A week of surgery – some impressions

One only has to be minimally involved in a surgical procedure to understand the appeal of this profession. It is instantly gratifying and very rewarding to be able to just fix something. That, working under time pressure and mixture of physical and mental skill make it a very exciting way to practice medicine.

So after a week of this, and just getting off call around 1:00 this AM after scrubbing in on a liver transplant I’ll tell you what has surprised me about surgery so far, and some of the things I didn’t realize going in.
Continue reading “A week of surgery – some impressions”

Stuck in Vegas? Go to Red Rock Canyon

No, the Denialism Blog is not my personal travel blog, although it might seem that way lately. I was in Guatemala last month, where I encountered dirty hippies and woo, and learned about a new religion called new age.

This week, I was at the Consumer Electronics Show doing a consulting gig for a large software company. CES is amazing–140,000 attendees, 2,700 exhibits. It’s like being at the biggest Best Buy evar. I saw a 150″ HD plasma television, with pandas on the screen, the smallest bluetooth headsets imaginable, neat location-aware devices, etc.

Perhaps the most difficult challenge with CES is that it is in Vegas, a tasteless, and generally rapey city. And so, if you find yourself there, I strongly recommend that you go to Red Rock Canyon. It’s just 20 miles west of the strip, and perfect for a few hours (or days) of hiking.

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My feet hurt

Eight hours standing in a single spot, how do surgeons do it? I’m hoping my endurance will build, especially knowing that some of the procedures I’m going to see in the next few weeks such as the “Whipple” or pancreaticoduodenectomy may take twice as long.

The good news is that I have lucked into working with great people – the misbehavior of surgeons is greatly exaggerated – and have learned lots of interesting things. The coolest yet was running the camera on a laparoscopic or “keyhole” surgery – it looked something like this.

Although what we did was more complicated (and harder to reach) it was both physically and mentally challenging. Basically, you are operating a camera in a 3 dimensional space, and the hand movements that will direct the position of the camera are reversed (usually). It’s a little bit like flying a plane, meanwhile, you’re standing for hours in a single spot, unable to lean on anything, maintaining a sterile field, and trying to track the position of the surgeon based on the movements of the instruments and a fair amount of mind-reading. It goes from exciting, to grueling pretty rapidly. Meanwhile the attending is standing in the same spot, running everything, not even bitching at me when I end up off target, perfectly content, like a stone wall, while my feet are killing me. How do they do it?

More soon.

Ask A Scienceblogger – Why don’t they make a birth control pill for men?

i-133b9fea8ea6b307d8c9133b7f3e23bf-dice.jpg This time the Ask a Scienceblogger Challenge is to explain why a male contraceptive pill does not exist.

Good question! It’s because medical researchers are all sexist bastards. Didn’t you know?

Actually that’s only part of the reason. Research into hormonal or pharmaceutical contraception for men is a hot topic. Male hormonal contraception is actually fairly effective. Using a combination of testosterone and other hormones to suppress the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary you can, after several months, prevent men from making sperm. For the men that respond (not all do), this treatment is highly effective as a contraceptive method. But the problems are delivery and efficacy. If you first screen men to see if they respond, then it is highly effective. But it doesn’t work on everyone: unlike the pill, you have to inject these drugs, put in implants or use a patch for delivery. This makes it far less attractive than the oral contraceptive pill for women, which is 98% effective when usedcorrectly and works with few exceptions. In the future, researchers may develop a more effective delivery and screening system for men that would allow them to more reliably assess the efficacy of the treatment.

Sexism has played some role in the long delay in the development of male contraception. But these days the far more important issues are those of physiology and capitalism. Women produce one egg a month and have a biologically built-in mechanism for preventing ovulation. Men, on the other hand, are sperm machines, producing an overabundance of genetic delivery vehicles from adolescence until death–with no simple mechanism to interrupt production. That’s why barrier methods, such as condoms, will likely remain preferable even after the development of hormonal birth control for men as they are highly effective and also prevent STD transmission. And for women, the pill (especially in lower-dose modern formulations) is safe, effective, and very well tolerated.

The second problem, that of capitalism, refers to the difficulty in developing a market for male contraception and thus the limited incentive for their production. It will be difficult for drug companies to sell a formulation for men that alters their hormones, lowers their sperm count (a cultural barrier), and requires doctors visits, injections, sperm counts, etc., when highly effective alternatives already exist. Many women will also likely prefer to remain in control of contraception because it’s their body, their health, and because men are liars. The capitalist barrier may be even more significant than the physiological obstacles.

