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.

I’m skeptical about … Tamiflu.

Flu season is upon us again with influenza now present in 48 states. So far, the disease has been only sporadically reported, although commercials for the anti-flu drug Tamiflu are already airing in epidemic proportions—not surprising considering that Roche has earned more than $18 billion off the drug since its introduction in 1999. As one financial analyst put it, Tamiflu is “a nice little earner.” I’ll say. But does it work? Continue reading

I’m skeptical about … screening mammograms.

In my last post about screening colonoscopies, I noted that the test harms 7 to 8 people for every one that benefits, but the harms are likely justified given that colonoscopy also has the capacity to prevent future cancers through polyp removal. I’m afraid the numbers for screening mammography in asymptomatic women to look for breast cancer are far worse. Here, it’s hard to make a case for universal screening. Continue reading

I’m skeptical about … screening colonoscopies.

Medical screening tests harm more people than they help. It’s true, and like the sinking of the Titanic: “It’s a mathematical certainty.” Remember first that the goal of medical screening is to detect or prevent potentially fatal diseases in an asymptomatic population. And the reason most people in the population are asymptomatic is because they don’t have the disease in the first place. You have to screen many to benefit a few. Continue reading

I’m skeptical about … arthroscopic knee surgery.

It’s a slick procedure, all right; a bit of spinal anesthesia, just 3 tiny incisions, some sophisticated gadgetry, a bit of maneuvering and sloshing, and all done. Zip, zip, zip. The recovery times are short, the complications few, and the whole idea of operating on the knee without any major incisions is just so downright appealing that it’s no wonder arthroscopic surgery is the most common orthopedic surgery performed in America, done almost a million times a year to the tune of more than $5 billion. But does it work?

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I’m skeptical about … multivitamins.

Sixty percent of adult Americans now take some type of nutritional supplement accounting for $36 billion in sales in 2014. To discuss all of them would require a tome thicker than Webster’s Dictionary, so I’ll restrict this post to multivitamins. Almost 80% of physicians recommend them to patients, while more than 70% take one themselves. Half of all American adults take a multivitamin at least some of the time. Should you? Continue reading

I’m skeptical about … strep throat.

Strep is a bacterium meaning that it has a cell wall, cytoplasm, DNA, and can replicate independently thereby rendering it susceptible to a host of antibiotics including penicillin. Viruses, on the other hand, lacking these same attributes do not respond to routine antibiotics. There are many varieties of strep including S. pneumoniae, the most common cause of pneumonia, but for the remainder of this post when I use the word strep, I am referring to group A beta-hemolytic strep, the bug that causes strep throat. Continue reading

I’m skeptical about … concussion.

In the US, head injury is the leading cause of traumatic pediatric death, resulting in roughly 7,400 fatalities, 60,000 hospitalizations, and more than 600,000 ER visits annually, so it follows that all this talk about concussion is a big deal, right? As an emergency physician and the parent of athletic kids who have been very active in soccer and gymnastics, I can’t begin to recall the number of times I have listened to a parent tell of rushing his/her child to the ER for a CT scan after some well-meaning health professional deemed the injury a “concussion.” The term conjures up a host of scary images. After all, everybody knows that Muhammad Ali’s Parkinson’s didn’t come from a bad-luck roll of the genetic dice; it came from getting his brain bashed in. Continue reading

I’m skeptical about … malpractice reform, part 2.

In my last post, I noted that malpractice reform enacted in Texas in 2003 making it almost impossible to sue physicians failed to save money or decrease defensive medical testing. We now have ER data from South Carolina and Georgia demonstrating the same thing. Doctors in those states continued ordering tests up the yin-yang despite legislation substantially reducing the likelihood of a lawsuit. Why? Continue reading