Doctors advising doctors

Hey, I guess people have known about that cutting entry in the index to an obstetrics text for a good long while. Here’s an article on the book and general ob-gyn attitudes, in which we learn that the indexer was … the author’s wife! I guess she’d know. But doctors know better now, right?

Recall that preeclampsia was once called toxemia because it was thought to be a build-up of toxins in the maternal blood that had not been secreted through the normal monthly purification of the menstrual cycle. Miscarriages must be caused by the woman doing something she shouldn’t have done, like picking up a bag of groceries. Bottle feeding was superior to breast feeding because men had used science to outsmart the female breast. In fact, for about half of the twentieth century, obstetrics consisted of rendering pregnant women unconscious, cutting a procto-episiotomy, and ripping the child out with forceps. Sounds very efficient and modern. [Yikes. That’s how I was born.]

But surely we don’t think this way today. Have you ever recommended that a woman be on bed rest for any condition in pregnancy? Have you ever mocked a woman with a birth plan? Have you ever told a woman to “take it easy”? Do you believe that a Cesarean delivery is an improvement over vaginal delivery? Do you believe that when women suffer from depression or anxiety it is related to abnormal hormone levels? Much of the worldview of modern obstetric practiced was formed with the belief that women were inept and incapable and that science needed to fix them. Think about that next time you integrate old myths into your practice.

Ritualized child abuse: circumcision

Want to spend an hour cringing and twitching? This is the abridged version of “Cut: Slicing Through the Myths of Circumcision“, and you will suffer if you watch it. It is a wasteful, terrible thing to do to a child.

One rabbi interviewed is at least honest about circumcision: “It’s painful, it’s abusive, it’s traumatic, and if anybody does it who isn’t in a covenant ought to be put in prison…I do abusive things because I’m in covenant with god.” What nonsense. What a wretched excuse for abusing children.

(Warning: lots of shots of babies getting chopped, as well as closeups of adult penises.)

The arguments for circumcision are pathetic and awful.

  • “You either believe [in the covenant of circumcision] or else nothing is true”. I’ve heard that before: it’s the argument creationists use to defend the absolute literal truth of the book of Genesis, because if that’s not true, the story of Jesus falls apart, and therefore the whole of Christianity is false. Yeah, so? Then it’s false.

  • “The mystery of circumcision is profound”. Ignorance should not inspire the kind of awe that motivates one to mutilate another person’s body.

  • The health benefits. Total bullshit. As one of the speakers in the movie explains, there have been progressive excuses: from it prevents masturbation to it prevents cancer to it prevents AIDS. The benefits all vanish with further studies and are all promoted by pro-circumcision organizations. It doesn’t even make sense: let’s not pretend people have been hacking at penises for millennia because there was a clinical study. Hey, let’s chop off our pinkie toes and then go looking for medical correlations!

  • It’s tradition. Grandpa and great-grandpa and great-great-grandpa did it, so I’ll perpetuate the cycle of abuse to my children. I have to reject that: it reduces a decision to do irreparable damage to a child to repetitive, superstitious, mindless behavior.

There is no reason, other than certain rare and specific medical conditions, for maiming anyone’s genitalia. Don’t do it to your children.

(Also on FtB)

What killed Steve Jobs?

You’ve probably heard the story going around that Steve Jobs’ death was avoidable, if only he hadn’t been so gullible as to steep himself in quack medicine. It turns out, though, that the story is a lot more complicated than that: David Gorski has written the best summary I’ve seen so far.

In short (because it is Gorski, after all, so it’s exhaustively long), there was an element of woo in Jobs’ early response. After his pancreatic cancer was first diagnosed, he delayed surgery for 9 months to try out some improbably dietary approaches. It was a massive operation that was strongly recommended, so it’s a little bit understandable that he wanted to avoid it, but surgery was also the best and most demonstrably successful approach to take. So first point goes to the verdict of gullibility against Jobs.

However, his cancer was a slow-going kind with a reasonable prognosis, so the delay can only be said to have possibly contributed to the worsening of his condition. Jobs made a poor decision, but not necessarily a fatal one. And subsequently, once he saw that the diet nonsense wasn’t working, he threw himself thoroughly into science-based medicine, getting the best treatment oodles of money could buy, getting the surgeries recommended to him, and even trying out some experimental therapies (real experimental therapies, the stuff where scientists monitor and evaluate the results honestly, not the random shenanigans quacks like to flatter with the word “experimental”).

So the final result is that real science kept him alive and healthy as long as possible, and that an early flirtation with ‘alternative’ medicine might have contributed somewhat to lowering the odds of survival, but that what killed him is cancer. And cancer is a bastard.

