The Skeptical EP

The Blog Page of Robert Clare MD

Credit: Non-Sequitur by Wiley Miller

“Questioning medical dogma to improve the lives of patients.”

Skepticism, from the Greek word skepticos (to inquire), is not simply a noun but a process. Skeptics demand evidence before accepting claims of truth; they enjoy the process of inquiry and analysis. Unlike cynics who take a negative view of both the claims of others and the people making them, skeptics are perfectly happy to change their minds when better evidence comes along. For physicians, a questioning attitude is an essential component to decision-making. When faced with increasing pressure from administrators and pharmaceutical companies to “Show me the money!” the best counter from the physician is “Show me the evidence!” The purpose of this blog is to raise awareness through an inquiry of the best available medical knowledge, to foster discussion, and to challenge prevailing truths in order to improve the lives of patients everywhere.

Disclaimer: The opinions put forth in this blog are just that: opinions. They should not be used as a substitute for your own good sense or that of your doctor. Readers of this column do so at their own risk—this blog is not intended to treat or diagnose disease. Information contained here should be considered a “dietary supplement.” None of it is FDA approved. Mistakes in data interpretation are mine alone (I don’t claim to be a statistician), and you should assume that mistakes will occasionally be made. All personal patient information has been altered.

Another update on opioids

In March of this year, the Senate passed the Comprehensive Addiction and Recovery Act (CARA) introduced by Senator Joe Manchin (D-WV). The bill includes amendments for mandatory prescriber education, expanded consumer education, increased funding for substance abuse treatment, increased accountability on the part of the FDA prior to the approval of new opioid medications, and changes to the wording of the FDA’s mission statement: “The FDA is also responsible for protecting the public health by strongly considering the danger of addiction and overdose death associated with prescription opioid medications when approving these medications and when regulating the manufacturing, marketing, and distribution of opioid medications.” Continue reading

I’m optimistic about … coffee

I first started drinking coffee in graduate school. Long before Starbucks, there was a small coffee bar on the UCLA campus, a wood-paneled enclave for hipsters with the requisite chalkboard displaying the day’s brews, a steady stream of foo-foo music wafting in the background mixing nicely with the deep intoxicating aroma of freshly brewed coffee. Continue reading

Posterior vitreous detachment

So I was at a wedding over the weekend when I kept noticing brief flashes of light from the corner of my left eye, like a shooting star that I couldn’t quite focus on. At first I thought this was just the overhead lights flashing as the band was playing, but then a ball of “fuzz” started blurring my vision–an annoying floater that failed to go away when I blinked. Continue reading

I’m skeptical about … opioids.

“Patient advocates in the legal profession have coined the term ‘opiophobia’ which describes the unscientific and irrational fear that many people, including health-care providers, have of the dangers and evils of narcotics, even when prescribed to relieve pain”

                                                                                        Annals of Emergency Medicine, 2004. Continue reading

I’m skeptical about … low back pain (part 2).

In my last post I discussed why imaging in the form of x-rays and MRI scans is not necessary for the vast majority of patients with acute low back pain. I should add that when MRI scanning is necessary the correct person to order that test is not the ER physician or your PCP, but rather a spine specialist who is capable of both interpreting and acting on the result. Continue reading

I’m skeptical about … low back pain.

As a long-time competitive inline speed skater, I can tell you that there are only 2 types of skaters: those who have had low back pain and those who will. Pretty much the same applies to the population at large with low back pain affecting more than 80% of adults at one time or another. It is the number one reason why patients are referred for physical therapy, the second leading cause of missed days at work (after colds), and the 5th most common reason why people visit a doctor. Continue reading

I’m skeptical about … osteoarthritis

Osteoarthritis, often referred to as degenerative arthritis, is a non-inflammatory disease affecting predominately weight bearing joints like the knee and hip. It is not merely a disease of bone but represents a spectrum of degenerative disorders affecting one or more of the following joint components: bone, articular cartilage, meniscal cartilage, ligaments (the fibrous material that connects bone to bone), the joint capsule and synovial fluid, and, lastly, the pericapsular muscles and tendons. Continue reading