Category: Surgical Procedures
Another challenge to surgical dogma
Better late than never with this one. The dogma that I’m referring to is the remaining practice of using NG tubes in anyone with upper gastrointestinal surgery (liver, stomach, pancreas, duodenum, proximal small intestine) and then placing a jejunostomy tube (a tube, also often called a J-tube, that goes into the jejunum, or the proximal part of the small intestine, through which...
Fecal Transplants: Getting To The Bottom Of The Matter
Many Americans will be introducing more food than usual to their GI tracts on this Thanksgiving Day, and so I thought I’d provide you with a special gastroenterology-related post to complement the mood. If you have already eaten, I might suggest that you come back to this post on an empty stomach. I will be discussing the alternative medicine practice known as...
Circumcision: What Does Science Say?
There are no compelling scientific arguments for or against neonatal circumcision. Benefits and risks are, scientifically speaking, small. However, the nonscientific arguments for and against circumcision are loud, and often irrational.
The Orange Man
Alternative medicine is not harmless, and carrots cannot cure cancer.
The media versus the frontiers of medicine and surgery
A couple of months ago, one of my esteemed co-bloggers, Wally Sampson, wrote an excellent article about borderlines in research in conventional medicine. Such borderlines are particularly common in my area of expertise (cancer, which is also Dr. Sampson’s area of expertise) because there are so many cancers for which we do not as yet have reliably curative therapies. Patients faced with...
Early detection of cancer, part 2: Breast cancer and MRI
Note: If you haven’t already, you should read PART 1 of this two-part series. It defines several terms that I will be using in this post, and I don’t plan on explaining them again, given that they were explained in detail in Part 1. Of course, if you’re a medical professional and already know what lead time bias, length bias, and stage...
Barriers to practicing science-based surgery
Much to the relief of regular readers, I will now change topics from those of the last two weeks. Although fun and amusing (except to those who fall for them), continuing with such material for too long risks sending this blog too far in a direction that no one would want. So, instead, this week it’s time to get serious again. A...
Colon “cleanses”: A load of you know what…
One of the more popular treatments in alternative medicine is the "colon cleanse," a treatment based on the idea that there is 20 lbs. worth of accumulated feces in your colon that is slowly poisoning you. There's only one way to put it. Colon cleansing is a load of crap.
When the popularity of new surgical procedures outpaces science
In science- and evidence-based medicine, the evaluation of surgical procedures represents a unique challenge that is truly qualitatively different from the challenges in medical specialties. Perhaps the most daunting of these challenges is that it is often either ethically unacceptable or logistically impossible to do the gold-standard clinical trial, a double-blind, randomized placebo trial for an operation. After all, the “placebo” in...