February 18th, 2011 by Lucy Hornstein, M.D. in True Stories
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Never in a million years would I have dreamed I would be able to say this, but I actually recommended a homeopathic remedy today. To briefly review, for anyone who may be under the mistaken impression that homeopathic remedies actually do anything — they don’t. Here’s why in a nutshell:
Homeopathy is an unscientific and absurd pseudoscience, which persists today as an accepted form of complementary medicine, despite there never having been any reliable scientific evidence that it works.
So what on earth possessed me to seriously recommend it? I’ll tell you.
I saw a beautiful little four-month-old today whose mother thinks he might be teething. Everyone thinks their four-month-olds are teething because they start getting more drooly as their hand-mouth coordination improves, allowing them to get more things into their mouths. Most of the time they don’t actually get their teeth until about six months, though four month olds pop out teeth often enough to keep us on their toes. I told her this. She’s cool. Here’s her problem:
“The daycare is getting fussy. They want me to bring in the Oragel. I don’t really think he needs it, and I don’t like the idea of giving medicine when it’s not really necessary.”
Daycares can be fussier than babies sometimes. That’s when I realized that a homeopathic teething remedy is the perfect solution:
- The baby is happy because someone’s rubbing his gums.
- Mom is happy because the baby’s not getting any medicine.
- Daycare is happy because they’re “doing something.”
Win-win-win.
*This blog post was originally published at Musings of a Dinosaur*
February 9th, 2011 by Lucy Hornstein, M.D. in Opinion, Quackery Exposed
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I heard yet another commercial on the radio this morning for some menopausal cure-all that was “clinically proven” to reduce hot flashes, improve sleep, increase energy, help you lose weight, and probably cure bad breath to boot. Anyone who calls in the next ten minutes gets a month’s supply for free. “Hurry.” Don’t.
At least they finally stopped running the one for the colon cleansing product that helped remove the “five to ten pounds of waste some experts* believe are spackled along the inside of the large intestine.” (*Emphasis mine. “Some experts” also believe the moon landing was a hoax, the Holocaust never happened, and homeopathy is effective medicine.) Somehow this colon cleansing stuff helps you preferentially lose belly fat. Not really sure what belly fat has to do with five to ten pounds of stuff spackled inside your intestine, but they’re not selling logic. “Call right now for your free sample.” Or not.
Then there was the pediatrician hawking the natural, safe, clinically-proven effective sinus cure that sounded suspiciously like saline spray. “Hurry and call right now.” Don’t bother.
Words are my friends, and I hate to see people abuse them.
“Clinical” is an adjective referring to “that which can be observed in or involves patients.” It’s the hands-on part of medicine that can’t be replicated in a lab or taught from a book. There is virtually no such thing as “proof” in the scientific sense. Laboratory and patient-based medical research can strongly suggest things. Scientific evidence can accumulate supporting things, and the more the better, of course. Read more »
*This blog post was originally published at Musings of a Dinosaur*
January 31st, 2011 by Lucy Hornstein, M.D. in Health Policy, Opinion
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I saw this via a friend’s Facebook post:
Really, IRS?
Believe it or not, the folks at the IRS think they know more about breastfeeding than doctors and medical researchers.
According to an article in the New York Times, the Internal Revenue Service has determined that breastfeeding “does not have enough health benefits to qualify as a form of medical care.” Therefore, women cannot count expenses for breastfeeding supplies in their tax-sheltered healthcare spending accounts.
In doing so, the IRS has ignored the guidance of experts at the Department of Health & Human Services and World Health Organization who are actively promoting breastfeeding because of its significant health benefits for mothers and children.
Sign our petition reminding the IRS to leave medicine to the experts!
Oh get real, people!
First of all, you will never — by which I mean not EVER — find someone more supportive of breastfeeding than I am. I nursed my last kid for two whole years, and the only reason I gave up the first time was because there were two of them (kids, that is). So don’t go trying to lump me in with those terrible, mean, unsupportive doctors who are sucking at the teat (pardon the choice of idiom) of the amoral, soulless baby formula manufacturers.
