Consent, politics, instinct, and more…

FSM Friends’ News and Articles

Chiropractic, chiropractic for kids, and a few of my greatest hits: “So I still find myself wondering, if a science-based chiropractor is equivalent to a good physical therapist, why not just go to a physical therapist instead of rolling the dice in a rigged game? But the question of just how generous to be when evaluating the chiropractic profession is entirely moot when we double back to the issue of pediatric chiropractic, particularly the nauseating concept of newborn/infant care. Any claim of chiropractic involving the evaluation and management of infants is indefensible nonsense based on magical thinking and pseudomedical garbage. All of it.”

Informed consent – why chiropractors don’t like it: Informed consent is one of the staple requirements of legitimate health care. It is incredibly important that the patient’s autonomy is protected so that they can make informed choices about their care. Informed consent requires that the patient understands what their treatment is, what the level of evidence for the treatment is, and what the risks and benefits are compared standard care or no care. So how can this possibly work with modalities like chiro? Modalities that:
• are not based in science;
• are unable to reliably demonstrate a significant benefit;
• come with significant risks compared to standard care;
• come at a much higher average cost for what benefit they do provide.
What IS it that they tell their patients when they seek consent?

Today’s Abused Health Concept

Politicisation of Science and Healthcare (aka promoting hydroxychloroquine use). Misguided use of hydroxychloroquine for COVID-19: “Early in the pandemic, many patients were severely ill, with fever, cough, and respiratory distress, and no specific treatment was available. Patients’ fear of not knowing what was coming next was harrowing… Both patients and clinicians were desperate.

On March 16, 2020, a study on use of hydroxychloroquine in patients with SARS-CoV-2 was “published” (online via YouTube) by Gautret et al. The preliminary data from this small study was “heard round the world.”

On April 4, the US president, “speaking on gut instinct,” promoted the drug as a potential treatment and authorized the US government to purchase and stockpile 29 million pills of hydroxychloroquine for use by patients with COVID-19.”… no health official in the US government endorsed [this] owing to the absence of robust data and concern about adverse effects. Nonetheless, use of hydroxychloroquine increased substantially, and the US Food and Drug Administration had issued an Early Use Authorization [later revoked]…

These events sparked an avalanche of studies, many of which are now completed and are being reported in the scientific literature. These well-conducted trials, including the study reported in this issue of JAMA, demonstrate the lack of efficacy of hydroxychloroquine in patients with COVID-19. In a twist of irony, the US president did not receive hydroxychloroquine, with or without azithromycin, when he contracted COVID-19 and was hospitalized at Walter Reed National Military Medical Center in early October.

Several lessons are gleaned from the experience with hydroxychloroquine in the treatment of COVID-19:
First, a single report based on a small, nonrandomized study must be considered preliminary and hypothesis generating, not clinically actionable. Likewise, anecdotal case reports and case series that include several cases likewise must be considered anecdotal and preliminary.
Second, US health officials, such as members of the Coronavirus Task Force, leaders from the National Institutes of Health, and officers of physician organizations and societies, who resisted being forced to promote the politically motivated use of hydroxychloroquine were correct and should be recognized for their steadfast commitment to science.
Third, patients who have a potentially life-threatening disease are desperate and will accept any treatment that appears to be effective, especially when such treatment is promoted by individuals who ordinarily should be trusted, such as the US president.

The clear, unambiguous, and compelling lesson from the hydroxychloroquine story for the medical community and the public is that science and politics do not mix. Science, by definition, requires diligence and an honest assessment of findings; politics not so much.”

Great Moments in Health and Science 

The development of endovascular thrombectomy: A key strategy for stroke treatment:  Through a small tube inserted into a blood vessel, blood clots such as those causing a stroke can be safely and quickly removed and normal blood flow restored.

Thanks to Science

We’re all science communicators. Here’s how to do it better “If you have expertise in medicine, biology or science in general, you can use your skills to promote evidence and combat misinformation. Science communication is an important skill, and the events of this year make it clear how important dedicated science communicators are. However, even if you don’t work in science communication, your knowledge can be important to those around you who respect you and your training. Your skills as a scientist are important and useful, no matter the field. All scientists are science communicators, and effective science communication is more important than ever. Although I don’t work in drug development, I understand enough of the chemistry to know how nucleoside analogs such as the drug remdesivir function. I excitedly explained how viruses are sloppier than normal human cells when replicating their genomes and how researchers can capitalize on this to make drugs. A few days later, I found myself having a similar conversation with my mom. I wasn’t in a place to predict the efficacy of any drug, but I could at least explain why antivirals like remdesivir had a shot at working, while hydroxychloroquine was less promising.”