dras knowledge

Thursday, June 24, 2004

When to choose traditional over "natural" medicine

It does strike me as a little hypocritical should someone esteem "natural" medicine, denounce doctors, then go for surgical breast augmentation. If she had chosen the naturopathic means for enhancement, she would have every reason to seek a naturopathic remedy. But, since she chose a medical option instead, she is obliged to return for a medical solution.

If she has fairly new implants and is already complaining of capsule, or if one is much worse than the other, it should be checked out by the surgeon and maybe radiologically. This could be a sign of acute leaking or rupture, or unresolved damage to surrounding tissue, which doubtless cannot be corrected with naturopathy or homeopathy or whatever else. Although modern implant material is non-toxic, living with a ruptured or leaky implant is often not a pleasant experience, I'm told. Implants naturally develop capsules over time to some degree, which often cause pain and contracture and make it difficult to screen for cancer. Implants with capsules don't look or (er) act(?) much like the real thing. When the cosmesis, (er) performance(?), and/or discomfort gets to a certain point, I expect she'll seek real medical attention. The sooner the better if she wants a good chance at a satisfactory outcome.

Thursday, June 17, 2004

"Oxegen" occurs what ails you

A big banner ad in my local paper this morning touts Oxegen (asupplement that purportedly increases nitrous oxide levels inthe body) as a wonder supplement that will boost your muscles,double or triple the caliber of your blood vessels*, improveyour sex life (I guess this follows from the first two claims)etc. etc. It is available at CVS drugstores (as the adrepeatedly reminds us). We are told that the supplement (or atleast its constituent ingredients) is backed by "controlled"clinical research, though of course none is listed in the ad.

My reply:
Since the late 80's much research has been done concerning Nitric oxide production and effects in the body. Abnormalities in the body's production of nitric oxide have been implicated in high blood pressure, atherosclerosis, diabetes, impotence, and stroke.

Per google and a quick MEDLINE search, Nitric oxide still appears to be a buzz-word in the supplement/body building industry with essentially all practical therapeutic application in science limited to clinical and animal studies.

Nitric Oxide (NO), commonly known as the exhaust gas that becomes poisonous Nitrogen Dioxide (NO2), is very different, but often confused with Nitrous Oxide (N2O), which is more associated with dentists, racing, whipping cream, or effluence from landfills. Out of the anesthesia context, I'd wager the only time you see Nitrous Oxide mentioned in medicine is when it is being mistaken for Nitric Oxide.

When you have something as cheap to make as L-arginine, and understanding its association with NO production in the body, along with the maintained scientific hype over NO effects in the human body, it's no wonder related supplements are a genuine cash cow for the supplement industry.

Mind you... Despite nearly a decade of intense scientific research on the body's production of NO and the impact of the NO on the human body, no real practical products for the pharmaceutical industry (including L-arginine) have emerged (outside limited use of NO gas administered for severe lung conditions.) There have been some disappointing outcomes in the NO related studies.

Interesting stuff, at least from the scientific perspective, about which I could yak on for a few more paragraphs. The nutrition sites I visited sure sounded scientific. A few were 95% nonsense (much like the one below), some, I could not have written better to be more convincing. Even with a cutting edge understanding of the physiology, it's easy to see how ANYONE can get caught up in the speculation of what a product could do versus what it is known or shown to do.

-dr

Monday, June 14, 2004

Hospitals kill children

http://pediatrics.aappublications.org/cgi/content/abstract/113/6/1741
http://www.ahrq.gov/news/press/pr2004/chhosppr.htm

How easy will it be to pull numbers out of this study and report to support a fear factor against mainstream care in favor of non-traditional (CAM) alternatives? I found this in the Baltimore Sun: "More than 4,000 children died in 2000 because of lapses, which cost more than $1 billion in extra hospital charges from longer stays and follow-up care for the ill and injured." and '"The bottom line is, as far as we can tell, these are all preventable.'" http://www.baltimoresun.com/news/local/bal-te.md.safety07jun07,0,3865600.story

