December 30th, 2011 by Steve Novella, M.D. in Opinion, Quackery Exposed
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Labels are a cognitive double-edged sword. We need to categorize the world in order to mentally capture it – labels help us organize our mental maps of the overwhelming complexity of things and to communicate with each other. But labels can also be mental prisons, when they substitute for a thorough, nuanced, or individualized assessment – when categorization becomes pigeon-holing.
We use many labels in our writings here, out of necessity, and we try to be consistent and thoughtful in how we define the labels that we use, recognizing that any sufficiently complex category will be necessarily fuzzy around the edges. We have certainly used a great deal of electrons discussing what exactly is science-based medicine, and that the label of so-called alternative medicine is really a false category, used mainly for marketing and lobbying (hence the caveat of “so-called”).
We get accused of using some labels for propaganda purposes, particularly “antivaccinationist” (often shortened to “antivaxer”). Also “denier” or “denialist”, as in germ-theory denier. Even though we often apply labels to ourselves, no one likes having an unflattering label applied to them, and so we have frequent push-back against our use of the above terms.
As with many such terms, Read more »
*This blog post was originally published at Science-Based Medicine*
November 29th, 2011 by Shadowfax in Research
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I have been working as an ER doctor for over a decade, and in that time I have come to recognize that there are certain complaints, and certain patients who bear these complaints, that are very challenging to take care of. I’m trying to be diplomatic here. What I really mean is that there are certain presentations that just make you cringe, drain the life force out of you, and make you wish you’d listened to mother and gone into investment banking instead. Among these, perhaps most prominently, is that of the patient with cyclic vomiting syndrome.
The diagnosis of cyclic vomiting syndrome, or CVS, is something which is only in recent years applied to adult patients. Previously, it was only described in the pediatric population. It has generally been defined as a disease in which patients will have intermittent severe and prolonged episodes of intractable vomiting separated by asymptomatic intervals, over a period of years, for which no other adequate medical explanation can be found, and for which other causes have been ruled out.
That is not much in the way of good literature about this disease entity, which is surprising, because it is something that I see in the emergency department fairly regularly, and something with which nearly all emergency providers are quite familiar. These patients are familiar to us in part because we see them again and again, in part because they are memorable because they are so challenging to take care of.
Some things about the cyclic vomiting patient that pose particular challenges: Read more »
*This blog post was originally published at Movin' Meat*
November 28th, 2011 by Steve Novella, M.D. in Health Policy, Opinion
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Prince Charles is a big supporter of “natural” medicine, which in practice means unscientific and ineffective medicine. He has no particular expertise in this area, and there is absolutely no legitimate reason why he should have any influence over the practice of medicine in the UK. But he is the Prince of Wales, and he has chosen to use that celebrity to promote CAM.
Prince Charles has also recently been criticized for his credulous support for medical nonsense. The Telegraph recently reported that Simon Singh, co-author with Edzard Ernst of Trick or Treatment, and exposer of CAM pseudoscience, spoke about Prince Charles at the recent Hay Festival in India. Singh had some sharp criticism, including:
He only wants scientific evidence if it backs up his view of the natural treatment of health conditions…
We presented evidence that disputes the value of alternative medicine and despite this he hasn’t changed his mind…
Singh’s point is that Prince Charles is Read more »
*This blog post was originally published at Science-Based Medicine*
November 22nd, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
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When lawyers talk, I listen. Two attorneys penned a piece on medical malpractice reform in the April 21st issue of The New England Journal of Medicine, the most prestigious medical journal on the planet. Here is an excerpt from their article, New Directions in Medical Liability Reform.
The best estimates are that only 2 to 3% of patients injured by negligence file claims, only about half of claimants recover money, and litigation is resolved discordantly with the merit of the claim (i.e., money is awarded in nonmeritorious cases or no money is awarded in meritorious cases) about a quarter of the time.
This is not self-serving drivel spewed forth by greedy, bitter doctors, but a view offered by attorneys, esteemed officers of the court. Apply the statistics in their quote to your profession. Would you be satisfied if your efforts were benefiting 2-3% of your customers or clients? Would this performance level give me bragging rights as a gastroenterologist? Perhaps, I should attach a new slogan to my business card.
Michael Kirsch, MD
Gastroenterologist
Correct Diagnosis and Treatment in 2-3% of Cases
We would have to Read more »
*This blog post was originally published at MD Whistleblower*
November 7th, 2011 by Michael Craig Miller, M.D. in Research
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If your child is being treated for attention deficit hyperactivity disorder (ADHD), you may have one less thing to worry about today. A study involving 1.2 million children and young adults provided reassuring evidence that the drugs used to treat ADHD do not increase the risk of death from heart disease.
Researchers, who published their results yesterday in the New England Journal of Medicine, analyzed medical records from a nationwide private insurance plan along with health plans based in Tennessee, California, and Washington State. They compared children taking stimulant drugs (like Ritalin and Adderall) that are commonly used to treat ADHD to children not taking these drugs.
Among all of the children, heart attack, stroke, or sudden death were rare, affecting a little more than 3 in every 100,000 children per year. Cardiac problems were no more common among children using a stimulant as among those not taking one.
The study Read more »
*This blog post was originally published at Harvard Health Blog*
