nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Tuesday, May 10, 2011

Notice To Readers

My posts to this blog will slow down.  At approximately one month from this date, it will no longer be available on the Kindle as a subscription.

After almost 1000 posts over a three year period, I will be moving on to other projects.  The blog website will stay up and I may publish to it on occasion.  As the sole author, I find the other things I'm doing are making it harder to maintain the flow.  It's unfair to subscribers, who expect a product on a regular basis.

For website subscribers and followers, there are no consequences.  For Kindle subscribers, you will see the number of posts get less over the next few weeks.  This will give you adequate time to unsubscribe.  At $0.99 a month the financial change will be minimal.  Amazon will keep posts available which you have already received, in case you want to re-download something (if I understand all the legalese correctly).

On the whole, it's been fun, and a learning experience.  In addition, it has kept me "up to date" on the literature, and the media's frequent mis-reading of it.

Health care reform is a mess, the media still plays on fears and hopes by hype and distortion, and even the science will frequently prove to be wrong.  So, nothing has changed, and won't...unless you do the work of finding out for yourself.

Thanks for reading.

Best wishes,

James J Dougherty, MD, MPH, FACPM
Brigadier General, USAF (ret)


Monday, May 9, 2011

Medical Quotes v2 - 9 May

 What is--and is not--a disease?
"The history of medicine is filled with examples of new drugs and technologies functioning to change popular and professional thinking about what counts as a disease or a health care problem....Neither baldness nor erectile dysfunction in aging men nor a less-than-desirable nose shape was considered a medical problem--until medicine found a way to do something about them."
--Medicine and the Market, by Daniel Callahan and Angela A. Wasunna (Johns Hopkins Univ Press, 2006)

Is mortality a disease?  How about poor decision-making...a disease?

Doc D

STUDY: Cancer Rates By Sexual Orientation. A Waste Of Research Funds

The last several days have been very boring...medically speaking.

If I see another bin Laden story, I'll lose control.

[Maybe there's a connection.  Maybe bad news (in the sense of "unworthy") crowds out the good (in the sense of "valuable information").]

So, all I've been reading are the usual highly technical journal articles, like this:
"Ranibizumab and Bevacizumab for Neovascular Age-Related Macular Degeneration"  (NEJM, Apr 28)
It's an important study, but has no appeal unless you're treating patients.

The rest of what the media is publishing hovers around ground-breakingly empty stories about how pets can improve health or 10 new healthy recipes for okra, and the like.

If I'm not interested in that fluff, then I assume you won't be.

But this one caught my eye, if only to condemn this kind of reporting
"Gay men 'report higher cancer rate than straight men'" (BBC News, 9 May, but also reported in other media.  The original study is in the journal Cancer)
Apparently women don't exhibit a parallel rate difference.

Studies like this come from the category of research--epidemiologic studies--that are least valuable, most often wrong, and most vulnerable to bias and confounding factors.

This will almost certainly turn out to be (1) an unverifiable result, (2) subject to selection bias, or (3) due to an unidentified, third variable that distinguishes the two groups (like age, education, income, and a whole laundry list of other inconsequential things).

What's its NOT, is any indication that sexual preference determines getting cancer.  

So, you have to ask why they even wasted the research funds.

Doc D

Friday, May 6, 2011

Measles Continues To Spread. Thanks, Wakefield, McCarthy, and...Oprah

Just Google the word "measles" to find that the US is not the only country experiencing a big increase in cases, all due to vulnerable unvaccinated children.

This follows in the immediate wake of increased cases of pertussis...for the same reasons.

I blame the people above, among others.  Andrew Wakefield published fraudulent research linking autism to vaccines.  Jenny McCarthy is still convinced (and will be, no matter what) that vaccines caused her child's autism, and Oprah has given McCarthy and others an open forum to reach millions with their scare tactics.

All this, in the face of repeated well-conducted, large-scale, controlled studies that show there is no such link to vaccines.

Someone said that the success of vaccines is the source of their downfall.  As the diseases--which ran rampant--began to disappear, people began to adopt New Age fears about things that are not "natural" or "organic."  (vaccines are organic, of course, but they're have to stick somebody).

I saw a case of measles in medical school, but none since.  I guess I'll have to go back to the textbooks to re-learn the diagnosis and therapy now that people are too stupid to protect their children. 

In my childhood, it was just expected that you caught chicken pox, measles, mumps, and rubella.  I got 'em all.  A few kids died.  It was part of life.  There were also about 100,000 cases of polio every summer, and parents feared greatly.  The vision of rooms full of iron lungs, breathing for children whose respiratory muscles had been paralyzed by the polio virus, was horrifying.