Male hormonal birth control options will probably be offered within a decade. But they will likely be a niche market, limited to people in committed monogamous relationships, or for the partners of women who can’t tolerate the pill, and thus, not widely adopted.

Woo hurts—it really hurts

A frequent argument of (weak) support for alternative medicine is that, well, maybe it doesn’t help much, but it couldn’t hurt.

Wrong!

Aside from the usual arguments that it wastes resources, distracts people from real medical treatments, etc., there are more, real dangers. One of the hallmarks of woo is that treatments are humorously broad. One idea or treatment is often touted for many different illnesses, and even different species. How is it that, despite all my years of training, I’m only an expert on adult human disease, and yet Gary Null, with a cracker jack box Ph.D. not only knows people, but pets, too?

But lets start with a story…

Continue reading “Woo hurts—it really hurts”

Surgery!

This new year is shaping up to be pretty exciting, and part of the changes in my life will be reflected in what I write about on the blog. First let me explain how the MD/PhD program I’m in works, and where I am in it.

The Medical Science Training Program (MSTP) or MD/PhD program is designed to promote bench-to-bedside or translational research. The idea is that if you take medical students and give them a PhD as part of their education they will be more likely to take science from the basic literature (bench research) and translate it to medical care (bedside research) or at least do research that is more applicable to clinical research. In practice this ideal is not always achieved, but we try. This program is funded by a grant from the NIH, and between 2-10 such positions exist at most medical schools.

The program starts with students doing two years of medical school, which at most U.S. universities consists of the basic science portion of the medical curriculum. In the first two years you learn biochemistry, physiology, anatomy, histology, pathology, microbiology, pharmacology, genetics, psychiatry, etc. and at the same time are introduced into clinical medicine, differential diagnosis, taking patient histories, physical exam, and all the other skills you need to become a medical doctor.

After you complete these two years, and take the first of the national standardized tests to check and make sure you’re not a total incompetent, MSTP students then go into graduate school. Yes, some intelligent people actually think this is a good idea and enter this program. Luckily, you get a good deal of credit to your graduate classes (or substitute some graduate classes in medical school) and for the most part go straight into lab work. Then it’s the standard grad school spiel which I explained previously. Briefly, you work in a lab, you struggle, eventually figure out what the hell you’re doing, and then write a thesis. Now the fun part, after being separated from the first two years of medical school by between 3 and 13 years you get tossed into patient care for the medical school third year.

The third and fourth years, referred to as “the wards”, is more like a medical apprenticeship. You spend between 4 and 8 weeks on a variety of wards learning the full breadth of medical practice. These consist of family practice, surgery, psychiatry, medicine (ICU, infectious disease, slumming around the hospital etc.), neurology, pediatrics and OB/GYN, and whatever electives you decide you are interested in. This is when you really learn medicine and how to apply your clinical knowledge to the actual treatment of sick human beings.

I’ve spent the last month studying, working with doctors to get my clinical skills back, and generally freaking out in preparation for tomorrow, my first day on the wards. And guess which I’m doing first!
Continue reading “Surgery!”

Defining New Age

One last note on my trip to Guatemala–as part of it, we traveled to Tikal, to see the ruins. Here’s the view from one of the temples early in the morning.

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Okay. So, our tour guide is relating various facts of dubious veracity on the ride to town. And then he says that a new religion has been invented, making my ears perk up. Very earnestly, he says:

It’s a combination of science, astrology, and one’s own ideas. It is called New Age

I almost fell out of my seat! What a great definition!

The End of the James Randi Challenge

After ten years the James Randi Educational Foundation is discontinuing its 1 million dollar paranormal challenge.

The James Randi Educational Foundation Million-Dollar Challenge will be discontinued 24 months from this coming March 6th, and those prize funds will then be available to generally add to our flexibility. This move will free us to do many more projects, which will be announced at that time.

I’m disappointed, because that means in two years we will lose one of the best anti-woo tools in the arsenal. That is, the offer of 1 million dollars to any woomeister who can prove their paranormal abilities are real in a controlled scientific test in order to shut them up. Otherwise it wasn’t that helpful, as the real prominent fakers knew better than to actually put their livelihood on the line as they describe:

Our expectations at first were that we’d attract major personalities by this means, but they’ve avoided having to take the test by simply not applying; those who have actually applied are generally honestly self-deluded persons who have difficulty stating what they can do, which can be understood if they really don’t know what they’re experiencing; we at JREF have gone through involved procedures to help them recognize their problems. Usually, they have indicated that they don’t know what real scientific rules are, when it comes down to their actually being properly tested.

But for two more years at least we’ve still got this ace up our sleeve. There is still time to apply all you woos out there!

