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- February 23, 2010
- 03:35 PM
- 57 views
Platelet rich plasma
by PalMD in White Coat Underground
Several months ago, Dr. Val Jones wrote about a growing fad in the treatment of musculoskeletal disorders. The therapy, called platelet rich plasma (PRP) injection, involves taking a small amount of blood from a patient, spinning it down in a centrifuge, and then injecting the plasma component into...somewhere. This treatment is becoming increasingly popular, and can be very lucrative for doctors. But does it work?
Blood platelets are very biologically active particles and plasma is not a bl........ Read more »
de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, & Tol JL. (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA : the journal of the American Medical Association, 303(2), 144-9. PMID: 20068208
Markou N, Pepelassi E, Vavouraki H, Stamatakis HC, Nikolopoulos G, Vrotsos I, & Tsiklakis K. (2009) Treatment of periodontal endosseous defects with platelet-rich plasma alone or in combination with demineralized freeze-dried bone allograft: a comparative clinical trial. Journal of periodontology, 80(12), 1911-9. PMID: 19961374
Nin JR, Gasque GM, Azcárate AV, Beola JD, & Gonzalez MH. (2009) Has platelet-rich plasma any role in anterior cruciate ligament allograft healing?. Arthroscopy : the journal of arthroscopic , 25(11), 1206-13. PMID: 19896041
- February 22, 2010
- 02:28 PM
- 60 views
Clinical Marijuana Research Update
by PalMD in White Coat Underground
Human beings are fundamentally narcissistic, and this narcissism can be antithetical to good science and good medicine. We place far too much confidence in our individual abilities to understand what happens to us, and we place far too much importance on our own experiences, inappropriately generalizing them. That's why science is so important in medicine---to avoid basing life-or-death decisions on something some guy thinks he might have heard once.
In my recent piece on medical marijuana in........ Read more »
Abrams DI, Jay CA, Shade SB, Vizoso H, Reda H, Press S, Kelly ME, Rowbotham MC, & Petersen KL. (2007) Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology, 68(7), 515-21. PMID: 17296917
Ellis, R., Toperoff, W., Vaida, F., van den Brande, G., Gonzales, J., Gouaux, B., Bentley, H., & Atkinson, J. (2008) Smoked Medicinal Cannabis for Neuropathic Pain in HIV: A Randomized, Crossover Clinical Trial. Neuropsychopharmacology, 34(3), 672-680. DOI: 10.1038/npp.2008.120
- February 12, 2010
- 11:58 AM
- 78 views
A lurker in the forest
by PalMD in White Coat Underground
Human papillomavirus (HPV) is a fascinating little bugger. Certain strains can interfere with tumor suppressor genes leading to cancer, especially cervical, anal, and some mouth cancers. Other strains cause genital warts. The vaccine offered in the U.S. (Gardasil) protects against the two strains that cause most cancers and against two strains causing warts. The vaccine has the potential to change the way our population is affected by these diseases.
But we are still learning more about thi........ Read more »
Poljak, M., Kocjan, B., Potočnik, M., & Seme, K. (2009) Anogenital Hairs Are an Important Reservoir of Alpha‐Papillomaviruses in Patients with Genital Warts. The Journal of Infectious Diseases, 199(9), 1270-1274. DOI: 10.1086/597619
- February 1, 2010
- 03:01 PM
- 112 views
Success in the fight against childhood diarrhea
by Peter Lipson in Science-Based Medicine
Rotavirus is the world’s most common cause of severe childhood diarrhea. In the U.S. alone, rotavirus disease leads to around 70,000 hospitalizations, 3/4 million ER visits, and nearly half-a-million doctor office visits yearly. But it rarely causes death.
