Friday night open thread

I have a few more science-y pieces in the hopper that may break my writer’s block. Meanwhile, PalKid never stops writing.  This is her to do list for her play date. In case you can’t read Kid here’s the translation:

  1. Run in and outside the house like crazy maniacs
  2. act like pets
  3. play games.

Not a bad plan, really, and it doesn’t vary that much from her usual behavior. But what is summer if not for running outside like a crazy maniac?

Since I’m not doing any serious writing I thought we could open the thread up for discussion/questions.  Anything you’ve wondered about medicine or American health care? Anything else? (This should not be personal medical questions.)

For some starters, why the hell would anyone take over-the-counter supplements? Why would anyone think they’re safer than other medicines?



  1. As a Canadian health care worker in a single-payer system with universal coverage of most medical costs, I’m baffled by your health insurance framework. What changes do you expect to see in the way you practice medicine as a consequence of the PPACA?

    • Hard to say since no one knows. I’ve been able to provide more preventative care over the last year or so. No, that’s not right. I’ve been able to provide the same preventative care but the patients have been able to get it without an out of pocket cost or co pay.

      I’ve recently become part of a much larger overall group, one that comprises many practices which will help position ourselves better when the ACOs roll out.

  2. This is awesome!
    How do you feel about the effectiveness of massage therapy to temporarily lower blood pressure and reduce stress over all?

    Do you trust osteopaths (specifically trained DOs), now that they’ve come such a long way from their quack background?

    What is the maximum velocity of an unladen swallow?

    Do you think that doctors should stop wearing long sleeved coats, to prevent the additional risk of carrying germs?

    What can you tell me about the effectiveness of phage therapy, and will we see it in the US more, soon?

    Do you think that “spiritual distress” should be included on the list of NANDA approved nursing diagnoses?

    How prevalent do you think trigger points are, and do you think a massage therapist should be allowed to claim to be able to soothe them?

    Can you tell me how long is the average wait time to receive treatment in the US compared to countries with universal healthcare?

    Do you think that ADHD is overdiagnosed?

    Do you think that cortisol should be available over the counter?

    That’s all I can think of for now. If you are willing to answer these for me, you are, like, the greatest.

    • 1) Who knows? There’s a little literature. It’s plausible, and it’s not harmful. It’s unlikely to have overall significant coronary heart disease (CHD) prevention or mortality prevention compared to usual therapy, unless it is treated like a medication and overall BP is controlled to goal.

      2) The current generation of osteopaths are largely trained the same way as MDs. While the bone crunching bit of osteopathy, much of which is kooky, still remains in schools, a ?majority of DOs do post-graduate MD training with their MD colleagues, and take MD boards.

      3) I don’t know.


      5) Evidence suggest (only suggest) that it might be a good idea for doctors in hospitals to perhaps wear fresh scrubs every day rather than street clothes, ties and coats from room to room. Ties are especially problematic as they don’t get washed often. The data aren’t yet strong enough to know whether we should actually do this. I don’t wear a tie, and this is my excuse, but i simply don’t like them.

      6) I’ve run out of answers for now, so we’ll get to some more later.

  3. bluefoot

     /  July 13, 2012

    Re supplements: I don’t think most people realize that supplements are not regulated the same way as actual medication. They see supplements in similar forms as actual medications (capsules, tablets. etc) and somehow equate the two.

    Working for a while doing CMC at a biotech company convinced me to never take supplements. The rigor that goes into synthesizing, formulating and manufacturing an actual drug product is quite impressive, and the tolerances for impurities, stability, uniformity, etc are very tightly regulated. And that’s not even counting the data tolerances for pharmacokinetics, etc. Supplements have have next to no regulation in comparison.
    Just the thought of taking something that was produced under non-GMP conditions when the formulation, process chemistry and/or source material is uncertain (at best) gives me the creeps. And recreational drugs made using hardware store-grade solvents in really dodgy conditions?….no thanks, not with a 10 foot pole. Talk about being scared straight through education… 🙂

    Did you hear about the TB outbreak in FL?

    • Huh. I take supplements. Then again, I’m a vegan and I gotta take my vitamin B12 from somewhere, don’t I?

