Ed’s corner of the web

My little corner of the pediatric world seems to be rather occupied of late with a recent study published in the BMJ.  The study looked at a group of 240 kids in the Netherlands who were given either amoxicillin (an antibiotic) or placebo for treatment of otitis media (ear infection).  Looking back 3.5 years later, the researchers discovered that those kids who were randomized to receive amoxicillin had a 2.5 times higher risk of recurrent ear infection.

The trend in recent years has been for less and less antibiotic treatment of ear infection, opting instead for a “wait and see” approach for uncomplicated cases.  This has been a reflection of data that shows that most ear infections are caused by viruses (not helped by antibiotics), and that it doesn’t seem to make much difference whether one treats simple ear infections with antibiotics or not.

So you would think that docs would be receptive to this additional data further reinforcing the lack of need for antibiotics in many, if not most, ear infections.  You would think that, but you would be wrong.  Pediatricians and family medicine physicians have spent a lot of time on the intertubes resisting reduction of their antibiotic usage in ear infections, citing personal experience and anecdotal evidence (“back in my day…”) while giving wild exhortations in CAPITAL LETTERS.

The one thing that these docs don’t use to make their point is data – real data.  By that I mean large, randomized, well-controlled studies that seek to eliminate confounding variables and answer a specific clinical question.  At what point does personal experience become real data?  Never.  How long does one have to practice before their anecdotes become a valid basis for policy?  Let’s just say longer than anyone is willing to wait.

I pause here to realize that even doctors, for all their education, for all the trust placed in them by their patients, are just as prone as anyone to having “blind spots” – areas of thought that refuse to accept evidence contrary to their beliefs.  For some doctors, it’s vaccines and autism.  For others it’s herbal medicine.  For these docs, it just happens to be antibiotics and ear infections.

So what will it take to shed enough light on the issue to get these docs to change?  A large part of it, I think, is getting people to take their blinders off.  But this, unfortunately, is something you can’t do for them.  It’s not easy to self-criticize, but I firmly believe that opening your own practice and knowledge to critique can only help you become  more knowledgeable, more humble, and a better doctor.  Failing to do so might preserve a frail ego, but it does disservice to everyone else.

This is just too cool for words…

The hard drive on my laptop met an untimely end about three weeks ago.  There were no warning signs, no ominous clicks.  Instead, the machine refused to finish booting into Windows one day.  I tried rebooting a few times, and each time the machine would get less and less far into the booting process.  Not good.  I chilled the drive and tried getting into safe mode, which only was stable for about 15 seconds.  Still not good.  Finally I got into a command prompt and got all my data out on a thumb drive.  Whew!

The real circus began when I called up Lenovo support.  Ostensibly it’s in Atlanta, Georgia, but I ran into just as many hard-to-decipher accents as I do when I call tech support in Mumbai.  But that was just the beginning.  Turns out my warranty had expired a mere six days earlier.  I shook my little fist at Shiva and was transferred to warranty sales, where I was offered a $149 extended warranty.  It was more than I would have liked, but I bit, figuring that purchasing a new hard drive and going through the reinstall process would be at least as costly in terms of time and money.

The warranty dude said that I should be able to use my warranty to get service on my laptop in 24 hours.  I called back the next day, only to find that the warranty wasn’t invoiced yet.  I had been misinformed, the new rep told me; warranties don’t invoice for 2-3 business days.  I called back again 4 business days later – still no dice.  This time I was told that it takes 10-14 business days for a warranty to become active.  Flustered, I requested that the extended warranty be canceled.  I couldn’t wait that long to get service on my laptop.  The rep apologized and said that he would expedite the warranty invoice process so I could get warranty service within 2 business days.  I hesitated (why couldn’t they have done this in the first place?!?) but eventually said ok, asking for some sort of email confirmation of the warranty being ready.  Of course, I never got that email confirmation.  I called back a few days later, thoroughly peeved, ready to cancel my warranty order for sure this time.  Guess what?  My warranty order had been canceled already, back at the time of my last phone call!  Gah!  It’s enough to make a guy go Mac…

So after a couple purchases at Newegg and an afternoon of installing software, I’m back to blogging on my laptop.  I’ve got a blacklog of stuff I wanted to write about but probably won’t have a chance to get to.  Fortunately, one topic has continued to be current enough for me to comment on: the “birther” movement.

Unfortunately, you’ve probably heard about these yahoos already.  The internet allows for the creation of an infinite number of echo chambers in which fringe lunatics can congregate and convince themselves that their ideas aren’t pure drivel.  The internet also allows for easy dissemination of these ideas, with the end result being that whackjob claims that would’ve been completely unheard in the pre-information age now have the capability of amassing a larger audience.  The birther crowd – those who believe that Barack Obama was born in Kenya and thus not qualified to be president – is just one sad, deluded poster child of this trend.

Two weeks ago I listened in on an NPR show in which Tom Ashbrook, the moderator, tried to host a discussion with Orly Taitz, one of the leaders of the birther movement.  I’m not the biggest fan of Tom Ashbrook’s style, but if anything he’s a very capable, experienced moderator.  I don’t think I ever heard Tom Ashbrook as not-in-control as he was that night.  Since Tom typically has very reasonable, intelligent people on his show, I think he may have made the mistake of assuming that his usual conversation-control tools would work on Taitz.  Then again, I don’t think anything short of a Tazer and injectable tranquilizers would have worked on Taitz that day.  Her careening, shrieking, disjointed commentary made my brain hurt, and any shred of credibility I might have afforded her (admittedly, not much to begin with) vanished instantly.

People like Taitz don’t go away, though.  And now, with the release of an image of a document purported to be Barack Obama’s Kenyan birth certificate, she continues to dig a deeper hole for herself.  This (pretty clear forgery) is now the smoking gun, the unassailable proof that Obama is the centerpiece of a vast left-wing, Communist, Zionist conspiracy designed to take over the world.  I’ll let snarkier minds lay out the details for you.

I could despair that such a ridiculous issue has wasted so much time and energy, that such rabid lunatics can steal the nation’s attention for such a long time.  And I do, admittedly – just  a little bit.  But outwardly, at least, I’m laughing.  I’m laughing in mockery of the stupidity, close-mindedness, and downright lunacy of these whackjobs.  I can at least get a little entertainment out of them.