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 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)

Quacks everywhere

David Colquhoun has posted an excellent series of posts on the Steiner Waldorf schools, 19th century crackpottery that persists even now, by hiding their fundamentally pseudoscientific basis under a fog of fancy invented terms. He discusses their goofy philosophy of anthroposophistry, their devious efforts to get state funding, and their unfortunate buy unsurprising history of racism. It’s wild and crazy stuff, and it’s been sidling under the radar for a while.

What initially drew me to DC’s site was his article on quackery in retreat: the University of Westminster has discarded some of their previous offerings in naturopathy. There is still a fair amount of junk in their curriculum, but there’s hope that those are waning too.

I needed that bit of solace, because my university’s official listserve sent me a wonderful offer earlier this week.

Mindfulness Based Stress Reduction
As part of our ongoing commitment to provide quality, integrated wellness programs, the University of Minnesota’s Center for Spirituality & Healing is pleased to offer a telephone-based version of the highly successful Mindfulness-Based Stress Reduction program (tMBSR). The tMBSR begins with an in-person, all-day workshop. The next six sessions are conducted via a web-based conference call. The tMBSR concludes with an in-person, all-day, mostly silent retreat.
tMBSR will teach participants how to intentionally cope with pain, illness, and the stress of modern life. Participants will learn mindfulness meditation skills, and build upon their own personal strengths to offset the adverse effects of stress by responding more effectively.

The program cost of $385 (*$350 for UPlan members) includes: • Guided instruction in mindfulness mediation practices • Web-based group discussions • Gentle stretching & yoga • Daily “homework” to improve skills • Individual, tailored instruction & support • Hand-outs, CDs & Yoga DVD • All-day workshop and all-day retreat.
*UPlan Members: The tMBSR program reimbursement is available to employees who are covered by the UPlan Medical Program. You must participate in both all-day events and 4 of the 6 conference calls to qualify to be reimbursed $200.00 of the registration fees.

All-Day Workshop & Retreat
September 17th, 2011, 9:00 am to 4:30 pm in Oyate
November 19th, 2011, 9:00 to 4:30 pm in Oyate

Oh, man. Our bogus magic medicine place, the Center for Spirituality and Healing, is sponsoring this garbage — oh, wait, “sponsoring”? No, milking the faculty. They want to charge us individually $385 for a day of “mindful meditation”, for which the university may give us partial reimbursement…which just means they’ve found a way to fleece the suckers and also to get our university to endorse it.

I was cranky. I fired back on the listserve.

I am stunned that the university is subsidizing this bunkum and quackery from the Center for Spirituality and Healing. I shouldn’t be surprised; after all, the university has this New Age crapfest called the CSH in the first place.

And then, of course, I was bombarded with rotten vegetables. People were upset: I was hurtful! I was contemptuous! How dare I question the university’s efforts to help us deal with stress? One person sent me this claim that Linehan’s Dialectical Behavioral Therapy (DBT) fixes a long laundry list of ailments, from anxiety to fibromyalgia to chronic pain, and that it caused “increased immune system functioning”, one of those common buzz phrases that the quacks often use. So I wrote back, for the last time.

I’ve read some of these studies, and am unimpressed. Most of them assess subjective phenomena (“chronic pain” is notoriously amenable to suggestion, for instance), involve very small subject numbers and small effects, and often seize upon random phenomena as significant — one study found that retention in their program was far greater than in the controls, for instance; their DBT program was offered for free to participants, while the control was paid psychotherapy. Surprise!

I think a university sponsored program to help employees deal with stress is a great idea. However, real programs that are effective are built upon evidence-based medicine, not the frivolous and fuzzy nonsense that we get from the Center for Spirituality and Healing. When our institution endorses “mindful meditation”, a procedure that is pretty much indistinguishable from the placebo response, they are literally doing the very least they can do for us.

Mindful meditation may be relatively innocuous fluff, but where do we draw the line? The CSH also endorses reiki, reflexology, aromatherapy, craniosacral therapy, traditional chinese medicine, and unbelievably, “healing touch” — this is tantamount to peddling magic. Here’s an example of how the CSH describes the mechanism behind ‘healing touch.’

Healing Touch blends the energetic techniques of a number of practices, both ancient and contemporary. It is based on the belief that human beings are composed of fields of energy that are in constant interaction with self, others, and the environment (also see the section on Theories and Principles for more information). The Healing Touch practitioner realigns the energy flow, which reactivates the patient’s mind/body/spirit connection in order to eliminate blockages to self-healing.

The goal of Healing Touch is to restore harmony to the energy system so that the patient is in an optimal state for healing to occur. In other words, the goals are to accelerate the recipient’s own healing process and to facilitate healing at all levels of the body, mind, and spirit.

