Science-based medicine versus the Flint water crisis
One aspect of science-based medicine that is not covered frequently on this blog, aside from vaccines and antivaccine pseudoscience, but perhaps should be, is the intersection of SBM and public health. Unfortunately, living as I do in southeast Michigan right now, I’ve been on the receiving end of an inescapable lesson in what happens when the government fails in its mission to...
The Fog of Medicine
I often get called on to be a diagnostician. The referring doctor is uncertain what is going on in the patient, often a fever of unknown origin, and they call me to help figure it out. Sometimes I do, sometimes I don’t. Making the correct diagnosis is not easy, even after 35 years. The classic phrase is the fog of war, but...
Docs v. Glocks: government regulation of physician speech
A few years ago, an Ocala, Florida, pediatrician, as part of a routine visit, asked a patient’s mother whether she kept firearms in the home. She refused to answer, feeling the question constituted an invasion of her right to privacy. The pediatrician then terminated the relationship and told the mother she had 30 days to find a new doctor for her child....
The Clean Eating Delusion
While some parts of the world are concerned with eating, because of food insecurity, the “worried and well-fed well” are increasingly obsessed with so-called “clean eating.” This is nothing new, but like every cultural phenomenon, it seems, has increased partly due to the easy spread of misinformation over the internet. If you are anxious about your health, and who isn’t to some...
Chronic Fatigue Syndrome: Rituximab Revisited
Three years ago I wrote about an experimental treatment for chronic fatigue syndrome (CFS): rituximab (brand name Rituxan). I was concerned that doctors who offered it, like Andreas Kogelnik, were jumping the gun by offering it before the evidence was in, and that they might be putting patients at risk. A correspondent who has been following the CFS forums asked me to...
The cost of repealing mandatory motorcycle helmet laws
It’s a seldom mentioned aspect of my professional history that I used to do a lot of trauma surgery in my youth. I did my residency at a program that included a county hospital with a busy trauma program where I saw quite a bit of vehicular carnage and an urban hospital (which has since closed) where I saw a fair amount...
Baby Translating Technology: Revolutionary Parenting Tool or Confirmation Bias Bonanza
Caring for a young infant, although a potentially rewarding means of producing a labor force for chores and minor home repairs, can be a trying ordeal for both new and experienced parents. The peaks and valleys of parental experience can leave a caregiver both exhilarated and agonizingly frustrated during a single hour of childcare, let alone the first few months. It is...
Don’t drink hair bleach
Hydrogen peroxide is consumed and injected in alternative medicine practices as a sort of "cure all". Is there any evidence to back this up? And how safe is it to inject or consume?
HPV Vaccine Safety and Acceptance
The public fight over the human papillomavirus (HPV) vaccine is still raging. The debate partly reflects the underlying logic of health prevention measures, which is essentially a statistical game of risk vs benefit. Unfortunately thrown into the mix are ideological opponents to vaccines who are distorting the facts at every turn. Notice that I said this was a “public” fight, because it...
Vaginal Birth After C-Section: How Safe Is It?
Doctors used to insist “once a C-section, always a C-section.” Today it is standard practice to allow vaginal births after C-section (VBAC) for appropriately selected patients. The American Congress of Obstetricians and Gynecologists (ACOG) has issued a Practice Bulletin to guide obstetricians in determining which patients are appropriate candidates for VBAC. We frequently hear criticisms of practice guidelines like these. The doctors...
Don’t Blame the Patient