The Friday Funny: (Video) The Dietary Advice Racket
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First, Mitchell and Webb took on homeopathy. This week, it’s bogus (word choice intentional) “nutritionists“:
*This blog post was originally published at Science-Based Medicine*
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Book Review – Over the Edge: Death in Grand Canyon
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Michael Gighlieri and Thomas Myers are coauthors of Over the Edge: Death In Grand Canyon, which is one heck of an interesting read. It is an encyclopedic rendition of all of the fatal accidents known (at the time of the writing) to have occurred in the Grand Canyon. The over-arching observation, made by the authors and almost certainly by the readers, is that the vast majority of these deaths were avoidable. Failure to recognize risk, or frank disregard for hazards, led to tragic loss of human lives. For every person who died, countless more suffered.
Early in the book and at intervals thereafter, the authors apologize for the graphic descriptions and for articulating the opinion that the fatalities were avoidable. They are apologizing for accurately observing that people can be uninformed, or informed and foolish. There is, of course, an element of risk inherent in many outdoor recreational activities, but the authors present an entirely different spin on risk – namely, unambiguously unnecessary risk. They are correct – too many people have paid the price, in the theme of this book, with loss of life and great emotional suffering (presumably) to family and friends.
There is a bit of adventure in the telling of tales, but this is not an adventure book. It is, rather, a series of accountings, some written in great detail and some more superficially. There is nothing boring about this book, but it is easily put down after a section is completed.
From the back cover: “Two veterans of decades of adventuring in Grand Canyon chronicle the first complete and comprehensive history of Grand Canyon misadventures. These episodes span the entire era of visitation from the time of the first river exploration by John Wesley Powell and his crew of 1869 to that of tourists falling off its rims today. These accounts of the nearly 600 people who have met untimely deaths in the Canyon set a new high water mark for offering the most astounding array of adventures, misadventures, and lifesaving lessons published between two covers. Over the Edge promises to be the most intense yet informative book on Grand Canyon ever written.”
The major and minor sections represent the categories of accidents: falls from the rims, falls within the canyon, heat illness (and dehydration), flash floods, river accidents (including crossings and drownings), air accidents, rockfall, envenomations, freak accidents, suicide, and murders.
The book is replete with lessons learned and safety advice – all of it useful for educators, adventurers, explorers, search and rescue personnel, and casual visitors. The book truly serves a purpose, which is to articulate history in such a way that the reader can learn from it, and hopefully, avoid the catastrophes that befell the unfortunate victims portrayed in these tales. Other interesting books co-authored by Dr. Myers are Fateful Journey – Injury and Death on Colorado River Trips in Grand Canyon and Grand Obsession – Harvey Butchart and the Exploration of Grand Canyon.
This post, Book Review – Over the Edge: Death in Grand Canyon, was originally published on Healthine.com by Paul Auerbach, M.D..
Average Americans Are Very Confused About Healthcare Reform
No Comments »Doubled over in pain, you stagger into the emergency room and are diagnosed with acute appendicitis. A surgeon leans over your stretcher:
Surgeon: You need an appendectomy.
You: What are my options?
Surgeon: Either I take out your appendix or you die.
Now that’s a conversation people can understand. But what if, instead of whisking you up to the operating room, the surgeon kept talking and invited a few other people into the discussion?
Surgeon: Do you think I should take it out by an open operation or laparoscopically?
You: Huh?
Laparoscopy equipment salesman: You know, cutting you open the old-fashioned way and leaving a big scar or having a tiny incision. Laparoscopy is much better than the open procedure.
Guy who sells scar-removal cream: Wait a minute. Better for whom? Laparoscopy takes fourteen minutes longer.
Hospital administrator: But hospital stay is reduced by 0.7 days on average, patients have less pain, and you can return to work sooner.
Surgeon: Laparoscopy costs more than an open operation while you’re hospitalized but less once you’re home. What’s your co-pay?
You: Doc, my belly’s hurting a lot more now.
Guy who owns shares in a drug company: What if we just treat him with antibiotics?
Surgeon: Don’t be silly. His appendix could burst.
Funeral director: What about doing nothing?
Very smart people are zoning out of the health care reform debate because they think it’s just too complicated.
The latest poll out today from the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente, says only 27 percent of the public has been following the health reform debate closely. Despite this, more than half (56 percent) of Americans think health reform is more important than ever.
