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The Fallacy Of Relying On Anecdotes In Medicine

Dr. Ian Gawler, a veterinarian, suffered from osteogenic sarcoma (a form of bone cancer) of the right leg when he was 24 in 1975. Treatment of the cancer required amputation of the right leg. After completing treatment he was found to have lumps in his groin. His oncologist at the time was confident this was local spread from the original cancer, which is highly aggressive. Gawler later developed lung and other lesions as well, and was given 6 months to live due to his metastatic disease.

Gawler decided to embark on an alternative treatment regimen, involving coffee enemas, a vegetarian diet, and meditation. Eventually he was completely cured of his terminal metastatic cancer. He has since become Australia’s most famous cancer survivor, promoting his alternative approach to cancer treatment, has published five books, and now runs the Gawler Foundation.

At least, that is the story he believes. There is one major problem with this medical tale, however – while the original cancer was confirmed by biopsy, the subsequent lesions were not. His oncologist at the time, Dr. John Doyle, assumed the new lesions were metastatic disease and never performed a biopsy. It was highly probable Read more »

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

Some Of Cleveland Clinic’s 2012 Recommendations Lack Evidence

©iStockphoto.com/Alexander Raths

Last week, the Cleveland Clinic sent out the following “News Tips”:

“Top 5 Medical Tests for 2012

As we head into 2012, healthy New Year’s resolutions will abound. People will pledge to work out more, eat healthy foods and finally go to see their doctor for a physical.

Cleveland Clinic experts note that there are a few tests that everyone should have during their yearly physical. For men, the following tests are recommended by many physicians:”

Included in the list were: Read more »

*This blog post was originally published at Health News Review*

Modern Snake Oil: Physician Touts Baseless Cures For Rheumatoid Arthritis

There’s an old saying in medicine: “Use the new medicine while it still works.” This is more than just a cute quip. The saying encompasses a few different phenomena. When a drug is tested on a few thousand people, the luck of the draw may show a greater effect than would be seen in a larger, more diverse population. Also, less common side effects will become more evident in a larger sample. Once several million people take the drug, it may turn out that the drug isn’t as spectacular in a large, diverse population, and that certain side effects, though rare, are serious.

This is one of the reasons I’m a very conservative and skeptical physician. Today’s miracle drug may be tomorrow’s Vioxx. Less conservative doctors may make much more enthusiastic recommendations. I found one physician promoting pomegranate juice for rheumatoid arthritis (or at least linking to the article on Joe Mercola’s site without comment). It sounds harmless enough, but what’s the evidence? (You can hunt for the page yourself; I’m not linking to Mercola.)

The statement is based on a pilot study out of Israel consisting of data from six patients. The measures used seem quirky, but are irrelevant anyway. There are no conclusions that can be drawn from such a small sample. Despite this, the authors conclude (and Mercola and the doctor who posted the link presumably endorse) that, “Dietary supplementation with pomegranates may be a useful complementary strategy to attenuate clinical symptoms in RA patients.”

Really? Based on what? Read more »

*This blog post was originally published at ACP Internist*

Physicians Search For Best Treatment Plan Based On Outcomes Of Similar Patients In Hospital Records System, Not Medical Literature

Wow. Todd Park, Chief Technical Officer at HHS, ought to be jumping out of his skin with joy at this one.

This time, House, M.D. fans, it was lupus. The article “Evidence-Based Medicine in the EMR Era” published in the Nov. 10 issue of the New England Journal of Medicine might have read like a House television script, but it was a real-life glimpse of what the most optimistic health IT advocates are hoping will become commonplace in U.S. health care: Mining EHR data to arrive at treatment decisions.

In a Health IT Exchange piece (on TechTarget) EHR data spurs real-time evidence-based medicine, Don Fluckinger summarizes (and dramatizes, accurately) this early specimen of care being transformed – beyond the literature – by looking at past records. Faced with a 13 year old lupus patient with a complex problem (see article for details)…

In four hours, they did a retrospective study of similar patients in the hospital’s data warehouse…, and decided to move ahead with the treatment based on the previous results of 98 [similar patients] … The authors said they will never know if they made the “correct” decision, but they did know that — in absence of randomized trial research to support their decision — they acted on the evidence of the best data available, coupled with their experience.

“Our case is but one example of a situation in which the existing literature is insufficient to guide the clinical care of a patient,” the authors wrote. …

What are we waiting for, people??  Imagine if Read more »

*This blog post was originally published at e-Patients.net*

Skeptic Uncovers Some Of The Week’s Medical Quackery

Hey there skeptifans. Here are the media Fails and Wins you sent me last week.

Edzard Ernst on alternative medicine
After Steve Jobs death, which we now know may have been hurried due to his decision to choose alternative treatments over evidence based ones, Maclean’s chose to run this Q&A with alternative medicine expert Edzard Ernst. Several years ago Dr. Ernst set out to find out if there is evidence to support the most popular alternative treatments. His findings were that the vast majority of alternative medicine is quackery. I hope this interview will help sway some people on the fence about chiropractic and other placebo treatments.

Family Doc Says No To Perilous Chickenpox Pops
Anna spotted this story on NPR. Apparently, there is a mom in Texas selling chicken pox infected lollipops to Read more »

*This blog post was originally published at Skeptic North*

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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