All that's gone now, but it's return was probably inevitable.  An irresponsible media and a handful of wacky advocates were enough to overcome people's ability to reason and to prey on their fears.  We deride primitive man for his irrational fears, and bizarre explanations for what happens to us (demons, witches, curses, etc).

But we're no different, just more technological.

I posted on the vaccine life cycle a long time ago.  The vaccination--disease disappearance--decreased vaccination--disease reappearance process has been recognized for decades.  See that post here.

As one distressed mother told a reporter, she had heard all the warnings about vaccines and thought that childhood illnesses were all pretty benign, anyway.  She didn't have her child vaccinated, and after the child's death, could only say, "I had no idea these illnesses were such a potentially deadly threat."

A tragic way to learn.

Doc D

Wednesday, May 4, 2011

Medical Quotes v2 - 4 May

Talking about how medical research is vetted by reviewers before publication:

"When, as a test, 211 of the British Medical Journal's frequent referees were sent an article purposely tainted with eight presumably detectable problems, the reviewers managed to catch an average of two.  More than half the time, peer reviewers don't even agree on publication worthiness, according to one study of a range of journals; reviewers for the New England Journal of Medicine, for example, see eye to eye only one-fourth of the time."
--Wrong:  Why experts keep failing us..., by David H. Freedman (Little, Brown, & Co, 2010)

Doesn't give you great confidence that the process weeds out poor or inaccurate work, does it?

Doc D

Europe Ahead Of US In Regulating Herbals. A Good First Step, Why Not Here?

There's an article in Science-Based Medicine (4 May) that discusses Europe's new regulatory requirement to demonstrate safety of herbal products.

It's about time.  Now if the US would just wake up to the harmful consequences of some of these often adulterated products.

For those who think herbal "medicines" can only be good for you, we have multiple instances of common ingredients--found in a range of these products--that damage the kidneys (aristolochia) and the liver (kava).  The worst case reported to date was ephedra (known as ma huang in Chinese medicine, used for asthma, colds, and weight loss).  From Wikipedia,
"Ephedra-containing dietary supplements have been linked to a high rate of serious side effects and a number of deaths, leading to concern from the U.S. Food and Drug Administration (FDA), the National Center for Complementary and Alternative Medicine, and the medical community.  However, initial efforts to test and regulate ephedra were defeated by lobbying and political pressure from the dietary supplement industry.  Ultimately, in response to accumulating evidence of adverse effects and deaths related to ephedra, the FDA banned the sale of ephedra-containing supplements on April 12, 2004."
How many people were harmed while lobbyists for the herbal manufacturers stymied efforts to restrict its use?  Even the Natl Center for CAM was worried.

In this country no herbal regulations exist.  You can take a plant, grind it up, and say it cures almost anything.  No proof required.  Your only problem, after you make millions off the gullible, is if enough people keel over dead that somebody notices they were all taking your product.  Pretty cool deal, huh?  Then you can flee the US and live handsomely in a non-extradition country.

As you might imagine European herbal manufacturers are screaming that this is a "ban" on herbals.  It's actually very simple, and not very stringent:  they have to be licensed by showing some evidence of safety.  That's minimal compared to what pharmaceuticals have to prove.

Some of my friends say, "Well the herbals are much cheaper, and I can better afford them."  This logic defies common sense.  Of course they're cheaper:  the makers don't have to spend money purifying the product and can leave in all the adulterants and other compounds for which we have no data on safety, and they don't have to do any research to establish that it works.  So, of course it costs less to make, and costs less to sell.  Not rocket science. 

To those who worry about the cost of effective drugs, save all your money and don't spend it on poor quality, adulterated products.

More importantly, all the large scale studies of most of these things--that people shell out 5-10 dollars for--have been shown to be ineffective.  So, doing nothing will leave you even more financially well off.

If your goal is to save money rather than get well.

Now that REALLY makes sense. 

Doc D

Monday, May 2, 2011

STUDY: Obese People Not Getting Sexually Satisfied

A survey-based study published in the Journal of Sex and Marital Therapy shows that "obese men's satisfaction scores fell between the cancer survivors and the general population, while obese women scored lower than both groups."


The research (reported in USA Today Your Life blog, 1 May) alleges that as body mass index increases men and women report decreased "functioning only for arousal and behavior."

Is there something else that this is "only?"  There must be other categories like performance, and attitude, or channeling, maybe.  After some consideration, I confess to being clinically illiterate in the jargon of the sexual literature.