Simply put, there are four main goals of the legislation:
About 20 percent of the 2.5 trillion dollar annual health care price tag does not contribute to better health.
Half-truths feed on fear. People are afraid of losing or compromising what coverage they already have. They’re afraid of higher taxes and lower quality of care. Who has the time or patience to read the 1,000-page bill proposed by the House of Representatives? So we rely on summaries and are susceptible to all sorts of misrepresentation. And nobody wants a plan with major faults rammed down their throat in the name of political expediency.
Today’s Kaiser Family Foundation report suggests that the tactics of special interest groups are working. Sixty percent of adults surveyed support a public option. But “(w)hen those who initially support the public plan are told that this could give the government an unfair advantage over private companies, overall support drops to 35 percent. Conversely, when opponents are told that public plans would give people more choice or help drive down costs through competition, overall support jumps to roughly seven in ten.”
It’s in the interest of those who oppose health care reform to make us feel that it’s just too hard to understand. I have certainly felt that way at times over the past year. But the stakes are too high for Americans to bale out on the discussion. Our common sense and sense of fair play are crucial to the national conversation. We should hear out the special interest groups; they often have legitimate concerns and thoughtful analysis. But we need to remember where they are coming from. And we must seek out information from sources that try to be nonpartisan, such as the
Kaiser Family Foundation.
No, you’re not stupid if you’re confused about health care reform. But you may be psyched out. You probably know a lot more than you think – but you may need to do some homework in order to participate in this extraordinarily important national debate. The national debate needs you.
For this week’s CBS Doc Dot Com, I moderate a debate about the public option between Wendell Potter, former head of public relations for Cigna and Rob Schlossberg, Executive Sales Director for BenefitMall. Mr. Schlossberg opposes it and Mr. Potter favors it.
To view the debate on a public option,
click here.
To view a brief discussion of for-profit vs. not-for-profit health insurance organizations,
click here.
For Janet Adamy’s excellent summary, “Ten Questions on the Health-Care Overhaul,” in the July 21st issue of the The Wall Street Journal,
click here.
Extra Video
The Economics Of Health Care
http://www.cbsnews.com/video/watch/?id=5181458n&tag=contentMain;contentBody
Unusual Diagnosis Of The Week: Digital Mucous Cyst
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Earlier this month I received an e-mail asking for information. I have changed it slightly:
I have been pouring over the computer, searching for information on a tumor. I had removed last week from my left long finger (third finger). The pathology report came back as a myxoid tumor. I was told it was a tumor, not a cyst. Could you help me give me more information?
To begin, most digital myxoid or mucous tumors are cystic in nature. Very few are not. It is difficult to find much information in the literature, especially the current literature.
Digital mucous cysts (DMCs) are benign ganglion cysts. They most often are located at the most distal joint of the finger or in the nail fold. Physicians call this joint the distal interphalangeal (DIP) joints. The fingers are most commonly involved, but DMCs may occur on the toes. (photo credit)
The etiology of these cysts is not known. DMCs are also called myxomatous cutaneous cysts, periungual ganglions, mucous cysts, myxoid cysts, synovial cysts, dorsal cysts, nail cysts, cystic nodules, digital mucoid cysts, digital myxoid cysts, and digital mucinous pseudocysts.
The cyst often has a smooth shiny surface on exam. If located near the nail, there will often be a groove in the nail as in the photo above. The cyst’s size may vary.
If the cyst is asymptomatic, then treatment is not required. Recurrence is common regardless of which treatment is used.
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Aspiration of the contents (72% success rate with multiple aspirations, 2-5 treatments)
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Cyrotherapy (56% to 86% success rate)
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Steroid injection
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Surgical excision (88% to 100%)
Restriction of joint mobility, nail dystrophy, and changes to the contour of the proximal nail fold are potential drawbacks.
When considering a difference diagnosis keep in mind the following:
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Epidermoid cyst
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Heberden node or Rheumatic nodule
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Fibrokeratoma (DMCs may resemble this when they form between the proximal nail fold and the nail and protrude with a keratoticlike tip.)
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Giant-cell tendon sheath tumor
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Myxoid malignant fibrous histiocytoma
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Myxoid variant of liposarcoma (These are less likely to present as firm circumscribed masses and more likely to be deeply seated.)
