Archive for the ‘Not Science’ category

Dr Freeride gives us a great example of some darn good parenting!

July 10, 2009

At the root of the skeptical blogging and science issues I blog about, is generally a failure of critical thinking. How can we improve our critical thinking, as a society? I think one way is to teach our children. I think we should teach children to critically think about things as young as we can, and then encourage them to think… all the time!

I’m not personally a parent, so feel free to flame me in the comments for the obvious idiocy of someone without kids handing out parenting advice. However Dr. Freeride over at Adventures in Science and Ethics provides exactly such an example.

What Fresh Hell Is This? Age of Autism and ALS

July 9, 2009

I’ve run across Age of Autism before, primarily when talking about vaccines and autism. Now AoA appears to be branching out – spreading misinformation about ALS as well.

A very brief primer o ALS before we get to Kim Stagliano’s nonsense.

ALS is  a disease that affects motor neurons – that’s the nerve cells that  either go from your brain to your spinal cord, or your spinal cord to the voluntary muscles in the body. While I may go into the details in a later post, for now it’s enough to know that ALS causes these nerve cells to progressively die. You have alot of different muscles in your body, so the initial symptoms of ALS vary depending on where exactly the nerve cells start to die. It can be as simple as being clumsier – starting to trip over things without realising it. It can be twitching in your hand that you didn’t really think about, but now is getting worse. Your speech may start to slur.

Then the symptoms tend to spread, and get worse. This happens at different rates in different people. Off the top of my head (and not off the top of a clinical trial) I think the mean survival after diagnosis is 3 to 5 years. There is alot of variability even then though – some people live 10 years, or more. Many patients with ALS end up dieing when the muscles that help with breathing, and swallowing are affected. At this point, a patient will need help breathing, and clearing their secretions (the gunk that you cough up or spit out), and is often already bedridden. Once this happens, they’re at very high risk to get pneumonia or other infections, which is often how these patients die.

ALS is a horrible disease. My heart goes out to people who have been diagnosed with ALS, and their loved ones. I can’t pretend I know how it feels to be handed basically a death sentence, and I won’t pretend I do. What I can say is that patients with ALS, or really any other devastating diagnosis, they’re prime targets for snake oil salesman. Your doctor tells you the situation is bad, someone else says “well yea, but I’ve got a miracle cure that THEY don’t want you to know about!”, often a patient might say ‘well what have I got to lose?’

Physicians are obligated to obligated to guide our patients away from dangerous treatments, and treatments that are just implausible. No one knows what causes ALS for sure. Despite this, I can be pretty sure when I say that the answer isn’t mercury poisoning. Chelation is therefore, completely useless as a treatment, and potentially dangerous.  Unfortunately, AoA appears to be saying that the One True Cause of ALS, or at least One Big Factor, is mercury.

Today Katie Wright put up a post here, comparing the pace of research in autism with that of ALS. Frankly her post contains so much gibberish, and so few facts that I couldn’t even find a way to fisk it appropriately. To be honest, her article isn’t all that interesting anyway. What’s more interesting is the note attached to the beginning of her post by the managing editor, Kim Stagliano. Here it is, in it’s entirety:

Managing Editor’s Note: I have a dear friend who was diagnosed two years ago with ALS. He was told there is no treatment and no cure. He found a website called Patients Like Me, that offered info from patients, not doctors. He found a doc willing to run tests – and learned he was highly mercury toxic. The diagnosis center had given him yet another flu shot just last year. He’s on the ALS equivalent of the DAN! protocol and has slowed the rate of descent. All because he didn’t take “go away and die” for an answer. Familiar, indeed, Katie.  KS

While I don’t know what the ALS equivalent of the DAN! protocol contains, if they’re claiming the cause of ALS is mercury poisoning their go-to answer probably includes chelation. Chelation is not a therapy that works for Autism, and it’s not a therapy that works for ALS. This is beyond offering false hope to a patient with a terrible disease, it’s irresponsible, dangerous medical mismanagement.