The same is not true for the developing world. Rotavirus disease is estimated to kill around a half-million [...]... Read more »
Madhi, S., Cunliffe, N., Steele, D., Witte, D., Kirsten, M., Louw, C., Ngwira, B., Victor, J., Gillard, P., Cheuvart, B.... (2010) Effect of Human Rotavirus Vaccine on Severe Diarrhea in African Infants. New England Journal of Medicine, 362(4), 289-298. DOI: 10.1056/NEJMoa0904797
Richardson, V., Hernandez-Pichardo, J., Quintanar-Solares, M., Esparza-Aguilar, M., Johnson, B., Gomez-Altamirano, C., Parashar, U., & Patel, M. (2010) Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico. New England Journal of Medicine, 362(4), 299-305. DOI: 10.1056/NEJMoa0905211
Patel, N., Hertel, P., Estes, M., de la Morena, M., Petru, A., Noroski, L., Revell, P., Hanson, I., Paul, M., Rosenblatt, H.... (2010) Vaccine-Acquired Rotavirus in Infants with Severe Combined Immunodeficiency. New England Journal of Medicine, 362(4), 314-319. DOI: 10.1056/NEJMoa0904485
- January 27, 2010
- 07:00 PM
- 106 views
Whose demons?
by PalMD in White Coat Underground
"...It never was our guise To slight the poor, or aught humane despise: For Jove unfold our hospitable door, 'Tis Jove that sends the stranger and the poor..."---Homer: The Odyssey, Translation by Alexander PopeA few weeks ago, Drugmonkey wrote a piece about perceptions of drug users. Specifically, the study looked at how mental health providers perceive people with substance use disorders depending on whether the patients were referred to being a "substance abuser" vs. havi........ Read more »
Kelly, J., & Westerhoff, C. (2009) Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms☆. International Journal of Drug Policy. DOI: 10.1016/j.drugpo.2009.10.010
Baldacchino A, Gilchrist G, Fleming R, & Bannister J. (2009) Guilty until proven innocent: A qualitative study of the management of chronic non-cancer pain among patients with a history of substance abuse. Addictive behaviors. PMID: 19897313
- December 21, 2009
- 02:35 PM
- 201 views
Multiple Sclerosis and Irrational Exuberance
by PalMD in White Coat Underground
Multiple sclerosis (MS) is fascinating illness that can range from mild annoyance to debilitating nightmare. The frightening nature and unclear cause of the disease makes it a magnet for questionable medical therapies (i.e. quackery). A piece published last week in (surprise!) the Huffington Post helps fuel the fires of suspicion and paranoia while failing to shed any light on the future of MS research.
Multiple sclerosis is a disease of the nervous system. Its victims develop symptoms bas........ Read more »
Frohman EM, Racke MK, & Raine CS. (2006) Multiple sclerosis--the plaque and its pathogenesis. The New England journal of medicine, 354(9), 942-55. PMID: 16510748
Zamboni, P., Galeotti, R., Menegatti, E., Malagoni, A., Tacconi, G., Dall'Ara, S., Bartolomei, I., & Salvi, F. (2008) Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. Journal of Neurology, Neurosurgery , 80(4), 392-399. DOI: 10.1136/jnnp.2008.157164
Zamboni, P., Galeotti, R., Menegatti, E., Malagoni, A., Gianesini, S., Bartolomei, I., Mascoli, F., & Salvi, F. (2009) A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. Journal of Vascular Surgery, 50(6), 1348-1358000. DOI: 10.1016/j.jvs.2009.07.096
- December 3, 2009
- 02:44 PM
- 206 views
How well do we understand sore throat?