The IRS may have worded the decision poorly, but they are not making medical decisions. They’re not even expressing a medical opinion. They are drawing a line that needs to be drawn between what constitutes “medical care” and “being healthy.” Read more »
*This blog post was originally published at Musings of a Dinosaur*
January 24th, 2011 by Lucy Hornstein, M.D. in Better Health Network, Opinion
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A reader requests:
Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last three doctors I went to, I realized they didn’t bring up my immunization records. Is this usually left for the patients to bring up on their own?
Good question. What exactly is a physical? Does it include blood work? What about an EKG? And a cardiac stress test? Is an “executive physical” an orgy of “more is better,” previously paid lavishly, really better than a “camp physical?”
Here’s the thing: There is no such thing as a “complete physical examination.” There are literally hundreds of different maneuvers and procedures that encompass various aspects of physical diagnosis. Performing every last one of these on even a single patient would not only take many hours, it would be a colossal waste of time.
A “physical” is a misnomer. The clinical portion of a medical workup is more correctly termed the “history and physical.” Of the two, everyone agrees that the history — information elicited from the patient, sometimes from family members or other medical records — is far more likely to yield useful information. It is the information gleaned from the history that guides the physical.
Knee pain? The history should include mechanism of injury, and physical exam should evaluate for McMurry, Lachman, and drawer signs, among other maneuvers. Bellyache? Need to know about associated symptoms such as nausea, vomiting, stool pattern, flatus, and the exam better include careful auscultation (listening) for bowel sounds and palpation (feeling) for masses, fluid, possible shifting dullness, plus eliciting any guarding or rebound, and probably a rectal exam looking for blood. It makes no sense to use a tuning fork for Rinne and Weber tests to evaluate different kinds of hearing loss on someone with heartburn. Likewise, evaluating the debilitating heel pain of plantar fasciitis does not require listening to the lungs. I trust you get the idea.
The question appears to be about the “routine physical” in the absence of any specific medical concern. A more accurate term for this is a “preventive service” visit, for which there are specific guidelines. Read more »
*This blog post was originally published at Musings of a Dinosaur*
January 15th, 2011 by Lucy Hornstein, M.D. in Better Health Network, Opinion
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I got a package in the mail today: My very own (complimentary) copy of Paul Offit’s new book, “Deadly Choices; How the Anti-Vaccine Movement Threatens Us All.” Needless to say, I can’t wait to read it. Not coincidentally, Dr. Offit has been making the rounds of interviews in the wake of the book’s release. Although I haven’t heard any of them directly, I did see a reference to this NPR interview on the FaceBook page of an old friend, who quoted from it thusly:
IRA FLATOW: You write that some pediatricians will not see kids who are not vaccinated. Is that a good solution to the problem?
DR. PAUL OFFIT: I don’t know what’s a good solution to that problem. And I feel tremendous sympathy for the clinician who’s in private practice. On the one hand, and my wife sort of expressed this, she’s a general practitioner, a pediatrician, you know, she’ll say, you know, parents will come into her office and say I don’t want to get vaccines, including, for example, the Haemophilus influenzae vaccine, which is vaccine that prevents what was, at one point, a very common cause of bacterial meningitis.
And, you know, we’ve had three cases or three deaths, actually, from this particular bacterial form of meningitis in the Philadelphia area just in the last couple years.
And, you know, to her, it’s like, you know, let me love your child. Please don’t put me in a position where I have to practice substandard care, which can result in harm, which can hurt your child. Please don’t ask me to do that.
And I certainly understand the sentiment. On the other hand, if you don’t see that child, you know, where does that child go? Do they go to a chiropractor who doesn’t vaccinate?
I think it’s hard because then you lose any chance to really immunize the child.
My friend then offers his take, that of a pediatrician in private practice. Read more »
*This blog post was originally published at Musings of a Dinosaur*