(Also on FtB)

Some students should not go into a health profession

I’m afraid Ben Cochran is one of them. He’s a nursing student who wrote a column in a newspaper because he was upset at the time it took for the emergency medical services at his local clinic to help him with his sneezy, phlegmy cold (which, I would have told him, is going to put a low priority on something they can’t really treat anyway). He places the blame: the clinic offers women’s reproductive services, and they were busy helping a “gaggle of preemie sluts [] get a free pass on harlotry” and treating their “cunt problems”.

But he really doesn’t have a problem with these women, he says. He just wants to end women’s medical services and the distribution of condoms on campus.

I don’t take issue with sex mongers. They serve their place. Hell, according to the bible, it’s
the oldest known profession on earth. So you sultry sex fiends are clearly established, but
this is a place of higher being. Please take your gaping holes elsewhere for medical services,
and leave the real health issues to those that actually belong on a college campus.

Yeah, he’s going to make a greeeeeat nurse. He’s already an expert on triage: men with runny noses must be treated before sluts with gynecological issues.

He’s going to have a tough time doing the work, though, with all the holes Ema ripped into him.

(Also on FtB)

Crowdsourcing for a good cancer text

Among the many joys plaguing me recently is learning that I get to teach, for the first time for me and for the first time at my university, I get to teach a course in cancer biology this spring term. I’m not totally unprepared for this — I was on a cancer training grant for about 5 years, got some basic education in clinical oncology as well as the basic science of the processes, and really, it’s all about gene regulation, cell cycle control, signal transduction, and specification and commitment, all stuff that is eminently familiar to a developmental biologist. But still, you can guess what I’ll be doing over Christmas break: cramming for one of the most depressing subjects in the world.

Anyway, here’s what I need. I’m going to have to order books for the students next month: the prerequisite for the course is simply cell biology and major status, so I need something that’s not too advanced, but has a good overview of mechanisms. This will not be a course in clinical oncology, but on the cell biology of cancer…but still, students will expect at least a little bit of direct medical relevance (I’ll probably ask around to find a local doctor who’d be willing to give a guest lecture, too). I am not a medical doctor, and this will not be a course to give out medical advice at all.

So, request #1 is for a good solid intermediate level cancer textbook.

Request #2 is for me: I’m going to have to dive into a crash cramming event in December/January to bring myself up to speed on current developments in the field, so I can be smarter than the students. What are some good review texts for a guy who knows a fair amount of biology but took his last course in oncology about 15 years ago?

(Also on FtB)

Michele Bachmann: pseudo-scientist and anti-vaxxer

There was another Republican debate (I skipped it; there are limits to the horrors I can endure), and apparently, many people think Michele Bachmann trumped Rick Perry by jumping on his ‘liberal’ endorsement of using the HPV vaccine to prevent cancers in women. Bachmann ranted about the federal government forcing innocent little girls to get mental retardation injections, and the teabaggers loved it. They loved it almost as much as they loved Rick Perry’s record of executions.

Orac rips her apart. It’s great fun, and informative, too.

As I’ve pointed out time and time again, Gardasil is incredibly safe by any measure. Also by any measure, it’s been very heavily tested and monitored. Of course, there is no evidence at all that the HPV vaccine can cause mental retardation. I’ve also pointed out how the vast majority of the reports of adverse reactions after the HPV vaccine made to the VAERS database were almost certainly not due to Gardasil and have castigated Medscape, of all publications, for buying into anti-vaccine myths about Gardasil. Meanwhile the American Academy of Pediatrics immediately issued a press release to correct Michelle Bachmann’s false statements about Gardasil. What Bachmann is peddling is pure pseudoscience. I suppose I shouldn’t be in the least bit surprised, given how gullible she is when it comes to science in general and how much she allows ideology to trump science.

Once again, the Republicans step forward as the anti-human, anti-science, anti-health party.

(Also on FtB)

No Jerry, no cure

We’re finally rid of Jerry Lewis and his smarmy, condescending sponsorship of a telethon for muscular dystrophy. I think he meant well, but he had the wrong ideas: this article celebrating his absence makes a significant point. There are many diseases for which there can be no cure short of magically rebuilding entire bodies and brains — that is, no cure short of changing essentially the entirety of who the person is.

All that money was supposed to find what Jerry called “a cure.” Every year he said “We’re closer than ever to a cure.” But every doctor and nurse will tell you the same thing: there is no cure. In the program for the 2011 annual meeting of the Muscular Dystrophy Coordinating Committee, the word “cure” does not appear.

What people with the disability need is help with their symptoms and with mobility. Their quality of life can be improved, their symptoms can be reduced. They also need “accessible public transportation and housing, employment opportunities and other civil rights that a democratic society should ensure for all its citizens.” That’s what Mike Ervin says–he calls himself “a renegade Jerry’s Kid” who was an official telethon poster child in the 1960s.

That’s not a message of hopelessness. To the contrary, it’s saying there are positive improvements that can be made that don’t involve relegating the disabled to the rubbish bin of ‘God’s mistakes’.

