When a “scientific study” is neither

by Peter Lipson in Science-Based Medicine

There is quite a bit of art to the practice of medicine: knowing how to get and to give information to a patient, how to create a sense of worry without creating a feeling of panic, how to use the best available science to help them maintain or return to health.  Underlying all of the [...]... Read more »

When a "scientific study" is neither

by PalMD in White Coat Underground

There is quite a bit of art to the practice of medicine: knowing how to get and to give information to a patient, how to create a sense of worry without creating a feeling of panic, how to use the best available science to help them maintain or return to health.  Underlying all of the [...]... Read more »

Asthma, placebo, and how not to kill your patients

by Peter Lipson in Science-Based Medicine

A number of years ago I was walking along Lake Michigan with a friend (a fellow medical resident) when she turned to me and said, “are you wheezing?  Do you have asthma?”  I had always been physically active and assumed my breathlessness while walking down the trail was due to the thirty extra pounds of [...]... Read more »

Asthma, placebo, and how not to kill your patients

by PalMD in White Coat Underground

A number of years ago I was walking along Lake Michigan with a friend (a fellow medical resident) when she turned to me and said, "are you wheezing?  Do you have asthma?"  I had always been physically active and assumed my breathlessness while walking down the trail was due to the thirty extra pounds of [...]... Read more »

The "hCG diet": a fraud literally without substance

by PalMD in White Coat Underground

Back in the 1950s, a British endocrinologist named ATW Simeons had an idea: a human pregnancy hormone called hCG (human chorionic gonadotropin) could help people lose weight without feeling hungry.  His idea was to put obese patients on a 500 kcal a day diet (in contrast, you probably eat about that much or more at [...]... Read more »

by PalMD in White Coat Underground

I can't seem to stop myself from writing about pee, and I'm not even a nephrologist.  But I deal with pee every day, and many of my younger patients with urinary tract infections will tell me all of the home and herbal remedies they tried before they came to see me.  One of the most [...]... Read more »

How much would you pay to see your doctor?

by PalMD in White Coat Underground

We pay far too much for health care in this country, spending ridiculous amounts and getting outcomes no better than countries that spend a fraction of what we do.  But most efforts at reforming the system have been aimed not toward better, more cost-effective care. The last twenty years have seen all sorts of experiments [...]... Read more »

Dr. Oz, you’re not helping diabetics

by PalMD in White Coat Underground

Dr. Mehmet Oz is one of America’s most influential doctors.  Just ask him.  He has a TV show and everything.  And in the past, much of his advice had been practical and mundane, the same advice you might hear from your own (perhaps less charismatic) physician.  But lately, he’s been giving out frankly bizarre medical [...]... Read more »

Blood coming out the wazoo

by PalMD in White Coat Underground

The ICU can be a terrifying place for an intern.  Of course, the patients are probably a bit more frightened, but then, many of them are unconscious.  Rounds are endless in the ICU; new admissions, work rounds, teaching rounds, evaluations for transfer, afternoon rounds, lasix rounds (don’t ask), all punctuated by CPR codes on the [...]... Read more »

A good idea gone horribly awry

by PalMD in White Coat Underground

In most scientific disciplines, medicine included, hypotheses start with observations.  When John Snow became curious about a London cholera outbreak, he looked for patterns and found that many cases centered around a local well.  While he didn’t have a clear idea what caused cholera, he suspected the water as a source, and tested his hypothesis [...]... Read more »

What does your doctor look like, and how much is she paid?

by PalMD in White Coat Underground

Not to be a nudge, but you could vote for me for a Medgadget Medical Weblog Award in one (or both, presumably) of two categories: Best Medical Blog, or Best Literary Medical Blog.  Voting will be open for another ten days. Currently, over 48% of medical school graduates are women.  Seven percent of medical school [...]... Read more »

Is abortion associated with mental illness?

by PalMD in White Coat Underground

Anti-abortion groups, having largely failed to convince the American public that abortion is morally abhorrent, have tried to shift the debate to their concern about women’s health.  The same groups who would forbid abortion after rape or incest, or when the mother’s life is endangered claim to be saving women from “post-abortion syndrome”, a mythical [...]... Read more »

Another worry for breast cancer patients?

by PalMD in White Coat Underground

Breast cancer is the most common (non-skin) cancer in women, and despite advances in treatment, it is still deeply feared, and with good reason.  But breast cancer is really several different diseases.  Breast cancers can arise from several different cell types, they can occur during the pre- or post-menopausal period, and they can have various [...]... Read more »

You wouldn’t lie to me, would you?

by PalMD in White Coat Underground

“Fake Pills Can Work, Even If Patients Know It” “Irritable Bowel Syndrome: Placebo Works Even if Patients Know” “Knowingly taking a placebo helps, study finds” “Sugar Pills Work Even When People Know They Are Fake” That’s just a sample of the headlines accompanying a new study on placebos published in PLoS ONE.  The study attempts [...]... Read more »

Stick a needle in your eye?

by PalMD in White Coat Underground

I was talking to a Reuters reporter the other day and learned of a new acupuncture study out of China, this one about amblyopia, or “lazy eye”.   Amblyopia is a common and interesting visual problem.  During development of the visual system if an eye is understimulated, the brain will not process data coming from [...]... Read more »

Pregnant and high: new treatments?

by PalMD in White Coat Underground

Many years ago a woman came to OB triage at my hospital.  She was about 28 weeks pregnant and feeling horrible.   As the nurses hooked her up to monitors and started an IV, she clutched a pink, kidney-shaped emesis basin, her boyfriend holding her hair back and away.  A few minutes later, she called [...]... Read more »

Breathe deep?

by PalMD in White Coat Underground

Winter has come to the Great Lakes, no matter what the calendar says.  This morning I walked out the door to take out the trash and the cold took my breath away.   I warmed up the car while I had breakfast, perhaps not the most environmentally friendly practice, but… On my way to work, depending [...]... Read more »

HIV in America—where do we go from here?

by PalMD in White Coat Underground

The HIV pandemic in the US has developed a stable appearance over the last few years, and that appearance is notably non-white and non-wealthy.  When the pandemic was discovered nearly thirty years ago, it was—in the US—primarily a disease of gay men.  In Africa, the disease is everyone’s.  Women make up significantly more than half [...]... Read more »

Omega-3′s and heart disease: where’s the evidence?

by PalMD in White Coat Underground

Omega-3 fatty acids (more properly called “n-3 fatty acids”) are a group of naturally occurring fat molecules.  They are found mainly in fish and other marine-derived oils, but some can also be extracted from plants.  Omega-3′s are currently very popular, but the evidence for their usefulness isn’t so clear.   A recent study failed to [...]... Read more »