Category Archives: Medicine

How to know you have influenza

I applaud this very nice essay in ACSH output for today on how to distinguish the flu–caused by influenza virus, from colds caused by any number of viruses. Continue reading

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What is science? Is medicine and biology science? Let’s discuss

A regular commenter took off on the Economics is not a science discussion to suggest Medicine and Biology are not science. My answer below is, Sometimes and It Depends.

Commenter:

Much of medical and biological studies are observational and not do not qualify as science either.

Commenter says–It’s mostly just conjecture. “Well I suppose” leads to “maybe”. Not science.

People are talking about the movie “The Martian” and the phrase in there about “science the poop out of it” or something like that. Not science. Hard work, observation and engineering. In my dad’s day they knew the difference between science and engineering. Now anything even remotely technical is “science”.

Disagree with your dictionary definition. “3. any of the branches of natural or physical science.” Especially not. Also, “4. systematized knowledge in general”. Not. It’s science because it’s systematized? Huh? My grandkids legos are systematized in little bins but it’s NOT science. Good grief.

So, my turn.

In medicine we like the term evidence based and that means repeat, rinse, repeat and test your hypothesis against the evidence, that’s the critical scientific methodology.

In the complex world of biological structure and function, much of which is still not understood, there are lots of opportunities to to be wrong. Miss a confounder and your hypothesis is an empty one.

Good examples of biological science in action–Koch’s postulates for proving the cause of a disease, with particular emphasis on infectious diseases.

Another scientific method is the Bradford Hill rules on proving causation, for example beneficial or toxic effect, which look a lot like the Koch postulates for chemicals or physical effects on living organisms.

The Koch postulates can be used to disprove a cause of a infectious disease and modified to provide knowledge of non infectious diseases.

The Bradford Hill rules can be used to prove or disprove a toxic or beneficial effect of an exposure to a physical or chemical agent or condition. .

From WIKI
Koch’s postulates are the following:

1. The microorganism must be found in abundance in all organisms suffering from the disease, but should not be found in healthy organisms.
2. The microorganism must be isolated from a diseased organism and grown in pure culture.
3. The cultured microorganism should cause disease when introduced into a healthy organism.
4. The microorganism must be reisolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

The Bradford Hill Rules can be turned for positive and negative evidence of effect, toxic or benificial.

The Bradford Hill Rules, from Wiki:

The Bradford Hill criteria for causation are a group of minimal conditions necessary to provide adequate evidence of a causal relationship between an incidence and a possible consequence, established by the English epidemiologist Sir Austin Bradford Hill (1897–1991) in 1965.

The list of the criteria is as follows:

1 Strength (effect size): A small association does not mean that there is not a causal effect, though the larger the association, the more likely that it is causal.
2 Consistency (reproducibility): Consistent findings observed by different persons in different places with different samples strengthens the likelihood of an effect.
3 Specificity: Causation is likely if there is a very specific population at a specific site and disease with no other likely explanation. The more specific an association between a factor and an effect is, the bigger the probability of a causal relationship.
4 Temporality: The effect has to occur after the cause (and if there is an expected delay between the cause and expected effect, then the effect must occur after that delay).
5 Biological gradient: Greater exposure should generally lead to greater incidence of the effect. However, in some cases, the mere presence of the factor can trigger the effect. In other cases, an inverse proportion is observed: greater exposure leads to lower incidence.
6 Plausibility: A plausible mechanism between cause and effect is helpful (but Hill noted that knowledge of the mechanism is limited by current knowledge).
7 Coherence: Coherence between epidemiological and laboratory findings increases the likelihood of an effect. However, Hill noted that “… lack of such [laboratory] evidence cannot nullify the epidemiological effect on associations”.
8 Experiment: “Occasionally it is possible to appeal to experimental evidence”.
Analogy: The effect of similar factors may be considered.