(Also on FtB)

A whole new world of quacks

My wife and I have three kids, and while that pregnancy and childbirth thing is way, way back in the past, we did have some strong opinions after our experience. Midwives were wonderful, we had only the best and most positive experiences with them, and they were the indispensable supporters we were glad to have there. The doctors…meh. They didn’t seem to be involved much, and it was rather strange when they’d come by after all the work was done and sign the birth certificate, as if they were taking credit. But my wife had relatively uneventful, uncomplicated deliveries (the second was a bit rough, and she had to stay overnight for observation afterwards; that kid was gigantic), and we knew that the doctors were essential if things went wrong, and we would have been horrified and greatly worried if they hadn’t been there. All our kids were born in clinics, with professionals all around us, because we weren’t going to take any risks. Childbirth is dangerous when things go wrong, and they really can go very, very wrong.

But now I’ve discovered The Skeptical OB, and it’s all about this crazy kooky weird world of homebirthers — people who, just like anti-vaxxers and HIV denialists, refuse to recognize that modern medicine is actually incredibly powerful and useful, and have these bizarre myths about what is “natural”. So they insist on having their babies at home, away from those horrible doctors, and they end up with dead mothers and dead babies.

That last case is particularly eye-opening. A woman writes into a forum dispensing this quackery, and complains about ditching her OBGYN and going with an unlicensed midwife, and proceeded to go into labor for eight days and delivered a dead baby.

Or this case, where a homebirther is irate because doctors recommend against her desired natural childbirthing experience, because she’s “high risk”. She thinks she isn’t, because her first delivery was easy. But then she mentions that her second delivery had a minor problem: the kid got “stuck” and required resuscitation (!) after delivery, and her third child was born unresponsive and died two days later. And then she wonders why doctors are so worried!

It’s all very disturbing and new to me, but I guess I shouldn’t be surprised. There are all these strange people around who, for some unfathomable reason, worship pre-18th century medicine and make a fetish of “natural”. Heart attacks are also entirely “natural”, but you won’t catch me suggesting that we skip the doctor if I have one.

(Also on FtB)

Triumph in Canada

Remember that silly blood type nonsense from the Canadian Blood Services? It’s gone, replaced with a much simpler page that states that your blood type will be determined when you give blood.

A few people have received email from CBS admitting that they’ve removed the nonsense.

Dr. Sher has asked me to respond to your recent e-mail regarding our What’s Your Type? new donor recruitment program. I understand that you have also sent an e-mail communicating your concerns to www.whatsyourtype@blood.ca and that others from our organization have provided you with specific details in response. I can confirm that the content you object to has been removed from our web site. The marketing materials for this program are being revised.

Thanks again for sharing your views with us.

Ian Mumford
Chief Operating Officer
Canadian Blood Services

Good for them. Science FTW!

(Also on FtB)

Not you too, New Zealand?

Let’s imagine that you, a rational person, are a high muckety-muck in some prestigious scientific institution — like, say, the Royal Society of New Zealand — and you’re asked whether some fringe subject — like, say, Traditional Chinese Medicine — should receive the endorsement of your society. How would you determine your answer?

If you’re anything like me, you’d go to experts and ask, “Is there good evidence that this really works? Is it a subject we should pursue in greater depth?”

Not the Royal Society of New Zealand, though. No, forget all that business of whether TCM actually works, or even does harm: instead, they hired a consultant psychologist who interviewed 30 people and asked them whether they’d used TCM. Their conclusion:

The Society recommends that TCM should become a registered profession and that registered practitioners should be clinically well qualified.

It apparently doesn’t matter whether it works or not, and the fact that it can cause harm was actually used to support endorsing it in a fine piece of topsy-turvy logic.

There is the potential of harm from the practice of TCM. Apart from the risks already outlined in the proposal document, clients consulting TCM practitioners are at risk of delayed diagnosis and treatment of their conditions, which can carry significant consequences. It is possible that an occult fracture is missed in a client consulting a TCM practitioner for foot pain, or early meningococcal disease overlooked in a client with fevers and general malaise.

Regulation of TCM will ensure that all TCM practitioners are aware of the limitation of their service, and to know when to refer clients to another health service if necessary. Improper practice of TCM, such as tuina (massage therapy) and tei-da (practice of bone-setting), has been shown to induce physical damage (e.g. joint dislocation, spindle damage, deep tissue/muscle damage) to the patients and some herbal medicine may also not be suitable for pregnant women. It will therefore be important to ensure that registered TCM practitioners are responsible and clinically well qualified.

I have decided that chewing broken glass is a cure for cancer. It is irrelevant whether it actually does so; it does cause severe bleeding and oral and throat damage, though, so I’m moving to New Zealand, where that will be cause to officially recognize and register my practice, so that the state can better protect my patients from harm.

(Also on FtB)