Since my 1 year blogiversary just passed and tonight is New Year’s eve, I thought I’d comb through my blog to bring you what I consider to be the best of Dr. Val and the Voice of Reason, 2007. Thanks again to all of you who have been reading my blog (”all 3 of you,” as my husband likes to say). Oh, and if any of you would like to join me in losing weight starting tomorrow - I have a neat group of like-minded folks gathered here. We are committed to regular cardio and weight training exercises as well as calorie reduction (based on the American Heart Association’s fitness guidelines). You can track your progress with a tool that displays your achievements week by week. There are over 100 people in the group already… come on in, the water’s warm.

And with no further ado, here are the best posts from 2007:

The Best “Feel Good” Posts

A Baby’s Life Is Saved - a young mother forces a doctor to reconsider his diagnosis, saving her baby’s life.

Do the Right Thing- a young intern fights to save the life of a patient that everyone else has written off.

The Wounds of Childhood- how I might have made a difference for a little girl who was marginalized.

Medicine: Face-to-Face- the story of how I treated a child for the same injury I had at her age: being mauled by a dog.

Informed Consent and the Animal Guessing Game- my reflection on the emotional side of consenting for a procedure.

Thanks to Surgeons- a heartfelt tribute to the surgeon who saved my life.

Fly the Ball- the life and times of a Pakistani doctor who builds a successful career in the US.

The Best Infuriating Posts

The Last Straw: My Road to a Revolution- the true story of a child with cerebral palsy who died because he was denied a wheelchair part by Medicare.

The Benefit of the Doubt- how my friend was labeled as a drug seeker and mistreated in the ER.

VIP Syndrome: A No-Win Situation - the story of how a young man with “connections” demanded and received inappropriate and expensive medical tests, leaving the doctors holding the bag.

The Case of a Predator in the Hospital- how one drug user managed to game the system, wreaking havoc on her fellow patients.

Don’t Believe Everything You Read in a Medical Chart- the story of how a misdiagnosis resulted in a patient being wrongly labeled as a drug seeker.

The Real Dangers of Pain Medicine - a woman who died of opiate induced constipation.

The Best Sad Posts

The Scream- how a cavalier end-of-life decision destroyed a family member.

The Size of Unhappiness- a reflection on America’s obsession with thinness.

Baking Cookies- that’s all I could do as a doctor in Manhattan on 9/11.

Unencumbered by Prognosis- my dear friend handles her diagnosis of stage 4 colon cancer with optimism and grace.

Alzheimer’s Dementia: A Life Lived In Reverse- the story of my grandmother’s dementia and her slow mental decline.

The Best Humorous Posts

Conversations at the Spa- the true story of my recent trip to a high end spa in California.

Kids Say the Darndest Things- these are some pretty good ones.

The Christmas Miracle- a “miraculous” icicle forms on a Christmas tree and pandemonium ensues.

Medical Haiku- some irreverent poems I created a few years ago.

Is that Your Real Skin?- the silly conversations that arise when you’re really pale.

Dudes- a quick look at how men perceive a new hairstyle.

The “Perfect” Wedding- the story of how my hair was transformed into an alien head on my wedding day.

The Best Healthcare Policy Posts

Why I Worry about a Government Sponsored Single Payer System - previous experience with government rulings make me distrustful of population based healthcare savings initiatives.

Pay for Performance: More Red Tape without Improved Quality of Care - the title pretty much sums this post up.

Are Physician Salaries Too High? - compare them to health insurance and corporate executive salaries.

Concierge Medicine for the Masses?- my physician is part of an “off the grid” movement in healthcare.

Rationing Healthcare and the Emperor’s New Clothes - I take a look at some of the funding allocation decisions being made by the government.

End of Life Care: Healthcare’s Big Ticket Item- I explore some of the high costs of end-of-life care and the ethical dilemmas that rationing it creates.

Posts That Make You Go…Hmmm

My First Day as a Doctor- it was a baptism by fire.

The Great Unveiling- who are we deep down inside?

