Choosing a Medical Specialty II—the view from above

MarkH is going through the process of deciding what to what to do when he grows up. This is a much more difficult and important decision than many may realize. In order to understand the gravity of this process, I’ll have to refresh your memories a bit regarding medical education.

In the U.S., to apply for medical school, you must have completed a (usually) 4-year bachelor’s degree from a university. During the final year, you take what amounts to an entrance exam (the MCAT), and send out preliminary applications (often with fees). If the schools like your preliminary applications, they will send you secondary applications which are more lengthy and involve more fees. If they like your secondary application, you will be invited for interviews. For those of you who may not be familiar with U.S. geography, this place is big—really big. When I went on my interviews, I typically crossed two or three time zones. I took the red-eye out of SFO for Washington National, leaving around 11 p.m. and arriving around 7 a.m. The process is time-consuming and expensive.

After finishing the interview process, you may or may not receive invitations to matriculate. If you don’t get an offer, and you still want to become a doctor, you must repeat the entire process the next year. It is, needless to say, unwise to go through this process unless you’re pretty sure you’ll be happy with your decision to go to medical school.
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Mathew Nisbet, Beneath Contempt

Well, Nisbet has replied to Mike, Orac and me (not to mention PAL). However his reply leaves something wanting, like, intellectual honesty.

Nowhere in any of these reasoned replies is there “name-calling”. What we are arguing is for the preservation of accurate labeling of arguments that fail to meet standards of honesty. There are arguments that are crap, and arguments that are useful and indicate the author is interested in exchange of ideas, fostering discussion, the truth etc. We believe it is useful not to just label these arguments but to teach people how to distinguish between legitimate debate and illegitimate debate.

I am beginning to understand that Matt Nisbet is unable to engage us on such a level because I fear he is simply incompetent to do so or incompetent to recognize our attempts to engage him in meaningful debate. There is no attempt at honestly addressing our points, at persuasion, or any semblance of a discussion I could respect and participate in. Just a straw man, and a pathetic one at that. And when one attempts to address his arguments on his own site, he doesn’t publish critical comments (or no more than one in three).

I’m done. Whether there is anything to “framing science” or if it’s just a con that lets Matt Nisbet publish opinion pieces as “research” I don’t care anymore. He’s not an opponent worth debating.

Happy Thanksgiving.

Thanksgiving thoughts

This is my annual Thanksgiving post (“annual” because I wrote it last year and I’m reposting it this year. It’s companion piece is over at my old place). –PalMD

It’s easy to see what Christmas means to an atheist—another day off work. What about Thanksgiving? This nominally secular holiday is practiced throughout North America by people of most faiths and cultures, and by those of no faith at all. But to whom are we giving thanks? Can “thank” be an intransitive verb?

This question falls into the same category as many ethical questions about atheism, such as “where do atheists get their morals?”, but this is a little different. First, does celebrating Thanksgiving require “giving thanks”?

I’d argue that it does not. To celebrate the joys of family, the harvest bounty, and just not working is enjoyable in and of itself. There is no moral imperative to “thank” anyone or anything. The pure joy of celebration is enough for many.

But thanking people is a good thing. It cements social bonds, creates interpersonal harmony. It’s a good idea to thank your family, your friends, and anyone else who has helped brighten your days. Why do that on one particular day? Why not? Devoting a day away from work to simply thank those around us is probably a good thing.

I am certainly not saying one should not thank God on Thanksgiving…that’s up to you. If you are one of those who believes in a deity, go for it. But remember that there are many ways to “thank” without having to believe in God. While you thank your God, you may also want to thank your atheist neighbor who, despite not fearing hellfire and damnation, returned your mower.

So happy Thanksgiving to both my loyal readers. I’ll be with my family filling my belly—heaven on Earth.

Denialists’ harvest—the AIDS body count in South Africa

As a physician, few things frustrate and sadden me as much as preventable deaths. I see it all the time—the guy who kept putting off his colonoscopy and was later diagnosed with metastatic colon cancer, the woman who put off coming to the doctor with her breast lump until it broke through her skin, the heart patient who couldn’t stop smoking. They all haunt me. But what if the ghosts were numbered in the hundreds of thousands rather than dozens?