by PalMD in White Coat Underground
He looked sick---really sick. He was sitting on a stretcher in an ER bay, flushed, breathing a bit quickly, but his youth seemed to compensate for the acuity of his illness, and he didn't feel nearly as bad has he looked. His fever was 104, his systolic blood pressure was in the 90s, his heart was racing. He'd had a sore throat recently, and rather than getting better started to feel weak, tired, and feverish. His mom finally dragged him in when he wouldn't stop shivering. His blood work wa........ Read more »
Centor RM. (2009) Expand the pharyngitis paradigm for adolescents and young adults. Annals of internal medicine, 151(11), 812-5. PMID: 19949147
Centor RM, Witherspoon JM, Dalton HP, Brody CE, & Link K. (1981) The diagnosis of strep throat in adults in the emergency room. Medical decision making : an international journal of the Society for Medical Decision Making, 1(3), 239-46. PMID: 6763125
Bliss SJ, Flanders SA, & Saint S. (2004) Clinical problem-solving. A pain in the neck. The New England journal of medicine, 350(10), 1037-42. PMID: 14999116
- December 2, 2009
- 01:28 PM
- 208 views
New Zicam study shows possible mechanism for anosmia
by PalMD in White Coat Underground
Remember the Zicam debacle? To catch you up, Zicam has been promoted for years as a "homeopathic cold remedy". It is of course neither. Since it contains measurable amounts of zinc, it isn't "homeopathic", and since there is no cure for the common cold, it's not a remedy. In addition to having neither of it's promoted qualities, the FDA has received hundreds of reports of people losing their sense of smell (became "anosmic") after using intranasal Zicam. As Steve Novella has pointed out, th........ Read more »
Lim, J., Davis, G., Wang, Z., Li, V., Wu, Y., Rue, T., & Storm, D. (2009) Zicam-Induced Damage to Mouse and Human Nasal Tissue. PLoS ONE, 4(10). DOI: 10.1371/journal.pone.0007647
- November 24, 2009
- 02:45 PM
- 740 views
Cannabis and cancer cachexia
by PalMD in White Coat Underground
One of the most frightening symptoms of advanced cancer is "cachexia", or severe, unintentional weight-loss and wasting. It's a terrible prognostic sign, and the only truly effective treatment is removal of the cancer. Treatment of this syndrome has the potential to improve quality of life in patients with advanced cancers. Various types of medications, including antidepressants, hormones, and cannabis derivatives have been tried with little effect. Treating the symptoms of incurable cancers........ Read more »
Strasser, F. (2006) Comparison of Orally Administered Cannabis Extract and Delta-9-Tetrahydrocannabinol in Treating Patients With Cancer-Related Anorexia-Cachexia Syndrome: A Multicenter, Phase III, Randomized, Double-Blind, Placebo-Controlled Clinical Trial From the Cannabi. Journal of Clinical Oncology, 24(21), 3394-3400. DOI: 10.1200/JCO.2005.05.1847
- November 13, 2009
- 01:59 PM
- 216 views
Mumps redux
by PalMD in White Coat Underground
The resurgence of vaccine-preventable diseases is a fascinating, if unwanted, phenomenon. Pertussis, measles, and now mumps are cropping up after long periods of quiescence. Mumps has been generally very well-controlled since the adoption of wide-spread vaccination, with no nation-wide outbreaks, but there have been a number of regional outbreaks, most notably in 2006 and now again in 2009. Since the widespread use of two-dose vaccines, mumps cases in the US have dropped by more than 99%.
In........ Read more »
Barskey, A., Glasser, J., & LeBaron, C. (2009) Mumps resurgences in the United States: A historical perspective on unexpected elements☆. Vaccine, 27(44), 6186-6195. DOI: 10.1016/j.vaccine.2009.06.109
- September 24, 2009
- 06:43 PM
- 385 views
Fibromyalgia, alternative medicine, and other bad ideas
by PalMD in White Coat Underground
It's like this: science requires a tolerance of failure. If your shiny, happy hypothesis fails to stand up to rigorous scrutiny, you drop it and move on. If instead of a true, disposable hypothesis, you have a fixed belief that will not change based on the data, you are delusional. Boosters of alternative medicine prefer the term "maverick" to "lunatic" but in the two are often the same.
