Eastern religion is often sterilized for Western consumption

---and marketed as health methodology, science, self help or, as in the case of this recent Medscape article, stress management. The article, innocuously titled “Stress and the Mind”, reminds us that stress results from a mismatch between what we expect and what the environment delivers; that we can help reduce this stress by adjusting our own attitudes and expectations; that we should count our blessings and cultivate altruism.

Well, there are no overtly religious themes there. At first glance it sounds like nothing more than sage advice. But, on closer inspection, the article appears to be a promotional piece for Vedanta, an ancient branch of Hinduism. One of the problems with the piece is a lack of full disclosure. Although the article has a link to the vedantausa page (which itself appears to be almost stripped of religious references---one has to go deep into the website to find them) and, for purposes of attribution, an acknowledgement of Swami A. Parthasarathy there is no author information and there are no references (this may be a site error---the links don’t work!).

In Medscape of all places.

Scientology implicated in stabbings

---according to this report from the Sidney Morning Herald.

THE young woman needed psychiatric care, and she knew it. She tried to get help twice, but her Scientologist parents had a religious objection to psychiatric intervention.

Read the rest.

The American Medical Student Association flunks the Quackometer test

I’ve cited many examples of quackery promotion by the AMSA before, but have not subjected the organization to any sort of quantitative analysis. So, I decided to plug their url into the Quackometer and this is what I found:

This web site is using lots of alternative medicine terms. It is full of scientific jargon that is out of place and probably doesn't know the meaning of any of the terms. It shows no sceptical awareness and so should be treated with a suspicious mind.

Now the Quackometer, mind you, is an experiment in whether quacky web sites can be identified by automation. Take that for what it’s worth. But its “reading” on AMSA pretty well matches my own observations.

It's been a good week (nonmedical)

I had some time off last week, so my wife and I joined the RW sibs in our home town (and the place we generally converge for family reunions), St. Louis. In addition to family time the trip afforded me an opportunity to visit some old haunts and play with my Sony Cyber-shot, some results of which are shown. I could have spent an entire day or two grabbing images of the architectural wonders of my beloved St. Louis, but I tried the patience of my family just to get these. (They'd probably think I was being dorky).

Above is the view looking east down Market Street. Union Station is on the right. The building on the left in front of the Arch is the St. Louis Civil Courts building.

Below is Aloe Plaza, across Market Street from Union Station.

Finally, a shot of my kid bro showing off atop the steps of Brookings Hall on the beautiful campus of his alma mater, Washington University.

Introducing the Quackometer

Boy am I gonna have some fun with this.

The latest buzz on hospital medicine

---with hospitalist thought leader Bob Wachter. You can access his podcast interview at the SHM national meeting here. Interesting how his projections on the number of future hospitalists keep increasing.

When medical ingenuity outpaces bureaucracy

The government is not, and should not be, the final arbiter of medical progress. This is particularly true in the field of electrophysiology. Dr. Wes drives the point home as he comments on a New York Times article about government scrutiny of the profusion of devices and ablation procedures for atrial fibrillation:

The field of electrophysiology has a history of far-exceeding regulatory capabilities in the bureaucracy of government. Look at radiofrequency catheter ablation. If we hadn't moved from DC shock to radiofrequency energy sources, many, many more people would have been harmed during catheter ablation procedures. Doctors did this because it was safer for patients and less anxiety-provoking for them during the procedure - not because of governmental regulations.

Patient empowerment: can it go too far?

In the last 30 years or so we have moved from medical paternalism to medical consumerism. An About.com article entitled Are You an Empowered Patient...or a Pain in the Neck? addresses some unintended consequences. (Via Kevin M.D.).

Among the questions asked are Do You Bring in Pages of Printouts from the Internet?

If so, you could be interfering with the effectiveness of your visit. One of two things may happen: Your doctor may spend most of your appointment time reading through your printouts, or your doctor may decide that he/she doesn't have time to even look at the printouts at all, and ignore them completely.

I would add that if Internet homework presented at the appointment is to be anything more than a distraction it needs to be evidence based. But evidence based patient participation, as I demonstrated before, is arduous and requires a certain degree of skill. How many patients can do it?

Exchanging anecdotes: Sicko versus Dead Meat

Kurt Loder’s critical review of Michael Moore’s Sicko makes the case that the film is unbalanced and non-evidence based:

Unfortunately, Moore is also a con man of a very brazen sort, and never more so than in this film. His cherry-picked facts, manipulative interviews (with lingering close-ups of distraught people breaking down in tears) and blithe assertions (how does he know 18,000* people will die this year because they have no health insurance?) are so stacked that you can feel his whole argument sliding sideways as the picture unspools.

