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“An Outrageous Assault”: Pelvic Exams by Med Students on Anesthetized Women 

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Please note: This blog contains descriptions of sexual assault. From Heart Failure , a book I wrote about my time at Tufts University School of Medicine: “I am all gloved up, fifth in line. At Tufts, medical students—particularly male students—practice pelvic exams on anesthetized women without their consent and without their knowledge. Women come in for surgery and, once they’re asleep, we all gather around; line forms to the left…We learn more than examination skills. Taking advantage of the woman’s vulnerability—as she lay naked on a table unconscious—we learn that patients are tools to exploit for our education.” Using female patients to teach pelvic exams without their consent or knowledge remains “a dirty little secret about medical schools.” It is an “age-old” practice that continues to this day in med schools around the world. It’s been referred to as “the ‘vending machine’ model of pelvic exams, in which medical students line up to take their turn…” “Only it’s not a ven...
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A Longer Life on Statins? 

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What are the pros and cons of relative risk, absolute risk, number needed to treat, and average postponement of death when taking cholesterol-lowering statin drugs? In response to the charge that describing the benefits of statin drugs only in terms of relative risk reduction is a “statistical deception” created to give the appearance that statins are more effective than they really are, it was pointed out that describing things in terms of absolute risk reduction or number needed to treat can depend on the duration of the study. For example, let’s say a disease has a 2% chance of killing you every year, but some drug cuts that risk by 50%. That sounds amazing, until you realize that, at the end of a year, your risk will only have fallen from 2% to 1%, so the absolute reduction of risk is only 1%. If a hundred people were treated with the drug, instead of two people dying, one person would die, so a hundred people would have to be treated to save one life, as shown below and at 1:0...
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The Real Benefits of Statins and Their Side Effects 

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A Mayo Clinic visualization tool can help you decide if cholesterol-lowering statin drugs are right for you. “Physicians have a duty to inform their patients about the risks and benefits of the interventions available to them. However, physicians rarely communicate with methods that convey absolute information, such as numbers needed to treat, numbers needed to harm, or prolongation of life, despite patients wanting this information.” That is, for example, how many people are actually helped by a particular drug, how many are actually hurt by it, or how much longer the drug will enable you to live, respectively. If doctors inform patients only about the relative risk reduction—for example, telling them a pill will cut their risk of heart attacks by 34 percent—nine out of ten agree to take it. However, give them the same information framed as absolute risk reduction—“1.4% fewer patients had heart attacks”—then those agreeing to take the drug drops to only four out of ten. And, if th...
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Are We Being Misled About the Benefits and Risks of Statins? 

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What is the dirty little secret of drugs for lifestyle diseases? Drug companies go out of their way—in direct-to-consumer ads, for example—to “present pharmaceutical drugs as a preferred solution to cholesterol management while downplaying lifestyle change.” You see this echoed in the medical literature, as in this editorial in the Journal of the American Medical Association : “Despite decades of exhortation for improvement, the high prevalence of poor lifestyle behaviors leading to elevated cardiovascular disease risk factors persists, with myocardial infarction [heart attack] and stroke remaining the leading causes of death in the United States. Clearly, many more adults could benefit from…statins for primary prevention.” Do we really need to put more people on drugs? A reply was published in the British Medical Journal : “Once again, doctors are implored to ‘get real’—stop hoping that efforts to help their patients and communities adopt healthy lifestyle habits will succeed, and...
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Should You Take Statins? 

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How can you calculate your own personal heart disease risk to help you determine if you should start on a cholesterol-lowering statin drug? The muscle-related side effects from cholesterol-lowering statins “ are often severe enough for patients to stop taking the drug. Of course, these side effects could be coincidental or psychosomatic and have nothing to do with the drug,” given that many clinical trials show such side effects are rare. “It is also possible that previous clinical trials”—funded by the drug companies themselves—“under-recorded the side effects of statins.” The bottom line is that there’s an urgent need to establish the true incidence of statin side effects. “What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug?” That’s the title of a journal article that reports that, even in trials funded by Big Pharma, “only a small minority of symptoms reported on statins are genuinely due to the statins,” and those taking stat...
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Are Doctors Knowledgeable About Nutrition? 

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Do you know more about basic nutrition than most doctors? “A poor diet now outranks smoking as the leading cause of death globally and in the United States, according to the latest data.” The top killer of Americans is the American diet, as you can see below and at 0:23 in my video How Much Do Doctors Actually Know About Nutrition? . If diet is humanity’s number one killer, then, obviously, nutrition is the number one subject taught in medical school, right? Sadly, “medical students around the world [are] poorly trained in nutrition.” It isn’t that medical students aren’t interested in learning about it. In fact, “interest in nutrition was ‘uniformly high’ among medical students,” but medical schools just aren’t teaching it. “Without a solid foundation of clinical nutrition knowledge and skills, physicians worldwide are generally not equipped to even begin to have an informed nutrition conversation with their patients….” How bad is it? One study, “ Assessing the clinical nutri...
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Fiber or Low FODMAP for SIBO? 

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It may not be the number of bacteria growing in our small intestine, but the type of bacteria, which can be corrected with diet. When researchers tested more than a thousand patients suffering for longer than six months from symptoms typical with irritable bowel syndrome (IBS), such as excess gas, bloating, diarrhea, and abdominal pain, but who do not appear to have anything more serious going on, like inflammatory bowel disease, a significant percentage were found to be suffering from lactose intolerance—intolerance to the milk sugar lactose. In infancy, we have an enzyme called lactase in our small intestine that digests milk sugar, but, understandably, most of us lose it after weaning. “Although genetic mutation has led to persistence of lactase in adults, about 75% of the world’s population malabsorbs lactose after age 30” and have lactose intolerance. However, a third of the patients were diagnosed with small intestinal bacterial overgrowth (SIBO). “The evidence for SIBO and IB...
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