Medicine
oracknows | February 24, 2009Alright, I know that, after yesterday's epic post (which was long even by Orac-ian standards), I said that I was going to try to get away from vaccine blogging for a while. I lied. Well, not really. At that time I really did mean it. But then I came across something that I just couldn't leave alone.
Regular readers of this blog know my opinion of Andrew Wakefield, namely that he is a fraud, a quack, a charlatan, and a danger to the health of autistic children and public health in general. There is, as documented in my post and elsewhere, abundant evidence to support my opinion. But apparently…
mikethemadbiologist | February 23, 2009I think before everyone gets excited about the effectiveness research that was funded in the Recovery and Reinvestment Act--basically, using the scientific method to find out how well different medical treatments work--we need to realize that the medical industry might have scored a coup here (italics mine):
The $1.1 billion earmarked for comparative effectiveness research remained in the bill that President Obama will sign Monday. The House conferees also insisted on keeping the phrase "comparative effectiveness" throughout the authorizing language, removing the Senate's insertion of the…
neurophilosophy | February 21, 2009
These gorgeous stipple-engraved plates come from The Anatomy of the Brain, Explained in a Series of Engravings, by Sir Charles Bell. The book was first published in 1802 and contained 12 plates, 11 of which were printed in colour; these come from an edition which appeared in 1823.
In the introduction to the book, Bell wrote:
In the Brain the appearance is so peculiar, and so little capable of illustration from other parts of the body, the surfaces are so soft, and so easily destroyed by rude dissection, and it is so difficult to follow an abstract description merely, that this part of…
palmd | February 19, 2009It seems the same questions keep coming up when looking at the cult leaders of the infectious disease promotion movement. When you listen to them preach or read their liturgy you can't help thinking, "dumb, evil, or both?" I think I'm going to vote for "both" when it comes to Deirdre Imus. Her sermon last week in the Huffington Post was so far over the top that my nose is still bleeding from climbing her tower of intellectual excrement.
Her title advises health consumers, "On Vaccinations: Consider the Source and Follow the Money."
I don't know what that means, but Deirdre explains, "…
revere | February 19, 2009Like a lot of people I am more inclined to believe research that is in accord with my prior beliefs. Put another (Bayesian) way, I don't have to change my beliefs much on the basis of evidence. That means I don't question the evidence rigorously. So with that warning, here's a story I instinctively believe because it accords with my prior beliefs -- and preferences. It has to do with washing your hands after using a public bathroom.
To be clear at the outset: I always wash my hands after using the bathroom. I'm not sure what the actual evidence for disease transmission is but I consider it an…
palmd | February 18, 2009Before I started medical school I worked at a clinic that served the deaf and hard-of-hearing community. I was the "front office", greeting patients, answering the phone by TDD/TTY or by relay service (this was before the existence of text messaging, instant messaging, or anything else that relied on cell phones or on the internet---none was in common use). I learned some rudimentary ASL (simple, polite phrases), and was introduced to the deaf community. It was simply fascinating. I learned about the controversies surrounding deaf culture (such as cochlear implants, assimilation, and…
oracknows | February 17, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
thusspakezuska | February 16, 2009I found out about both of these courtesy of the Chronicle Review Note Bene/New Books in Print feature. Both look extremely interesting.
First, Revisiting Race in a Genomic World, from Rutgers University Press.
With the completion of the sequencing of the human genome in 2001, the debate over the existence of a biological basis for race has been revived. In Revisiting Race in a Genomic Age, interdisciplinary scholars join forces to examine the new social, political, and ethical concerns that are attached to how we think about emerging technologies and their impact on current conceptions…
scientificactivist | February 16, 2009As part of the stimulus package passed by Congress last Friday (H.R. 1: American Recovery and Reinvestment Act of 2009), the US will be ramping up efforts to encourage evidence-based medicine. This is a very good thing.
Specifically (from The New York Times):
The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness.
Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and…
oracknows | February 16, 2009Unfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of "Best of" reposts lined up. If you've been reading less than a year or two, they're new to you. If not, I hope you enjoy them again. I don't know when I'll be back, other than maybe a brief update or two…
palmd | February 16, 2009The New York Times is reporting that the economic stimulus bill will include over a billion dollars to fund research into medical evidence. This is a good thing, but it's bound to be controversial. I've mentioned before that we need to spend money to improve our medical infrastructure, and this could be a step in the right direction.
