When science ain't science

A stimulating article in this week’s Nature challenged readers to date the following two exam questions.
1. Describe the preparations of Sulphur used for cure of itch insect. Give the different methods of applying them.
2. Psorinum and Sulphur are Psoric remedies. Discuss the ways in which the symptoms of these remedies reflect their miasmatic nature.
According to the author, David Colquhoun from the Department of Pharmacology at the University College London, the former question was first set at his own institution in 1863, at a time when the London cholera outbreak was thought to be caused by vapours (miasmas).
The second question was part of the 2005 homeopathy exam at London’s University of Westminster’s.
Apparently, three UK universities now offer science degrees in homeopathy, and of 61 university or college level complementary medicine courses, 45 are BSc honours degrees.
A long term skeptic of complementary medicine, Coulquhoun has his own website devoted to publicising “assorted dubious, erroneous, nutty or downright fraudulent claims about drugs and other sorts of treatment”.
His particular beef is CAM making its way into universities, who he claims have a duty to ensure science degrees are scientific. Most CAM is not science because the vast majority of it is not based on empirical evidence, he says. Even worse, he claims many of its doctrines and practitioners are openly anti-science, and challenge the notion of objective evidence.
At least, says Colquhoun, other “mickey mouse” degrees, such as golf-course management and baking, offered at the “new” universities are honest, and what you see is what you get.
On the other hand, antiscientific science degrees may be a good way for universities to make money, he says, but in doing so are becoming the antithesis of what a university should be.

You've got to love general practice

Saturday morning surgery and the receptionist – medical record in hand – sheepishly asks if I know Mrs M. My reply in the negative attracts a vigorous description of a 94year-old housebound woman who rules her world from the confines of her bed.
The colourful introduction left me with no doubt that despite her age, Mrs M was one demanding and persuasive lady. Apparently, we’ve even received calls from the local MP when Mrs M’s decided our services weren’t quite up to scratch.
“Last time doctor was just about to visit Mrs M, she called to remind him not to forget the bulb he’d promised to buy and replace in her fridge”, the receptionist said. “He’s even started clipping the ivy around her front door”.
On this particular Saturday morning, the problem according to Mrs M at least, was an errant community nurse who’d forgotten to instill her eye-drops. As well, she’d run out of sleeping tablets, and hadn’t slept for a week, she testily informed the receptionist.
Furthermore if, as the only doctor working that day, I didn’t come and put them in, she’d threatened to call the media.
Strangely, I couldn’t wait to visit.
On a not-very-serious level, as a medical editor, I was bemused to be in a position to offer her a doctor and media representative at the same visit, but was also fascinated by her feistiness.
On arrival, I negotiated the clutter and detritus of a long, and recently immobile, life.
I cleaned her eyes, instilled her eye-drops, and copped a serve for not delivering a script for sleeping tablets rather than the tablets themselves. But she had a back-up plan, and like most of the people in Mrs M’s life, I found myself following her instructions to the letter.
“Call the chemist on this number, and tell them to get Angela from the fruit shop next door to bring the tablets down on her way home”.
We did and they did.
You’ve got to admire her pluck.

Market sidelines care

Dr Kerri Parnell
Jan, 26, presented with URTI-like symptoms, and being a new patient got all the usual questions – medical, family, social history and so on.
Within minutes, her eyes filled with tears, and our subsequent chat revealed, apart from a minor illness which can sap the defences of the best of us, that her job was the problem.
A newbie pharmacist in a major teaching hospital, Jan felt condescended to by her pharmacy colleagues and the junior doctors “who felt pretty special” now they’d been accepted to an institution with kudos.
But her main gripe was the piecemeal treatment she believed patients received.
“I see these same young doctors on the wards cowering before nurses telling them to prescribe drugs which often aren’t indicated”, she told me. “They’re not game to say no”.
“And then although pharmacists are meant to see patients before they go home to explain their medications, they’re often discharged when we’re not around. We’re understaffed, the nurses are understaffed, and the doctors are too”, she said, by now quite distressed.
Jan’s working day bore little resemblance to that she’d anticipated, and her picture of a leading hospital was indeed bleak, marked by overworked staff in a disconnected system that allowed little continuity of care.
An opinion piece in today’s Lancet reminded me of her dilemma.
The ascendancy of market rhetoric has diminished the value of relationships between health-professionals and patients, says Dr Iona Heath, allowing access to the health-care system to be “prioritised over the need to sustain a relationship with a known and trusted professional”.
I’d like to think Jan was just having a bad day. That our hospitals encourage and reward sustaining human interaction as well as technical expertise.
And that the management culture pervading our hospitals won’t dissuade kind and intelligent professionals like Jan from its corridors.