But out of curiosity I went to the journal's website.  I'd never heard of it.  There were articles on erotic stories as sexual adjuvants, a proposed "Hypoactive Desire" registry,  the democratizing of transgenderism (what?), and pregnancy sex in Turkey.

It's been a while since I've had as much fun with nonsense.  I hope my tax bill didn't fund any of this.

IMO, this journal falls somewhere between the New England Journal and Hustler Magazine.

Doc D

Sunday, May 1, 2011

Medical Quotes v2 - 1 May

When I first bought a personal computer it was very expensive.  As technology got better, the price went way down.  Why has health care done the opposite? 

Everybody has an opinion.  Here's a refreshing perspective about spending that doesn't come directly out of your own pocket.

"On the whole, advancing medical technology, unlike agriculture or telecommunications, has been accompanied by exploding costs.  Why is health care the exception?  The reason is simple:  Americans do not pay directly for physicians or hospitals or other health providers.  A third party makes the vast majority of payments in the United States.  And as Prof. Friedman has observed, nobody spends somebody else's money as wisely as he spends his own."
--The Cure:  How Capitalism Can Save American Health Care, by Dr. David Gratzer (2006)

For those who say that market-based health care has failed, that's not the case.  To praphrase G. K. Chesterton on Christianity, it's not that market-based care has been tried and failed, it's that it's been found hard, and not been tried. 

The last time we had market-based care in this country was prior to World War II, when employers began to offer health insurance as an inducement, under wartime wage caps that made it hard to attract employees.  Since then, health care has become the most highly regulated segment of our economy.

Doc D

Dr. Mercola Warned By The FDA About Unwarranted Claims

Proof that in the Information Age popularity is a credential that fosters belief.

Dr. Mercola is one of those notorious alternative health gurus who make a lot of unverified claims about the therapeutic benefit of nutritional and other substances.  People who believe his claims point to his popularity as a reason to believe what he says; "he can't be wrong if he's so popular."  "He's appeared on Dr. Oz's show more than once."  Really?

When did popular hysteria become a valid form of reasoning?
And readers know my opinion of the supernatural stuff that Dr. Oz promotes.

In this country, anyone is free to make a claim about things that can't be confirmed or verified, like energy healing, homeopathy, and naturopathy.  No oversight is possible because the foundation of these claims can't be addressed; they all rely on invisible and undetectable forces that only an adept or person with special knowledge (unavailable to normal humans) can identify and exploit.

Conversely, in this country, you can't claim an FDA-approved medical device has capabilities that are beyond those for which the device was approved.  And Dr. M crossed that line.

Dr. Mercola's website claims that his Meditherm camera can diagnose or screen for diseases of the breast, and is more sensitive than mammography.  This is false, and I hope women won't be fooled into avoiding mammography.  The FDA has sent a warning to Dr. Mercola (see here) to stop making this claim, and to withdraw several other statements about his Meditherm camera.

From the FDA letter:
"Your website promotes the Meditherm Med2000 Telethermographic camera for uses for which you have not obtained marketing approval or clearance, which is a violation of the law....The FDA requests that you immediately cease making claims, identical or similar to those described above, for this product. You should take prompt action to correct these violations. Failure to correct these violations promptly may result in the initiation of regulatory action by the Food and Drug Administration without further notice. These actions include, but are not limited to seizure, injunction, and/or civil money penalties."
For the record, the device under consideration merely measures skin temperature over a specified surface area.  Skin temperature fluctuates greatly as the surrounding air temperature changes, basal metabolic rate increases or decreases, with fever, and when substances are in contact with the skin (chemicals, but also clothing).  As such, it is an imprecise measure of temperature at the surface, much less of what's going on below the skin.

The FDA originally approved the Meditherm camera for "viewing and digitally storing thermal patterns generated by the human body..."  Nothing was stated or implied that it was approved for screening, diagnosis, or treatment.

Apparently the good doctor has decided to defy the FDA (Chicago Tribune, 26 Apr).  This is going to be interesting.  It will put him in the same category as Dr. Wakefield, the anti-vaccine "fraudster" who lost his medical license.

In my opinion, some recognized, expert agency needs to exercise oversight of all alternative and complementary substances and devices.  They are sometimes harmful, but we have no way to know until they cause enough harm to surface through anecdotes.  The only reason Dr. M is being stopped is because he's using a medical device that comes under the purview of the FDA.  We need the same regulatory safety for herbals, supplements, and wacky therapies that don't make sense.
Finally, it's OK if you watch Dr. Oz, or read Dr. Mercola's long as it's for the entertainment value and not real health advice.

Doc D


What I'm Reading - Updated 3 May