It is nearly impossible to get someone to abandon a belief in alternative medicine, no matter how stron........ Read more »
Baranowsky, J., Klose, P., Musial, F., Haeuser, W., Dobos, G., & Langhorst, J. (2009) Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatology International. DOI: 10.1007/s00296-009-0977-5
- September 24, 2009
- 03:20 PM
- 195 views
CAM and Fibromyalgia
by Peter Lipson in Science-Based Medicine
One of the common themes regarding alternative medicine is the reversal of normal scientific thinking. In science, we must generally accept that we will fail to validate many of our hypotheses. Each of these failures moves us closer to the truth. In alternative medicine, hypotheses function more as fixed beliefs, and there [...]... Read more »
Baranowsky, J., Klose, P., Musial, F., Haeuser, W., Dobos, G., & Langhorst, J. (2009) Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatology International. DOI: 10.1007/s00296-009-0977-5
- September 9, 2009
- 05:26 PM
- 304 views
Why does plausibility matter? Because bad medicine kills
by PalMD in White Coat Underground
In the latest conversation about placebos, Steve Silberman got a number of things just right, including these converse statements:
Anthracyclines don't require an oncologist with a genial bedside manner to slow the growth of tumors.
...the placebo response has limits. It can ease the discomfort of chemotherapy, but it won't stop the growth of tumors.
Placebo, if it exists as a utile clinical entity (and I'm still not convinced) cannot cure cancer---but chemotherapy can, no matter what hand wa........ Read more »
Chabot JA, Tsai WY, Fine RL, Chen C, Kumah CK, Antman KA, & Grann VR. (2009) Pancreatic Proteolytic Enzyme Therapy Compared With Gemcitabine-Based Chemotherapy for the Treatment of Pancreatic Cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. PMID: 19687327
- July 1, 2009
- 03:07 PM
- 372 views
Happy New (Medical) Year!
by PalMD in White Coat Underground
The medical education calendar begins and ends on the first of July each year, and in the hospital, that means a brand spanking new crop of young doctors. While this may sound a bit scary, the facts are a bit subtle (and not terrifying). Some of the questions regarding the so-called July Phenomenon are:
Are hospitals more dangerous in July?
Is care more expensive in July?
Are hospital stays longer in July?
The data show that there does not appear to be an increase in poor outcomes in July ........ Read more »
Barry, W., & Rosenthal, G. (2003) Is There a July Phenomenon?. The Effect of July Admission on Intensive Care Mortality and LOS in Teaching Hospitals. Journal of General Internal Medicine, 18(8), 639-645. DOI: 10.1046/j.1525-1497.2003.20605.x
Ford, A., Bateman, B., Simpson, L., & Ratan, R. (2007) Nationwide data confirms absence of ‘July phenomenon’ in obstetrics: it's safe to deliver in July. Journal of Perinatology, 27(2), 73-76. DOI: 10.1038/sj.jp.7211635
- June 30, 2009
- 03:00 PM
- 515 views
I get mail–chiroquacktic edition
by Peter Lipson in Science-Based Medicine
A long while back, at the original wordpress incarnation of my usual blog, I wrote a piece on the reasons that chiropractic is unscientific nonsense. Because it was popular, I resurrected it. Well, a chiropractor has come to bravely defend his field and left me a comment.
A study in the May 2007 issue [...]... Read more »
SARNAT, R., WINTERSTEIN, J., & CAMBRON, J. (2007) Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update. Journal of Manipulative and Physiological Therapeutics, 30(4), 263-269. DOI: 10.1016/j.jmpt.2007.03.004
SARNAT, R., & WINTERSTEIN, J. (2004) Clinical and Cost Outcomes of an Integrative Medicine IPA. Journal of Manipulative and Physiological Therapeutics, 27(5), 336-347. DOI: 10.1016/j.jmpt.2004.04.007
- June 29, 2009
- 08:22 PM
- 486 views
I get mail--chiroquacktic edition
by PalMD in White Coat Underground
A long while back, at the original wordpress incarnation of this blog, I wrote a piece on the reasons that chiropractic is unscientific nonsense. Because it was popular, I moved it over here. Well, a chiropractor has come to bravely defend his field and left us a comment.
