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Despite Its Lack Of Evidence, Iridology Has Survived On The Medical Fringe For Over A Century

There are many medical pseudosciences that persist despite a utter lack of either plausibility or evidence for efficacy. Some practices emerged out of their culture of origin, or out of the prevailing ideas of a pre-scientific age, while others were manufactured out of the imagination of perhaps well-meaning but highly misguided individual practitioners. They were just made up – homeopathy, for example, or subluxation theory.

Iridology belongs to this latter category – a system of diagnosis that was invented entirely by Ignatz Peczely, a Hungarian physician who first published his ideas in 1893. The story goes that Peczely as a boy found an owl with a broken leg. At the time he noticed a prominent black stripe in the iris of one eye of the owl. He nursed the bird back to health and then noticed that the black line was gone, replaced by ragged white lines. From this single observation Peczely developed the notion of iridology.

Peczely’s idea was that the iris maps to the rest of the body in some way, and therefore the flecks of color in the iris reflect the state of health of the various body parts. This basic approach to diagnosis or treatment is called the homonculus approach – the idea that one part of the body maps to the rest of the body, including the organ systems. Reflexology, auricular acupuncture, and even straight chiropractic follow this approach.

This is what might have happened next: Read more »

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

New Report In The Annals Of Internal Medicine On Cervical Cancer Screening

The latest issue of the Annals of Internal Medicine contains 2 noteworthy papers on cervical cancer screening. The first, a systematic review of studies commissioned by the USPSTF, looked at 3 methods for evaluating abnormalities in women over 30 years:

high-grade cervical cell dysplasia (Dr. E. Uthman, Wikimedia Commons)

1. Conventional cytology (as in a Pap smear; the cervix is scraped and cells splayed onto a microscope slide for examination);

2. Liquid-based cytology (for LBC, the NHS explains: the sample is taken as for a Pap test, but the tip of the collection spatula is inserted into fluid rather than applied to slides. The fluid is sent to the path lab for analysis);

3. Testing for high-risk HPV (human papillomavirus). Currently 3 tests have been approved by the FDA in women with atypical cervical cells or for cervical cancer risk assessment in women over the age of 30: Digene Hybrid Capture 2 (manufactured by Quiagen), Cobas 4800 HPV (Roche) and Cervista HR HPV (Hologic); another Roche Diagnostics assay, Amplicor HPV, awaits approval.

These HPV assays use distinct methods to assess DNA of various HPV strains.

There’s a lot of jargon here, and I have to admit some of this was new to me despite my nearly-due diligence as a patient at the gynecologist’s office and my familiarity as an oncologist with the staging, clinical manifestations and treatment of cervical cancer. Who knew so many decisions were made during a routine pelvic exam about which manner of screening? Read more »

*This blog post was originally published at Medical Lessons*

Still No Consensus On Optimal Treatment For Ductal Carcinoma In Situ (DCIS)

Ductal Carcinoma in Situ (DCIS) in the breast, histopathology w/ hematoxylin & eosin stain, Wiki-Commons image

More, a magazine “for women of style & substance,” has an unusually thorough, now-available article by Nancy F. Smith in its September issue on A Breast Cancer You May Not Need to Treat.

The article’s subject is DCIS (Ductal Carcinoma in Situ). This non-invasive, “Stage 0” malignancy of the breast has shot up in reported incidence over the past two decades. It’s one of the so-called slow-growing tumors detected by mammography; a woman can have DCIS without a mass or invasive breast cancer.

While some people with this diagnosis choose to have surgery, radiation or hormonal treatments, others opt for a watchful waiting strategy. The article quotes several physicians, including oncologists, who consider Read more »

*This blog post was originally published at Medical Lessons*

When Age Plays A Role In Medical Decision-Making

Missed Diagnosis Lawsuit and the Dynamics of Age Related to Risk

Years ago I had the opportunity to care for Mr Smith, a 101 year old man who presented to the hospital with chest pain and shortness of breath. Besides having  101 year old heart and lungs that tend to follow their own  biological clock,  this man also had a massive chest tumor filling 85% of one side of his thorax.

Whoah really?  What does that mean in a 101 year old man?  Most folks this age have exceeded the normal bell curve distribution of life and disease.  When you reach 101 years old, there isn’t a lot of chronic anything you can catch with the expected time you have left on earth.

Every now and then, however, we find patients who are the exception to the rule, such as the 101 year old guy that present with a new cancer diagnosis.  That’s where being an internist comes in handy. Read more »

*This blog post was originally published at The Happy Hospitalist*

Hospital CEO Is Diagnosed With Cancer While Building A New Cancer Center

Pat Elliott, me and a HUGE cactus at Banner MD Anderson!

I am just back from the Phoenix-metro area. It’s now the 5th largest in the United States and despite home foreclosures, there is still a feeling of growth in many areas. Gilbert, a nearby suburb, has expanded to over 200,000 people and a growing major medical center. I spent several days interviewing patients and staff about the soon-to-open, Banner MD Anderson Cancer Center. The hope is that by bringing MD Anderson’s world-renowned expertise, clinical trials and processes to this new center, cancer care around Phoenix and the southwest will be improved. Look for my video interviews coming soon.

But, in the meantime, one interview stuck out for me; the one with the Banner Health President and CEO, Peter Fine. Peter is in his late 50s and is a health care industry professional who has been guiding Banner Health and its 23 hospitals well for over a decade. For the past several years, Peter has been strategizing the building of a major cancer center on one of his hospital campuses. Peter knew he would need a renowned partner to make it successful and three years ago he chose MD Anderson Cancer Center, in Houston, consistently ranked as the nation’s #1 cancer center (and where I was treated in a leukemia clinical trial).

Even before the partnership contract was inked, a strange thing happened. Peter found a swollen lymph node in his neck and it didn’t go away. Read more »

*This blog post was originally published at Andrew's Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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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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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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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