Medicine
mikethemadbiologist | March 31, 2009A small bill could have huge implications for preventing the evolution of antibiotic resistance. Every couple of years, the Preservation of Antibiotics for Medical Treatment Act (PAMTA) is offered for consideration. Two weeks ago, Democratic Rep. Louise Slaughter proposed PAMTA again for consideration. Here are the key provisions ofthe proposed bill:
The findings are very comprehensive. Given the number of times, the legislation has been proposed, you would expect this (you just keep adding more justification), but citing NARMS (the National Antimicrobial Resistance Monitoring System)…
palmd | March 30, 2009This war taking place in our nation's medical schools and academic medical centers. Orac at Respectful Insolence has been tracking this trend, as have those of us writing at Science-Based Medicine. It is a war between those who feel that medicine should continue to be based on science and those who want to integrate faith-based practices. The model for this war is not that of pedagogical disputes or funding scuffles. More than anything else, it resembles a religious war.
The basic story goes like this: medical schools are in charge of educating future doctors. Individual hospitals are…
clock | March 26, 2009Let's see what's new in PLoS Genetics, PLoS Computational Biology, PLoS Pathogens and PLoS ONE this week. As always, you should rate the articles, post notes and comments and send trackbacks when you blog about the papers. Here are my own picks for the week - you go and look for your own favourites:
Association of Tinnitus and Electromagnetic Hypersensitivity: Hints for a Shared Pathophysiology?:
Tinnitus is a frequent condition with high morbidity and impairment in quality of life. The pathophysiology is still incompletely understood. Electromagnetic fields are discussed to be involved in…
purepedantry | March 24, 2009I have been reading more on the Natasha Richardson story overnight, and it appears the story has moved into blame-placing mode. (For the original discussion of the story, read this.)
Possible places to lay the blame (that I have read thus far):
The absence of mandatory helmet laws
Canadian medicine's failure to administer rapid CTs
Quebec's inadequate air ambulances
Inadequate patient education
More on these under the fold.
I said before about mandatory helmet laws (and many others said in the comments of the previous post) that while I don't have a problem with mandatory helmet laws for…
oracknows | March 24, 2009About a month and a half ago, I happened to be fortunate enough to be able to swing the time to attend a symposium in which Brian Deer (whom anyone reading this blog lately is well familiar with) spoke. It was an opportune time, coming as it did around the time when he had just published his new blockbuster story about how Andrew Wakefield, architect of the MMR vaccine scare in the U.K., had apparently falsified data for his infamous 1998 Lancet paper that started it all. The symposium was entitled Science, the Media and Responsibility for Child Health: Lessons Learned from the MMR Vaccine,…
PTSD, Mental Health, and the Military: Problematic Reporting at Scientific American and ScienceBlogs
tqa | March 24, 2009
Author (and fellow ScienceBlogger) David Dobbs has an article on PTSD in the latest Scientific American, and has several related posts on his blog here at Sb. Dobbs' primary argument seems to be that PTSD is being widely overdiagnosed, in part because the condition itself is poorly defined, and in part as the result of various social and economic factors. At least a couple of other bloggers enjoyed his writing on the topic. Personally, I'm not so sure.
As many of you know, I've got some fairly significant ties to the US military. My wife has deployed twice, and has had close and personal…
jstemwedel | March 24, 2009
Protocol Breach Reported in Biederman Study of Preschoolers - Health Blog - WSJ
How big a protocol breach is "too big"? And what kind of "expectations" should a physician-scientist entertain before a clinical trial commences?
(tags: medicine research-with-humans ethics)
jfleck at inkstain » Elephant Diaries: Connecting the Dots on the George Will Affair
The traditional media still makes an impact in a world where most people are opportunistic (rather than directed) consumers of information.
(tags: communication media blogging)
Philosophers' Playground: The First Amendment and The…
oracknows | March 23, 2009Has it really been that long?
More than two years ago, I wrote a post entitled Death by Alternative Medicine: Who's to Blame? The topic of the post was a case report that I had heard while visiting the tumor board of an affiliate of my former cancer center describing a young woman who had rejected conventional therapy for an eminently treatable breast cancer and then returned two or three years later with a large, nasty tumor that was much more difficult to treat and possibly metastatic to the bone, which, if ture, would have made it no longer even possibly curable. My discussion centered on…
ddobbs | March 20, 2009A few weeks ago, Matt Stevens, the National Guard captain and medic who served in Iraq and whom I mentioned in my Scientific American article, "The Post-Traumatic Stress Trap, wrote me an email about the social unease he often encountered when he showed any behavior that might remind people he had served in Iraq -- a greater seriousness, an impatience with petty concerns or inefficiency, or even just talking about the place.
I have begun to think of military PTSD as to some extent a civilian problem rather than a soldier problem. To expand slightly here; civilians/politicians send soldiers…
oracknows | March 20, 2009Oh, goody! Vox Day wants to play.