There is a reason that the flu shot is recommended for patients with ALS – I mentioned that they often die of pneumonia or other respiratory infections. The flu can often lead to those infections. Any additional protection you can give a patient from pneumonia then, is protection that they should have. Suggesting a fairy tale – that ALS is caused by mercury toxicity – will just lead to putting them needlessly at risk. Not to mention the danger of giving a sick person chelation therapy they don’t need.

 Perhaps more on this later – depending on whether or not AoA follows this up with more stupidity, and time pending, as always.

My Motivation

April 16, 2009

I was going to post this later, after HC:Part 4, but I’ve been inspired by the last line of PalMD’s post here. Part 4 is coming tomorrow.

In the short life of this blog a number of commentors and emailers have asked what my motivation is. They usually mean to imply that I’m a pharma shill, or that I don’t care about children. Offensive implications aside, it’s still a good question. The answer is the same as the answer I give to another question: Why do I want to be a doctor?

Why have I decided to spend 4 years in college, 4 years in medical school, and 3-7 years in post-medical-school training just to be a doctor.

 I get asked if I do it for the money. A lot. I don’t do it for the money. In fact right now, I have more debt in student loans than my parent’s mortgage. Since my bachelors is in engineering, I’ve put off earning pretty decent money for 7 to 10 years, which balances out that salary thing quite a bit. So no, not the money.

I get asked if I do it because I have a God complex. Admittedly I’m not the most humble person in the world. This was true long before med school, and will be true long afterwards. But it’s a big stretch to say I have a God complex.

I get asked a hundred other silly questions. Is it because medicine is just cool? Notably one surgical patient said “It must be because yesterday you got to have your hand in my belly, it’s either that, or the nurses… it must be the nurses.” I have the utmost of respect for nurses, and the patient in question did too, I think that was the morphine talking. No it’s not any of those.

I’m in medicine now, because I can’t think of a more beautiful profession. As doctors, we hold the most sacred of all trusts. It is the most intimate of all relationships. In my training, people tell me secrets that they won’t even tell their spouses, or their children. Sometimes I elicit secrets they even try to hide from themselves.

 No one is more vulnerable, more laid bare, than a patient in need. With all of our talk of patient autonomy, in reality, you place your life in someone else’s trust when you go to a doctor.

Patients, and we are all patients – today, tomorrow, some day, we are all patients –  place our lives, and our loved ones in doctors’ hands.

When you see a doctor, the good ones aren’t motivated by that insurance payout, though that’s necessary to pay the bills. They aren’t motivated by how interesting the human body is, though it is more captivating than anything else in existence. The best doctors know that at the end of the day, it is our privilege as a profession to care for the health of  our community, our society, and our world.

Think for a second about what that means. We are not responsible for only our small subset – the few patients we can see in a day. As a collective we are responsible for, and accountable to, the world.

As physicians, it is our responsibility, it is our honor and our supreme privilege to serve people in the most basic, and most important of ways.  

That’s why I’m going to be a doctor.  That’s why I write here. It’s why I demand citations, why the burden of proof is so high. How can we trust the lives of billions to the diseased ramblings of some voodoo practitioner? It’s why I react strongly to the pseudo scientists and pseudo doctors.  How can someone who truly believes that we act for society even suggest the physically impossible, the unlikely, unproven, and dangerous? Offering false hope is beyond the pale, and insulting to the world.

 It’s  why I object when some amateur – and it’s invariably amateurs – cites gibberish to back their brand of nonsense. It’s why I take it personally when someone purports to know the secrets of the universe.  If you possess such secrets, why not prove them? Doing otherwise is not just an insult to my profession. It’s an insult to the public trust – that we hold above all else.  

It’s why I am offended, and infuriated, when a Doctor betrays that trust. When a doctor, through sins of commission, or sins of omission, betrays the very basis of our profession, our covenant with society, that cuts most deeply of all.

To me, there is only one solution to all of these betrayals. Light must be shown on them. Bright lights. We can maintain the public trust only by policing it ourselves, and by policing those purporting to act in such trust.

That’s my motivation.  I want to light a candle – because one blog is no spotlight – to shine a light on these pests that would destroy the foundation of my profession – it is my honor, and my privilege to do so.

 

 

 

 

 

 

 

(Edited for grammar on 4/18/09)