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Latest Posts

The Medical Misinformation Of The Huffington Post

Today I refer you to an excellent post by Peter A. Lipson, M.D., at the blog Science Based Medicine entitled “HuffPo blogger claims skin cancer is conspiracy.”

The post focuses on an article by someone who contends that the link between sunlight and skin cancer is a conspiracy by dermatologists and the cosmetic dermatology industry. Dr. Lipson’s highly insightful analysis about the “interview” process and how doctors must act these days on behalf of their patients concludes:

This article shows a misunderstanding of journalistic ethics, medical ethics, and medical science. It’s a disaster. And it’s no surprise that it’s in the Huffington Post.

While this is a medicine story, my question relates to why an organization with a lot of great front-page news so frequently posts medical articles that are wrong and, sometimes, downright dangerous.

Read the article first, then read Dr. Lipson’s analysis.

Disclosure: I am an occasional contributor to Science Based Medicine but, like all contributors there, receive no compensation.

*This blog post was originally published at Terra Sigillata*

Tea Brewed From Angel’s Trumpet Causing Hospitalizations In Kids

Brugmansia_lg.jpgToxicity reports are re-emerging in southern California this week after a dozen hospitalizations of kids using teas made from a fragrant flowering plant called Angel’s Trumpet.

A tea made from the plant is used to produce hallucinations, but they can progress to extremely unpleasant experiences. Moreover, Angel’s Trumpet can be deadly, accelerating the heart rate and causing fatal cardiac rhythmic disturbances and bronchoconstriction that can trigger asthma attacks in sensitive individuals. Read more »

*This blog post was originally published at Terra Sigillata*

The Mystery Of Alcoholics Anonymous

To further emphasize my admiration for superb sci/med/health writing, I wish to add another writer to my growing blog category of “Journalists, Awesome.”

Via my drug abuse research colleague, DrugMonkey, my attention was drawn to a new Wired magazine article by Brendan I. Koerner entitled, Secret of AA: After 75 Years, We Don’t Know How It Works. I strongly recommend this long-form article for anyone in the field of substance abuse and dependence research, psychology and general clinical research, students of excellent science writing, alcoholics and their family members, and anyone who thinks that good science writing no longer exists.

I don’t want to influence your views any further, other than to say that since I poured my first whiskey and water for my grandmother when I was around 7, I’ve had a longstanding interest in why Alcoholics Anonymous helps so many alcohol-dependent folks kick the disease for decades while others trying the approach continue to crash and burn or otherwise abhor its very tenets, especially the “Higher Power” focus. The reader comments there also reflect this bipolar view of the unorganized organization. Read more »

*This blog post was originally published at Terra Sigillata*

What’s Your Poison? Science And Medicine Vs. Chemical Poisoning

The Poisoner's HandbookThis is going to be a quick welcome to Deborah Blum who has just moved her blog, Speakeasy Science, to ScienceBlogs.

Why quick?

Because I am only 22 pages away from finishing her latest book, The Poisoner’s Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York.

This engaging tale of the race of science and medicine against chemical poisonings for profit and punishment features the true story of NYC chief medical examiner Charles Norris and toxicologist Alexander Gettler.

Of course, the other actors are arsenic, methanol, chloroform, thallium, and radium, among others. In the teens through the mid-1930s, long before benchtop atomic absorption spectrophotometry and LC/MS instruments, Norris and Gettler devised methods to detect poisons in human tissues with high sensitivity. These advances led to the prosecution of some, the absolution of the wrongly-accused, and revealed that our own government poisoned citizens who dared to challenge Prohibition. Read more »

*This blog post was originally published at Terra Sigillata*

Challenges Continue For Women In Science And Medicine

I didn’t turn on the computer yesterday (yes, it was glorious), so I missed Mother’s Day coverage in our local newspaper. When we returned home, I was happy to see that on the front page of the print copy the dean of Duke School of Medicine, Nancy Andrews, M.D., Ph.D., was featured with her daughter in the lab on their “fun Saturdays” together.

Also cited and pictured in the article was Duke vice dean for research and professor of pharmacology and cancer biology, Sally Kornbluth, Ph.D., and her daughter.

Written by News & Observer science editor Sarah Avery, the article describes how women are increasing in ranks in biomedical degrees earned while still lagging at the associate professor level and up. This trend was cited specifically for faculty and administrators in basic science departments of medical schools, but is widespread in academic science and engineering. Read more »

*This blog post was originally published at Terra Sigillata*

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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