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Defining The Label: What Is An Antivaxer?

Labels are a cognitive double-edged sword. We need to categorize the world in order to mentally capture it – labels help us organize our mental maps of the overwhelming complexity of things and to communicate with each other. But labels can also be mental prisons, when they substitute for a thorough, nuanced, or individualized assessment – when categorization becomes pigeon-holing.

We use many labels in our writings here, out of necessity, and we try to be consistent and thoughtful in how we define the labels that we use, recognizing that any sufficiently complex category will be necessarily fuzzy around the edges. We have certainly used a great deal of electrons discussing what exactly is science-based medicine, and that the label of so-called alternative medicine is really a false category, used mainly for marketing and lobbying (hence the caveat of “so-called”).

We get accused of using some labels for propaganda purposes, particularly “antivaccinationist” (often shortened to “antivaxer”). Also “denier” or “denialist”, as in germ-theory denier. Even though we often apply labels to ourselves, no one likes having an unflattering label applied to them, and so we have frequent push-back against our use of the above terms.

As with many such terms, Read more »

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

Pain Relief Study Has Potential — With A Spin

The development of drugs and other treatments for specific symptoms or conditions relies heavily on either serendipity (the chance finding of a beneficial effect) or on an understanding of underlying mechanisms.

In pain, for example, there are limited ways in which we can block pain signals –- such as activating opiate receptors, or inhibiting prostaglandins. There are only so many ways in which you can interact with these systems. The discovery of a novel mechanism of modulating pain is therefore most welcome, and has the potential of leading to entirely new treatments that may have a better side effect profile than existing treatments and also have an additive clinical effect.

A recent study by Nana Goldman et. al., published in Nature Neuroscience, adds to our understanding of pain relief by identifying the role of adenosine in reducing pain activity in the peripheral nervous system. The researchers, in a nice series of experiments, demonstrated that producing a local painful stimulus in mice causes the local release of ATP (adenosine triphosphate) that peaks at about 30 minutes. This correlates with a decreased pain response in the mice. Further, if drugs are given that prolong the effect of adenosine, the analgesic effect itself is prolonged. Read more »

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

Political Victory On Healthcare Reform Trumps Careful Analysis

At, the Department of Health and Human Services publishes data on the “Health Care Status Quo.”

It reads a bit like what would happen if you took the Dartmouth Atlas of Healthcare and buried it in Stephen King’s Pet Sematary.

The front page of now has a map of the 50 states where you can click and read about the “current status of health care and the need for reform.”

(I should add that DC is included in the map, too.  But as of the time of posting the link doesn’t seem to work).

It lists a grab-bag of categories of information on each state.  But no matter what the data shows in a state, the HHS report always concludes the same thing.   Fifty times out of fifty:

[Insert state name here] families simply can’t afford the status quo and deserve better. President Obama is committed to working with Congress to pass health reform this year that reduces costs for families, businesses and government; protects people’s choice of doctors, hospitals and health plans; and assures affordable, quality health care for all Americans.

A good example are the reports for Massachusetts and Texas- two very different states with very different data.

  • 25% of Texans are uninsured, while only 2.6% of “Massachusettsans” are.
  • Overall “quality of care” in Texas is “Weak,” while in Massachusetts it is “Strong.”
  • The percentage of people with employer-based coverage in Texas dropped from 57% to 50% from 2000 to 2007, but held steady at 72% in Massachusetts
  • 20% of Texans reported not visiting a doctor due to high costs, but only 7% of Massachusetts residents did, and “this has significantly improved since 2007.”
  • Average premiums for health insurance are about 5% cheaper in Texas, even though the market is described as being less competitive than Massachusetts
  • 27% of middle income Massachusetts families spend more than 10% of their earnings on health care, compared to 17% in Texas

What’s going on?  The HHS doesn’t seem terribly interested in exploring it.  It just says it wants some kind of unspecified health care reform, this year.

I suppose this is the way the political process works.  Make the case there is a serious problem, and seek support to do something – anything – about it, now.  As Secretary Sebelius put it:  “we cannot wait to pass reform that protects what’s good about health care and fixes what’s broken.“  I don’t think anyone really knows what this means, but maybe that’s the point.

It’s a strategy for a political victory, but not for real, needed reform of our system.

*This blog post was originally published at See First Blog*

Science Is Hard, And Best Left To Professionals (The Same May Be Said For Journalism)

It might seem a bit undemocratic, but science, like medicine or dentistry, is a profession. One doesn’t become a scientist by fiat but by education and training. I am not a scientist. I apply science. My colleague Dr. Gorski is a scientist (as well as physician). He understands in a way that I never will the practical process of science—funding, experimental design, statistics. While I can read and understand scientific studies in my field, I cannot design and run them (but I probably could in a limited way with some additional training). Even reading and understanding journal articles is difficult, and actually takes training (which can be terribly boring, but I sometimes teach it anyway).

So when I read a newspaper article about science or medicine, I usually end up disappointed—sometimes with the science, and sometimes with the reporting. A recent newspaper article made me weep for both. Local newspapers serve an important role in covering news in smaller communities, and are often jumping off points for young, talented journalists. Or sometimes, not so much.

The article was in the Darien (CT) Times. The headline reads, in part, “surveys refute national Lyme disease findings.” Epidemiologic studies, such as surveys, are very tricky. They require a firm grounding in statistics, among other things. You must know what kind of question to ask, how many people to ask, how to choose these people, etc, etc, etc. So what institution conducted this groundbreaking survey on Lyme disease?

Actually, they are quoting the famous work of one Kent Haydock, chairman of the Deer Management Committee. But I’m sure he outlined his methods carefully. Or not.

Haydock conducted:

[T]wo surveys — which polled 41 Darien households after a showing of the Lyme Disease film, Under Our Skin, at the Darien Library last month… . In the 41 households that completed the questionnaire, 47 total Lyme disease cases were reported. In 64 percent of those cases, the patient had relapses after an initial Lyme treatment, which required additional treatment for a chronic or long-term conditions.

So, Haydock showed the agitprop chronic Lyme advocacy film Under Our Skin to local families, presumably not selected at random, and then asked them if they had signs of Lyme disease and if it was ruining their lives. Not surprisingly, the answers to both questions were “yes” a remarkably high percentage of the time.

His conclusion: the surveys “show that Lyme not only exists in great numbers, but also in debilitating, chronic and long-term cases.”

This is not epidemiology. This is not science. This is an uninformed opinion dressed up with meaningless numbers. If you get together a group of people who are interested in Lyme disease, show them a propaganda film, and query them about it, the only thing you’ve “measured” is your ability to count people who come to a movie and hold a certain belief. If there were any valid conclusions to be drawn (and with these numbers, there probably aren’t) it’s that many people in this small group think they have Lyme disease—and even that’s over-reaching.

It’s bad enough that the deer commissioner did this. But arguably, it’s much worse that the reporter and editor published it. The only thing this accomplishes is fanning the fears of the readers.

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

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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