You remember Vox "Hey, it worked for Hitler" Day," don't you? It's been a long time. In fact, I had to do a search to find the last time I had a run-in with him, and it appears that it's been about a year since I last noted him mindlessly parroting antivaccinationist myths and spouting his usual misogyny. Alas, Vox has been a regular irritant to this blog since very early on, when he didn't like my likening his views towards women to the Taliban for his arguing that women shouldn't be allowed to vote because they are "fascists at heart." Since then, every so…
revere | March 20, 2009If the 1960s film, The Graduate, were to be made today (Graduate, II: The Stimulus), the iconic scene at the party where a friend of the family takes Dustin Hoffman aside and whispers in his ear, "I have only one word for you, Plastics") would be transmogrified into, "I have only three words for you, Health Information Technology." HIT, and its love child with the recently passed stimulus package, the Electronic Medical Record, have all the characteristics of a good idea destined to go bad. One of my vivid memories from my early career was being shown a new kind of quiet printer, called an…
jstemwedel | March 18, 2009Orac takes issue with a pair of posts I wrote yesterday about the National Center on Complementary and Alternative Medicine (NCCAM). I gather he thinks I've been far too trusting as far as the information provided on the NCCAM website, and that I'm misrepresenting the issues the critics of NCCAM have with the center. If my posts communicated that they were giving the straight dope on NCCAM and the objections to it, then I blew it; that wasn't at all what was intended. Rather, I wanted to have a look at the ethical issues that arise from such an official effort to examine medical treatments…
sb admin | March 18, 2009University of California Berkeley's Health Research for Action is calling on OSHA to revise its occupational health standard on lead, which is now 30 years old. In a report entitled "Indecent Exposure: Lead Puts Workers and Families at Risk," the authors describe the adverse health effects of lead in workers with blood-lead levels of 5-10 ug/dL---a fraction of OSHA's medical removal trigger of 60 ug/dL. They note:
"...extensive research has shown that lead causes significant health problems in adults at much lower levels. Cumulative exposure to low to moderate levels of lead has been…
j7uy5 | March 18, 2009Today's edition of the Journal of the American Medical Association
contains a study that employed PET scans to determine the effect of
modafinil upon dopamine concentration and reuptake in the human central
nervous system. They conclude with a caution that clinicians
should be mindful of the potential for abuse and dependence in persons
taking modafinil.
The problem with the study is that it adds very little, if anything, to
clinical practice.
href="http://jama.ama-assn.org/cgi/content/short/301/11/1148">Effects
of Modafinil on Dopamine and Dopamine Transporters in the Male Human…
jstemwedel | March 17, 2009In my last post, I started wading into the question of what kinds of ethical questions arise from clinical trials on "alternative" medical treatments, especially clinical trials supported by the National Center on Complementary and Alternative Medicine (NCCAM). The ethical questions include whether alternative treatments expose human subjects to direct harm, or to indirect harm (by precluding a more effective treatment), not to mention whether the money spent to research alternative modalities would be better spent on other lines of research. I think it's worthwhile to dip into the NCCAM…
jstemwedel | March 17, 2009A little while ago, PalMD put up a post at Whitecoat Underground about the current state of the National Center on Complementary and Alternative Medicine (NCCAM), especially at a moment in history when the federal government is spending loads of money (and thus maybe should be on the lookout for expenditures that might not be necessary) and when health care reform might actually happen. Pal wrote:
The whole idea of setting up such an agency is a bit quixotic---after all, the National Institutes of Health already study health science. .... Many, many studies have been funded which fail basic…
oracknows | March 17, 2009Until recently, most of my research was laboratory-based. It included cell culture, biochemical assays, molecular biology, and experiments using mouse tumor models. However, one of the reasons that I got both an MD and a PhD was so that I could ultimately test ideas for new treatments on patients and, if I'm good enough and lucky enough, ultimately improve the care for cancer patients. If there's one thing, though, that I've learned in my nearly nine years in academic surgery, it's that far fewer patients end up enrolled on clinical trials than are eligible to participate in them. Every…
j7uy5 | March 17, 2009Dr. Richard
Friedman, professor of psychiatry at Weill Medical College of
Cornell University, has an article in the New York Times. In it,
he claims that reforms in medical residency training may be leaving
young doctors "a little more hesitant and uncertain than you might
like."
At first I was hesitant to write about it, because I was uncertain as
to what point he is trying to make. But then I decided to go
ahead.
href="http://www.nytimes.com/2009/03/17/health/17mind.html?pagewanted=print">Accepting
the Risks in Creating Confident Doctors
By RICHARD A. FRIEDMAN, M.D.
Published:…
ddobbs | March 14, 2009
My story in the April 2009 Scientific American story, "The Post-Traumatic Stress Trap", just went online. Here's the opening:
In 2006, soon after returning from military service in Ramadi, Iraq, during the bloodiest
period of the war, Captain Matt Stevens of the Vermont National Guard began to have a problem with PTSD, or post-traumatic stress disorder. Stevens's problem was not that he had PTSD. It was that he began to have doubts about PTSD: the condition was real enough, but as a diagnosis he saw it being wildly, even dangerously, overextended.
[snip]
"Clinicians aren't separating the…
clock | March 12, 2009Wow! This is massive!
From Anesthesiology News:
Scott S. Reuben, MD, of Baystate Medical Center in Springfield, Mass., a pioneer in the area of multimodal analgesia, is said to have fabricated his results in at least 21, and perhaps many more, articles dating back to 1996. The confirmed articles were published in Anesthesiology, Anesthesia and Analgesia, the Journal of Clinical Anesthesia and other titles, which have retracted the papers or will soon do so, according to people familiar with the scandal (see list). The journals stressed that Dr. Reuben's co-authors on those papers have not…