Much of what we do in medicine is science-based, and much of it has evidence to support it, but some does not. There are plenty of open questions about how we practice medicine, and in order to deliver safe, quality care, we need answers. For example, a…
oracknows | February 15, 2009What's an advocate of evidence- and science-based medicine to think about the National Center for Complementary and Alternative Medicine, better known by its abbrevation NCCAM? As I've pointed out before, I used to be somewhat of a supporter of NCCAM. I really did, back when I was more naïve and idealistic. Indeed, as I mentioned before, when I first read Wally Sampson's article Why NCCAM should be defunded, I thought it a bit too strident and even rather close-minded. At the time, I thought that the best way to separate the wheat from the chaff was to apply the scientific method to the…
palmd | February 15, 2009Science is hard. But science, and the methodological naturalism that underlies it, has proved to be the best way to observe, describe, and explain our reality. Sure, people can come up with ridiculous straw man arguments like, "but how do you measure love?" but these arguments ring hollow. (We measure "love", a behavior, by the observable behaviors that human beings report when they are "in love".) To a scientist, the appeal to magic to describe the world is difficult to understand, since the real puzzle is so much more fun. If, for example, you discover the cause of a particular disease…
oracknows | February 11, 2009I have to say, this is getting monotonous.
Let me back up a minute. One of the most common beliefs among users and advocates of "complementary and alternative" medicine (CAM) is that supplementation with vitamins will have all sorts of beneficial health effects. True, this belief is also pervasive among people who wouldn't go to an acupuncturist if you held a gun to their head, but it has become most associated with CAM. That this is so can actually be viewed as evidence of just how successful CAM activists have been in completely yoking all manner of lifestyle interventions to prevent or…
ddobbs | February 10, 2009Marcia Angell makes it plain:
The fact that drug companies pay prescribers to be "educated" underscores the true nature of the transaction. Students generally pay teachers, not the reverse. The real intent is to influence prescribing habits, through selection of the information provided and through the warm feelings induced by bribery. Prescribers join in the pretence that drug companies provide education because it is lucrative to do so. Even free samples are meant to hook doctors and patients on the newest, most expensive drugs, when older drugs -- or no drug at all -- might be better for…
palmd | February 9, 2009In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is part II of my diary from the trip. Part I is here.
To Juticalpa
As we left Teguz, we crossed one more bridge and began to climb into the hills that surround the high valley in which rests the city. Thin dogs wandered along the roadside sniffing at the animal skulls lining the road. Women and children crowded into ravines to wash clothes in the river which was both…
terrasig | February 9, 2009I know that many of you have seen this article by Matthew Perronne since it was picked up by the majority of AP outlets this morning:
Two drugmakers spent hundreds of millions of dollars last year to raise awareness of a murky illness, helping boost sales of pills recently approved as treatments and drowning out unresolved questions -- including whether it's a real disease at all.
Key components of the industry-funded buzz over the pain-and-fatigue ailment fibromyalgia are grants -- more than $6 million donated by drugmakers Eli Lilly and Pfizer in the first three quarters of 2008 -- to…
tsmith | February 8, 2009Last fall, I wrote about a new research paper which tried to replicate some of Andrew Wakefield's original results, which not only claimed a correlation between MMR vaccination and autism, but also the presence of measles virus in intestinal tissue. Wakefield had suggested that an inappropriate response to the presence of measles virus in this tissue may trigger conditions such as bowel disease and autism. The more recent study was unable to replicate any of Wakefield's findings--not surprising, since so many papers in the last decade have found no connection between vaccination and autism…
pharyngula | February 7, 2009If you want to know where the current ridiculous anti-vaccination scare came from, there's one well known source: Andrew Wakefield. He published a paper in 1998 that claimed there was a link between vaccination and autism that was a popular sensation, and had a dramatic effect.
Despite involving just a dozen children, the 1998 paper's impact was extraordinary. After its publication, rates of inoculation fell from 92% to below 80%. Populations acquire "herd immunity" from measles when more than 95% of people have been vaccinated.
Last week official figures showed that 1,348 confirmed cases…
tqa | February 7, 2009
A series of articles just published in The Sunday Times reports that it appears likely that Andrew Wakefield falsified much of the data that was used in the 1998 Lancet article that first identified the MMR vaccine as a potential cause of autism. If the charges leveled by the paper are remotely accurate, Wakefield is guilty of homicide - perhaps not legally, but certainly morally. If previous claims made by the paper are accurate, Wakefield may have acted for financial gain.
If even a fraction of the accusations leveled by The Times are true, Wakefield engaged in absolutely outrageous…