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Latest Posts

What’s Inside Osama Bin Laden’s Medicine Cabinet?

NBC News obtained from sources in Pakistan a list of drugs found in Osama bin Laden’s medicine cabinet, after Navy SEALs left the scene of the raid and Pakistan officials took over the compound.

My Medicine Cabinet by Steve Isaacs via Flickr and a Creative Commons licenseThe list shows that bin Laden was a fairly typical–almost American–consumer of over-the-counter medications. There was nothing to indicate he needed dialysis or had diabetes or Marfan syndrome. He did have secondary osetoporosis, according to physicians who examined photos of him over time. (That’s an actual job, by the way, for physicians who’d want a career drawing up profiles about the health of world leaders or terrorists and feeding that information to intelligence analysts.)

Bin Laden stocked pain relievers for kids living at the compound, some home remedies for nerves and gastrointestinal upset, and Avena syrup, which is an extract of wild oats that’s been associated with enhancing sexual desire. Much hay has been made from those wild oats, such as who might have been taking them.

*This blog post was originally published at ACP Internist*

Dr. Steve Novella Defends Science And Reason On The Dr. Oz Show

I must say I was a bit shocked two weeks ago when I was contacted by a producer for The Dr. Oz Show inviting me on to discuss alternative medicine. We have been quite critical of Dr. Mehmet Oz over his promotion of dubious medical treatments and practitioners, and I wondered if they were aware of the extent of our criticism (they were, it turns out).

Despite the many cautions I received from friends and colleagues (along with support as well) – I am always willing to engage those with whom I disagree. I knew it was a risk going into a forum completely controlled by someone who does not appear to look kindly upon my point of view, but a risk worth taking. I could only hope I was given the opportunity to make my case (and that it would survive the editing process).

The Process

Of course, everyone was extremely friendly throughout the entire process, including Dr. Oz himself (of that I never had any doubt). The taping itself went reasonably well. I was given what seemed a good opportunity to make my points. However, Dr. Oz did reserve for himself the privilege of getting in the last word—including a rather long finale, to which I had no opportunity to respond. Fine—it’s his show, and I knew what I was getting into. It would have been classy for him to give an adversarial guest the last word, or at least an opportunity to respond, but I can’t say I expected it. Read more »

*This blog post was originally published at Science-Based Medicine*

Physicians Against Dr. Oz’s Misinformation – A Battle They Cannot Win?

A handful of physicians are collaborating to take Mehmet Oz, MD, to task on what they’re calling outlandish claims and bad medical advice. Their suggestion is to no longer pay attention to that man behind the curtain.

David H. Gorski, MD, PhD, at the blog Science-Based Medicine went after Dr. Oz for hosting segments about faith healing and consulting psychics. Dr. Gorski pulls no punches, saying, “Dr. Oz has in some ways imitated Oprah and in some ways gone her one better (one worse, really) in promoting the Oprah-fication of medicine. And this season has been a particularly bad one for science-based medicine on The Dr. Oz Show.”

(Dr. Mehmet Oz may be using his “Degree in Thinkology” to come up with some of his show topics.)

Val Jones, MD, the woman behind the curtain at GetBetterHealth.com, joined the crusade against Dr. Oz, saying that he’d descended from “competent and caring cardiothoracic surgeon whose research interest was reducing preoperative stress” to “America’s chief snake oil salesman.” She is organizing a campaign to drown out the bad information with better messages. (As a disclosure, ACP Internist‘s blog contributes to and draws posts from GetBetterHealth.com.)

ACP Member Peter A. Lipson, MD, also wanted to clear the air about primary and secondary prevention of heart attacks, “one of an internist’s most important tasks, given that heart disease is one of the three top killers of North Americans.” Read more »

*This blog post was originally published at ACP Internist*

Homeopathy: Why is Fraud Legal?

Imagine hearing a commercial on the radio:

Send us money, and we won’t send you anything in return.

No one would do that, right? How about this:

Send us your money and we’ll send you an empty box.

Better? Not much. Now how is that different from:

Send us money and we’ll send you stuff we’ll call medicine that we claim will help you, but there’s no actual active ingredients in it at all.

I don’t think there’s one bit of difference. Wouldn’t you agree that that commercial is fraud, pure and simple? The problem is that the general public doesn’t understand that the word “homeopathic” means “diluted beyond the point where it contains any active ingredients.”

I’ve recently heard commercials for homeopathic vertigo treatments, eye drops for allergies, irritable bowel, and spider veins on legs. I’m tempted to contact the radio station and complain, but stopped short realizing that their first question is going to be, “But is it legal?”

That’s the problem: it is. So what I want to know is, why? Read more »

*This blog post was originally published at Musings of a Dinosaur*

Warning: Dr. Mehmet Oz Is Not A Trustworthy Source Of Health Information

When I was in medical school at Columbia University College of Physicians and Surgeons, Dr. Mehmet Oz had the reputation of being a competent and caring cardiothoracic surgeon whose research interest was reducing preoperative stress. I remember hearing about a music study of his in which soothing melodies reduced blood pressure and heart rates in patients preparing for heart surgery. I felt pleased that a surgeon was leading the charge in improving patients’ O.R. experiences, and had no inkling that 15 years later Dr. Oz would be America’s chief snake oil salesman.

I have been slow to criticize Dr. Oz on my blog because of a sense of loyalty to my medical school, however yesterday he crossed the line when things got personal – a friend of mine was negatively impacted by his misinformation to the point where her life was endangered. From watching his TV show, she was led to believe that she would put herself at risk for thyroid cancer if she got a mammogram. Several of her relatives have had breast cancer, and she should be particularly vigilant in her screening efforts. However, because Dr. Oz said that mammograms may themselves cause cancer, she opted out of appropriate screening.

My colleague Dr. David Gorski at Science Based Medicine has done an excellent job of documenting Dr. Oz’s almost Charlie Sheen-like career descent. Although he began his work as (presumably) a science-respecting surgeon, he now spends a lot of his time hosting a TV show that features faith healers, anti-vaccinationists, and psychics.

But how does the average lay person know how to evaluate Dr. Oz’s health claims? When Oprah’s network promotes him as “America’s physician” the platform itself offers him credibility, and a reach that can damage and misinform millions like my friend. I have a feeling that many of my peers at Columbia are concerned about Dr. Oz’s promotion of quackery, but once they’ve invested in his brand for so long, it’s easier to turn a blind eye to his nuttiness than to oust him from his academic positions. At what point is a celebrity doctor doing more harm than good to an institution’s reputation? Is he now “too big to fail?”

But back to my main point – dear readers if you watch Dr. Oz and think that he’s a credible source of health information, please be aware that much of what he says is inaccurate, exaggerated, and based on mystical belief systems. Please don’t act on his advice without checking with your own physician first.

Sadly, good science doesn’t always make good television. But the truth can make you well. Be warned that you are unlikely to find the truth consistently on the Dr. Oz show.

Latest Interviews

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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Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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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.

***

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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