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Demystifying Medicine One Month at a Time

Category: medical urban legends (page 1 of 2)

Medical Conspiracism

conspiracy-theory-caution_0Do you believe any of the following*?

  • The FDA prevents the public from getting natural cures for cancer because of pressure from drug companies.
  • Cell phones cause cancer, but due to corporate pressure, the government won’t disseminate the information.
  • Global distribution of GMO (genetically-modified) foods by Monsanto is part of a plan to help shrink the world’s population.
  • Doctors and the government still want to vaccinate children though we know these vaccines cause autism.
  • Putting flouride in our water is a mechanism for allowing industries to rid their factories of phosphate waste.

I don’t believe any of them. A lot of Americans do. Eighteen percent of respondents to a recent survey believe in three or more of these canards. Almost half of the respondents believed at least one. None of them are true. But people believe what they want to.

The survey was done by a political scientist at the University of Chicago, who previously has studied the prevalence of belief in political conspiracy therapies. I like that he was willing to cross over into Medicine to continue the exploration.

One conclusion from this work will likely not surprise you: conspiracy believers were more likely to use herbal supplements, seek alternative medicine, and eat organic food; and less likely to receive flu shots, use sunscreen, or have regular physicals.

That said, there’s no evidence that physicals “do” anything, other than perhaps let you establish a stronger relationship with your ‘provider’ or ‘medical home.’ Many medical authorities counsel against them in people without symptoms of illness.

So maybe the conspiracists are right in at least one regard…

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*The statements I listed here are my paraphrasings of the actual statements used in the survey.

MD vs NP

Some friends and I have a piece posted on the Health Affairs Blog.

One co-author is a doctor, the other is a nurse practitioner (NP). He runs the student health center at a university.

Our piece reflects on the vitriol between physicians and nurse practitioners in online forums, and ideas for restoring civility to the conversation.

Nurse practitioners are nurses who get extra training in clinical medicine, such that they are able to diagnose and treat most illnesses and provide outstanding patient care. By now, if you haven’t been cared for at least once in some capacity by a nurse practitioner, then you haven’t really “used” the health care system.1tlcfl231

Licensure in health care fields is state specific. Historically, when NP certification came into being, NPs were uniformly expected to have “supervisory” relationships with physicians. The docs were supposed to oversee their practice, from case review to monitoring prescriptions. Hence, the origin of the term “physician extender.”

It was only a matter of time until NPs existed in sufficient numbers and had enough experience to amass data proving they can in fact practice medicine well without supervision. Many states, facing shortages of able-bodied health care professionals, have changed their licensure requirements to allow NPs to practice fully and independently.

Other states are considering the move. People feel very strongly on both sides of the issue. Medical societies have weighed in. Strong feelings are fine, but name calling and vilification of the other parties do nothing to advance progress, solve problems, or of course take care of patients.

I’ve worked with many nurse practitioners over my career. There are many standouts I’d choose to be my own caregiver.

What about you?

Noodlin’

Noodling: Fun for the whole family.
(photo: National Geographic)

I live in Oklahoma. It was bound to happen.

Patient comes to our office for a “hospital follow-up” visit.

He’d been in the hospital with a severe hand infection. It had necessitated intravenous antibiotics coupled with surgical incision and drainage (“I&D”).

What caused his infection?

He lacerated his hand. Underwater. Muddy water. In the act of catching 20+ pound catfish. With his bare hands.

Noodlin’.

“Been doin’ it since I was twelve,” he told me. “Never had this happen before.”

I started wondering about the bacterial flora of catfish bites.

He wasn’t bitten, though. Scraped his hand on a rock reaching into a small underwater cave. That’s where you find the catfish.

And catch them with your bare hands. If you’re a noodler, that is.

Click here if you want to see a short video of some noodlers in action. It’s called “Okie Noodling.”

Remember, Noodlers: No Hooks, No Bait, No Fear…

Recanting

Bibles of psych. Since 1954.

The story about Dr. Spitzer’s late-life recanting of the ‘gay cure’ got me to thinking.