REFERENCES
Digital mucous cyst – emedicine dermatology, the online textbook
Cystic Lesions of the Hands; Clinical Advisor, November 12, 2008; Noah S. Scheinfeld, MD, JD
Digital myxoid cysts: a review; Cutis; Feb 1986;37(2):89-94; Sonnex TS.
Myxoid Cysts; JAMA, Dec 1965; 194: 1239; Frederick A. J. Kingery
Ganglion of the Distal Interphalangeal Joint (Myxoid Cyst): Therapy by Identification and Repair of the Leak of Joint Fluid; ARCH DERMATOL/VOL 137, MAY 2001; David de Berker, MRCP; Clifford Lawrence, FRCP
Ray Amputation As A Treatment for Recurrent Myxohyaline Tumor of the Distal Extremity; Plastic and Reconstructive Surgery. 111(4):1573-1574, April 1, 2003; Mowlavi, Arian; Quinn, Brendon M.; Zook, Elvin G.; Milner, Stephen
Soft-Tissue Sarcomas of the Upper Extremity: Surgical Treatment and Outcome; Plastic and Reconstructive Surgery. 113(1):231-232, January 2004; Steinau, Hans-Ulrich; Kuhnen, Cornelius
Soft-Tissue Chondroma in the Thumb; Plastic and Reconstructive Surgery. 110(6):1599-1600, November 2002; Avc, Gülden; Aydogdu, Eser; Ydrm, Serkan; Aköz, Tayfun
*This blog post was originally published at Suture for a Living*
Sarcoidosis And The Marshall Protocol sCAM
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While there are many taxonomies of SCAM, one thing almost all alternative therapies have in common is they are originally the de novo discovery of one lone individual. Working outside of the mainstream, they are the gadflies who see farther because those around them are midgets.
Hanneman conceives of homeopathy, the treatment of all disease.
Palmer conceives the cause of all disease and its treatment in chiropractic
Mikao Usui, while having a mid-life crisis, conceives Reiki.
Virgin births all. These pioneers boldly go where no man has gone before.
Others have been less acclaimed after seeking out new life. An example is Virginia Livingston, MD, the discoverer of the cause of all cancer (1). She discovered a bacterium, the cause of cancer, she called Progenitor cryptocides, which, unfortunately only she could grow. Her therapies include an autogenous ‘vaccine” made from your own urine, which will probably preclude widespread use even in alternative therapies circles. I wonder if Jenny would object to vaccines if there were naturally derived from the patients urine?
Discovering a new form of pathogenic microbiology that no one else can see or grow is not uncommon, since people seem to be unable to recognise artifact on slides, be it Oscillococcinum being seen by Joseph Roy 200 years ago or Virginia Livingston in the 1960’s. Sometimes I regret the discovery of H. pylori as a cause of gastritis as it gives the alternative microbiologists a medical Galileo to point at. H. pylori is used as an example, erroneously, of a bacteria causing disease that was laughed at by the medical establishment (Parenthetically, as my flawed memory has it, while I was an Infectious Disease Fellow the data for H. pylori came trickling in. I remember discussing the papers with one of my attendings who was an expert in GI infections. We all thought is was an interesting hypothesis and waited further data with interest. I cannot remember anyone dismissing the idea out of hand with derisive laughter. But then, I remain convinced that infections are the cause of all disease, at least the diseases that matter).
A letter from a reader led me to another lone reseacher who has discovered the cause and treatment of many, if not all, diseases. So may I introduce to you, Trevor Marshall, the developer of the Marshall Protocol. (As I have said many time, I want something in medicine named after me, and it is not the glove breaking during an exam. “Damn, I just had a Crislip. I need to go and clean my nails.” If Swan or Groshong can get some silly little catheter named after them, well, I should be good for some eponym). You have not heard of Trevor Marshall? Often the fate of originality is to languish in obscurity.
The Marshall Protocol has all the characteristics of modern alternative therapy: a single discoverer, a hitherto undiscovered biology, an unproven therapeutic intervention and one of the most aggravating issues in SCAM’s: Taking a scientific truth the size of a molehill and transmogrifying it into a Cascade Range of exaggerated disease etiology and treatment. Unlike most SCAM’s, however, as best as I can tell Dr Marshall does not seem to be in the business of making a business from his discovery, although he does have patent applications for his protocol.
*This blog post was originally published at Science-Based Medicine*
