Patient Participation in Decision-Making
“Patient-Centered” decision-making is a new buzz-word in medicine. It is a metaphor for a general approach to care that puts the patient’s experience and needs at the center, as opposed to the needs of the physician or the system. While this is an effective marketing term, and a useful principle as far as it goes, as a guide to medical practice it...
DSM-5 and the Fight for the Heart of Psychiatry
The new DSM is out, what are people saying about it?
Will Your Smartphone Become a Tricorder?
The Star Trek universe is a fairly optimistic vision of the future. It’s what we would like it to be – an adventure fueled by advanced technology. In the world of Star Trek technology makes life better and causes few problems. One of the most iconic examples of Star Trek technology is the medical tricorder. What doctor has not fantasized about walking...
Enbrel for Stroke and Alzheimer’s
A recent article in the LA times tells of a husband’s quest to find a treatment for his wife’s Alzheimer’s disease. This is a narrative that journalists know and love—the brave patient or loved-one who won’t accept the nihilism of the medical establishment, who finds a maverick doctor willing to buck the system. The article itself at least was not gushing, it...
Politics of Public Research Funding
A great deal of science is funded by the US government. The total research funding for 2009 was 54.8 billion dollars (much more if you include all R&D). A breakdown by agency of total R&D shows that the NIH (National Institutes for Health) funding is 28.5 billion while the NSF (National Science Foundation) is 4.1 billion. There is general agreement that this expenditure is...
Science-Based Public Service Announcements
Changing behavior is difficult. It is also an increasing priority for health care. We have entered a period of history when lifestyle choices have a dominant impact on health and longevity. People are no longer dying young of incurable infectious diseases in significant numbers. Rather they are surviving long enough to die from their bad habits. Further, health behaviors are having a...
Does Brain Training Work?
Websites such as Luminosity.com make some bold promises about the effectiveness of computer-based brain-training programs. The site claims: “Harness your brain’s neuroplasticity and train your way to a brighter life” “Your brain’s abilities are unique. That’s why your Personalized Training Program adapts to fit your brain and your life goals.” “Just 10 hours of Lumosity training can create drastic improvements. Track your...
Pseudoacademia
The integrity of the scientific basis of medicine is under attack from numerous fronts. It is not only the intrusion of pseudoscience and mysticism into mainstream institutions of medicine, but also attempts to distort or game the scientific process for ideological and financial reasons. Ideological groups such as the anti-vaccine movement, or grassroots organizations promoting pseudodiseases such as chronic Lyme, electromagnetic sensitivity,...
Evidence Thresholds
Defenders of science-based medicine are often confronted with the question (challenged, really): what would it take to convince you that “my sacred cow treatment” works? The challenge contains a thinly veiled accusation — no amount of evidence would convince you because you are a nasty skeptic. There is a threshold of evidence that would convince me of just about anything, however. In...
Clinical Decision-Making Part III
How do doctors make clinical decisions to arrive at a diagnosis? Part 3 of a 3-part series.