Of course, the intent of the information is to bring awareness, and maybe safeguards or policy change, to improve quality of care delivery and perhaps reduce the natural courses of human error. But it's an all to easy extension to make the argument to NOT use doctors and hospitals for health care needs. The AHRQ press release seems to suggest most of the errors are inferred due to the existence of a post- procedure infection. Methods of analyzing the data in arriving at the AAP published conclusions look very high-tech. I look forward to "letters" in future editions.

dr-

Monday, June 07, 2004

Scientology seeks public funds and gradeschool forum

June 7, 2004
http://deseretnews.com/dn/view/0,1249,595068582,00.html
Bizarre or not, school plan alive
Copyright 2004 Deseret Morning News
By Jennifer Toomer-CookDeseret Morning News
Giving schoolchildren nutritional supplements to boost academic performance. Detoxifying alternative high school students through exercise in saunas. Teaching study skills to struggling students under a program created by L. Ron Hubbard, whose philosophies founded the Church of Scientology. Some lawmakers think these could be good ways to improve public schools. The Education Interim Committee last winter gave its blessing to those and other academically geared proposals forwarded by the group Innovations in Education as part of a bidding process to improve public schools. The Legislature this spring redirected $1 million in hopes state school leaders would implement the proposal, though there's some question whether the unconventional parts would be included. Gov. Olene Walker vetoed the item. But the proposal lives on.
>snip<
For more information and commentary see:
http://www.studytech.org/study_tech.php
http://www.appliedscholastics.org/
http://deseretnews.com/dn/view/0,1249,595068983,00.html
http://www.nevadarancher.com/rminer/rm2003/rmsep4a.htm

Friday, June 04, 2004

Science and Religion

Science and Religion, again

Getting rid of chiropractic (or, for that matter, Hulda and her ilk) is about as realistic a goal as getting rid of religion in general. Appealing idea, but unworkable---far too many ardent followers.

My reply:
This statement seems to equate ideals of faith-based alternative and potentially fraudulent health practices with all of religion. I believe science and religion can coexist harmoniously and that religion will always provide a necessary fiber of human society that can't be supplanted by scientific derived data. The danger is in doing so, or substituting or confusing science with religious faith or religious faith with science. This is what we should get rid of.

Some of the faithful may need to reassess the purpose of religion in their lives. Despite similarities, there is a distinction between religious faith and the religious-like faith of some quackeries and pseudoscience.

Religious faith has more to do with such as the following:
1. Save the soul
2. Establish identity in the universe
3. Teach to have charity to fellowman
4. Provide direction in coping with life's trials

Religious-like faith, superstition, and pseudoscience, as is seen in much of (sc)alternative medicine, has more to do with such as the following:
1. Provide simple explanations of nature's mysteries
2. Reveal biologic data not understood by man
3. Dictate a rite that will grant health or wealth or wishes

Not all religion is pre-occupied with demonization of disbelievers. Zeal is a likely companion of faith based belief, but it is not always expressed as discontent to unbelievers.

We can, and should, broad-stroke all in medicine that is not verifiable as religion; but, we can't bucket all religion as fraud, or no better.

By the way, the late (and greatly lamented) Stephen J. Gould put forth an idea he called "Non-overlapping Magisteria." I recommend his works (even ifyou aren't into paleontology) and I find his concept very useful when dealing with people where religion Vs. science is important.

What is health fraud?

I was once given about 40 minutes to speak with a group of Associate degree nursing students about Health Insurance fraud. I touched a little on how ineligible services can be misrepresented on insurance claims. Thinking back, I could have done much better by presenting a separate topic on EBM. What seemed plain to me, ie., surface EMG does not equal EMG, or prolotherapy does not equal trigger point injections, was taken by this group as insurance companies denying potentially beneficial care.

Since then I have continued to be amazed at the lack of sometimes common-sense critical thinking of Allied Healthcare professionals* when it comes to so-called Integrative medicine. Many seem to be eager to embrace it based solely on proponent published propaganda.

-dras

*I confess, I've been equally amazed at physicians, pharmacists and large health institutions eagerness to accept some obvious dubious practice or treatment as well. *sigh*