      • Until there is significant reform, we are stuck with the supps we have. However, there are prescription supps that undergo PhARMA style testing rather than OTC nothingness. Vitamin D, B12, and others are available as pharmaceuticals rather than nutritional supps.

    • Saint Stay At Home

       /  July 14, 2012

      Bluefoot, this is startling information. I just tossed a basket on our counter of otc vits and remedies. Where can I read more? Are there reputable companies for supplements?

  4. saffronrose

     /  July 14, 2012

    How much of a difference, wrt hypertension, does the ingestion of moderate amounts of caffeine (12-20 oz of coffee or cola), instead of sticking with the decaf one’s physician usually recommends? Please feel free to refer me/us to articles that go into detail, if that’s more reasonable for you.

    The only “supplement” I take these days is a papaya enzyme tablet when my gut doesn’t like me. No, it is not homeopathic. They taste better than most unhappy-gut pills’ aftertaste, too.

    As a teen, I knew that street drugs were not for me, aside from with what money would I buy them? Hated nose spray and anything else up my nose (Imitrex–ghastly stuff, and doesn’t work on top of that!), could barely swallow tiny pills, couldn’t face smoking, the smell of weed being smoked nauseates me, hated needles/small slippery veins, and all the highs sounded like being sick with a headcold. I hate being dizzy, thus find it no fun.

    Other vices–Alcohol? Better taste good, what little I can drink before I get the hangover that precedes the drunk, for me. Gambling? Sorry, just don’t grok it: that part that does is missing from my brain.

    • Me too with the EtOH…never did much for me. Some people are particularly susceptible to the CV effects of caffeine, so it’s really case buy case. I recommend people with high BP keep an eye on caffeine consumption.

  5. sleddog

     /  July 14, 2012

    What do you see as the disadvantages of having a NP or PA be your primary care doc? It seems that if we want more people to be getting preventive care and having more frequent contact with primary care providers, those of us who are relatively medically uncomplicated for the time being need to be willing to go to NPs and PAs, as there are not enough family medicine / general medicine docs to go around. What do you think?

  6. sleddog

     /  July 14, 2012

    “primary care doc” should be “primary care provider”

  7. A Reader

     /  July 15, 2012

    I have a chronic condition (non life-threatening) which most of the doctors I’ve seen have been unfamiliar with, and none have known how to treat. I have, however, been referred to at least one quack, who recommended, I kid you not, hypnosis and art therapy.

    My preliminary search of the medical literature did not turn up much research on this condition, so I’m not sure what effective medical treatment would even look like. On the other hand, it looks like there is a lucrative market for home treatments.

    In my effort to get treated, how do I avoid quackery and ensure that whatever treatment method I use is science-based? How do I find out what kind of treatments are effective? What kinds of questions can I ask a doctor’s office before I set up an appointment?

    Right now I don’t trust anyone.

    • It’s terribly hard. What I have done for unusual conditions is sought out experts, even if they aren’t local. A good web search focusing on big university medical centers can often get you there. Once you find a name, it can be nice to do a google scholar search to see if they’ve published on the disease (not a requirement). Once I nail down a couple of names, I start cold calling.
      I’ve had patients given therapies that seemed odd to me for rare conditions, but a google scholar search has often educated me a bit. Working with your own PCP can be helpful.

  8. Alex

     /  July 15, 2012

    Hello, I have 2 questions:

    1) The first one is a bit of a restatement of what Scott asked in the first. What is your view of the current healthcare/insurance system in the US when compared to Canada or several European countries (like most notably, the Nordic Welfare States)? Obviously, it’s a complex question and I don’t expect an essay as an answer; a brief answer will do.

    2) This one is going to sound a bit weird. You may or not remember that back in the day when you were on Scienceblogs (before PepsiGate), there was another great “medical blog” (for lack of a better word), Effect Measure. By any chance, do you know if those behind that blog have resumed their blogging? White Coat Underground, Respectful Insolence and Effect Measure were my favorite science blogs back then. And two of them still are!


  9. effect measure was written by the revere(s) who have stepped away from blogging. the pump handle has filled its niche.

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