Category: Diagnostic tests & procedures

Real internists train in hospitals and clinics. "Chiropractic Internists" train at The Embassy Suites.

Chiropractic Internist: A “specialty” to avoid

The "chiropractic internist" is the creation of an industry association which promotes chiropractors as "primary care physicians." After 300 hours of instruction in a hotel conference room, they claim they can treat "anything that a medical doctor can."

/ January 5, 2017
precisionmedicineinfo

Precision Medicine and Uncertainty

Precision medicine is a development that promises to tailor treatments to the individual patient based on genetic and other molecular and cellular analyses. In his 2015 State of the Union address, President Obama announced the Precision Medicine Initiative. A website for Precision Medicine claims to offer “perfect care for every individual.” Much of what we read about precision medicine gives the impression...

/ November 15, 2016

When science- and evidence-based guidelines conflict with patient wishes: What’s a doc to do?

There’s a misconception that I frequently hear about evidence-based medicine (EBM), which can equally apply to science-based medicine (SBM). Actually, there are several, but they are related. These misconceptions include the idea that EBM/SBM guidelines are a straightjacket, that they are “cookbook medicine,” and that EBM/SBM should be the be-all and end-all of how to practice clinical medicine. New readers might not...

/ October 3, 2016

Genetic Testing: Does Knowing Risk of Disease Make a Difference?

The complete sequencing of the human genome by the Human Genome Project was a remarkable accomplishment and a cause for celebration. Several companies including 23andMe, Navigenics, and deCODE have capitalized on that scientific achievement by offering genomic testing directly to the public. They promise more than they can deliver, and consumers don’t understand the limitations of the test results. The subject has...

/ August 23, 2016

The ROCA Screening Test for Ovarian Cancer: Not Ready for Prime Time

Ovarian cancer is relatively rare but deadly. The lifetime risk of ovarian cancer is 1.5% compared to 12% for breast cancer, but it is the 5th most common cause of cancer death for women. Since the ovaries are hidden deep in the pelvis and the symptoms of ovarian cancer are non-specific, the cancer is often advanced by the time it is diagnosed...

/ June 21, 2016

Is the Annual Physical Unnecessary?

I was approached by The Wall Street Journal to write an article for their Big Issues in Health Care debate series. The subject was “Is the annual physical unnecessary?” I was to take the “yes” side and an internist was to take the “no” side. I wrote the following article. The editor wrote me a couple of times with questions. The internist...

/ April 26, 2016

Functional medicine: The ultimate misnomer in the world of integrative medicine

We at Science-Based Medicine often describe “integrative medicine” as integrating quackery with medicine (at least, I often do), because that’s what it in essence does. The reason, as I’ve described time and time again, is to put that quackery on equal footing (or at least apparently equal footing) with science- and evidence-based medicine, a goal that is close to being achieved. Originally...

/ April 11, 2016

Regulating CAM Aussie Style

CAM proponents view National Health Interview Surveys recording the supposed popularity of CAM, an amorphous conflation of anything from conventional medical advice to mythical methods, as an invitation to unleash even more unproven remedies on the public. My interpretation is quite different. I see the same figures as proof that we are doing too little to protect the public from pseudoscience. In...

/ March 31, 2016

Carotid Artery Stenosis: Surgery, Stent, or Nonsurgical Stroke Prevention?

The carotid artery in the neck is a common site of atherosclerosis. As plaque builds up, it leaves less room for blood flow and can cause strokes through clotting or embolization. Carotid stenosis is defined as a greater than 70% narrowing of the lumen (the space through which the blood flows in an artery). It can cause symptoms, including transient ischemic attacks...

/ March 29, 2016