This means that all those wishing to be claimants are required to get their applications in before the deadline, properly filled out and notarized as described in the published rules.

Ten years is long enough to wait. The hundreds of poorly-constructed applications, and the endless hours of phone, e-mail, and in-person discussions we’ve had to suffer through, will be things of the past, for us at the JREF.

Those who believe they have mystic powers now have two full years to apply… Let’s see what happens.

Skeptics’ Circle Number 77 – White Coat Underground

White Coat Underground has the overmedicalized edition. I’m pleased to see Happy Jihad House of Pancakes arguing for more skepticism in the humanities as part of the circle. And a great post on epidemiology and autism from Andrea.

Orac had some important things to say about consensus, and just to clarify my position on how a skeptic should regard consensus it’s simple. It is a sign of crankery to attack consensus as a concept, for example see this nonsense from creationist John West whining about consensus on evolution. However, a big part of being a scientist is challenging various consensus views (usually consensus views of lower strength than what the cranks are after – another sign). This is why so many crank arguments about consensus are so laughable to people who have actually worked in science. You don’t get published for writing up studies repeating the same results endlessly, science rewards novelty and new findings. If you have high-quality data that contradicts the consensus, you should attack it and your paper will likely be widely read. While it’s true that in many fields an old guard will defend their view to the death, the history of science is that of the data ultimately saving the day. It’s perfectly OK to attack a specific scientific consensus but you do it by publishing papers, and arguing with legitimate data and high-quality argument. A crank is one who attacks the mere idea of consensus, who acts through political channels to try and change scientific knowledge, who tries to subvert consensus with no data except maybe some cherry-picked nonsense,who uses a bunch of conspiracy theories to explain why no one believes them, and all the while cries persecution if they’re not immediately believed or if their BS isn’t a mandatory part of public school curricula.

Just to clarify.

Finally, of note today, Steven Novella has started a new blog Science Based Medicine that will likely be worthy of note.

Kucinich and UFOs

Today’s WSJ picks one of Dennis Kucinich’s old scabs: just what happened with this whole UFO sighting claim that he made? Remember that back in October, Kucinich mentioned the incident in a debate, but he has smartly kept the matter quiet since. Well, apparently, this incident happened when Kucinich was staying at Shirley Maclaine’s house (Maclaine was away at a performance), with Maclaine’s security guard, Paul Costanzo, and Costanzo’s anonymous ex-girlfriend:

The day was strange from the start. For hours, Mr. Kucinich, Mr. Costanzo and his companion noticed a high-pitched sound. “There was a sense that something extraordinary was happening all day,” says the girlfriend. She and Mr. Costanzo say that none of the three consumed alcohol or took drugs.

As they sat down to a dinner, Mr. Kucinich spotted a light in the distance, to the left of Mount Rainier. Mr. Costanzo thought it was a helicopter.

But Mr. Kucinich walked outside to the deck to look through the telescope that he had bought Ms. MacLaine as a house gift. After a few minutes, Mr. Kucinich summoned the other two: “Guys, come on out here and look at this.”

Mr. Costanzo and his girlfriend joined Mr. Kucinich, where they took turns peering through the telescope. What they saw in the far distance, according to both witnesses, was a hovering light, which soon divided into two, and then three.

After a few minutes, the lights moved closer and it became apparent that they were actually three charcoal-gray, triangular craft, flying in a tight wedge. The girlfriend remembers each triangle having red and green lights running down the edges, with a laser-like red light at the tail. Mr. Costanzo recalls white lights, but no tail.

Mr. Costanzo says each triangle was roughly the size of a large van, while his former girlfriend compares it to a “larger Cessna, smaller than a jet certainly.” Neither recalls seeing any markings, landing gear, engines, windows or cockpits.

The craft approached to within 200 yards, suspended over the field just beyond the swimming pool. Both witnesses say it emitted a quiet, throbbing sound — nothing like an airplane engine.

“There was a feeling of wanting to communicate something, but I didn’t know what,” says Mr. Costanzo.

The craft held steady in midair, for perhaps a minute, then sped away, Mr. Costanzo says. “Nothing had landed,” he says. “No strange beings had disembarked. No obvious messages were beamed down. When they were completely out of sight, we all looked at each other disbelieving what we had seen.”

At Mr. Kucinich’s suggestion, they jotted down their impressions and drew pictures to memorialize the event. Mr. Kucinich kept the notes, according to Ms. MacLaine, who said he promised her recently that he would try to find them.
In an interview with WSJ’s Jeffrey Trachtenberg, actress and author Shirley MacLaine discusses the cosmic scope of her new book, “Sage-ing While Age-ing.”