GP clinics unjustified

GP clinics unjustified
Dr Kerri Parnell
No prizes for detecting an election in the wind in NSW with an opposition leader giving press conferences in his speedos while the Premier madly announces things he hopes will give him the edge. Last week it was digital mammograms, something about the Pap smear registry, 2500 more nurses and plans to plonk twelve extra GP clinics in emergencey departments.
This latter idea has worked well in some areas for specific reasons, such as the lack of an after-hours deputising service leaving GPs to provide after hours care or lose accreditation points.
Premier Iemma hopes GP clinics will solve two problems – perceived public desire for extended-hour medicine and ED overcrowding.
“If you’ve got a sick child late at night, and you’re looking for a doctor, often the only place you can get that service is an emergency department at a hospital”, the fully-clothed Mr Iemma told journalists.
Maybe I'm wrong but I suspect late night GPs a "nice-to-have" not a necessity. Given access to sensible phone advice, such as from a children’s hospital, few children can’t wait until morning, and the ED isn’t a bad place for this group. Finding quality GPs to work in the clinics will be challenging to say the least.
On ED overcrowding, a letter to a newspaper last week put it well: GP clinics won’t fix ED overcrowding because a lack of GP care isn’t the problem. Dr Tony Joseph, NSW chairman of the emergency medicine college says most patients present appropriately to EDs, where the real problem is access block due to a shortage of inpatient beds.
6minutes suspects that emergency physicians also fear that a drop in numbers will mean less dollars for their department.
In the spirit of collegiality, I’ll let Dr Joseph’s parting shot at GPs – “an expensive and untrained locum workforce” - go through to the keeper.

Whispers in the dark disempower parents

It’s said “a picture tells a thousand words’, but sometimes language conveys the better story. In other cases, such as a piece in last weekend’s newspaper called “The Sleep Whisperer”, a good writer can send a bad message.
After a brilliant, if hyped, word picture of an exhausted new mother, the article portrayed parenthood as a nightmare of epic proportions. Even the first sentence - “At 3am, no-one can hear you scream”, was a take on the tagline from the horror movie, “Alien” - “In space no-one can hear you scream”.
After sleeping, or not sleeping, for weeks “on a crappy mattress on the floor of her room so my husband could sleep undisturbed in our giant bed”, our new mother was seduced by tales of a woman with “magic powers to make babies sleep through the night” when they reached six months old. And unlike parenting services such as Tresillian, the baby-whisperer did all the work, and in the comfort of your own home.
It worked a treat, so why did the piece leave me so angry?
My first though was jealousy; this couple had dodged emotional responsibility sipping Chardonnay in the lounge-room whereas I’d done the hands-on version.
On reflection however, what upset me was that the article disempowered parents. Many new parents struggle with a baby disinclined to sleep, but the last thing they need is a magician.
As my wise cousin Julie taught me, except for in exceptional circumstances, almost any committed couple can teach their infants to go to sleep unaided.
Choose a weekend when no-one’s working, put the baby to bed, make a strong cuppa and put Rage on the TV”, the mother of four wonderful children advised. “Check them after one song, then two, then three … you’ll get the idea”.
She was entirely correct, and it came much cheaper than baby-whisperers at $20 to $35 an hour.
GW 2007;3-4 March

Quiz me

I love a quiz. Some better than others, factual quizzes that arent too hard and have a pop culture element, such as the SMH Good Weekend quiz, are my faves.
But almost any quiz will do, or games or TV shows - Trivial Pursuit, trivia nights, anything with Eddie McGuire ...
On car trips with the kids, I've done "Are you a back-stabber?" and "Who's your red carpet twin?". FYI, I'm not and Hilary Duff.
But I couldn't resist this one -

What Medical Specialty Is For You?
A few minutes later and after taking the Hippopotamus Oath, here was my result.
"The medical specialty for you is.... Ophthalmology Ophthalmology is the best of all specialties. As an ophthalmologist, you will be unable to spell the name of the field you went into. You will loudly assert the difference between your field and optometry, but eventually, you will be making too much money to care."

Funnily, I did do a stint at an eye hospital and considered ophthalmology fairly seriously for a month or two.
Maybe I should have stuck it out.

If it quacks like a duck ...

Here’s a riddle.
The AGPN’s for it, the AMA says it’s full of holes. The RACGP’s keeping fairly mum about it. What is it?
Yes, the Access Card, aka an identity card, an iPod or according to Joe Hockey, a place to put your shopping list.
Currently before parliament, the controversial legislation arouses strong emotions on both sides. For some, the mere thought of a unique identifying number for every individual is anathema, but unless the card is canned, this will be the case – although whether the number is printed on the card or on the chip inside is still under debate.
For a transcript of an excellent ABC radio program on the card, click here.
A major and legitimate fear is ‘function creep’, described on the program by Professor Alan Fels, head of the government’s Access Card task force, as a card set up for a particular purpose acquiring many other functions over time.
For example, the UK ID card set up in 1939 with three particular purposes, including to prove the owner wasn’t German, had 39 functions when it was abolished in 1951. For this reason, AMA President Mukesh Hakerwal, says the purposes of the card must be specified in the legislation.
The touted advantage of people entering their own medical details on the card seems to me a furphy; I can’t imagine it’ll really allow doctors to skip a group and cross-match, for example.
The under 18 issue is confusing. While the Department of Human Services says “what occurs today will occur with the access card”, the AMA’s still got its knickers in a knot.
And let’s not waste words on whether the card is voluntary, in reality it isn’t. there’s also little doubt that at some stage a clever hacker will get data they shouldn’t have.
Finally, the justification for including place of birth completely eludes me.
Apart from all of the above, the card sounds like a good idea!