Night Float in the Hospice- what it feels like to care for the dying.

Dying with Dignity- I refused to practice intubation on a deceased patient as his family members waited for news in the next room.

Face Transplants: Ethical Dilemmas- should they be covered by health insurance?

The Man Who Couldn’t Speak- a strange diagnostic dilemma solved by a doting mom.

The Best High Brow Posts

Cancer: Do We Really Understand It?- a wonderful post by guest blogger Avrum Bluming, questioning if we really do know as much as we think we do about this formidable foe.

Hormone Replacement Therapy: A Critical Review- another wonderful post by Dr. Bluming.

Good Science Makes Bad Television- a series on research methodology and why the public should care about it.

The Power of Magical Thinking- describes how to recognize snake oil salesmen.

What You’ll Learn in Pre-Med Classes- a rant about how irrelevant some of the course work is that is required for admission to medical school.

What the Heck is a Rehab Doc?- the history of my medical specialty: PM&R.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Well, it’s been 1 full year since I began blogging… amazing how time flies. I’ve really enjoyed getting to know some fellow medical bloggers out there, and also recruiting and encouraging some of my peers to blog here at Revolution Health.

On my 1 year anniversary, I’d like to thank my peers and supporters for reading my blog, and give some kudos to some of my favorite bloggers… In no particular order, here are some of my favorite health related blogs and why I enjoy them so much:

My Favorite Blogs About Improving The Healthcare System

KevinMD- great aggregate of important health news and opinions

MedInnovationBlog- Dr. Richard Reece has wise words about the kind of innovations that will help move American medicine in a positive direction.

The Physician Executive- Zagreus Ammon (that’s his pen name) speaks prolifically about many aspects of healthcare for the poor.

Terra Sigillata- Abel Pharmboy has a PhD in Pharmacology and is a defender of science.

The Covert Rationing Blog- Dr. Rich talks about the implications of our healthcare spending, and who is helped/harmed by our priorities.

Let’s Talk Healthcare- I’ve learned a lot from Charlie Baker, the CEO of a large health insurance non-profit in Massachusetts: Harvard Pilgrim. He started his blog this year too.

Running A Hospital- Paul Levy is the CEO of Beth Israel-Deaconess in Boston. He’s a pioneer in the hospital administration blogger field.

My Favorite Specialist Blogs

SurgeonsBlog- Sid Schwab is a general surgeon and a great writer - a must-read.

Colorectal Cancer- Heinz-Josef Lenz has created a comprehensive teaching tool for patients with colon cancer.

All Things Orthopedic- Jim Herndon is the past president of AAOS and writes a very balanced blog about news and research in orthopedic surgery.

Ten out of Ten- an Emergency Medicine physician with a quick wit and great stories.

White Coat Rants- an Emergency Medicine physician who’s just a little bit older than Ten out of Ten, and also has great stories!

Edwin Leap- is an Emergency Medicine physician with a deep religious faith.

Women’s Health- Vivian Dickerson is the past president of ACOG and likes to shoot from the hip at Revolution Health.

Dr. Wes- a cardiologist who keeps his blogs pithy and punchy.

Suture for a Living- Dr. Bates is a plastic surgeon whose blog posts could be collected to create a textbook on plastic surgery techniques. Truly impressive.

Reflections In A Head Mirror - Dr. Bruce Campbell is an ENT surgeon with heart.

All Things Neurological- Dr. Williams is a poet and neurologist with a passion for the inner city.

My Favorite Generalist Blogs

Dr. Stacy: The Portable Pediatrician- Dr. Stacy has a way of explaining everything in a straight forward and really practical way. She’s always got great tips for readers.

Dr. Anonymous - a family physician in Ohio and a really great friend. He even invited me to do a radio show with him!

Musings of a Dinosaur - Dr. Dino is a family physician in private practice who fights for his patients and for always doing the right thing.

Here to Help- Joe Scherger is a member of the Institute of Medicine and a family physician in San Diego. He’s passionate about improving the healthcare system.