A study in the May 2007 issue of the Journal of Manipulative and Physiological Therapeutics reports health plans that use Chiropractors as Primary Care Providers (PCPs) reduce their health care utilization costs significantl........ Read more »
SARNAT, R., WINTERSTEIN, J., & CAMBRON, J. (2007) Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update. Journal of Manipulative and Physiological Therapeutics, 30(4), 263-269. DOI: 10.1016/j.jmpt.2007.03.004
SARNAT, R., & WINTERSTEIN, J. (2004) Clinical and Cost Outcomes of an Integrative Medicine IPA. Journal of Manipulative and Physiological Therapeutics, 27(5), 336-347. DOI: 10.1016/j.jmpt.2004.04.007
- June 9, 2009
- 04:33 PM
- 536 views
What is disease? Diabetes, diagnosis, and real science
by PalMD in White Coat Underground
One of the concepts we often discuss around here is "what is disease?" As we've seen in the discussion of Lyme disease and so-called Morgellons syndrome, this is not always an easy question to answer. Knowing what states are disease states does not always yield a black-or-white answer. The first step is usually to define what a disease is. The next problem is to decide who in fact has that disease. The first question is hard enough, especially in disease states that we don't understand too ........ Read more »
The International Expert Committee. (2009) International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care. DOI: 10.2337/dc09-9033
- June 9, 2009
- 03:27 PM
- 561 views
What is disease? Diabetes, diagnosis, and real science
by Peter Lipson in Science-Based Medicine
One of the concepts we often discuss around here is “what is disease?” As we’ve seen in the discussion of Lyme disease and so-called Morgellons syndrome, this is not always an easy question to answer. Knowing what states are disease states does not always yield a black-or-white answer. The first step is [...]... Read more »
The International Expert Committee. (2009) International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care. DOI: 10.2337/dc09-9033
- June 8, 2009
- 07:24 AM
- 426 views
The psychology of crankery
by PalMD in denialism blog
Our recent discussions of HIV/AIDS denial and in particular Seth Kalichman's book "Denying AIDS" has got me thinking more about the psychology of those who are susceptible to pseudoscientific belief. It's an interesting topic, and Kalichman studies it briefly in his book mentioning the "suspicious minds":
At its very core, denialism is deeply embedded in a sense of mistrust. Most obviously, we see suspicion in denialist conspiracy theories. Most conspiracy theories grow out of suspicions abo........ Read more »
Viren Swami, Tomas Chamorro-Premuzic, Adrian Furnham. (2009) Unanswered questions: A preliminary investigation of personality and individual difference predictors of 9/11 conspiracist beliefs. Applied Cognitive Psychology. DOI: 10.1002/acp.1583
Rogers, P., Davis, T., & Fisk, J. (2009) Paranormal belief and susceptibility to the conjunction fallacy. Applied Cognitive Psychology, 23(4), 524-542. DOI: 10.1002/acp.1472
- May 22, 2009
- 08:00 AM
- 359 views
Are Patients in Universal Healthcare Countries Less Satisfied?
by PalMD in denialism blog
A dishonest campaign has started against healthcare reform in this country and the first shot has come from Conservatives for Patients Rights (CPR), a group purporting to show that patients in universal health systems suffer from government interference in health care. To bolster their argument, they have a pile of anecdotes from people around the world who have suffered at the hands of evil government-run systems. The problem, of course, is that anecdotes are not data, it is impossible to det........ Read more »
Schoen, C., Osborn, R., Doty, M., Bishop, M., Peugh, J., & Murukutla, N. (2007) Toward Higher-Performance Health Systems: Adults' Health Care Experiences In Seven Countries, 2007. Health Affairs, 26(6). DOI: 10.1377/hlthaff.26.6.w717
Nolte, E., & McKee, C. (2008) Measuring The Health Of Nations: Updating An Earlier Analysis. Health Affairs, 27(1), 58-71. DOI: 10.1377/hlthaff.27.1.58
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