In July of 2015, I wrote a post questioning the recommendations of the American College of Cardiology / American Heart Association (ACC/AHA) to expand statin use in asymptomatic individuals. The reason this topic is so important is that it affects literally millions of people at a cost of multiple billions of dollars. Continue reading
The Skeptical EP
The Blog Page of Robert Clare MD
“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.
Thanksgiving / Giving Thanks, 2016
The other day I reached deep into the bottom drawer of my desk and emerged—not with what I was looking for—but rather a handful of badges. There, encased in plastic, were earlier versions of myself dating back more than 25 years to residency. Since then I’ve worked in a lot of hospitals, met a lot of doctors and nurses, and treated nearly 100,000 patients. Continue reading
Update on low back pain.
In April, I posted 2 essays on low back pain (“I’m skeptical about … low back pain,” parts 1 and 2). In them, I explained why the American way of treating this ubiquitous disorder is so expensive, wasteful, and ineffective. It relies largely on pharmaceuticals to mask pain, and technologies to image the spine that rarely affect patient outcomes. Continue reading
I’m optimistic about … type 2 diabetes.
Diabetes mellitus is a heterogeneous spectrum of disorders characterized by episodes of high blood glucose (sugar) and impaired glucose metabolism due to a lack of insulin, resistance to insulin, or both. The term diabetes comes from the Greek for siphon, and mellitus from the Latin for sweet, thus offering a description of the disease; sweet urine. Continue reading
Update on arthroscopic knee surgery.
A year ago, in my post “I’m skeptical about … arthroscopic knee surgery,” I reviewed several randomized controlled trials demonstrating that for degenerative arthritis of the knee, arthroscopic surgery doesn’t help. Continue reading
Update on prostate cancer
In a post from December 2015 (“I’m skeptical about … PSA screening”), I borrowed an analogy from Dr. Gilbert Welch, a Dartmouth epidemiologist, who noted that cancers are like animals in a barnyard enclosed by a fence. The goal is to keep them contained. Continue reading
I’m skeptical about … coronary stents.
The heart never takes a holiday. Over the course of a lifetime, this amazing pump can expect to beat more than 3 billion times. No disruptions, no breaks, no rest days. And anything that stands in the way of a beating heart represents a potentially fatal hurdle. Continue reading
I’m optimistic about … medical mindfulness.
People don’t like to wait; not for hamburgers, haircuts, or medical care. And more and more, the same assembly line practices applied to the sale of consumer goods are now being brought to bear in the delivery of healthcare—everything from the incorporation of Lean Toyota process improvement practices, to electronic medical records, to hospital billboards with LED displays of ER wait times. Continue reading
I’m skeptical about … the FDA (part 2)
In my last post I discussed reasons why the FDA hasn’t kept us safe from dangerous drugs, either by approving those with questionable safety profiles (t-PA for stroke), or by failing to act when a drug’s widespread use reveals hazardous side-effects (Vioxx for inflammation). Continue reading
I’m skeptical about … the FDA (part 1).
The Food and Drug Administration is a huge federal bureaucracy overseeing the safety and efficacy of more than a trillion dollars’ worth of consumer goods annually, ranging from medicines to cosmetics to foods, vaccines, and veterinary products. Continue reading