The color of flesh
In medicine we use all of our senses to evaluate patients. If I open up an abscess and I'm overwhelmed by the smell of rotted cheese, I can be pretty sure the abscess started as a sebaceous cyst. If I hear a "whooshing" sound over the abdomen in a smoker, I look more closely for an aortic aneurysm. A subtle buzzing sensed through my fingers can indicate an arterial fistula. And the glowing yellow of jaundiced skin can point me straight to the liver. Read the rest of this post... | Read t

New institute to promote science-based medicine
The struggle to promote the scientific practice of medicine and the fight against pseudo-science and quackery just got a big boost. The newly-announced (but long in the making) Institute for Science in Medicine was launched this morning with an inaugural press release calling attention to quackery in the current U.S. health reform bills. Many of the folks involved in the Institute are familiar names, and represent an international effort to keep health care safe and effective. So help spread the word, and keep an eye on this space and the ISM website

Captain of the men of death
I have in front of me a weathered copy of Cecil's Textbook of Medicine from 1947. It belonged to my father, who graduated from medical school in the 1940s. Even then, it was known that pneumoccus, a common bacterium, can live harmlessly in the nose and throat and only sometimes causes disease. Pneumoccocal disease was and is still a leading cause of disease and death*, killing perhaps a million children per year. It causes ear and sinus infections, but also meningitis, and is the most common cause of pneumonia. In the past it was referred to as "the captain of the men of death" for it's ability to claim so many. It is also closely associated with influenza---the pneumococcus that m

Naturopaths take advantage of mammography fears
A news item this week profiles a northeast naturopath who is using thermal imaging to screen for breast cancers. This is a frightening development. The news about conflicting mammogram recommendations has women wondering what the right approach really is. The question in the new USPSTF recommendations is one of values. The science says that a lot of women in their 40s need to be screened and undergo invasive procedures to save one life. We are left to decide if that life is worth it. Or we can throw our hands in the air and start charging women for useless alternatives.

Fake medicine to get Ontario's imprimatur
I live about ten miles due north of "Canada's automotive capital". We often look across the straights to the medical system in Ontario, one in which all citizens have a provincial insurance card. We see how everyone has access to care---or at least some care. I've treated many Canadian patients who have access to American insurance and prefer to get their care on this side of the border, where there are fewer hassles. Of course if you have no insurance at all, hassles abound, and we'll leave a discussion of the merits and difficulties of the Canadian system to another day. But o