Author: MJ

1-26-2013 

Are we over the current steroid-shot-in-the-spine scare? You know, the drug that people were injected with that had slimy mold floating in it because the manufacturer’s production was, to say the least, faulty? Hundreds of people injected came down with infections in the brain or spinal cord, and several died.

That particular fiasco has probably subsided. But don’t let that make you complacent.

Here’s the deal: DO NOT have a procedure or take a medicine you don’t need. Particularly if that medicine is going to be injected into a part of your body that normally doesn’t see the light of day. It’s just too easy to have a screw up that you can’t foresee.

Of course this does not mean I think you should avoid all meds and treatments. It’s just that too often, we docs, and well, without pointing any fingers, OK, let’s point fingers, specialists in particular, make something sound so routine and straightforward that it’s no big deal. You’d feel foolish objecting. They might even wonder why you’re there if it’s not to get something. The doc might be incredulous: why would you refuse his advice? A good doc will give you a variety of options and tell you the pros and cons of each, and will not be offended by your questioning safety, efficacy, alternatives or second opinions.

Believe me, I’ve seen it. And I’m a doc. I encounter this attitude every week. Why did you call me if you’re not going to do what I recommend?

Perhaps, I called you for your opinion. Perhaps, I wanted to see how your thoughts and approach lined up with mine, or the other specialists I’ve recruited to this task. Perhaps, I simply wanted to pick your brain and take some time to process my options.

It’s amazing to me, and embarrassing, that this is how my colleagues sometimes dismiss our patients. Medicine is so often an art and not a science. The evidence on whether steroid shots help people with chronic back pain, for example, falls into the weak- to no-evidence category.

The unfortunate bottom line: there is no evidence for a lot of the things we do; we docs are simply doing the best we know how based on whatever evidence exists. Of course our recommendations improve with research, but not all research is equal, and much of what is passed off as the standard of care still originates as BOGSAT – bunch of old guys sitting around talking.

You should learn to ask your doc about evidence for what he/she is suggesting, research-based evidence, and we should tell you. And when the evidence is weak, non-existent, or, “it’s just my experience”, we should be honest about that too. Now I’m not saying our experience isn’t important, but before you go placing your health in the hands of this flawed system, I suggest you have a pretty good idea of what the system can and cannot do for you, and where the weak links are. In the case of the moldy steroids, the danger lay in the drug supplier, not the docs who were dispensing—but that didn’t matter to the patients who were harmed.

The point is we don’t know where the next risk might arise; if you don’t need it, don’t do it.

1/18/2013 

…and…I hope you got your flu shot.

I admitted a lot of really sick people of all ages this week with confirmed influenza – fever, cough, muscle aches. Of course we don’t put most people with the flu in the hospital, just the ones who can’t breathe. One of my patients is on a ventilator, and we’ve had several deaths in our county from flu already, including young people. The latest was a 17 year old previously healthy girl. That should concern you. You see, we typically think of flu as being most vicious in the very young and very old, however some strains of flu are actually worse in the young and healthy because they trigger the body’s immune system to fight even harder, and it’s the immune system itself that can overwhelm the patient and cause death. We don’t have too much in the way of treatment for that. The best we can do is prevention. So, get your flu shot, no matter your age. This year and every year.

Influenza virus is a tricky devil. It changes shape and gets stronger when it develops in other animals like mice, or pigs, or birds, and then it works its way to the human population where it becomes much more lethal for the first few years because we’ve never encountered the new version before. This is what caused the Spanish Flu Epidemic that killed roughly 20 million people in the early 1900’s. You might think that’s because we didn’t have good medicines then, but you’d be wrong. It’s because the virus was just that ugly- killing 1 out of every 4 people exposed to it especially young, healthy people. We still don’t have good medicines to treat new varieties of influenza like bird flu.

The potential for epidemics with previously unknown flu viruses is not only real, but unpredictable. That’s what motivated me to create a story around it in my novel, VIRION. You can click on the link on the homepage of this website, or go to Barnesandnoble.com or Amazon.com if you’d like to order it. Paperback and e-book formats available—and I’ll come to your book club for the discussion questions at the end if you like!