The E-Patient Revolution- Charlie Smith is the past president of the American Board of Family Practice and loves to explain medicine to a lay audience.

My favorite relationships blog: Mira Kirshenbaum

My favorite autism blog: A Mother Confronts Autism

My favorite medicine with recipes: The Blog That Ate Manhattan

My favorite nursing blog: Emergiblog

My favorite altruistic blogger: Blogborygmi (Nick Genes has devoted his blog to featuring others in Grand Rounds).

My favorite “grandfather” blogger: GruntDoc (one of the first EM bloggers)

My ultimate favorite geeky blog - for all the best new medical technology and gadgetry: MedGadget

My favorite blogger who’s not blogging currently: Musings of a Distractible Mind

And finally, my “secret favorites”- these are bloggers who can be pretty harsh, and I don’t always agree with them, but I sure do enjoy their straight talk:

Respectful Insolence- a scientist takes on the wacky claims of snake oil salesmen.

PandaBearMD- an ex-marine serves up some cynical advice and observations.

The Happy Hospitalist- this internist has some strong opinions and good reasons for them.

Wow, so I guess I have quite a few favorite blogs! I look forward to the New Year and all the great things that they will teach me. Thanks for the memories and keep blogging, my friends!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

A hat tip to KevinMD’s guest blogger, JoshMD for this great link. The British Medical Journal offers a short historical analysis of 7 common medical myths, sometimes perpetuated by physicians themselves:

• People should drink at least eight glasses of water a day
• We use only 10% of our brains
• Hair and fingernails continue to grow after death
• Shaving hair causes it to grow back faster, darker, or coarser
• Reading in dim light ruins your eyesight
• Eating turkey makes people especially drowsy
• Mobile phones create considerable electromagnetic interference in hospitals.

To find out why each of these commonly held beliefs are either untrue or unsubstantiated, check out the original journal article. It’s a lot of fun.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

This is my final post in a series inspired by Dr. Barker Bausell’s recent book, “Snake Oil Science: The Truth About Complementary and Alternative Medicine.” Since I began this series, the New York Times has published a rave review of Bausell’s book, which only further confirms the importance of Bausell’s contributions.

Although Bausell’s main thesis is that there are currently no large, randomized controlled trials (published in leading medical journals) demonstrating the effect of any CAM therapy beyond placebo, I have chosen to highlight some of his thinking about research methodology as it applies to the medical literature in general.

So far I have explained why most research (if not carefully designed) will lead to a false positive result. This inherent bias is responsible for many of the illusionary treatment benefits that we hear about so commonly through the media (whether they’re reporting about CAM or Western medicine), because it is their job to relay information in an entertaining way more so than an accurate manner (i.e. good science makes bad television).Then I explained a three step process for determining the trustworthiness of health news and research. We can remember these steps with a simple mnemonic: C-P-R.

The C stands for credibility- in other words, “consider the source” - is the research published in a top tier medical journal with a scientifically rigorous review process?

The P stands for plausibility- is the proposed finding consistent with known principles of physics, chemistry, and physiology or would accepting the result require us to suspend belief in everything we’ve learned about science to date?

And finally we arrive at R - reproducibility. If the research study were repeated, would similar results be obtained?

This third and final pillar of trustworthy science is a simple, but sometimes forgotten, principle. If there is a true cause and effect relationship observed by the researcher, then surely that cause and effect can be demonstrated again and again under the same conditions. Touching a hot stove burner always results in a burned hand. No matter how frequently you test this causal relationship, the result will be similar.

Sometimes conflicting results are obtained by repeating a study. When this happens, the reader should be careful in interpreting the conclusions - there may be a flaw in the study design, or it may be that the conclusions drawn were inaccurate. There could have been a false positive result, or no appreciable effect of the treatment under consideration, therefore leaving the results to chance. Flipping a coin gives you heads one minute and tails the next. Yet a person unfamiliar with coins could conclude (after one flip) that it has a head on both sides. In the end, therefore, one can be more confident in a study’s result if it is born out by other studies.

