September 23rd, 2010 by Harriet Hall, M.D. in Better Health Network, Book Reviews, Opinion, Quackery Exposed, Research
3 Comments »
It infuriates me when someone misappropriates the word “science” to promote treatments that are not actually based on science. I have just read a book entitled The PTSD Breakthrough: The Revolutionary Science-Based Compass RESET Program by Dr. Frank Lawlis, a psychologist who is the chief content advisor for Dr Phil and The Doctors. There is very little science in the book and references are not provided. It amounts to an indiscriminate catalog of everything Dr. Lawlis can imagine that might help post-traumatic stress disorder (PTSD) patients.
He describes recent brain imaging studies suggesting that signs of traumatic brain injury are associated with PTSD. He thinks PTSD can no longer be considered a psychological condition, but must be approached as a complex biological, physical, psychological, and spiritual condition. He says many of these patients have brain damage. Read more »
*This blog post was originally published at Science-Based Medicine*
April 27th, 2009 by Harriet Hall, M.D. in Better Health Network
6 Comments »
We criticize alternative medicine for not being evidence-based, and they criticize conventional medicine in turn, saying that much of what conventional medicine does is not based on evidence either. Sometimes that criticism is justified. I have run across a conventional practice that I suspect began because it sounded like a good idea, but that never was adequately tested and is not carefully thought out for individual patients.
I recently had a bone marrow aspiration. The written instructions said not to eat or drink for 6 hours before the procedure, to bring someone to drive me home, and to expect an IV. I suspected from these instructions that they were planning to use IV sedation, and I was right.
I questioned the need for sedation. I am prejudiced about bone marrow aspirations. I observed several and did one myself during my internship. When I had finished, the patient asked me when I was going to start. We did the procedure at the patient’s bedside in a multi-bed ward with no sedation, only local anesthesia. So my prejudice was that the procedure was no big deal and was not terribly painful.
I can imagine that some patients may be terrified by the idea of a needle going into their bone and may want to be sedated and not remember the experience. But I was not anxious about it, and I saw no need for the fentanyl and Versed they wanted to give me. I figured it would only prolong my time in the hospital, produce amnesia, expose me to a small risk of adverse effects, and leave me groggy; so I asked to opt out. They readily agreed – although they did keep asking me if I was really sure I didn’t want it. They would not have offered the option of no sedation if I had not known to ask.
The pathologist doing the procedure told me the injection of local anesthetic into the skin was the most painful part of the procedure. He was wrong. It was the ONLY painful part of the procedure. The penetration of bone and the aspiration of marrow produced only a pressure sensation.
This study reported that 85% of non-sedated patients had intense pain. I find that hard to believe, based on my personal experience and the experience of the pathologist that the local anesthetic was the worst part of the procedure. I wonder if those patients were anxious and were expecting intense pain. At any rate, I think giving me IV sedation would have been the wrong thing to do.
I had a similar experience with an excisional breast biopsy. They offered me general or local anesthesia and I chose local as presumably the safer option. Then they said they would use IV sedation along with the local. I asked why. They said to relieve anxiety. I told them I wasn’t anxious so if that was the only reason for sedation, I didn’t want it. I finally prevailed. I was comfortable, alert, had a good time chatting with the anesthesiologist, and was able to leave the recovery room much sooner than sedated patients.
I’m not saying that IV sedation is not indicated for some patients, but I am convinced it was not indicated for me. Has it become a knee-jerk reflex to sedate everyone as a general principle? Why? To avoid complaints and keep patients more cooperative during procedures? Are we paternalistically deciding that it is better if the patients don’t remember the procedure? I wonder: if minor procedures are not remembered, might the mystery increase anxiety and fear of the unknown for future procedures? We must ask seriously whether IV sedation is done more for the patient’s benefit or the doctor’s. The answer will vary with the procedure and the patient.
Rather than sedating every patient, why not use some judgment? Even if the patient is anxious, perhaps a non-drug option could relieve that anxiety without risking the side effects of drugs. Surely some anxiety is due to fear of the unknown. Would it help to show patients a video of someone comfortably undergoing the procedure without sedation, with an explanation of exactly what was happening? Would simple reassurance or personal attention from a patient advocate be helpful? Worth looking into? I think so.
