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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*

Many Are Not Getting The Preventive Care They’re Entitled To

Who doesn’t think preventive health care is important?  Probably nobody if you ask this question abstractly.   But when it comes to getting it–well that’s a different matter.  Medicare stats show that too few people are getting preventive services even when they are free.  It’s darn difficult, it seems, to get people to take good care of themselves.

By mid-November, of the four million or so new beneficiaries who signed up for Medicare this year, only 3.6 percent had had their “Welcome to Medicare” exam.  Only 1.7 million of the more than 40 million seniors, most of whom were already on Medicare, had had their “Annual Wellness Visit.” A poor showing indeed given all the hoopla and hype surrounding the preventive benefits that health reform was supposed to bring to seniors.

To review:  All new Medicare beneficiaries are entitled to a free physical exam within the first twelve months that their medical, or Part B, coverage becomes effective.  It’s a one-time benefit, and Medicare says that seniors are told about the benefit when they sign up.   A Medicare spokesperson added that Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Should Children Receive Medical Treatments That Have No Evidence Of Efficacy?

In November, the journal Pediatrics published an entire supplement devoted to Pediatric Use of Complementary and Alternative Medicine: Legal, Ethical and Clinical Issues in Decision-Making. The authors purport to have “examined current legal, ethical, and clinical issues that arise when considering CAM use for children and identified where gaps remain in law and policy.” (S150) Their aim is to “illustrate the relevance and impact of identified [ethical, legal and clinical] guidelines and principles,” to recommend responses, identify issues needing further consideration, and thus “assist decision makers and act as a catalyst for policy development.” (S153)

Unfortunately, as we saw in Pediatrics & “CAM” I: the wrong solution, the authors’ solution for the “issues that arise when considering CAM use for children” consist, in the main, of placing a huge burden on the practicing physician to be knowledgeable about CAM, keep up with CAM research, educate patients about CAM, warn patients about CAM dangers, refer to CAM practitioners, ensure that CAM practitioners are properly educated, trained and credentialed, and so on.

Limit CAM? Not happening

Curiously absent are recommendations placing responsibility on those who profit from the sale of CAM products Read more »

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

Pox Parties: Half-Truths, Anecdotes, And Fear


There has been much abuzz about “pox parties” – the practice of parents getting a bunch of unvaccinated kids together with an infected one (pick one, really, though chicken pox is the focus of the recent article in Time) in the hope that their little sweethearts become ill and therefore “naturally” immune to the disease. This deliberate infection involves things as seemingly innocent as breathing the same air as the infected to the stomach-turning sharing of bodily fluids (Saliva lemonade, anyone?). To compound the issue, it seems that parents aren’t always taking into account how the viruses are transmitted, and end up trying oral transmission to  transmit a disease that is transmitted through the air. And yes, the whole thing is as stupid as it seems.

Given that the people partaking in these events have likely not vaccinated their children against anything else, these parties could be a source point for multiple highly contagious infections. Most of us have had chicken pox as children and don’t remember it fondly – now imagine having chicken pox with mumps, mono, and maybe a little hepatitis A to top it off. It is also easy to forget in Western luxury that these innocuous childhood illnesses are actually lethal. Just measles? Well, one death per 3000 measles infections might not seem like much, until you consider the fact that in 2008, 164,000 people died of the measles worldwide - approximately the same number of civilians that have died in the entire length of the current Iraq war. That’s an annual number, and it’s gone down by almost 80% over 10 years. How? Read more »

*This blog post was originally published at Skeptic North*

Pleading The Case For Boys To Receive The HPV Vaccine

A recent announcement is likely to generate a lot of controversy. The Advisory Committee on Immunization Practices of the CDC has recommended that boys and young men be vaccinated against human papillomavirus (HPV). Previously the guidelines said boys “could” be given the HPV vaccine. Now they have recommended that boys age 11 to 12 “should” be vaccinated, as well as boys age 13 to 21 who have not already had the full series of 3 shots. The vaccine can also be given to boys as young as 9 and to young men age 22 to 26.

The vaccine was originally promoted as a way to prevent cervical cancer. Boys don’t have a cervix, so why should they be subjected to a “girl’s” vaccine? There are some good science-based reasons:

  • Boys can transmit the virus to female sex partners later in life, leading to cervical cancer in women.
  • More importantly, boys themselves can also be directly harmed by the virus. It can cause genital warts, cancer of the head and neck (tongue, tonsils and throat), anal and penile cancer, respiratory papillomatosis, and giant condyloma of Buschke and Lowenstein. In rare cases, immunocompromised patients can develop epidermodysplasia verruciformis.
  • HPV has even been Read more »

*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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