Moore and others clamor for universal access. But as Loder illustrates, in socialized healthcare systems this access is often merely access to waiting lists. That point is also well made in the 2005 documentary Dead Meat which portrays Canada’s system in a negative light.

When it comes right down to it, the two films constitute an exchange of anecdotes. A balanced view of the controversy might require viewing both.

Neuromuscular disorders in the ICU

Acute Neuromuscular Weakness In The Intensive Care Unit was reviewed in a recent issue of Critical Care Medicine.

Katrina charges against nurses dropped

---in exchange for their testimony in the continuing grand jury proceedings against Dr. Anna Pou. Via Forbes.

Forensic scientist tests DNA in her husband’s underwear

---to prove infidelity.

A state forensics scientist who said she tested DNA in her husband's underwear to find out whether he was cheating could be disciplined if investigators determine she violated the use of state equipment.

Her findings? “Another female. It wasn't me.”

P4P for patients

That’s what the Healthy Americans Act, S.334, cosponsored by Senators Bob Bennett (R-Utah) and Ron Wyden (D-Ore.) seems to offer. Patients would have financial incentives to lead healthy lifestyles.

Healthy behavior incentives are working in other countries around the world. For example, in Switzerland, where only 11 percent of GDP is spent on health care and everyone is required to purchase his own private health plan, competition has led to innovative incentives. Some plans offer lump-sum cash awards for those who stay healthy; others penalize unhealthy habits or behaviors.

People respond to incentives, and if there are incentives for individuals to stay healthy, we will make a significant difference in driving down health care costs. The Healthy Americans Act promotes personal responsibility and prevention by offering discounted premiums for participation in wellness programs and by rewarding providers for helping their patients stay healthy.

How are doctors reacting to the Avandia meta-analysis?

The July 1 issue of DOC News tackled that question. Doctors are reporting a range of actions:

Therein lies the dilemma for physicians: How should they advise the legions of patients calling with rosiglitazone questions? On one end of the spectrum, clinicians are watching and waiting. On the other end, they are taking all their patients off rosiglitazone, sometimes switching them to pioglitazone, and sometimes taking them off all TZDs. Physicians taking a middle-of-the-road position are discontinuing rosiglitazone only in patients with the highest cardiovascular disease (CVD) risk and more closely monitoring those who stay on the drug.

Some physicians are asking patients to make the decision. But how well can patients parse the evidence? How many patients can appreciate the methodological and statistical issues surrounding the meta-analysis and evaluate them in light of other evidence about TZDs and alternative treatments?

Dr. Curt Furberg of Wake Forest University seems to go a step beyond his editorial opinion in NEJM by suggesting that all patients be switched from Avandia.

"If my wife were on a TZD, I'd switch her," Furberg says. "You don't gamble when treating patients. You play it safe."

The blogosphere’s reaction to the Google health Advisory Council

Is it a case of sour grapes? The Open Medicine Blog wonders.

U.S. versus Canada in treatment of survivors of cardiac arrest

Survival of cardiac arrest due to ventricular arrhythmia not due to a transient or reversible cause is a slam-dunk indication for an implantable defibrillator. However, almost twice as many eligible patients in the U.S. receive this treatment as do those in Canada according to this report from CMAJ:

In Canada, 3793 patients survived to discharge after a cardiac arrest; 628 (16.6%) of these were implanted with a cardioverter defibrillator before discharge. The implant rate rose steadily from 5.4% in 1994/95 to 26.7% in 2002/03. In the United States, 23 688 (30.2%) of 78 538 such survivors received an implantable cardioverter defibrillator before discharge.

Scrubs for Sicko

Some healthcare workers are campaigning to promote the film.

AMSA teams with Michael Moore, lauds Sicko

From an AMSA press release:

Members of the American Medical Student Association (AMSA) joined nurses, survivors of the private health insurance industry, Michael Moore, and members of Congress in a historic hearing on the negative health impacts of the for-profit private insurance industry.

Here’s the rest.

Tinea pedis

Med Rants has done some research on treatment. One important reason to treat is the fact that many cases of lower leg cellulitis derive from tinea pedis.

Tips for cost effective inpatient medicine

In response to a reader's request DB of Med Rants posted these suggestions.