October 14th, 2010 by RamonaBatesMD in Better Health Network, News, Opinion, Quackery Exposed, Research, Uncategorized
Tags: Aesthetic Society, American Society of Aesthetic Plastic Surgery, ASAPS, Chris Woolston, Cosmetic Surgery, Dr. Ramona Bates, Fat Injections, Health Scams, Health Skepticism, LA Times, Stem Cell Face-Lifts, Suture For A Living
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It’s been almost a month since the LA Times ran the article by Chris Woolston entitled The Healthy Skeptic: Stem cell face-lifts on unproven ground. It’s well written and presents a fairly balanced view. While I am a fan of stem cell research, I think the “claims” are often put ahead of the science. This is one of those times. I can’t find any decent articles to support the claims of the plastic surgeons doing “stem cell face-lifts.”
My view is echoed in the article (bold emphasis is mine):
Rubin says he’s excited about the potential of stem cells in the cosmetic field and beyond. Still, he adds, there are many unanswered questions about the cosmetic use of stem cells, and anyone who claims to have already mastered the technique is jumping the gun. As Rubin puts it, “Claims are being made that are not supported by the evidence.”
While researchers in Asia, Italy, Israel and elsewhere are reporting decent cosmetic results with injections of stem cell-enriched fat, Rubin says that nobody really knows how the stem cells themselves are behaving. He points out that fat injections alone can improve a person’s appearance, no stem cells needed.
Rubin believes it’s possible that injected stem cells could create new collagen and blood vessels — as they have been shown to do in animals studies — but such results have never been proved in humans. And, he adds, the long-term effects of the procedures are an open question.
Stem cell face-lifts could someday offer real advances, says Dr. Michael McGuire, president of the American Society of Plastic Surgeons and a clinical associate professor of surgery at UCLA. But he believes that scientists are still at least 10 years away from reliably harnessing stem cells to create new collagen and younger-looking skin. Until then, promises of a quick stem cell face-lift are a “scam,” he says.
The American Society for Aesthetic Plastic Surgery (ASAPS) issued a statement two weeks after the article first appeared. Read more »
*This blog post was originally published at Suture for a Living*
October 12th, 2010 by DrRob in Better Health Network, Opinion, Uncategorized
Tags: Definition Of A Patient, Description Of A Patient, Doctors' Perspective, Dr. Rob Lamberts, General Medicine, Healthcare Consumer, Musings of a Distractible Mind, Patients As Consumers, Patients As Healthcare Customers, Patients' Role In Healthcare, Role Of A Patient, What Is A Patient
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What is a patient? What do they do? What’s their role in the doctor’s office? Are they chassis on a conveyor belt? Are they puzzles for doctors to solve? Are they diseases? Are they demographics? Are they a repository for applied science?
Or are they consumers? Are they paying customers? Are they the ones in charge? Are they employing physicians for their own needs?
It depends. It depends on the situation. It depends on perspective.
Some physicians are very offended when the “consumer” and “customer” labels are applied to patients. They see this as the industrialization of healthcare. We are no longer professionals, we are made into “providers” — sort of smart vending-machine made out of flesh.
Patients, on the other hand, get offended when doctors forget who pays the bill. They see the exam room as a right, not a privilege. They think they should be the most important person in the exam room, being treated with respect rather than having to bow at the altar of doctor knowledge.
Who’s right? It depends. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
July 16th, 2010 by DrRich in Uncategorized
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Podcast:
DrRich is relieved to learn that the world’s most famous global warming experts have now been exonerated by three separate formal reviews. Dr. Michael Mann from Penn State University was cleared by a review conducted by Penn State University. Dr. Phil Jones, Director of the University of East Anglia’s Climate Research Unit (CRU), was cleared by a review conducted by the University of East Anglia, and also by a four-member “independent panel,” one of whose members was Prof. Geoffrey Boulton, a personage who had been on the faculty of East Anglia’s School of Environmental Sciences for 18 years, and who (prior to being placed on the “independent panel”) had been a vocal defender of Dr. Jones’ actions regarding Climategate.
Right-wing global-warming-deniers, of course, have decried the results of these reviews as a “whitewash,” pointing out, among other things, that Penn State and East Anglia both continue to receive tens of millions of dollars in federal “research” funds so they can continue to prove that global warming a) exists, and b) is man-made, thus suggesting that these institutions were determined to acquit their star grantsmen of scientific misconduct no matter what the objective findings. This kind of whitewash, they say, not only supports the global warming “hoax,” but even worse, further undermines the integrity of the scientific process upon which so much of modern society so utterly relies.
Of course, if right-wingers are correct, then reversing modern society and putting us all back in the glorious horse-and-buggy days is the very goal of the global warming mavens. (DrRich, a student of history, is well aware of how difficult it must have been 110 years ago to walk the streets of New York City without ending up splattered with dung to your knees, and he wonders what life would be like today, navigating the highways and byways of America, if all 300 million of us were relegated again to modes of transportation that defecate nearly continuously.)
