if a friend testifies about a great new potion, well, why not try it?
Why not, indeed. Your doctor knows quite a bit about the medications being prescribed, and the problems being treated. Your friend, alas, does not.
When someone offers you an “alternative therapy”, ask them what it is an alternative to. Does it work better that something else? Is it safer? How do you know? Why should I believe you?
Those questions apply to your doctor as well, but hopefully, you have already decided whether or not you trust your doctor and modern medicine. Try applying this simple test–when you have crushing chest pain and shortness of breath, who do you want to call: the GNC guy or an ambulance?
Maybe further explanation is needed to tease out the difference between “real” medicine and “alternative” medicine.