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Morgellons: When People Mistakenly Believe They Have Parasites

I saw a patient recently for parasites.

I get a sinking feeling when I see that diagnosis on the schedule, as it rarely means a real parasite.  The great Pacific NW is mostly parasite free, so either it is a traveler or someone with delusions of parasitism.

The latter comes in two forms: the classic form and Morgellons. Neither are likely to lead to a meaningful patient-doctor interaction, since it usually means conflict between my assessment of the problem and the patients assessment of the problem.  There is rarely a middle ground upon which to meet. The most memorable case of delusions of parasitism I have seen was a patient who  I saw in clinic who, while we talked, ate a raw garlic clove about every minute.

“Why the garlic?” I asked.

“To keep the parasites at bay,” he told me.

I asked him to describe the parasite.  He told me they floated in the air, fell on his skin, and then burrowed in.  Then he later plucked them out of his nose.

At this point he took out a large bottle that rattled as he shook it.

“I keep them in here,” he said as he screwed off the lid and dumped about 3 cups with of dried boogers on the exam table.

To my credit I neither screamed nor vomited, although for a year I could not eat garlic.  It was during this time I was attacked by a vampire, and joined the ranks of the undead. Read more »

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

Nurses Stand Up For Science And Patient Safety, Then Face Jail Time?

balanceYou may have heard about the whistleblower case in Texas where 2 nurses reported a physician (Dr. Rolando G. Arafiles, Jr.) to the State Medical Board for unethical medical practices. Even though the American Nurses Association’s Code of Ethics requires nurses to report physicians who may be of harm to patients, these two were punished for doing the right thing. (Apparently, the local sheriff was a friend of Dr. Arafiles’ and took it upon himself to charge the nurses with misuse of official information, a third-degree felony in Texas, because patient medical record numbers were included in the letter to the Texas Medical Board). The criminal prosecution charges were dropped against Vicki Galle, but the case against Anne Mitchell is ongoing.

But the real story – what was Dr. Arafiles doing that was so egregious? – has yet to be made public by the nurses. And thanks to bloggers Mike Dunford, and Orac over at, the truth is being revealed. Video footage of Dr. Arafiles’ bizarre medical beliefs and practices are available here. Apparently, he prescribed colloidal silver to treat H1N1 flu, promoted the false idea that vaccines contain a wild array of toxins (everything from MSG to fetal tissue), and was diagnosing patients with “Morgellons disease” which he describes as a parasitic infection that produces fibers that turn host cells into plastic. Read more »

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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