Healing Touch integrates easily with other modalities a practitioner may already be using. These modalities may include conventional medical practice in hospitals, clinics and in home care, or other body-mind oriented therapies such as massage, guided imagery, music therapy, acupressure, biofeedback, and psychotherapy.

This is pure gobbledygook. None of this makes sense. None of this has been demonstrated empirically: it can’t be, because it’s all made up.

None of these ‘therapies’ work. Every time they’ve been tested using objective, clinical outcomes, they’ve been found to be completely ineffectual. Our university is selling us New Age snake oil, and I’m deeply embarrassed to see the credulity and the wastefulness demonstrated by an institution that ought to be dedicated to rigor and reason. Can we please use our health care dollars a little more wisely?

Man, I hate the center for spirituality and healing. I’m ashamed and embarrassed every time I get ads from that place — they are trading on the educational and scientific integrity of our institution of higher learning to make money for quacks and to elevate witch doctors and shamans to the status of medical professionals. I’m hurtful? I think frauds selling overpriced stress-reduction magic to our faculty and staff is what really hurts.

No, I’m not signing up for the Mindfulness Based Stress Reduction classes. Just their existence has increased my stress, and it’s not worth $385 to show up and watch my blood pressure skyrocket.

(Also on FtB)

How good is American health care?

A study in the Journal of the Royal Society of medicine has assessed the effectiveness of health care in 19 western countries and come up with a simple ranking system: a measure of the the number of lives saved relative to expenditures proportional to the GDP. One parameter, called the GDPHE, or GDP Health Expenditure was a measure of how much money the country was sinking into health care per citizen; by dividing this by the mortality rates, they got a measure of the effectiveness of the health care system.

This is a ranking system, and I have mostly a hyper-competitive American audience, so you all want to know whether you win or not, right? You want the data that shows that the US is #1! And here it is, the one result that shows us at the top of the ladder, our average health care as a function of GDP.


Look at that: we don’t just win, we win big, leaving our closest competitor, Germany, in the dust. We spend 125% of the money Germany does per person. Does it feel good, America? We are tossing bigger buckets of money into health care than anyone else.

But now for the number that really matters, the GDPHE ratio. How many lives are we saving with all that money? Here’s the answer. Look at the last column, which is the ratio of money spent to lives saved.


Oops. We’re…#17. We’re almost the worst — thanks, Portugal and Switzerland, for neglecting the medical needs of your citizenry more than we do.

Our health care is miserably inefficient, and we pour extravagant sums of cash into it, but you might ask whether it works at all. And the answer is a bit of good news, yes, it does. This study also compared death rates over time and came to the conclusion that, in the US, more than half a million people are alive today who would not have been with the medical care we offered 25 years ago. Medicine in the US is good, it’s just far more economically wasteful than it ought to be.

I’m still thinking I ought to retire to Ireland.

(Also on FtB)

Newage sewage flushed into the Atlantic

The Atlantic published a rather contemptible apologetic for alternative quackery titled “The Triumph of New-Age Medicine, which basically declared victory for the altie wackaloons. The way it did this was devious, and reminded me so much of creationist tactics. First, it declares that “mainstream medicine itself is failing”; it doesn’t really have any evidence of this, it just declares that modern medicine is built around the infectious disease model, and that it hasn’t solved all health problems. Familiar stuff, hey? If a science can’t explain every jot & tittle of every detail of every phenomenon, if there are still open questions and problems, why, it must be wrong!

Secondly, it portrays the altie quacks as nice, caring, sweet people who really, really care about their patients, and their ‘treatments’ as, at worst, totally harmless. Referring to one peddler of holistic care, the author says “Concerns of outright malpractice or naked hucksterism seem grossly misplaced when applied to a clinic like Berman’s.” Why? Because Berman is “gentle” and “upbeat” and has a pleasant demeanor. As everyone apparently knows, con artists must always be rude and pushy and arrogant and nasty and alienating. Oh, wait…no, they’re the opposite of that.

And then, thirdly, is the sly substitution. We’re finding that the best way to manage chronic illnesses like heart disease is with life-style changes that improve nutrition, physical condition, and overall well-being, and reduce the underlying causes. So what does this article do? It credits all that good common sense to the quacks who promote reiki and acupuncture and exotic herbs. You know what my traditional, mainstream, hidebound doctor of real world medicine first prescribed for me at those early signs of heart disease? Changes in diet and more exercise. She didn’t seem to think I needed homeopathic placebos in order to do something that would make a difference.

It was an infuriatingly dishonest article. Now Steven Salzberg, who was also quoted in it, has gotten a good rebuttal published in the Atlantic, and has also been interviewed on MPR on the subject.

I know that when I go to see a doctor, I want to see a commitment to figuring out what works. I am not at all impressed if they’re pushing fraudulent pseudoscientific BS into my treatment, no matter how sweet and smiley and sensitive they are. A good bedside manner is important, but it’s no substitute for incompetence.