That’s what it must be like to be Thabo Mbeki, that is if he has a conscience. It may (or may not) be bad “framing” to call someone a “denialist” but a new study seems to say that whatever you call it, denialism kills. When government leaders allow themselves to be duped by denialists murderers non-acceptors of truth sickfuckdenialistbastards….Damn it, I’m sticking with “denialist”. When government leaders allow denialists to guide their public health policies, people die, apparently in large numbers. I’ll have to leave it to my epidemiology colleagues to evaluate the quality of the study (which on my read looks OK), but even if it’s off by one order of magnitude, the results are horrifying.
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Cranks cry persecution, Nisbet listens

Ever since we began writing here about denialism we’ve emphasized a few critical points about dealing with anti-science. For one, denialists aren’t interested in legitimate debate – they are not honest brokers and the tactics they use exist to artificially extend discussion of settled scientific issues. Second, one of the most time-honored traditions of cranks is claiming persecution in response to rejection of their nonsense. Take for a recent example Coby’s exposure of the “environmentalists want to jail global warming denialists” myth. You don’t need to do anything to make a crank cry persecution, if they have to they’ll just make up some persecutory event or tale.

So, I don’t have a lot of tears to shed for global warming denialists who insist they are being falsely compared to holocaust deniers. In that they use the same tactics as holocaust deniers to create the false appearance of debate, they are the same, true, but the comparison largely ends there. Unlike holocaust deniers their ideological motivations are different. And, of course, any reasonable person realizes that holocaust denial has not made the use of the term “denial” itself an assertion of antisemitism. If a doctor confronts an alcoholic about their denial of their alcoholism, they’re not suggesting they hate Jewish people too. When a psychiatrist tells their patient they’re in denial, that’s hardly comparing them to the Nazis. When we say a public figure has issued a denial of some scandal, we’re not suggesting they advocate a new holocaust. And finally, when we suggest any number of other people are denying reality, whether it be holocaust denial, evolution denial, HIV/AIDS denial, etc., the point is clear that we are referring to their methods more than their motives which are necessarily varied. It should also be clear that holocaust denial has not ruined the word deny or denial or denier for any number of other applications – this is just another example of denialists claiming persecution after being called on their BS.

Nisbet disagrees, and he sides with Timothy Ball of all people who is very upset that he’s being called a “denier” in this PRI segment. Cry me a river. Bizarrely Nisbet suggests that in this radio segment he is so persuasive that we will never use the word “denier” again. I disagree, and it sounds like the reporter, Jason Margolis, disagrees as well:

The relevant section follows (forgive transcription errors):
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Link love, shameless promotion edition

ResearchBlogging.orgIf you’re not yet familiar with, you need to click the picture. It’s a blog-aggregator that pulls together posts about peer-reviewed research, and since the intersection of published research and blogging is getting a lot of play lately, this is a must-see.

In addition, Dave Munger is launching a new forum to discuss research blogging where yours truly will be a janitor moderator.

Next, I’ve started a new forum for the discussion of many of the issues seen in this space, at Science-Based Medicine, and any other interesting issues that come up. It’s set for moderated registration, as is the research bloggging forum, which simply means go there, register, and very shortly you will be in business, and you can have a few other places to waste your time online.

And speaking of Science-Based Medicine, I’ve loved this blog since it debuted, and I very fortunate to have been invited as a regular over there. You should be reading it regularly. It’s good for the brain.

Finally, ScienceOnline09 is fast approaching, and I will be moderating a session on beginning blogging and on anonymity online (along with Abel). If you are coming, or just interested in the topic, stop by the wiki and leave suggestions.

That is all.

NCCAM: the not-even-wrong agency

The National Center for Complementary and Alternative Medicine (NCCAM) is a government agency tasked with (among other things), “[exploring] complementary and alternative healing practices in the context of rigorous science.” In this space we have talked about NCCAM quite a bit, but I have to admit that I don’t think about them very much. The other day, though, I was reading though JAMA and I came across a study funded by the agency. The study, which showed that Ginkgo does not prevent Alzheimer’s-type dementia, was pretty good, so I cruised on over to NCCAM’s website to see what else they’ve been up to.