It must be admitted, by anyone who has perused some of the leaked e-mails sent and received by Dr. Jones (making it doubtful that any of the three review panels had actually done so), that from any really objective viewpoint the global warming experts had engaged in some very questionable behaviors, which appear to have been aimed at advancing their theories, and suppressing any opposition, by any means at their disposal. The e-mails depict Jones and prominent colleagues discussing how to “tweak” climate change data in order to hide such embarrassing climatic phenomena as the Medieval warming period, “the little ice age” that followed it, and the global cooling we’ve been seeing over the past decade. Including these historical temperature fluctuations in their data would make their famous hockey stick graph look less like a hockey stick, and more like the random profile of a mountain range. (And once Al Gore won an Oscar for showing slides of the hockey stick, that was not an option.) They also collaborated to “control” the peer-review process so that only the “right” peers would be doing the reviewing, and the “wrong” peers would be cut off altogether. And, as a final deft touch, they all shared electronic high-fives when a noted global warming skeptic died unexpectedly.
Then, of course, just a few days after the embarrassing e-mail leak, the CRU was forced to admit (thanks to Britain’s Freedom of Information act) that they had, apparently intentionally, destroyed all the raw temperature data upon which their elaborate computer models were based. (They say they ran out of space to store it, apparently failing to recall the many forms of magnetic storage readily available to scientists today). The destruction of this data utterly precludes other scientists from checking, and attempting to reproduce, the critical predictive model upon which the theory of man-made global warming largely rests.
Oops.
This inconvenient truth renders their climate change model a black box. It places the rest of us in the position of having to “just trust” the global warming experts, upon whose work (for instance) President Obama bases his proposal for a fundamental change in our economy, our way of life, and our foundational political philosophy.
So it is perhaps somewhat understandable that right-wingers object so vociferously to the alleged “whitewash.” Their general complaint seems to be that the scientific process should always be pristinely unbiased, and that the gross bias so clearly displayed by global warming experts in this case not only corrupts the case for global warming, but also corrupts the scientific process itself, to the extent that every scientist in the world should be screaming for the heads of the miscreants, and indeed, must do so, to salvage the very legitimacy of science.
DrRich is sympathetic to the argument that the implications of Climategate are troublesome, but not because the climatologists have behaved in a terribly biased way. Biased thinking within a scientific debate is not only common practice, but also it is a critically important part of the process. Raw contention between very biased scientists with very different viewpoints is how we get scientific progress in the first place. DrRich is not even disturbed that the currently-entrenched global warming experts have used their position of relative strength to suppress the upstarts who dared to oppose them. That’s also pretty much standard behavior in the academy, and it, too, serves a useful purpose.
Rather, what’s troublesome about the global warming controversy is that outside authorities of incredible power have taken an extraordinarily strong position in the scientific debate, and have lent their massive influence to one particular side. Whenever this sort of thing happens, the “winner” of the scientific contest is often not determined by superior scientific merit, but by other factors.
Scientific progress works like this: A new theory is conceptualized to explain some phenomenon, usually by a whippersnapper of one variety or another. The entrenched experts, whose careers, reputations, social status, incomes, and sexual fulfillment are based on the old conception, find the new theory to be absurdly wrong (or in some cases heretical), and probably dangerous. Since preserving the “truth” is the highest calling of all, the experts engage in every device they can muster (from “controlling” the peer-review process to burning heretics at the stake) to see that the truth (as they define it) prevails.
To the uninitiated – and certainly to the upstart whippersnappers – this process seems primitive and unkind. But actually it is quite useful and practical, and in the long term is very beneficial to mankind. For most of the new theories thought up by whippersnappers are, in fact, garbage. In order to break through the imposing barriers of bias constructed by the entrenched experts, the novices really have to believe in what they are espousing, and their new theory, ultimately, has to actually offer some substantial improvement over the currently accepted one. The whippersnapper, if very lucky, finally becomes the foundation of a new generation of experts – and the process begins all over again. Hence, science progresses. The process is geared toward the gradual discovery of truth, and not toward the nurturing and vindication of whippersnappers. And eventually, truth always does prevail – and often it does so within just a few generations.
In the short term, of course, this process can look very messy and unfair. It is certainly subject to great bias. In fact, we take pains to set up the accepted experts with lots of grant money, prestige, titles, &c. precisely to make sure they’ll do everything they can to preserve the status quo. We do this so that when the paradigm actually shifts, it shifts because the merits of the new paradigm are sufficient to overcome all the bias – and not because of a whim. This process keeps science – and society – from being whipsawed this way and that.
Where the process breaks down is when a powerful outside influence – say, a religion or a government – firmly takes a side in the scientific debate. For example, just ask any of the would-be astronomers from the time of the pre-Renaissance Popes how well the scientific process of competing biases worked out for them.