Doctors are frequently accused of prescribing unnecessary drugs out of habit or reflex. I suggest that IV sedation for minor procedures is an example of over-prescription that is based more on custom than on good evidence.
*This blog post was originally published at Science Based Medicine.*
March 14th, 2009 by Steve Novella, M.D. in Announcements, Quackery Exposed
2 Comments »
My colleagues and I will be holding a Science-Based Medicine conference on Thursday, July 9th. This is an all-day conference covering topics of science and medicine. The conference is designed for both a professional and general audience.
The conference will be at the Southpoint Casino and Hotel in Las Vegas, Nevada. It is also part of The Amazing Meeting 7 (TAM7) which is run by the James Randi Educational Foundation (JREF). You can register for the conference either separately or packaged with TAM7. You can register for both here.
Physicians can earn 6 hours of category 1 CME credits for attending the conference.
Below is the list of speakers and the titles of their talks, and below that is the bio for each speaker.
Topics:
Introduction to Science-Based Medicine (Steven Novella, MD)
Case studies in cancer quackery: Testimonials, anecdotes, and pseudoscience (David H. Gorski, MD. PhD)
A Scientific Critique of Chiropractic (Harriet Hall, MD)
Why Evidence-Based Medicine is not yet Science-Based Medicine (Kimball Atwood, MD)
Lyme: From the IDSA to the ILAD to the ABA (Mark Crislip, MD)
Online Health & Social Media: The Good, The Bad, and The Ugly (Val Jones, MD)
Conclusion (Steven Novella, MD)
Speakers:
Steven Novella, MD
Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe. He authors NeuroLogicaBlog and contributes to several other science blogs: The Rogues Gallery, SkepticBlog, and Science-Based Medicine, of which he is also the founding editor.
David H. Gorski, MD, PhD
Dr. Gorski is an Associate Professor of Surgery Division of Surgical Oncology, Wayne State University School of Medicine, Detroit, MI. He is also the Program Leader, Breast Cancer Biology Program, Barbara Ann Karmanos Cancer Institute. His cancer research has been funded by the NIH, ASCO, and the Breast Cancer Research Foundation. He is a long-time science blogger who regularly tackles issues related to science and medicine. He is the associated editor of Science-Based Medicine.
Harriet Hall, MD
Dr. Hall is a retired family physician. She spent 20 years in the Air Force as a flight surgeon and family physician and retired as a full colonel. Also known as “The SkepDoc” from her column in Skeptic magazine, she has written extensively about alternative medicine. She is an editor of The Scientific Review of Alternative Medicine and the Science-Based Medicine blog, is an advisor to Quackwatch, and is a contributing editor to both Skeptic and Skeptical Inquirer magazines. Her website is www.skepdoc.info.
Kimball Atwood, MD
Dr. Atwood is a practicing anesthesiologist who is also board-certified in internal medicine. He has been interested in pseudoscience for years. He was a member of the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, and subsequently wrote its Minority Report opposing licensure for naturopaths. He is an associate editor of the Scientific Review of Alternative Medicine and co-editor of Naturowatch. He is particularly concerned with implausible claims being promoted, tacitly or otherwise, by medical schools and government. He is also dubious about the ethics of human trials of such claims.
Mark Crislip, MD
Dr. Crislip has been a practicing Infectious Disease specialist in Portland, Oregon since 1990. He is Chief of Infectious Diseases for Legacy Health System.
He is responsible for the Quackcast, a skeptical review of Supplements, Complementary and Alternative Medicine, The Persilflagers Annotated Compendium of Infectious Disease Facts, Dogma and Opinion a guide to Infectious Diseases, the Persifalgers Puscast, a podcast review of Infectious Diseases, and Rubor, Dolor, Calor, Tumor, an infectious disease blog.
Val Jones, MD
Dr. Jones is the CEO of Better Health, LLC, a medical blogging network, and VP of Strategic Partnerships at MedPage Today, an online health news source for healthcare professionals. She has been the Senior Medical Director for Revolution Health, and the founding editor of Clinical Nutrition & Obesity, a peer-reviewed e-section of the online Medscape medical journal. Dr. Jones volunteers once a week as a rehabilitation medicine physician at Walter Reed Army Medical Center.
