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Low-Dose Naltrexone: Medical Revolution Or Pseudoscience?

On SBM we have documented the many and various ways that science is abused in the pursuit of health (or making money from those who are pursuing health). One such method is to take a new, but reasonable, scientific hypothesis and run with it, long past the current state of the evidence. We see this with the many bogus stem cell therapy clinics that are popping up in parts of the world with lax regulation.

This type of medical pseudoscience is particularly challenging to deal with, because there is a scientific paper trail that seems to support many of the claims of proponents. The claims themselves may have significant plausibility, and parts of the claims may in fact be true. Efforts to educate the public about such treatments are frustrated by the mainstream media’s lazy tendency to discuss every study as if it were the definitive last word on a topic, and to site individual experts as if they represent the consensus of scientific opinion.

Recent claims made for low-dose naltrexone (LDN) fit nicely into this model –- a medical intervention with interesting research, but in a preliminary phase that does not justify clinical use. And yet proponents talk about it as if it’s a medical revolution. Read more »

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

Topical Medications And Bathing: A Source Of Water Pollution

I have written two posts in the past on proper disposal of unused medications, and I have always been mindful of the medicines as a source of environmental water pollution. This past week the American Chemical Society reminded (head-slapped me) that topical medications are a source of environmental water pollution from their active pharmaceutical ingredients (APIs). Yes, the simple act of bathing washes hormones, antibiotics, and other pharmaceuticals down the drain into the water supply.

Ilene Ruhoy, M.D., Ph.D. and colleague Christian Daughton, Ph.D. looked at potential alternative routes for the entry into the environment by way of bathing, showering, and laundering. These routes may be important for certain APIs found in medications that are applied topically to the skin — creams, lotions, ointments, gels, and skin patches. These APIs include steroids (such as cortisone and testosterone), acne medicine, antimicrobials, narcotics, and other substances. Read more »

*This blog post was originally published at Suture for a Living*

Overachievers May Turn To Prescription Drugs To Gain A Competitive Advantage

There’s no doubt that prescription drug abuse is a major problem in America, and it’s escalating in epic proportions.  Prescription drug abuse affects men, women and teens.  Concerning trends include older adults, adolescents and women.

On MSNBC’s website, Karen Asp writes, Superwoman syndrome fuels pill-pop culture, and it’s about how “Overwhelmed overachievers turn to prescription drugs for an edge.”

This article is a little misleading since there are many women who are hardworking “superwomen” who do not indulge in illicit drug use. Read more »

*This blog post was originally published at Health in 30*

Drug Seekers And Pain Complaints In The ER: How To Know What’s Real

The first seven patients I saw today were in the ED for:

  • Dental Pain (ongoing for three years)
  • Back Pain (third visit in one month, 18 in 2006)
  • Migraine Headache (six visits in a month, and second ED visit in 18 hours)
  • Back Pain (this one was legit)
  • Chronic Recurrent Abdominal Pain (ran out of Oxycontin and doctor “out of town”)
  • “Cyclic Vomiting Syndrome” (in which only narcotics stop the vomiting)
  • Oxycontin withdrawal

Sometimes I wonder why I bother. I occasionally wish my job demanded something more than a valid DEA license, and decision-making skills beyond “yes narcs” and “no narcs.” It just drains the carpe right out of your diem to start the day off in a series of ugly little dogfights over drugs with people whom, to put it charitably, you have concerns about the validity of their reported pain. Read more »

*This blog post was originally published at Movin' Meat*

Broken Arm? Try Some Ibuprofen

Pain management is a hot topic in medicine in general and certainly in medicine for the outdoors. Injuries in particular, and many illnesses, cause pain, which in turn causes the victim to suffer. To a great extent, pain is subjective, but regardless of whether your pain is a “1” or a “10,” it can be disabling and even dangerous, particularly if it causes you to be distracted in a situation of risk (e.g., climbing, swimming, walking along a ridgeline).

Broken bones usually hurt a great deal. It’s commonly believed that the pain is always of a severity to require the administration of “strong” pain medicine, notably, something containing a narcotic compound. This may not be true. Read more »

This post, Broken Arm? Try Some Ibuprofen, was originally published on Healthine.com by Paul Auerbach, M.D..

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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