It seems apparent, to DrRich at least, that most of the world’s governments, including ours, find that the bias of the global warming experts very nicely aligns with the historical bias of governments, which is to say, accruing ever more power over the endeavors of the people. It may possibly be for this reason that governments have thrown in – body and soul – with this side of the debate, to the extent that “global warming” has now become largely sacrosanct. Man-made global warming is officially deemed (like the 2011 U.S. Budget) to be “settled science,” and is beyond reasonable question. No new scientific evidence to the contrary is admissible. Competing viewpoints are, in fact, heretical. And even when gross evidence of academic misbehavior on the part of global warming experts is revealed, that evidence is excused, paved over and ignored.
This mindset is the only one that fully explains the tone and the content of the Climategate e-mails, and the subsequent exoneration of the climate scientists who wrote them.
Most readers, DrRich expects, agree with him to this point. (For, how could it be otherwise?) But, you may be asking, what does any of this have to do with healthcare, or more specifically, with healthcare rationing?
As we enter into a new era of healthcare, where medical decisions will be taken out of the hands of imperfect physicians and entrusted to panels of federally-sanctioned (and thus pretty much infallible) experts, who will analyze the available data and construct the guidelines of behavior by which all physicians will henceforth be judged, we ought to keep the problem of unbalanced bias in mind.
Today we have a healthcare system in which competing interests, and their competing biases, battle for prominence. The process is messy, ugly and often unfair, but with long-term results that are generally reasonably favorable. Or at least, the damage is generally contained. But we are headed toward a healthcare system in which only one great interest – that of our government, with its overwhelming bias toward cutting the cost of healthcare – will predominate.
A great fallacy under which many of us labor is that the government has no strong biases, and that a process overseen by the government will be inherently far more “fair” than a process that incorporates the biases of for-profit enterprises. But in truth, the government is the biggest, meanest, special interest of all. And like all sovereign authorities, this one is not only able to, but is expected to get the results it deems necessary by the measured application of violence.
For those who believe any government, anywhere, which has total control over any human enterprise can still behave fairly, DrRich begs you to please have another look at history. When we allow government (and its agents) to have the only say over medical decisions, then those medical decisions will be made with all the robust, open-minded, free, give-and-take exchange of ideas we are seeing from the global warming experts today. And while medical progress – like progress in general – cannot be forever halted, it will become as sclerotic as the scientific progress enjoyed by those pre-Renaissance astronomers.
The scientific process will always be biased. Where we invite serious damage is where we admit only one form of bias, and forcibly stifle all the rest. It’s bad for climate science, and it will be bad for healthcare.
________________________________
Now, read the whole story.
DrRich explains it all in, Fixing American Healthcare – Wonkonians, Gekkonians and the Grand Unification Theory of Healthcare.
Now on Kindle! (and for next to nothing)
*This blog post was originally published at The Covert Rationing Blog*
May 26th, 2010 by BobDoherty in Better Health Network, Health Policy, Humor, Opinion, Research, Uncategorized
Tags: A.A. Milne, Accountable Care Organizations, Advance Practice Nurse, Consultant Physicians, Duplicate Testing, Edward Bear, Family Caregivers, Family Medicine, Follow-Up Phone Calls, Follow-Ups, General Medicine, House At Pooh Corner, Insurance Companies, Internal Medicine, Internists, Jay Larson, Lab Studies, Medicare Payment Rate, NEJM, New England Journal of Medicine, Office Visits, Patient Satisfaction, Patient-Centered Medical Homes, Pharmacy Callbacks, Physician Assistant, Physician Satisfaction, Pre-Authorizations, Prescription Renewals, Primary Care, Qualified Non-Physician, Return Calls, Richard Baron, Team-Based Primary Care, Unnecessary Referrals, Winnie The Pooh, Worried Patients
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Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.
– From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.”
Internists, I expect, will identify with Edward Bear.
Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues.
Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Montana, and found that for every one patient seen in the office, tasks are done for 6 other unscheduled patients. Jay writes: “So really there [are] internists [who] are managing about 130 patients per day. Not much consolation when they only get paid for 18 per day.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
April 3rd, 2010 by Medgadget in Better Health Network, News, Opinion, Research, Uncategorized
Tags: .mp3, Baby Monitor Bracelets, Danish, General Medicine, Heart Rate, Henoc Monte, Infant Safety, Jessica Mendoza, Mother, Pediatrics, Primary Care, Sikker, Temperature, Two-Way Communication, Yanko Design
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It’s only a concept, but the Sikker (Danish for “safety”) baby monitor is a great idea by designers Jessica Mendoza and Henoc Monte that will likely have both parents and babies alike going gaga.
The bracelets, charged on a docking station during the day, would allow two-way communication between mother and child, as well as the ability for the mother to monitor the baby’s temperature and heart rate. It would also allow the mother to play .mp3 lullabies to the baby.
If built, they’d probably have to ditch the idea of monitoring temperature, since any readings at the wrist would be poor indicators of core body temperature, but connecting parent and child via bracelet is a good idea that has promise, and it’d be great to see this built.
More from Yanko Design: Sikker is for Safety
*This blog post was originally published at Medgadget*