First I imagined all the jobs that the steady progress of innovation and technology have eliminated:

Ice men, telegraph operators, lamplighters, copy boys, milkmen, typesetters. These are only a few.

Travel agents have become an endangered species, too, as people can book their own trips online through dozens of different websites. [Though a recent article claims a comeback of sorts for travel agents.]

I guess now we can add therapists practicing the ‘gay cure’ to the list of outmoded professions. No doubt there will be holdouts for a while.

Dr. Spitzer was a giant in his field. He was a main contributor to the third and fourth revisions of the Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatry.

Ironically, as a young academic, he had been instrumental in de-listing homosexuality as a disorder (1973), seeing psychopathy related to sexual orientation as mere “sexual orientation disturbance,” i.e. anxiety caused by issues of orientation, gay or straight.

As an iconoclast, Dr. Spitzer was always looking to speak truth to power. Yet he became the power. So when he decided to study a group of former gays claiming to have been ‘cured,’ he was swimming in dangerous waters. His poorly-conveived study gave validity to a pseudoscience that mainstream psychiatry and psychology viewed with disdain.

And now, with homosexuality again big news, Dr. Spitzer realized that it was time to publicly acknowledge his mistake and recant. He typed a letter to the journal that had published his 2001 study. Here’s the final paragraph:

I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy [‘gay cure’ therapy–ed.]. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some “highly motivated” individuals.

Commentary about Dr. Spitzer’s letter was voluminous. Many appreciated his courage and honesty. Others angrily wrote him off as a sick old man [he suffers from Parkinson’s and is near 80] trying to curry favor or seek the spotlight again.

My own view is that as a man of principle he did what he felt he had to do to promote truth in a contentious world. His apology reads sincerely to me, and he acknowledges that he caused harm, something no honest physician ever desires.

Galileo Galilei (1564-1642)

It’s quite a story.

Dr. Spitzer caused me to think about other famous ‘recantations.’ Galileo immediately sprang to mind. In 1633 he was found by an Inquisition of the Church to be “vehemently suspect of heresy.”

Talk about harsh. He was required to “abjure, curse, and detest” his written opinions that the Sun, and not Earth, was at the center of our solar system [heliocentrism]. He lived under house arrest for the remainder of his life.

Popular legend holds that at the end of his trial he muttered “and yet it it moves,” referring to Earth.

There the comparison ends. Dr. Spitzer won’t be muttering anything of the sort.

Practical Matters

Muscle biopsy = not fun

It’s always amused me that even though I have a medical education, there are many basic physiologic questions I can’t answer:

  • What is sneezing and how is it controlled?
  • Why are yawns contagious?
  • What makes you feel the need to stretch after you’ve been in one position for awhile? For that matter, what causes that “stretching feeling” and the accompanying sound you hear in your head?
  • How and why do knuckles crack?
  • What causes muscle cramps and what the heck are they?

Well, this week, researchers announced they’d found an answer to one of the eternal questions:

  • Why does massaging muscles make them feel so good?

And though it feels good, does it make any “real” difference at a molecular level in terms of what happens to the muscles?

How’s this for a study design? Eleven men volunteered, and then, according to Shots:

The men exercised hard, riding a stationary bike until they could ride no more. After that, one leg got a 10-minute massage. The researchers compared muscle cells from the two legs at a very deep level.

They found that the massaged muscles produced fewer cytokines, proteins that can cause swelling and soreness. Those lucky muscles also made more new mitochondria, which produce energy in the body’s cells.

singular: mitochondrion

Mitochondria are the organelles (tiny organs in our body’s cells) that make energy by using oxygen in a chemical reaction to create a chemical called ATP. As the basic storage unit of cellular energy, ATP is what at a macro level allows us to move, think, eat and dance (among other activities).

What goes unsaid in the description of the experiment above is that each man had to undergo not one but two muscle biospies–one for each leg to compare the massaged muscle to the non-massaged one.

That is not a pleasant prospect. But these men are apparently devoted to science. And apparently not deterred by pain.

No word on whether they were compensated for their time and tissue.

One other important discovery: massage did nothing to diminish the amount of lactic acid in the muscles. The idea that massage gets rid of it is bunk.

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