A quick glance at NCCAM’s front page:

    “Ginkgo Evaluation of Memory (GEM) Study Fails To Show Benefit in Preventing Dementia in the Elderly”
    “CAM and Hepatitis C: A Focus on Herbal Supplements ‘No CAM treatment has yet been proven effective for treating hepatitis C or its complications.'”
    “Selenium and Vitamin E in Prostate Cancer Prevention Study, ‘selenium and vitamin E supplements, taken either alone or together, did not prevent prostate cancer.'”

It seems that NCCAM is finding out something we already strongly suspected: improbable medical claims are usually wrong. Since that’s not how they see things, and since I don’t believe that there is such a thing as alternative medicine, I was curious how they defined CAM.
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The stupidest internal NIH memo ever – or why I can’t wait for the new administration

One of the great things about science is that it is open, international, and celebrates the free exchange of ideas. However, during the last 8 years we’ve seen some odd things at the National Institutes of Health – the premier governmental scientific institution in the world. The paranoia of the current administration has filtered down and contaminated day to day operations of what is essentially an academic health sciences campus.

For example, for some bizarre reason they decided to erect a 10 foot high iron fence around the entire campus:
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And at the entrances every car is searched, every day. And why? What makes the NIH campus different from any other medical campus in the country? We all work with the same radioactive isotopes, etc. They have a higher level infectious disease research lab which if you were really worried about could be fenced in rather than fencing in the entire 300 acre campus. What is the reason for this excess of security?

I happen to think there is no good reason and that the NIH security is run by paranoid idiots. The best evidence I have of this is a recent memo I’ve obtained that was sent to Health and Human Services employees about foreign visitors from the Deputy Secretary. Here is the relevant section:

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Really? Now if an NIH investigator wants to bring a foreign speaker in to give a talk, not only can they not plug in their thumbdrives in the lecture hall computer to upload their powerpoint for fear of espionage, but they have to be followed into the bathroom too? Could you imagine? You invite some bigwig foreign scientist – like say any of this year’s Nobel Laureates in medicine – and when they have to make a pit stop you’d be forced to follow them in the bathroom for fear they’ll steal our lucky charms.

I hope in the next administration the first thing they do is tear down that stupid fence and treat the NIH like any other academic medical campus, and find whoever wrote this stupid memo and fire them. This type of paranoid security obsessiveness is uneccessary and counterproductive to the free exchange of ideas science needs in order to be open, international and collaborative.

What does your health insurance cover?

For many Americans, it’s open enrollment time, the period your employer give you to make changes in your health insurance coverage. You may not understand your insurance very well, but you have to understand this one important fact: your health care providers know even less about your insurance than you do. Most doctor’s offices have a sign that says something like, “Your insurance is your business.” There is know way for your doctor’s office to know all the details of all the different insurance plans.

Each state has different rules, and each part of the country differs in what kind of health plans predominate. In some areas, non-coverage is so common that it almost doesn’t matter what you know, other than the location of a free clinic. But for those of you looking at new or existing health plans, you must read through the documentation, especially the summaries that tell you what is and isn’t covered.

For example, many plans cover a yearly preventative physical. Many do not. If you don’t tell your doctor whether or not preventative services are covered, you may end up with an unexpected bill. Preventative physicals are often covered without a co-pay, but most other visits do have a co-pay.

Your plan will include a glossary, but some terms deserve special attention.
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Ginkgo does not prevent dementia, or “I can’t remember what NCCAM is good for”

ResearchBlogging.orgHere’s a question for you: is there, or should there be, any difference between studies of “alternative” and non-alternative medicine? I’ve argued before that there is no such thing as alternative medicine. So why do we need a separate agency to study “alternative” medicine? The National Center for Complementary and Alternative Medicine seems to be just such an agency. For example, the latest study of Gingko biloba for the prevention of dementia could have been funded by other agencies, such as NIMH. Why NCCAM?

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