So, if you are honest about testing the postulates and the rules–you can produce reliable, reproducible explanations or you can prove up your hypothesis as valid. That’s evidence based science. You can’t cherry pick the rules however for the ones that work to prove your hypothesis. They come as a unit, and exceptions to the proof are less scientifically reliable. There are some exceptions, for example the organism sometimes are hard to culture in the case of Koch’s postulates.

A modification of the Koch’s postulates can provide diagnostic criteria for diseases that are not infectious.

If you hold to the rules, you can test a hypothesis, and in fact infectious disease, diagnostic nosology, pharmacology and toxicology can be made scientific.

Medicine is only science if it is scientific and evidence based–otherwise it may or may not be right based on observational anecdotal information or “fly by the seat of your experience or the experience of others,” but it is not scientific, evidence based medicine unless it is reproducible and falsifiable. When I say testable and reliably reproducible, that covers the Popper requirement that it be falsifiable.

An example of an organized effort to produce evidence based medicine is the Cochran Project that is devoted to gathering reliable medical research and identifying unreliable research.

http://www.cochranelibrary.com/

Simple examples of the problem of reliable science in medicine is the confounder of an unknown or even known–some genetic unknown or the known problem of placebo effect. So that’s why when medicine gets serious it does Randomized Controlled studies that are blinded and placebo controlled to test drug effects.

In the case of the second inquiry–biology, the scientific knowledge of living things requires the use of chemistry, physics, and observational disciplines like anatomy and functional anatomy to determine both complex and not so complex functions of living things. Biology can begin with cold cuts, microscopic studies and chemical analysis to achieve reliable knowledge, but when we go to complex functionalities it gets harder.

One example is that at the cellular level anatomy and chemical functionality are not simple–they are as complex for the one-celled as the much more complex organism. No simple way to make DNA reproduce or membranes function properly, so bacteria have the same cellular complexities as the cell of an elephant or a human.

Methicillin Resistant Staph Aureus (MRSA), virulent bug

Giants football player Daniel Fells has a bad MRSA infection of the foot that may have progressed to osteomyelitis (bone infection) and bone infections are hard to treat. .

Talk in this report about amputation, but that is worst case–antibiotics well chosen are usually effective. This case report caught my eye because last year we had an MRSA foot infection case in the jail, acquired at another jail and treated in the hospital before the inmate was transferred to us.

Occasionally MRSA causes pneumonia or systemic infections–very bad news. MRSA used to be seen mostly in nursing home populations, then spread to the community–high rates in athletes, soldiers, colonization rates are influenced by antibiotic usage.

I see cases all the time in the jail, usually starts with the complaint–I got a spider bite–red, tender painful spot. MRSA is a virulent bug indeed.

More on the Kentucky bamstercare CoOp failure

These things are bound to fail, they involve utopian socialist silliness, community based and governed (usually socialist cronies) health insurance programs with little chance of competing and surviving.

Underwriting for a community rated program is a nightmare because of adverse selection. How does one control costs and become viable?

Here’s an essay by Grace-Marie Turner in Forbes. She has been involved in health insurance issues for many years, and is an advocate for market based programs, not government single payer socialism. Continue reading

Diagnostic codes on personality disorders goes goofy in the ICD10

I am so happy I don’t have to worry about the new diagnostic coding.

It appears from the author’s comments in the essay below, that psychology and psychiatry diagnostic codes have been expanded to excess in what is called the ICD 10, the latest catalog of diagnoses in medical practice, essential to medical records keeping and billing.

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Nobel Prizes for discovery of anti parasite and anti protozoal drugs

Good news, people out there doing good work.

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Starve a cold feed a fever, take meds for fever–well not so fast

Fever is a defense mechanism, treating fever is treating the mom mostly but it does reduce the achy miserable feeling and reduces fluid loss.

Treat the symptoms–allow the fever if the person or child is not too fussy and miserable.

Sudden onset of high fever causes a benign siezure called febrile seizures that scares the beejesus out of parents. Kids prone to febrile seizures should be monitored for fever just to avoid the scares, until they outgrow their tendency.

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