And so as we conclude this series, I hope that you now feel well equipped to perform CPR (credibility, plausibility, reproducibility checks) on health news. A little healthy skepticism can protect your brain from all the mixed health messages that barrage us each day. At the very least, now you’ll appreciate why most health news reports include an expert quote stating something to the effect of “it’s too early to know for sure if these findings are relevant.” That statement may be the most trustworthy of the entire report.

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Next up: Shannon Brownlee’s book “Overtreated: Why Too Much Medicine Is Making Us Sicker And Poorer.” Shannon and I corresponded about this book two years ago, so I’m looking forward to seeing how it has turned out. Once I’ve finished it I’ll give you my thoughts here in this blog.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

I really enjoy sci-fi action movies. I love the convincing special effects and the fact that heroes can accomplish the physically impossible without skipping a beat. Implausible events unfurl with convincing reality, and you never know what might happen with the plot.

I also enjoy the TV show, America’s Funniest Home Videos, for different reasons. The mundane nature of actual reality, and the often predictable, but hilarious mistakes made by those I relate to result in some pretty hearty laughs.

But there is a big difference between these two forms of entertainment: science-fiction requires the suspension of belief in plausibility, while home videos are based on plausible outcomes. When it comes to medical research, though, plausibility can mean the difference between science fiction and reality.

Over the centuries, scientists have eagerly concocted explanations for medical phenomena. However, it wasn’t until quite recently that our knowledge of science has expanded into an amazingly concrete and fairly deep factual account of how things work. I credit the scientific method for these astonishing advances that have vastly improved our quality of life. Without rigorous testing, repeating, and retesting in a controlled manner, we wouldn’t have many of the life-saving medicines, procedures, devices, and treatment options that we have today.

And yet, we really like science fiction. We like to believe in magical solutions and discoveries that break the mold - that there could be something out there that we find that no one else has thought of yet, or observed, or harnessed. This drive to discover is a wonderful force for investigation and scientific advancement, but it is a double edged sword. The other side can result in irrational beliefs, magical thinking, and snake oil science.

Take for example the field of homeopathy. Founded by German physician, Samuel Hahnemann in the 18th century, this system of medical treatment is founded upon the principle that like treats like, and that a medicine is at its strongest when it’s at its weakest possible concentration. So, for example, if you have cold symptoms (runny eyes and nose) the treatment would be to drink onion juice (because onion fumes produce runny eyes and a runny nose), but at a concentration so dilute that there is actually not even one molecule of onion extract left. Hahnemann believed that water has memory - and that the fact that water molecules had been recently in the presence of onion molecules gave the water healing powers. In fact, the act of shaking the water made it even more potent as a therapy.

Now, I have no doubt in the sincerity of Hahnemann’s beliefs. I also have no doubt that homeopathy (for those who believe in it) can have a strong placebo effect. But to believe that there is an actual physiological effect of shaken water for the treatment of all sorts of diseases, is to deny everything that is known about human physiology, immunology, genetics, and biochemistry. Should one man’s beliefs negate the results of millions of scientific studies? The proposed mechanism of action of homeopathy is implausible, and therefore may be confidently discarded as anything more than a placebo. (And if you don’t believe me, Dr. Barker Bausell has a wonderful review of the homeopathy literature that confirms this).

Well, some of you skeptics say, Galileo’s beliefs (that the earth is round, not flat) were not accepted by scientists in his day (and yet he was right and they were wrong), so how can we say with certainty that any proposed mechanism of treatment is truly implausible? Isn’t anything possible?

I suppose a tornado could tear through a junk yard, creating a Boeing 747 by accident, though I’m pretty sure we’ll never see that on America’s Funniest Home Videos - though we may see it in a sci-fi movie. But I’m glad you asked about anything being possible - because this brings us to our final pillar of good science: reproducibility. If something is true, it should be true again and again, right? Galileo was proven right because in test after test, ships did not fall off the end of the flat earth. Its in the repetition of tests that we can confirm the truth. Let’s take a final look at evidence through the lens of reproducibility.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.